Saturday, December 6, 2008


The Institute of Medicine reported this week Military personnel who suffer severe or moderate traumatic brain injury (TBI) face an increased risk for developing several long-term health problems. This evidenced based study reported that conditions include Alzheimer's-like dementia, aggression, memory loss, depression, and symptoms similar to those of Parkinson's disease. Even mild TBI is associated with some of these adverse consequences, noted the committee that wrote the report.

In addition, the report notes that brain injuries sustained as a result of exposure to the force of an explosion without a direct strike to the head -- one of the most common perils for soldiers in Iraq and Afghanistan -- may be underdiagnosed due to the lack of research on blast injury. It calls for the U.S. Department of Defense and the U.S. Department of Veterans Affairs to step up clinical and animal studies of blast-induced neurotrauma (BINT).

The Healing Project would go further and immediately screen and database the 300,000 to 400,000 service members exposed to blasts.

"Explosive devices and other weaponry have become more powerful and devastating throughout the wars in Iraq and Afghanistan, and we are seeing much higher rates of nonpenetrating traumatic brain injury and blast-induced injury among military personnel who have served in these countries than in earlier wars," said George W. Rutherford, professor of epidemiology and preventive medicine and vice chair, department of epidemiology and biostatistics, School of Medicine, University of California, San Francisco, and chair of the committee that wrote the report. "It is important to identify and understand any long-term health effects of these injuries so that wounded service members do not lose valuable time for therapy and rehabilitation."

Studies conducted in Iraq by the Air Force Medical Service with the Headminder system would argue that up to 5% of exposures, that is 15,000 to 20,000 m-TBI injuries, would require additional follow-up. The DoD is only reporting 5,500 injuries total traumatic brain injuries. Furthermore, while animal studies are useful, replicating injuries in animals models are unlikely to provide necessary data to provide human clinical guidance. It is time to implement a web-centric longitudinal screening technology to track the evolution of these injuries in an epidemiologically sound fashion.

While we agree with the Institute in broad strokes, scientists and clinicians have been aware of the injuries and the likely outcome of these injuries since 2004. Neither the DoD or the VA has demonstrated any real interest in identifying or treating M-TBI dealing with its attendant co-morbidities. Both organizations have used research to delay the identification of and/or deny the very existence of the injuries. The report makes it clear blast concussion is not like a sports injury nor is it PTSD (two of the DoDs and VAs favorite excuses why they do nothing). Now that we have a change of government, it is time for Secretary of Defense Gates to clean out DoD HA and US Army Medcom. The delayers, the deniers and the dinosaurs need to be quickly cashiered and replaced by people who will get the job done now.

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