Quackery at the VA: Our veterans deserve real medicine, not fake medicine [Respectful Insolence]

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Quackery at the VA: Our veterans deserve real medicine, not fake medicine [Respectful Insolence]

I get e-mail.

Often, the e-mail I get consists largely of rants from various cranks about how I am a “pharma shill” and whether I feel any regret over the babies I’m supposedly turning autistic by my advocacy for vaccines. Much less often, I get e-mails praising me for my work. Sometimes, I even get e=mails that tell me that my blogging was the reason someone turned away from the dark side of antivaccine quackery or other pseudoscience. Those e-mails make my day.

I also sometimes get e-mails like this:

I’m in the VA healthcare system in Los Angeles. I had previously read your article about how ‘alternative medicine’ is creeping its way into the VA system.

I was referred to the “healing touch” “nurse” because an actual physical therapy appointment takes three months to get. At first I thought this was some massage technique and would help relieve some muscle tension in my shoulder. Well come to find out it they put me in a room with traditional Asian-themed relaxation music and enough aromatherapy that I felt like I was in a nail salon.

She began to tell me how the “energy of the universe” flows through her hands and because of her touch, many many people have had their lives changed. So I guess sort of like the television church shows but this is taxpayer money.

After about 5-10 minutes of anecdotal stories and claims that there have been “studies” that this works, she proceeds with the “treatment” which basically involves her putting her hands on me and saying she is “feeling” that I have had pain in areas. She goes down a list of stomach, leg, back, neck, headaches, anxiety, etc. saying she can “feel this.” More like she can read my VA file which is in the computer. Even then she is 50% correct about my problem areas which I can also replicate with a coin toss.

At the end she asked me how I felt and I told her I felt the same. Then she said that it’s a “cumulative effect” and that the “healing energy” needs to build up in my body. “Remember to drink a lot of water for 24-48 hours because the energy is still in your body.” Unbelievable! I was polite and smiled, but I wanted to scrutinize this so bad.

Normally you could chalk this up to Los Angeles and how we have this anti-science subculture here, but this is the VA. And tax dollars are paying for it. To add insult to injury, these monies spent on crap like energy healing also make it where I can’t get the care I need from REAL doctors and physical therapists due to lack of funding.

Just wanted to give you a first-hand account that this quackery has fully made its way into the VA healthcare system. Thanks for the great website and teaching me a lot about science and medicine that would otherwise be more difficult and less entertaining to read.

Later in the e-mail exchange, he said:

By the way, they are also offering acupuncture at the West LA facility and I was offered this to treat migraine headaches. I told them my concerns (info i got from your site actually) that through studies they found that it’s entirely placebo and I was wondering if they had any additional evidence. This doctor, who I actually believe is a real doctor, told me that they had been shown evidence that people felt a lot better. I responded with “Well, it’s also been documented that when a doctor asks how your day was and demonstrates they ‘care’ then patient outcomes improve big a noticeable margin as well. So how is acupuncture different than that?” Her response was something about nerve pathways, etc. At least she didn’t tell me something about Chi or I’d go nuts. Again, taxpayer money diverted to quackery instead of things that are proven to help and have science to back it up.

I’ve written on numerous occasions about how quackery (or, as I like to call it now in the age of Trump, fake medicine) has infiltrated military medicine and less frequently about how the same thing is happening in the VA medical system, but there’s nothing like an actual personal anecdote to make it really real to me, which is exactly what this anecdote did. Healing touch is a form of “energy medicine.” In contrast to reiki, where the reiki master claims to be able to channel “healing energy” into the patient from the “universal source,” practitioners of “healing touch” claim to be able to manipulate the patient’s “energy field” to produce healing and/or relieve symptoms. I approach these stories from the viewpoint that our veterans deserve the best medical care available, and that that medical care is science-based medicine. “Complementary and alternative medicine” (CAM), “integrative medicine,” or whatever the nom du jour is for the quackery masquerading as “wellness” or “holistic medicine” that is currently infiltrating civilian hospitals as renowned as The Cleveland Clinic should have no place in military medicine or the VA either.

In other words, our veterans deserve real medicine, not fake medicine integrated with real medicine.

Spurred by my reader’s anecdote, I did a bit of Googling. In addition to finding the usual stuff, such as a VA web page about CAM use for post-traumatic stress disorder (PTSD) that says that there’s only “limited evidence about the effectiveness of CAM as a treatment for PTSD” but notes that “89% of VA facilities offered CAM and 1% were in the process of developing CAM programs” and that a recent survey of all 170 specialized VA PTSD centers showed that 96% of respondents offer CAM for PTSD.

Then there was this gem of an article published last year in The Journal of Alternative and Complementary Medicine by a couple of heavy hitters in the world of integrating quackery into medicine, including Richard C. Niemtzow MD, PhD of the U.S. Air Force Acupuncture and Integrative Medicine Center, Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, MD, as first author and Wayne B. Jonas, MD of the Samueli Institute as well. We’ve met both of them before, particularly Dr. Niemtzow, who is best known for wanting to bring acupuncture to the battlefield. (No, I’m not making this up.) Jonas, of course, is the President and CEO of the Samueli Institute, one of the foremost proponents of integrating fake medicine into medicine.

Along with the usual drivel about how acupuncture is ancient and effective (it’s neither), Niemtzow et all note:

Acupuncture is well known in Eastern cultures for its analgesic benefits. Many medical practices in Western countries have focused not only on this modality but on other integrative approaches to combat pain. As addiction to prescription opioid medication is skyrocketing in the United States, Western physicians are rapidly exploring the benefits of acupuncture for the relief of pain. In particular, BFA, which uses a specific sequence of five ear points for rapid pain relief, is the most popular and “go-to therapy” utilized by military medical acupuncturists around the globe. This is because of its history of providing rapid, safe, and effective pain relief in wounded warriors over many years. As a consequence, and also influenced by the APMTF, a $5.4 million DoD–VA Joint Incentive Fund (JIF) project—“Acupuncture Training Across Clinical Settings (ATACS)”—was funded by the DoD–VA Health Executive Committee in April 2013. The ATACS Program provides BFA [battlefield acupuncture] instruction to DoD and VA healthcare providers (HCPs) and gathers relevant information to ascertain its impact on pain and, in particular, its ability to reduce opioid use.

Successful implementation of an IM [integrative medicine] program by any healthcare system requires a disciplined multistep process. The first step involves selecting a modality that is evidence-based, safe, and has the potential to demonstrate its value in achieving desired outcomes. Selection of appropriate modalities may be ascertained by a combination of a review of available clinical trials, published literature, and/or by empirical clinical experience. Such was the argument for BFA. A second key step, particularly in a large and/or complex healthcare system, is to ensure that HCPs receive a systematic and standardized training program from experienced and well-qualified instructors. This is particularly critical when rolling out an IM modality, for which practitioners may have never been trained.

See what I mean? There is an active effort to train HCPs in the VA in acupuncture and to promote fake medicine under the guise of real evidence-based medicine. As much as advocates claim that acupuncture is evidence-based, it’s just not. It’s a prescientific medical modality that is rooted in vitalism and nothing more than a theatrical placebo, with the “best” clinical evidence indistinguishable from the normal “noise” in clinical trials that occasionally produces false positive results. Of course, CAM advocates don’t like it when it is pointed out that acupuncture is fake medicine. Unfortunately, because acupuncture involves sticking needles into the skin, many physicians think there might be something to it, leaving aside all the mystical mumbo jumbo. Certainly, a decade ago I was in that group. Heck, even someone I admire as much as Paul Offit fell victim to the acupuncture narrative in an otherwise excellent article on quackademic medicine by seeming to argue that it is more than a placebo and citing the “endorphin” explanation, even as he got it right that it doesn’t matter where you stick the needles in or even if you stick them in. That’s how powerful the narrative can be.

Reading e-mails like my readers angers me. Remember, the reason he was referred to a “healing touch” quack is because the wait for a physical therapy appointment was three months, which is an unacceptable length of time. In other words, the Los Angeles VA doesn’t have enough physical therapy resources to meet the needs of its veterans, but it has energy medicine quacks willing to fill in the gaps. I can’t help but wonder if this situation comes as a result of the failure of the federal government to invest enough resources into the VA Medical System. More physical therapists and fewer quacks, I say! Unfortunately, since the VA hired Dr. Tracy Gaudet as director of the VHA’s Office of Patient Centered Care and Cultural Transformation, fake medicine has become increasingly entrenched (or should I say “integrated”) into the VA. Naturopaths are even now lobbying to be employed by the VA. Nothing has come of their efforts that I’m aware of thus far, but if there’s one thing I know about naturopaths, it’s that they’re persistent. They’ll keep trying.

With all the problems the VA health care system has, shortage of resources and long waits have always been among them. Unfortunately, in response to the shortage of real medicine, the VA seems to be taking a page from the Mao-era Chinese playbook and trying to “integrate” fake medicine with real medicine to paper over the problem.

Our veterans deserve better.

(Why?)

Published at Fri, 27 Jan 2017 12:00:48 +0000