There are two kinds of fools: those who can’t change their opinions and those who won’t

by U.S. Medicine

October 11, 2012

“There are two kinds of fools: those who can’t change their opinions and those who won’t.” – Josh Billings (1818-1885)

Newly retired Air Force colonel and columnist, Harriet Hall MD, also known as the “The SkepDoc,” recently published an article in the Medical Examiner (08/21/2012) entitled, “Quackery and Mumbo-Jumbo in the U. S. Military – Cupping, Moxibustion, and Battlefield Acupuncture are Endangering Troops.”  In essence, she laments that our modern, technology savvy, military medical system is exploring integrative medicine techniques – acupuncture in particular.  I think her wholly negative view of the military’s exploration of integrative medicine is summed up with her comment that, “a disturbing current of pseudoscience in the military is wasting money, perpetuating myths, and putting our troops in danger.”  Dr. Hall even goes so far as to suggest this issue has turned her experience as a federal medicine provider from one of pride to “a source of embarrassment.” 


Editor-in-Chief, Chester ‘Trip’ Buckenmaier III, MD, COL, MC, USA.

I was particularly struck by Dr. Hall’s characterization of the military’s integrative medicine efforts as “endangering troops.”  As a federal medicine provider who actually works in pain medicine at home and while deployed, I have had a sense that troops are in far more danger from our “modern” use of opioids than I ever had prescribing a course of acupuncture for a wounded warrior.  Moreover, I am aware of far more military patient deaths attributable to opioids because of medical errors, misuse or abuse than similar outcomes from acupuncture.  Has anyone died from the erroneous use or abuse of battlefield acupuncture?

 Admittedly, my opinions about acupuncture have evolved significantly over the years, and I have written about those changes in this column.  Obviously, I disagree with Dr. Hall’s myopic assessment of the value of the military’s efforts to augment pain medicine with integrative techniques, although I respect her right to an opinion. 

While digesting Dr. Hall’s manuscript, I could not help thinking about the story of Dr. Ignaz Semmelweis (1818-1865), the “Savior of Mothers.”  Dr. Semmelweis was a Hungarian physician who observed, then proved statistically, that he could drastically reduce the incidence and mortality of puerperal fever (childbed fever), common at the time with a mortality typically ranging from 10% to 35%.  His groundbreaking solution was simple — hand-washing by physicians and caregivers between patients.

Despite his success, he was widely ridiculed by the “modern” medical establishment of the day.  Physicians were offended by the suggestion that they should wash their hands, because Semmelweis could not explain how his technique worked. Sound familiar? 

Sadly, Dr. Semmelweis would become progressively more frustrated and dejected by the general lack of acceptance of his solution, committed to an asylum and eventually die there.  The explanation of why his technique was successful would not be available until years following his death, with the discovery of the “germ theory” of infection by Louis Pasteur and its confirmation by Joseph Lister, who developed sterile technique in surgery.  I do not think any modern federal medicine practitioner would pass between patients now without first employing Semmilweis’ hand-washing technique.  Perhaps as a fitting postscript to the brilliance and tragedy of Dr. Semmilweis’ life is the metaphor, “Semmelweis reflex,” that is used to describe individuals who reflexively reject new ideas or knowledge due to ingrained paradigms or beliefs. 

There are two kinds of fools: those who can’t change their opinions and those who won’t

Acupuncture has been around for millennia.  Because of this long history, the language and thought processes that the ancients used to understand the effects of this medical practice can seem like so much “mumbo-jumbo.”  Admittedly, I do not have a clear understanding of how some patients respond to acupuncture in the same way. As an anesthesiologist, I understand how  they respond to opioids.  As a scientist, I always prefer to have a molecular level of understanding about how a drug or therapy works. As a physician, I am experienced enough not to be paralyzed when that understanding simply is not available.

In my own practice, I routinely use volatile anesthetic (inhalational) agents, confident that I can consistently anesthetize patients with these gases for surgery.  I also am aware that the full mechanism of action for the volatile anesthetics remains a mystery, and yes, patients are occasionally harmed or even killed using these drugs.  I doubt Dr. Hall would suggest my use of volatile agents for anesthesia is “quackery.”  Certainly the effect of the volatile anesthetics, despite our incomplete understanding, is a great deal easier to objectively measure than the effects of acupuncture.  From my perspective, the difficulties in objectively evaluating acupuncture are less an indictment of the practice as of medical science’s inability to explicate its effects on the human body.  So many conventional paradigms of medicine, accepted as truth by the so-called non-quack medical establishment, have ended up in the dustbin of history, while acupuncture marches on.  Blood-letting for evil humors, craniology, electromagnetic coils, radioactive water, no hand-washing. Need I continue? 

If medical history tells us anything, it is that the medicine we practice today as the “standard,” will not be the standard tomorrow.  The medical peers of our not-too-distant future will likely look back upon us with a wry smile and shake of the head as they try to fathom our lack of comprehension.  I do not understand how acupuncture works for some patients, but it works for many — and has for thousands of years — while so many other “standards” of care have been banished.  I, for one, applaud the military for demonstrating the leadership and courage to try something other than traditional opioids to improve upon the available tools for pain management of our patients.  For now, that is enough, until medicine matures sufficiently to understand how volatile anesthetics and acupuncture work.

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