How can anyone choose the worst practice among so many false claims? Well, those that cause real harm to patients are worse than those that are merely useless. I also decided to give extra weight to newer forms of mumbo jumbo. But I could have chosen differently, and I encourage readers to nominate their own favorites in the Comments section.
And the 2011 winner of the worst quackery award is: battlefield acupuncture. This particular bizarre medical practice offers a trifecta of ills:
- It offers no medical benefit and carries a real risk of harm for some patients.
- The U.S. government is wasting tens of millions of dollars per year on it, and plans to increase its spending next year.
- The patients are wounded combat veterans who have no choice about where to get treatment.
Battlefield acupuncture has a growing number of supporters in the U.S. Defense Department (especially Richard Niemtzow, its proud inventor), who are determined to see it delivered to as many troops as possible. I've written about this before, but it's in the news again this month, in Wired magazine. In battlefield acupuncture, the "doctor" (no competent doctor would do this) sticks needles into the patient's ear to relieve pain. Yes, that's right: needles in the ear.
Battlefield acupuncture was invented out of whole cloth by military doctor Richard Niemtzow, who runs an acupuncture clinic out of Andrews Air Force Base in Maryland. Niemtzow appears to be the leading advocate for the use of acupuncture on wounded soldiers, and he has been disturbingly effective. The military publication Stars and Stripes reported in August that the Air Force has
"launched a program to train more than 30 military doctors to use acupuncture in the war zone and at their base clinics. The program will be expanded next year with the Air Force, Army and Navy combining funds for two courses to certify 60 active-duty physicians as medical acupuncturists."Multiple scientific studies have shown clearly that acupuncture doesn't work. The benefit is the same no matter where you place the needles, or even if you use toothpicks that don't pierce the skin. (See a summary here, with multiple references.) Acupuncture points and "meridians" - the pathways that acupuncturists claim to manipulate with their needles - don't even exist.
Acupuncture carries a real risk of harm, too, primarily from infection. Acupuncturists don't practice sterile procedure, as I've pointed out before. They claim that they do, because they think that using sterilized needles is sufficient. Wrong again. Sterile procedure requires that every site of needle insertion be properly sterilized, because most infections are caused by bacteria already present on the skin. As reported last year in BMJ:
"Although most patients recovered, 5-10% died of the infections and at least another 10% had serious consequences such as joint destruction, paraplegia, necrotising fasciitis, and multiorgan failure."Pretty serious harm from a procedure with no real benefit.
A big part of the Wired story is how the billionaire founders of the Samueli Institute, an institute dedicated to pseudoscience, have used their political muscle to obtain millions of dollars in Defense Department earmarks to support acupuncture research. ($7.6 million in 2010, for example.) Make no mistake, there's plenty of money in acupuncture, as in the rest of the alt-med industry.
But the real harm is in treating wounded soldiers by sticking needles in their ears, instead of offering real treatments. To their credit, some soldiers are not fooled by Niemtzow's claims. As a veteran over at Military.com said,
"In civilian medicine, this [battlefield acupuncture] would be called malpractice. This smacks of using military personnel in the field as guinea pigs. That's a dangerous game. If the pain of severe trauma isn't treated effectively in a timely manner, shock and even death can follow."That discussion appeared in 2008, but three years later, Andrews Air Force Base has a full-time acupuncture clinic, and the military is training more doctors in this dangerous, ineffective, and highly unethical practice. For this, battlefield acupuncture gets my award for the worst quackery of 2011.
(For further reading, see David Gorski's excellent takedown of battlefield acupuncture from 2008.)