Putting Heads Together to Improve Brain Injury Care

by U.S. Medicine

October 12, 2015

By Sandra Basu

WASHINGTON — If you had more money for traumatic brain injury research, where would you invest it?

That is one of the questions VA Secretary Robert McDonald asked TBI researchers at a recent conference He also inquired whether VA has enough staff engaged in TBI research.

A new handheld medical device for analyzing brain injuries was approved earlier this year by the U.S. Food and Drug Administration to help clinicians assess mildly-presenting head trauma patients. Army photo

A new handheld medical device for analyzing brain injuries was approved earlier this year by the U.S. Food and Drug Administration to help clinicians assess mildly-presenting head trauma patients. Army photo

“We currently have over 140 funded ongoing TBI research initiatives, but we need you to tell us whether our investments are keeping pace with requirements,” he said.

McDonald and other federal and private sector leaders spoke at a recent VA-sponsored TBI summit that brought together researchers from VA, DoD and the private sector.

TBI investments in VA have increased from $2 million in 2006 to more than $36 million in 2014, McDonald pointed out, saying that VA’s vision is that it “can, should and must be the national leader in research, diagnosis and treatment of TBI.”

“We need you to tell us what resources you need for VA to be nationally and internationally acknowledged as the leader for TBI research, diagnosis and treatment,” he told attendees at the two-day conference evaluating the VA’s research program.

He noted that VA has an obligation to “get this right,” when it comes to anticipating the enduring impacts of TBI for the current Iraq and Afghanistan veterans. “Otherwise, there is another access crisis lying in wait.”

The Defense and Veterans Brain Injury Center reports that, since 2000, more than 327,000 servicemembers have been diagnosed with TBI. The challenge is predicting the long-term costs associated for the care of those veterans, McDonald said.

“Let’s not leave an unresolved problem as our legacy,” he said. “Research can show us the progressive effects of TBI in areas like the earlier onset of Alzheimer’s and dementia at younger ages. There’s a cost in resources for that impact. Let’s figure it out, and let’s figure it out now.”

The VA has been conducting a range of research into TBI finding, for example, the association between traumatic brain injury and chronic traumatic encephalopathy or determining that older veterans with a TBI diagnosis have a 60% greater risk of developing dementia.

Conference panelists such as NIH National Institute of Neurological Disease and Stroke Director Walter Koroshetz, MD, pointed out that VA fills a niche in TBI research that would be difficult for other organizations.

“You are in a position, because you are a healthcare system, to do things that we can’t do at NIH, because we are dealing with people who are in multiple different healthcare systems. … So we don’t have the chance to look at people over a long period of time very easily,” he said.

Koroshetz pointed out that much more work needs to be done. As an example, he said, researchers still “have no idea what blast injury does to the human brain, because there has been so little biology available for anyone to study.”

The VA, however, has a “really good brain bank” that could advance the research, he said, adding, “It’s important not only to the veterans we have now, but this is critical to the servicemembers who are going to be facing this problem in the upcoming years because this isn’t going away.”

VA is in a better position to conduct long-range studies because of its patient population, Koroshetz noted, explaining,  “This is way too expensive for [NIH] to say, ‘Let’s take 100,000 people who suffered a concussion and follow them for the next 30 years.’ But the VA, you have 100,000 people who have suffered concussion in your system that you can follow for the next 30 years.”

More Collaboration

Meanwhile, retired Army Vice Chief of Staff Gen. Peter Chiarelli urged a change in the incentive system, suggesting that too little data sharing occurs among medical researchers in the United States.

“It recognizes individual accomplishment and does not recognize team science. I also feel that the problem is we are not focused on the patient; because, if we were, we would handle these tough problems together,” said Chiarelli, now CEO of One Mind for Research, an organization pushing for more collaboration in the scientific community and greater access to scientific data.

He said he overheard an attendee at that very conference express amazement that all of “this research was going on.”

“I used to believe that sharing the data was the key, [and] it’s very, very important, but collaboration is the key,” Chiarelli emphasized. In addition, he said that “critical medical information” is published in refereed journals “that are overpriced that most people don’t read.”

“If Boeing passed out information about problems they had with their planes in refereed journals, what do you think would happen after the first plane fell out of the sky?” he asked.

On another topic, the retired general said troops should be provided the “opportunity to make a decision when they come in the Army to go ahead and offer their brains up, should they die,” so that better brain research could improve protection and/or care when injured servicemembers become veterans.

Without those improvements, he said, it will be “VA that will have to pay the bill.”



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