Tens of thousands of Veterans of the Iraq and Afghanistan wars have returned home with traumatic brain injuries (TBI). Many TBI injuries are caused by blasts from those nasty improvised explosive devices, but they can also be caused by any jolt to the head that rattles a soldier’s brain inside his helmet.
There are numerous research centers across the country conducting research on TBI. It is difficult to determine how many because some don’t advertise and some don’t reveal if they are funded by government or private sources, or a combination of both.
The US Department of Veterans Affairs (VA) has spent $1.5 billion treating Afghan/Iraq war Veterans for TBI since 2007, according to a spread sheet provided by VA spokesperson Ndidi Mojay, from their Washington, DC office. She could not provide totals for research money spent on TBI since the two Middle East wars began. But after days of pulling teeth, another VA spokesperson – Phil Budahn – provided another chart showing the VA is spending about $32 million per year for research on “TBI and other neurotrauma.”
TBI research/treatment appears to have become a growth industry for a medical condition with no cure. It seems a little like the problems with bringing in money to various cancer organizations, see: http://usedview.com/article/the-pinkification-of-America
The first spread sheet shows the VA will spend $340 million in 2013 for “TBI treatment.”
The VA appears to have no accountability for research but it does have individualized treatment plans, according to Mojay. “Veterans with a positive TBI screen are evaluated by a TBI specialist to provide a definitive diagnosis and develop an individualized rehabilitation plan of care,” she said.
Pulitzer Prize winning writer Eric Newhouse has been looking into this. “I’ve been deeply troubled about the lack of TBI diagnoses. Five years ago, the Rand Corporation interviewed several thousand soldiers returning from Iraq and Afghanistan and predicted that 18 percent of them would return with PTSD.” Newhouse is on a lecture circuit speaking about Middle East war issues, and health care for Veterans, and he is disturbed that more isn’t being done to help our Veterans.
For instance, there are multiple Centers of Excellence, sponsored by tax dollars that conduct research on Veterans with TBI or TBI symptoms. But they lack a unified approach and don’t share findings… unless the sharing includes publishing a paper in a journal and a free trip to Hawaii to present the paper at a conference full of researchers going in different diagnostic and protocol directions.
“According to the Defense and Veterans Brain Injury Center, 266,810 soldiers were diagnosed with PTSD from 2000-12. But the Rand Report predicted 19 percent of the soldiers would suffer a TBI, and the VA has only diagnosed 54,000 of those injuries. That disparity is both perplexing and troubling to me,” said Newhouse.
The effectiveness of the TBI programs is called into question by our federal government on a yearly basis. In a federal Office of Management and Budget Program Assessment Rating report, OMB found fault, citing that it had neither long-term health outcomes measures nor regular independent evaluations of the program’s effects on TBI patients and their families.
An article by Cols. Charles Hoge and Carl Castro published in the April 16, 2009 issue of the New England Journal of Medicine (NEJM) cites problems with TBI screening tools used on soldiers returning from Iraq and Afghanistan. According to the NEJM article, mild traumatic brain injury is being overemphasized and may be misdiagnosed in soldiers, which may cause other medical problems like substance abuse, depression and post-traumatic stress disorder (PTSD) to go undertreated or untreated.
Most of the grant applications and journal articles begin with the same, boring, old statement: the signature wound of the Iraq and Afghanistan wars, occurs when a sudden trauma or head injury disrupts the function of the brain.”
Make no mistake, this author is a Veteran of the Viet Nam Era and has five uncles who served in the various armed forces, along with a twice decorated father who retired as an Army Major. Our hearts go out to the troops.
The brain injury, commonly referred to as a concussion, is a brief loss of consciousness or disorientation ranging up to 30 minutes. Though damage may not be visible on an MRI or CAT scan, common symptoms of mild TBI include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration or attention.
But after ten years of studies, all America has is publications by TBI researchers who tour the world on the taxpayer’s buck. There is a basic treatment protocol, but there is no cure.
In 2011, the taxpayers paid for a play at a Berkshire’s resort in Massachusetts – a skit about soldiers with TBI. Can you say “IRS employees dancing on stage YouTube video?”
This summer the federal government closed a center in Charlottesville that provided treatment for military members and veterans with traumatic brain injuries because the facility had a low patient volume and high costs compared to other facilities.
In May, CBS’s Sixty Minutes showed the UCLA brain injury center is doing the same research Walter Reed Hospital is doing, but Walter Reed’s new TBI center tests only 20 patients a month with the latest state of the art brain scanning technology. Quotes in the Sixty Minutes report included “we will see 9,000 new cases per year” and “we can’t cure brain injury, we can just help the patients cope.”
The VA medical center in Martinez, CA straps special caps on soldiers’ heads and injects gel into 64 holes in the cap. Donning flip-flops and a mane of electrodes, soldiers sit in a booth with a video game joystick, clicking responses to a series of visual and sound triggers.
At the VA medical center in Houston, soldiers wear a similar cap and are slid into a magnetic resonance imaging tunnel to play poker games with the researcher who is watching brain waves move on a color monitor. Veterans get $50-125 to get into the tunnel or participate in other studies to gauge TBI damage or mental acuity.
The center received three, four and five million dollars in 2009, 2010 and 2011 respectively, and another $4.8 mil in 2012. Most of the money is spent on salaries for (a yearly average) 12 PhD’s, five MDs and 16 college students, many connected to the Baylor College of Medicine. In fact, the researchers, who get paid 3/8 of a salary from Baylor prefer to office at the Baylor building because it has nicer offices, while using the Houston VA medical center’s MRI system and interview offices.
But after the millions of dollars, all Houston has achieved is publishing dozens of journal articles per year with researchers traveling to Hawaii and Europe to present them. As of summer 2013, the Center had only tested 200 Veterans over the four years of chowing at the research money trough.
The Houston TBI Center is also applying for a multi-million dollar grant to study how some soldiers behave on an illegal drug, and the Center has submitted a renewal application for more than $5 million to continue playing poker with soldiers in the MRI tunnel. One challenge for the Houston center is that it has not had a director for 18 months. So, an accountant type – Rhonda O’Donovan – has been managing the department. The “second in command” – who should be leading – is Harvey Levin, a PhD who has positioned himself, through journal articles, as a leader in TBI knowledge. The Houston Chronicle quoted O’Donovan as saying she was pursuing more grant money in an article where they released a new journal publication saying Veterans are affected differently by TBI because of their genes. Sources say neither O’Donovan nor Levin want to lead, and may not have the requisite people management skills, but as long as they stir the pot of research articles and keep filling out the grant applications, their jobs are safe. V.A. Medical Center managers Adam Walmus and Linda Petersen could have intervened when this reporter “blew the whistle” on these issues, but they chose to do nothing.
The Houston center is also applying for a multi-million dollar award to assess the impact of Veterans referred to the Veterans Court (VC) by evaluating structural brain injury and brain dysfunction in violent and non-violent offenders. The Houston Center has had success in helping Veterans in trouble make it through the local court system.
The Contra Costa Times reported the VA is funding about 100 studies across the country focused on TBI and the kind of blast injuries that troops in Iraq and Afghanistan often suffer. The newspaper quoted Patricia Dorn, when she was interim director of the VA’s Rehabilitation Research and Development Service in Washington, D.C., which sponsors the Houston and Martinez studies. Now the interim director is Tim O’Leary.
“Although identification of pathological changes in mild traumatic brain injury (TBI) has posed challenges, 2012 has also been a year of advances and debate,” according to Levin.
From soccer to football to our wounded war Veterans, there is a lot of research being conducted on traumatic brain injuries. But this article questions its relevance or cost-effectiveness. For instance, Ralph DePalma MD and his team from the Department of Veterans Affairs in Washington, DC. are preparing another journal article for publication, but look how the first sentence of the article begins: Blast-related TBI was first noted with the use of trinitrotoluene during World War 1, while PTSD appears to have affected combatants as long as the history of war.”
Really? So the question of what research has been doing goes further back than Houston’s five million dollar grants?
The other convenient relationship among TBI centers is that they often claim the same employees. One researcher in Washington, DC is listed on his center’s roster, and Houston’s roster.
One of DePalma’s few insights in the article was that 52-percent of returning warriors has one or more of the following: Pain, TBI and PTSD; 9.6% of them have TBI; 29.4% has PTSD, and 40% have pain, while 6% have all three.
One study keeps getting repeated and regurgitated in nearly every journal article. A four year study concluded in December 2012 examined the brains of deceased athletes and linked repetitive brain injuries to a degenerative brain disease called chronic traumatic encephalopathy The study by the Boston University School of Medicine reported on the autopsies of 85 brain donors, and because they could get a link to the National Football League head injury debate, it got a lot of mileage.
In fact it keeps getting cited, in researchers’ articles, so they can publish, and present the paper out of town and keep the money flowing. Very little new intellectual thought is coming from the articles.
Levin and his team discuss the following as if it is their trophy: The majority of patients receiving neurorehabilitative therapies will have undergone some type of clinical neuroimaging, often in the acute stage of injury as well as during a more chronic stage of recovery. However, most often neuroimaging studies are just cursorily reviewed by the clinician, primarily to get a sense of where the most obvious pathology may reside and some global indication of brain integrity, but generally not for prognostic decision-making.”
And Levin got in trouble with the VA when he published an article in the prestigious Lancet magazine of the United Kingdom, without stating his funding came from the VA.
The researchers in Houston have been writing about, well, research methods – not how to treat soldiers with TBI. Here’s a sample: The use of innovative methods for varying the magnetic ﬁeld strength, the delays between the sending and receiving of the radio waves, and the acquisition and display of the signal intensity allow a wide range of images to be produced, some of which best demonstrate anatomy while others are better at detecting pathology.”
That’s interesting, if you’re a PhD, but what have you done for our wounded war veterans lately, and for how many have you improved health or lifestyle?
No one would disagree with the fact that guidelines for evaluation and management derived from experience within the VA support the practicality of care of Veterans with mild TBI. Primary care or core teams require ready access to specialty consultation for diagnosis and interdisciplinary management. Ongoing research efforts focus upon improved diagnosis, understanding of short and long term TBI effects, evaluation of existing treatments and development of novel approaches for rehabilitation and community reintegration are needed, according to DePalma.
But ongoing research efforts appear to be helping only the researchers. In the meantime, Newhouse says, “I’m interested in revealing more of the truth about the VA’s TBI claims.”
The VA’s treatment plans are found here: http://www.dcoe.health.mil/Content/Navigation/Documents/VA%20Dod%20Manag…
In the interest of full disclosure, this writer used to write grant proposals, website content and news releases for the VA.