ChinPsy

Does battlefield acupuncture exist? Soldiers are supposed to get the best medical attention possible under any given circumstances, and should get it. Tactical medicine includes the best and most efficient medicine given in a pressured tactical environment.

The question is: “Do acupuncture have a place in treating soldiers, and if so, where in the medical chain is this place if it exists?” We live in an age where everything needs to be science. The golden rule today is to only offer scientific proven efficient medical treatment. Well, this is not completely the truth. The British Medical Journal state in an article from 2007 (BMJ, 2007) that after analysing 2.500 scientific proven medical treatments and cutting through the statistics that 13% were beneficial, 23% were likely to be beneficial, 8% both harmful and beneficial, 6% unlikely to be beneficial, 4% both harmful and ineffective, and finally 46% unknown if effect of harmful. The same investigation has been done before in USA with similar results; between 10-20% had proven efficacy. Western medicine normally point at scientific efficacy as the key to their medical system, but as we have seen, this is at best an illusion. Most western medical doctors say that therapies offered out of their rationale are not science or medicine, and is quackery. In 1994 an average US citizen were prescribed 8 drugs by doctors. 12 years later we find this number to have grown with 62%. Perhaps we might say that Big pharma is starting to promote polypharmacy in the lack of treatment efficacy. 29% of the US citizens use a minimum of prescription medications at any given time. Well, it is also documented a 65% increase in medical overdoses the last 7 years. The security of this scientific medicine might be questioned as we know in a study which included 350.000 hospitalized children concluded that almost 79% were prescribed drugs that wasn’t FDA approved for children. A similar study in England concluded that 90% of INFANTS suffered the same destiny. Research has concluded that the reduction in infant deaths is due to soap and not scientific medicine and vaccines. The sad truth here is that COMPETITION between medical approaches and – systems is the main cause to the lack of acceptance of among many, acupuncture. To question other medical systems, disapprove others, to name as quackery and to approve their own medical system as scientific medicine is the current strategy. Just as an anecdote, the 10 largest drug companies in the world have the same profit as the 490 other largest companies in the world. Who said that money is of no importance? A pharmaceutical company is a private company that searches for profit. Pfizer paid in 2009 40.000.000 pesos to 4500 medical doctors in USA to make publicity for their products. An average pharmaceutical company uses 300% more on marketing than on research. Something that indicates that the high costs of most drugs is connected to high marketing costs and not high research costs. As we know, only 23% of the scientific proven medical treatments actually work to a certain degree.

 

Acupuncture is only partially proven at best, but most likely most therapeutic clams will fall in the category not proven. As a rule, everything not proven scientifically has nothing to do in the treatment chain. Not much to offer then, you might think after reading about scientific medicine. At the same time we are obligated to offer everything that might improve the wellbeing of a soldier. Some critics believe that acupuncture is without real effect, and if some effect exists it is only a placebo effect. Here we need to remember that the lack of scientific evidence does not mean the same as that it does not have any function; it indicates that we lack modern scientific investigation. 2500 years of use have given some hard empirical evidence that is difficult to overlook. Let us ignore this topic of science, and look behind the endorphin effect activated when acupuncture needles are put. Let us also ignore the fact that if you throw a stick to a dog, he will release the very same endorphins in his brain.

Then let us go back to the question: “Do acupuncture have a place in treating soldiers, and if so, where in the medical chain is this place if it exists?” The aim for battlefield acupuncture is for sure not treating haemorrhaging or projectile punctured lungs. Battlefield acupuncture is not even classical acupuncture; it is a type of auricular therapy. Here we need to understand that auricular therapy invented by Paul Nogier from France is not the same as Ear acupuncture invented by Dr. Cheng from China. Auricular therapy is not acupuncture. Battlefield acupuncture is therefore a newly constructed therapy that uses small acupuncture needles inserted in the ears of patients that happens to be soldiers. Little documentation exists on this new therapy and therefore we can say little about it. Let us therefore find the place for classical acupuncture as found in Chinese medicine in a setting related to soldiers and battlefield.

Acupuncture have among much more been used to treat Post traumatic stress disorder (PTSD), stress, anxiety and different pain conditions. It has been a goal to focus the use of acupuncture in more evidence based settings, but in the lack of thereof we find that acupuncture used on empirical treated diseases. Acupuncture will never been to be a substitute for tourniquets, morphine and bandages. As a medicine, acupuncture fit in a more relaxed environment. Acupuncture is known for creating relaxation, reducing pain and shortening the restitution time when sick. Soldiers put their life on stake, and they deserve only the best treatment if needed. We cannot say that since we lack research and the effect might be placebo, we cannot provide it. Everything that makes some sense and that does not harm the soldier has to be provided in the proper way. Since acupuncture in battlefield related situations are relatively new in the West we need to do some additional planning. First we have to look for new and innovative solutions for the soldiers within the sphere of acupuncture. No experimentation with the wellbeing of soldiers is acceptable.

 

In battle we have the other soldiers as the first medical providers when injuries occur. The fellow students are often the persons that decide over life and death. Then we have the paramedic and the medic that arrives with an additional level of emergency care. As soon as tactical possible the injured soldier will be transported to a MASH unit. A MASH unit is the primary place for first aid and emergency treatment; here you have surgery and other medical facilities. If you bleed heavily they will perform some basic surgery before you are sent to more complex medical facilities in a safer area. A MASH unit is not really the place for aromatherapy and Reiki healing; here it is action and blood that fills the agenda. If a MASH unit do not work well injured soldiers will die. Well, it might be argued that these therapies might have a place in a MASH also. My argument is that everything that makes sense in a therapeutically adjusted setting should be provided for. Of course, a surgeon in a MASH unit cannot be changed for a massage therapist; some criteria’s is needed. Life and life assuring measures is primary, but in the vacuum that follows we have a space where other alternatives might improve many aspects in the injured.

Effective and fast assessments are the crucial aspect in any medical emergency treatments. A quick and effective way to move injured soldiers from the battlefield to the definitive treatment facility will save more life. Research have shown that soldiers wounded in combat will have 90% more chance to survive if they are transported and evaluated medically quickly. Quick, efficient and qualified transportation is the key. Tactical paramedics, tactical transportation of injured in the battlefield to a safe area, quick medical evaluation, first class emergency treatment and not least direct transportation to final treatment facility. The strategy for the best treatment is essential for survival.

Battlefield acupuncture might have its place several places in this chain of medical attention, but we have to admit a battlefield is filled with chaos. The only we might add to this chaos is stability and speed; perhaps acupuncture should stay away from the first steps in medical attention. Within this regiment of helplessness and loss of control, a tactical rigid structure, a chain of command will guide our wounded soldiers to a proper treatment, and thereby increase the chance for survival. An adult evaluation of the scenario will provide us with some kind of treatment structure might function. A loss of focus only leads to more chaos. If something fits, it fits, and if not, not. Acupuncture on a massive femoral haemorrhage does not fit, but to relax a soldier before a battle or to calm him down after injury acupuncture might be a nice option.

Battlefield acupuncture is thought to Landstuhl Regional Medical Center (LRMC) doctors to help both persons wounded in war and others with pain. Here we need to remember that acupuncture is not used ON THE BATTLEFIELD, it is used as an additional medical technique on patients in hospital AFTER other relevant treatment is conducted; for example on phantom pain after amputations. Battlefield acupuncture includes an extensive use of auricular therapy from Nogier and NOT directly Chinese acupuncture.

Reference:

BMJ, 2007. http://clinicalevidence.bmj.com/ceweb/about/index.jsp;http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp