VA Continues Long History of Industry Partnerships to Improve Veterans’ Care
SAN DIEGO — The VA has long recognized the creativity and problem-solving power that comes from combining a diversity of perspectives with deep expertise. Often the department has internal resources that facilitate solutions that improve care for veterans, but it has not shied away from reaching out to the private sector for assistance when that can yield better outcomes. On the flip side, the VA has offered its massive health records databases and the broad knowledge of its clinicians to help industry develop and test potential treatments.
A partnership between the VA and Merck, for instance, led to the approval of the shingles vaccine 15 years ago. The original Shingles Prevention Study was conducted and funded by VA’s Cooperative Studies Program in collaboration with the National Institutes of Health National Institute of Allergy and Infectious Diseases. Merck supplied the vaccine and additional funding came from Merck and the James R. And Jesse V. Scott Fund for Shingles Research.
While Merck received the Prix Galien USA Award for Best Biotechnology Product for the vaccine in 2013, the real winners were the thousands of veterans and other older individuals who were spared the excruciating nerve pain associated with postherpetic neuralgia, which can last from two weeks to years after shingles occurs. The vaccine reduced the incidence of postherpetic neuralgia by nearly 70%.
“For some people, shingles can ruin their retirement and their lives. In the area of the body where the shingles rash occurred, just the touch of a shirt can be very painful. If you have shingles on your head, even a breeze can be intolerably painful,” said the study’s lead investigator, Michael Oxman, MD, an infectious disease specialist at the San Diego VA Healthcare System and professor of medicine and pathology at the University of California-San Diego.
The VA’s Precision Oncology Program (POP) provides another example of cooperation with industry for clinical trials. Part of the White House’s National Cancer Moonshot initiative, POP brings the VA and industry leaders together to increase clinical trial participation for targeted cancer therapeutics, build a national VA database of patient characteristics and tumor mutations, and share data to accelerate new treatment options.
Advanced Oncology Research
Many organizations have signed on to help the VA improve treatment for veterans with cancer and advance oncology research. Sanford Health and philanthropist Denny Sanford extended free pharmacogenetics testing to veterans who have survived cancer to better understand which medications are most effective for individuals with specific genetic profiles. The Pharmacogenomics Action for Cancer Survivorship or PHASeR program will also provide information to help clinicians predict how a patient will respond to other medications, including antidepressants and opioids. Ultimately, the program will benefit 250,000 veterans at 125 VA sites.
“This will be the largest pharmacogenetic testing effort in the country by orders of magnitude,” said Deepak Voora, MD, director of the PHASeR program, associate professor of medicine, and executive member of the Center for Applied Genomics and Precision Medicine at Duke University School of Medicine. “We have the potential to improve patient care for each veteran we test, and the scale of the effort will allow us to see trends and conduct research that could improve medical care for the entire population.”
Bristol-Myers Squibb Foundation funded 10 lung cancer screening centers as part of the VA Partnership to Increase Access to Lung Screening (VA-PALS). In addition to $6 million for clinical trial research and the screening centers, the program includes a $4.5 million cloud-based management system/teleoncology system to monitor veterans who have had the screening. More than 900,000 veterans are at risk of lung cancer, and 7,700 are diagnosed with the disease each year.
IBM Watson donated 10,000 genomics studies to the VA to assist the department’s oncologists in selecting targeted therapy for patients. “What we use IBM Watson to help us do is to bring knowledge focused on this patient’s results, to interpret it in the best way that we can, based on the patient’s tumor type and what drugs might be useful to treat that patient’s tumor,” said Michael Kelley, MD, VA’s national program director for oncology and professor of medicine at Duke University. “To be able to interpret the results of those genomic tests, we need different technologies and we need those technologies to work very quickly.”
Aside from cancer, the VA partnered with Cigna to develop and distribute resources for safer prescribing of opioids for veterans. The tools include best practices, treatment options, tools to reduce risk and clinician education.
Since March, the VA has tapped its vibrant private sector network to secure personal protective equipment for frontline healthcare professionals and promising treatments for veterans who have contracted COVID-19. It also has provided essential support for industry by facilitating massive clinical trials for potential therapeutics in record time. The VA began clinical trials for Gilead’s remdesivir on March 18. It also is taking part in Hoffman-La Roche’s study of tocilizumab and Regeneron’s sarilumab.
VA also participated in trials for COVID-19 vaccines being developed by Moderna, AstraZenca, Janssen and Pfizer. Through the Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) program, it has been involved in testing multiple monoclonal antibody treatments, including Eli Lilly’s LY3819253 and Lilly and AbCellera’s LY-CoV555, as well as several antithrombotic therapies.
As the pandemic demonstrated, the long-standing ties between VA and industry allow rapid response to new diseases and application of cutting-edge technology to improve outcomes for some of the most persistent challenges in healthcare.
The benefits also go both ways. VA researcher Andrew Schally, Ph.D., MDHC, DScHC, achieved international recognition as a 1977 Nobel Laureate for Medicine or Physiology. The prize was in recognition of his discovery of the structure of certain key hormones of the hypothalamus: thyrotropin-releasing hormones, luteinizing hormone-releasing hormones and follicle-stimulating hormones. His discoveries led to the recognition of the hypothalamus as the controlling factor of the pituitary gland and allowed new research in contraception, diabetes, abnormal growth, mental retardation, as well as depression and other human mental disorders. Schally, who remains on staff at the Miami VAMC, holds 32 U.S. patents licensed to five companies and his discoveries led to the development of drugs to treat advanced prostate cancer.
As the VA celebrated its 100th anniversary at its headquarters in Washington in 2019, VA Secretary Robert L. Wilkie spoke about the growth of these vital partnerships: “[I]t would not surprise me if the story of our next 100 years is a story of partnerships with the VA working outside its own walls with people and groups who share our goal of helping those who have borne the battle.”