In the annals of the Iraq and Afghanistan wars, there is perhaps no more significant a number than the human cost. Since 2001, the U.S. has sent more than 2.2 million troops to battle; more than 6,600 were killed and 50,000 were seriously or catastrophically injured.
This is a dismal reality, particularly resonant given the recent 10th anniversary of the Iraq War. Yet, there is also tremendous promise in what we have learned about the human body and mind in the last decade, and how such knowledge could affect the lives of both military and civilian patients.
The s0-called signature wounds of both conflicts — post-traumatic stress disorder and traumatic brain injury — have catalyzed medical research. In just six years, the Department of Defense has invested a minimum of $2.7 billion in understanding invisible psychological and neurological injuries.
Researchers are tracking biomarkers that identify both PTSD and TBI rapidly and more convincingly than the current subjective tests used by physicians. The $700 million apportioned for TBI research has spawned more than 500 projects, including an effort to develop a portable diagnostic tool for TBI, which I’ve written about here.
The government funding has invigorated a difficult field, according to Col. Dallas Hack, director of the Combat Casualty Care Research Program for the Army Medical Research and Materiel Command. At least 30 clinical trials testing a drug treatment for TBI have failed. That risk, Hack said, has been lessened by the government’s investment and is a significant incentive for commercial companies to explore development.
While psychological health and TBI have deservedly been the focus of major research initiatives, DoD has funded other vital endeavors. One study aims to construct a profile of combat wounds that either healed or failed to do so and identify attendant biomarkers. This project was undertaken after soldiers experienced ghastly infections resistant to treatment, partly attributable to unique bacteria present in Afghanistan. Another initiative developed a facial reconstruction technology known as electromechanical reshaping, which uses an electric current to bend cartilage. One research group was funded to create a portable device that uses vitamin B2 and UV light to “inactivate” pathogens and leukocytes in whole blood transfused after combat injuries.
The Department of Veterans Affairs has its own set of research priorities. Of those injured in Iraq and Afghanistan who are considered “polytrauma” patients by virtue of sustaining injuries to more than one organ system, 1,600 have moderate to severe brain injuries, 1,400 are amputees and 900 were severely burned. Faced with rehabilitating soldiers who have suffered such complex wounds, the VA has tried to improve how it coordinates this care. (See my story on this here). It has also worked to develop technologies like hearing and vision implants as well as robotic prosthetic devices. The agency has its own TBI program, which is exploring treatment approaches like personalized medicine and nerve regeneration.
The VA’s annual budget for medical and prosthetic research is about $580 million, but it can be difficult to identify what of that spending is directly related to the Iraq and Afghanistan wars. A spokeswoman for VA said that PTSD research, for example, is often associated with the two conflicts, but is beneficial for all veterans.
It can be similarly challenging to know how much DoD spends on research stemming from the wars. Cynthia O. Smith, a spokeswoman for the agency, said there are different funding streams that support an expansive mission: “This includes optimizing health and fitness through the prevention of disease, controlling deployment-related exposure to environmental and occupational hazards, global surveillance, individual medical readiness, and health risk assessment and management.”
Despite the promise of both DoD and VA sponsored research, there remain challenges in coordinating such a massive research program and implementing the right treatments for troops and veterans. A January 2012 report (PDF) by the Government Accountability Office found that DoD’s psychological health and TBI research needed better quality control mechanisms to report financial data.
A report released this week by the Institute of Medicine noted that its committee has “serious concerns” about whether or not patients are being provided evidence-based treatments for PTSD and depression. It also questioned the use of a neurocognitive assessment tool, arguing that there is a “lack of clear scientific evidence” for its role in measuring function after a head injury. Its 700-plus page report had plenty of other concerns.
It will be a worthy challenge to keep track of each major research project related to the injuries of the Iraq and Afghanistan war and note failures or new evidence-based standards and practices. I’ve barely hinted at how the military has mobilized the research community to answer some of the wars’ incredible challenges.
Take, for example, the huge longitudinal study known as Army STARRS, which aims to predict soldier resiliency (I’ve written about that here); or the efforts to develop treatment for suicidal ideation or behavior (I highlighted a nasal spray example here); or even how civilian medical providers have been involved, perhaps the most notable being a double-arm transplant performed on an Army veteran at Johns Hopkins this January.
If you’ve taken part in any of these projects, or might be a beneficiary of the research, I’d love to hear what you think in the comments below.