[humanser] The Wars Come Home: The Traumatic Brain Injury Epidemic

[Susan Tabor]

Thank you so much for posting this; incredibly, incredibly sad! Yet another
of the spoils of war is the tendency of society to deal with discomfort
concerning war by attempting to put those who fought it out of sight and out
of mind.--Susan

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From: humanser-bounces at nfbnet.org [mailto:humanser-bounces at nfbnet.org] On
Behalf Of Mary Ann Robinson
Sent: Wednesday, June 22, 2011 7:21 PM
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Subject: [humanser] The Wars Come Home: The Traumatic Brain Injury Epidemic

The Wars Come Home: The Traumatic Brain Injury Epidemic
  By Conn Hallinan
  Dispatches From The Edge
  June 18, 2011
  "We are facing a massive mental health problem as a result of our wars in
Iraq and Afghanistan.  As a country we have not responded adequately to the
problem.  Unless we act urgently and wisely, we will be dealing with an
epidemic of service related psychological wounds for years to come."
  Bobby Muller, President Veterans for America
  "The multiple nature of it [multiple tours and longer deployments] is
unprecedented.  People just get blasted and blasted and blasted."
  Maj.  Connie Johnmeyer, 332nd Medical Group
  According to official Defense Department (DOD) figures, 332,000 soldiers
have suffered brain injuries since 2000, although most independent experts
estimate that the number is over 400,000.
Many of these are mild traumatic brain injuries (mTBI), a term that is
profoundly misleading.
  As David Hovda, director of the Brain Injury Research Center at the
University of California at Los Angeles, points out, "I don't know what
makes it `mild,` because it can evolve into anxiety disorders, personality
changes, and depression." It can also set off a constellation of physical
disabilities from chronic pain to sexual dysfunction and insomnia.
  MTBI is defined as any incident that produces unconsciousness lasting for
up to a half hour or creates an altered state consciousness.  It is the
signature wound for the wars in Iraq and Afghanistan, where roadside bombs
are the principal weapon for insurgents.
  Most soldiers recover from mTBI, but between five and 15 percent do not.
According to Dr.  Elaine Peskind of the University of Washington Medical
School, "The estimate of the number who returned with symptomatic mild
traumatic brain injury due to blast exposure has varied from the official VA
[Veterans Administration] number of 9 percent officially diagnosed with mTBI
to over 20 percent, and, I think, ultimately it will be higher than that."
  Serious consequences from mTBI are increased when troops are subjected to
multiple explosions and "just get blasted and blasted and blasted," in the
words of Maj.  Connie Johnmeyer.
Out of two million troops who have served in Iraq and Afghanistan, over
800,000 have had multiple deployments, many up to five times or more.
  But mTBI is difficult to diagnose because it does not show up on standard
CAT scans and MRI's.  "Our scans show nothing," says Dr.  Michael Weiner,
professor of radiology, psychiatry and neurology at the University of
California at San Francisco and director of the Center for Imaging
Neurodegenerative Disease at the Veteranbs Administration Medical Center.
They do now.
  An MRI set to track the flow of water through the brainbs neurons, has
turned up anomalies that indicate the presence of mTBI.  However, the
military has blocked informing patients of results of the research, and if
history is any guide, the Pentagon will do its best to shelve or ignore the
results.
  The DOD has long resisted the diagnosis of mTBI, as it has avoided paying
for a successful -- but expensive -- way to treat it.  The price of that
resistance is escalating suicide rates and domestic violence incidents among
returning soldiers.  In 2010, almost as many soldiers committed suicide as
fell in battle.
  MTBI is hardly new.  Some 5.3 million people in the U.S.  are currently
hospitalized or in residential facilities because of it, and its social
consequences are severe.  A Mt.  Sinai Hospital study of 100 homeless men in
New York found that 80 percent of them had suffered brain trauma, much of it
from child abuse.  A study of 5,000 homeless people in New Haven discovered
that those who had suffered a blow that knocked them unconscious or into an
altered state were twice as likely to have alcohol and drug problems and to
be depressed.  It also found mTBI injuries were correlated with suicide
attempts, panic attacks, and obsessive-compulsive disorders.  And a recent
study by Dr.
Elaine Peskind of the University of Washington School of Medicine found that
mTBI is a risk factor for developing Alzheimerbs disease.
  In spite of the documented consequences of mTBI, the military has been
extremely tardy in dealing with it.  Part of the problem is military culture
itself.  The Pentagon found that 60 percent of the soldiers who suffered
from the symptoms of mTBI refused help because they feared their unit
leaders would treat them differently.  Many were also afraid that if they
reported their condition it would prevent them from getting jobs as police
and fire fighters after they got out of the service.
  Even if soldiers wanted treatment, there are few resources available to
them.  "There are two things going on regarding vets," says Col.  (ret) Will
Wilson, chair of the American Psychological Associationbs Division 19
(Military Psychology).
"One, there are not enough care providers available, and, two, there are not
enough people focusing on the problem outside the military."
  Indeed, there are not enough military psychologists to treat the problem,
and since the military pays below-market rates for civilian psychologists,
up to 30 percent of private psychologists are unwilling to take on soldiers
as patients.  The cheapest and easiest solution is to shoot up the vets with
drugs.  A study by Veterans for America found that some soldiers were taking
up to
20 different medications, many of which canceled out the effect of others.
  The situation appears to be even worse for National Guard and Reserve
units, who make up almost 50 percent of the troops deployed in Iraq and
Afghanistan.  The Veterans for America found that such troops "are
experiencing rates of mental health problems 44 percent higher than their
active duty counterparts"
and that their health care is generally inferior.
  A Harvard study found that 1.8 million vets under 65 have no health care
or access to the Veterans Administration.  "Most uninsured veterans are
low-to-middle income workers who are too poor to afford private coverage but
are not poor enough to qualify for Medicaid or free VA care," the study
found.
  Treating mTBI injuries is difficult, but by no means impossible.  Dr.
Alisa Gean, chief of Neuroradiology at San Francisco General Hospital, who
has worked with wounded soldiers at U.S.  Armybs Regional Medical Center at
Landstuhl, Germany says the old conventional wisdom that brain damage was
untreatable is wrong.  "We now know that the brain can heal.  It has an
intrinsic plasticity that allows it to recover, and this is particularly
true for the young brain." A recent study by the Massachusetts Institute of
Technology found that "neurons in the adult brain can remodel their
connections," thus "overturning a century of prevailing thought."
  One method that has worked effectively is cognitive rehabilitation therapy
(CRT) that retrains patients for tasks like counting, cooking, and memory.
But CRT takes time and it can be expensive, ranging from $15,000 to $50,000
per patient.
However, the DOD-BS health program -- Tricare -- refuses to endorse CRT,
because it says there is no scientific evidence that justifies the expense
involved.
  However, an investigation by T.  Christian Miller of ProPublica and Daniel
Zwerdling of National Public Radio found that the vast majority of
researchers, even those associated with the DOD, sharply disagreed with
Tricarebs evaluation of CRT.  According to the two reporters, "A panel of 50
civilian and military brain specialists convened by the Pentagon unanimously
concluded that cognitive therapy was an effective treatment and would help
many brain damaged troops." The therapy is also endorsed by the National
Institutes of Health, the National Academy of Neurophysiology and the
British Society of Rehabilitative Medicine.
  Instead of accepting the advice of its own researchers, however, Tricare
hired ECRI- a company which had already done a study concluding that CRT was
ineffective-to examine the therapy.
But critics charge that the study was so narrow, and the assumptions behind
it so loaded, that it was almost a given that the study would conclude the
benefits of cognitive therapy were "inconclusive." Outside researchers
blasted the ECRI study, one of them describing it as "hooey" and "baloney."
In spite of the criticism, then Deputy Secretary of Defense Gordon England
concluded, "The rigor of the researchbandhas not met the required standard."
  However, Miller and Zwerdling concluded that Tricare's resistance to CRT
was not about science, but the bottom dollar.
According to the reporters, a Tricare-sponsored study found "that
comprehensive rehabilitative therapy could cost as much as
$51,480 per patient.  By contrast, sending patients home from the hospital
to get a weekly phone call from a therapist amounted to only $504 a
patient."
  Defense Secretary Robert Gates has already made it clear that he intends
to cut the military's $50 billion annual health budget.  No matter how
effective CRT is, it's not likely to get past the brass, who would rather
spend the money on weapon systems than on healing the men and women who they
so casually put in harmbs way.
  So far, the military has put the clamps on the new MRI technique.  Dr.
David L.  Brody, an author of the study, told the New York Times that
researchers were blocked from giving the MRI results to patientsdd"We were
specifically directed by the Department of Defense not to so," adding, "It
was anguishing for us, because as a doctor I would like to be able to help
them in any way.  But that was not the protocol we agreed to."
  Given that mTBI is so difficult to diagnose, and sufferers are many times
told there is nothing wrong with them, that seems an especially cruel
protocol.  "Many of them [the doctors] were hoping we could give results to
their care providers to document or validate their concerns."
  In the end it will come down to treatment, and whether the wounded vets
will get the care they need, or sit by a phone and wait for their once a
week call from a therapist.
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