TBI, PTSD Research Will Go On Despite DoD Budget Crunch

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By Sandra Basu

WASHINGTON – While 2013 has been a difficult year so far when it comes to the budget, the Military Health System’s top doctor promised that funding for traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) research will be protected.

“We are not going to wholesale shift money out of research in these important areas to solve other budgetary problems. We are going to have to find creative ways to solve budgetary problems,” Assistant Secretary of Defense for Health Affairs Jonathan Woodson, MD, told a congressional subcommittee during a recent hearing.

Woodson’s comments were made during a hearing in which Subcommittee Chairman Rep. Joe Wilson (R-SC) questioned whether DoD, as a result of sequestration and the continuing budget resolution, might have to halt medical research funding in these areas to pay other bills.

At a hearing in March, Woodson had warned that sequestration could force cuts to research that would be “deep and steep and delay progress.” At the more-recent hearing, however, Woodson said most of the research for 2013 has already been funded “so those projects are ongoing.”

Soldiers with 3rd Brigade Combat Team, 4th Infantry Division, complete the Warrior Administered Retrospective Casualty Assessment Tool, a computer-based, structured clinical interview which is the gold standard for determining if someone suffered a traumatic brain injury (TBI). The WARCAT captures all significant injuries Soldiers sustained during their deployment. Photo by Devin Fisher

Research Funding

The service surgeons general also weighed in on mental health research in a budget-constrained environment.

Army Surgeon Gen. Patricia D. Horoho, RN, said she has made decisions for Army Medicine that will protect funding for warrior care, behavioral health and primary care. She told the subcommittee that the Army’s Medical Research and Materiel Command, which oversees many of the research projects, is focused on keeping its top researchers.

“We want to maintain the talent, because you can’t raise that up quickly,” she said. “That is a concern of mine: How do we make sure we maintain the capabilities for future research that needs to be done?”

Navy Surgeon Vice Adm. Matthew L. Nathan, MD, meanwhile, told the subcommittee that Navy Medicine has received no indication they would be forced to remove funding from research and/or development to pay other bills.

“We are proceeding until apprehended with all research in behavioral health and wounded warrior programs,” he said. “There are research programs and research grants that are heavily laden with civilian personnel … and the Department of Navy has been, so far, fairly flexible in allowing exemptions to furloughs where possible to protect any programs that are prioritized as wounded warrior and/or recovering warrior programs.”

Air Force Surgeon Gen. Thomas W. Travis, MD, said mental-health research in the Air Force has not been impacted yet but warned that now would not be a good time to halt funding.

“We are just now learning so much and to cut off the funding at this time would be really a shame,” he said.

Research Needs

Cmdr. Russell Carr, MD, service chief of the adult behavioral health clinic at Walter Reed National Military Medical Center in Bethesda, MD, told lawmakers that his clinic, like those elsewhere in DoD, continue to see patients impacted by combat.

“The wars continue in our offices, just like in every mental health clinic in the DoD. Most everyone we see is suicidal. We use all the approaches at our disposal, both evidence-based and innovative ones to keep them alive, to help them reconnect with the rest of America,” he said.

Carr said knowledge about PTSD has “grown exponentially” since the wars began and that “research must continue.” As an example of how PTSD research has made an impact, he cited the work on the use of Prazosin, a high blood pressure medication that was found to decrease arousal symptoms and nightmares.

Rep. Susan Davis (D-CA) wanted to know whether PTSD and TBI research can be done more quickly and the results provided to front-line clinicians faster.

To make sure that research findings are applied in clinical practice, Woodson said the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury is publishing a series of guidelines for clinicians so that they do not have to “plow through all of the literature.”

“One of DCoE’s main benefits has been to get the experts together, decide what is the best evidence on what works and get it out to the field. This strategy has reduced death rates from trauma. And it is reducing, I think, the impact of these nonvisible wounds of war and allowing us to treat them more effectively,” he said.

Woodson also said that, with collaborations, DoD researchers can move through the science and the process of investigation quicker.

“We are trying to re-engineer the way we do research as much as we are trying to make sure the clinicians have the latest and greatest best evidence treatments available,” he said.

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