Training and Medical

[buglerbilly]

Artificial blood could be used within next decade

Patients undergoing transplant operations could be given artificial blood produced from stem cells within the next decade, researchers claim.


It could involve packing haemoglobin – which carries oxygen around the body – into a synthetic cell-like structure Photo: Alamy

By Nick Collins, Science Correspondent

7:30AM BST 27 Oct 2011

Clinical trials using blood created from adult stem cells are set to begin within the next two or three years, raising the prospect it could soon become routinely used where real blood is unavailable.

Scientists are also developing alternative bloodlike substances which could be injected into the body as a "stopgap" until an actual blood transfusion could be performed.

About two and a half million units of blood are given to patients in Britain every year, costing about £130 each, and modern doctors have minimised the risk of patients receiving infections such as Hepatitis A and C during transmission.

But new infections such as vCJD, the human form of mad cow disease, remain a risk and there are also concerns blood becomes less effective the longer it is stored.

Blood produced from stem cells would avoid these risks and could be manufactured as type "O-negative", which is produced by just 7 per cent of the population but is suitable for use in into up to 98 per cent of patients.

While it would be an imperfect substitute for real blood and therefore not be used in all operations, artificial blood could revolutionise treatment in ambulances, war zones, disaster areas, experts said.

It could also be used in certain hospital situations, for example in elective surgery, and save hundreds of thousands of lives in parts of the world where blood banks are not available.

A team at Edinburgh University has developed a method of taking adult stem cells from bone marrow and growing them in the laboratory to produce cells which look and act almost identically to red blood cells.

Once their technique is fine-tuned the team may consider using stem cells taken from embryos, or reprogrammed skin cells, instead of adult cells because although the end product does not mimic red blood as closely, they can be grown in much greater quantities in the lab.

Prof Marc Turner said: "I think it will probably be two or three years before we get to clinical trials and I would think it will be a decade or so before one sees these kinds of artificial red cells or cultured red cells in routine general practice."

A more radical solution, which Essex University researchers say could be perfected within five to 10 years, is to develop a completely artificial alternative to blood which performs the same key functions and would be safe to use in patients of every blood type.

This could involve packing haemoglobin – which carries oxygen around the body – into a synthetic cell-like structure, or using a chemical to hold the haemoglobin together so that it can be injected without the need for red blood cells.

One artificial substitute based on cows' blood is already licensed in Russia and South Africa, but despite being developed in America it was rejected by the country's drug authorities as unsafe after trials showed it raised the risk of stroke, heart problems and pancreatitis.

[JimWH]

Shark Attack Victim Gets 'Bionic' Leg Analysis by Jesse Emspak


That's pretty cool. Above knee amputations are functionally a far worse outcome than below knee amputations, because, as this article says, they tend to have a super funny gait with a prosthetic (since you lack a knee to help your leg shorten during swing phase). I believe the funny gait also contributes the development of pressure sores in the stump which cause far more trouble than one might think.
Be interested to see whether the same basic technology could be applied to a below knee prosthesis. As is, with good rehab a low BKA can actually result in a functional outcome which is damn near identical to still having a foot (probably a bit better for running on a flat surface). With a predictive robotic ankle joint one imagines that almost complete functionality might be achieved. Certainly enough functionality for the individual to be able to live and work exactly the same as any able bodied person in anything other than a physically strenuous occupation.

[JimWH]

[B]Artificial blood could be used within next decade
Not a substitute for blood, but not a bad adjunct to what we have. Could see this being particularly useful in a casevac setting. Most trauma algorithms see you starting volume replacement with a solution which is ultimately salty water. Works fine, but does have a haemoduilutional effect which has implications in terms of clotting and oxygen carrying capacity (i.e. you wont). This wont fix the clotting problems, but it will help the oxygen carriage. Which why I could easily imagine if being quite helpful to have a couple of litres of this stuff in the back of the casevac helicopter so that when they scoop up the pt they're able to boost the oxygen carrying capacity at the same time that the expand volume, which in turn is one less thing to do once the casevac bird lands at the PHCF/T.

[buglerbilly]

That's pretty cool. Above knee amputations are functionally a far worse outcome than below knee amputations, because, as this article says, they tend to have a super funny gait with a prosthetic (since you lack a knee to help your leg shorten during swing phase). I believe the funny gait also contributes the development of pressure sores in the stump which cause far more trouble than one might think.
Be interested to see whether the same basic technology could be applied to a below knee prosthesis. As is, with good rehab a low BKA can actually result in a functional outcome which is damn near identical to still having a foot (probably a bit better for running on a flat surface). With a predictive robotic ankle joint one imagines that almost complete functionality might be achieved. Certainly enough functionality for the individual to be able to live and work exactly the same as any able bodied person in anything other than a physically strenuous occupation.

With the number of shark attacks we've had in WA this year, there could be a number of opportunities to try this out here................mind you most seem to be fatal unfortunately. A mate of mine still swims off Cottesloe beach most mornings even after the last fatal attack (body never found, just his shark-ripped Speedo's) I told him I'm not coming to his funeral if his death has been caused by rampant stupidity..........

[JimWH]

Shark attacks are still a relative rarity Bug. Plenty of BKA and AKA coming out of Afghanistan, and way more funding for the research.

[buglerbilly]

Shark attacks are still a relative rarity Bug. Plenty of BKA and AKA coming out of Afghanistan, and way more funding for the research.

I know that, I was trying to be minorly flippant on what is a serious subject...............

[buglerbilly]

What’s Choking U.S. Troops? Feds Have No Idea

By Katie Drummond October 31, 2011 | 4:55 pm



In a 2010 study of 80 soldiers who struggled to run two miles, half of them were huffing and puffing because of undiagnosed bronchiolitis.

And the feds have no idea why.

The military’s widespread use of open-air burn pits — massive heaps of Styrofoam, human waste and plastic water bottles, in flames around the clock — seemed to be the most obvious answer.

But results of a study published today by the Institute of Medicine, and commissioned by the Department of Veterans Affairs, are frustratingly inconclusive — largely because the military didn’t collect adequate data for researchers to do their jobs.

The team set out to determine whether the burn pits used to incinerate waste at military bases in Iraq and Afghanistan were culpable for the increased prevalence of respiratory, cardiovascular and neurological ailments afflicting recent veterans. But what they know after all that research is essentially what they knew at the study’s outset. First, that more and more troops are complaining of chronic health problems. And second, that the air quality in both combat zones was pretty awful to begin with.

Since 2001, cardiovascular problems among military personnel have soared from 65,520 to 91,013 in 2010. Neurological conditions have more than tripled, going from 9,688 to 32,667.

Some troops are so sure that burn pits caused their illnesses, they’ve already sued the contractors responsible for them: Close to 1,000 are currently in litigation against megaliths KBR and Halliburton, which were charged with overseeing some pits.

But burn pits aren’t the only suspect: With dust storms a common occurrence, soldiers spent plenty of time choking on cloudy air in Iraq and Afghanistan, which the report notes might be enough to cause “long-term health effects.” Not to mention that much of the dust was laden with neurotoxic elements, including chromium and iron.

Researchers studied air samples collected by military officials at Joint Base Balad between 2007 and 2009. They detected 51 chemicals and a plethora of particulate matter (caused by, for example, dust and exhaust fumes). The toxins and particulates found in the samples have been linked to, among others, the following health problems: Cardiovascular disease, asthma, adrenal, liver and kidney failure, birth defects, cancer, anemia and decreased function of the central nervous system.

“The air in the areas tested contained more pollutants — sometimes much more — than U.S. air standards,” Dr. David Tollerud, lead researcher on the study, told reporters. “What they inhaled was comparable to that of very polluted urban environments around the world.”

In other words, troops were living in an environment akin to the heart of Mexico City — if Mexico City was also burning heaps of synthetic goods and human waste adjacent to residential areas and workplaces. So troops should worry about illness. But is the risk reserved for those who worked close to a burn pit? That question’s a little tougher to answer.

“We can’t dismiss the potential of the burn pits themselves as being the cause of health effects,” Dr. Tollerud, who was also a key researcher in establishing Agent Orange’s health threats, said. “But exhaust from automobiles, jet emissions, and other pollution, not to mention dust storms, could also be involved.”

That said, the air samples did contain dioxins, the same chemicals found in Agent Orange, the herbicide now blamed for widespread illness among Vietnam veterans.

And much like Agent Orange — which the VA only this past year acknowledged as the culprit for veteran’s health problems — it seems the confusion surrounding this generation’s long-term health conditions will take decades to resolve — if it ever is.

The report notes that researchers were hampered by “a lack of data” collected by the Department of Defense. Nobody kept track of what was burned, when, how much, or in what proximity to soldiers. And now that the military has shut down all of the open-air pits in Iraq, getting relevant air samples is impossible.

Despite this dearth of data, the military somehow managed to release two of their own reports on air quality earlier in the decade, and both concluded that any health risks from burn pits fell within an “acceptable” range.

The IOM committee isn’t so sure: They’ve suggested another, long-term study that follows troops — especially those who’d been deployed at Balad — and tracks incidence of respiratory problems, neurological impairment and cancer, which often develops later in life. In other words, soldiers will just have to wait until they get sick to help scientists figure out why.

Photo: U.S. Air Force

[buglerbilly]

Showdown Looming Behind Pentagon's Suicide Battle

November 01, 2011

Military.com|by Phil Ewing



America is losing the battle against servicemember and veteran suicides, a new report warned Monday, which could set up a political showdown between two perhaps unlikely opponents: troop advocates and the national gun-rights lobby.

The report, issued by the Center for a New American Security, recommends that Congress repeal a provision in this year's National Defense Authorization Act that would bar military commanders from talking with troops about troops' personally owned firearms -- a factor in nearly half of Soldier suicides last year. Report authors Margaret Harrell and Nancy Berglass put it this way:

"Congress should rescind the NDAA 2011 restriction on discussing personally owned weapons so that unit leaders can suggest to service members exhibiting high-risk behavior, acting erratically or struggling with depression that they use gunlocks or store their guns temporarily at the unit armory," they wrote. "Given this change in law, unit leaders should engage both at-risk service members and their family members, and encourage them to obtain gunlocks or to store privately owned weapons out of the household."

The National Rifle Association pushed for the ban on personal gun restrictions earlier this year after learning these kinds of rules were being put in place locally at posts around the U.S. Chris Cox, director of the NRA's lobbying arm, said in a message to members earlier this year that it was "preposterous" that commanders at Fort Riley, Kan., wanted troops to register privately owned weapons kept on and off base.

Cox also denounced a proposed militarywide plan that would require "troops to register all privately owned firearms kept off base, and would have authorized commanders to require troops living off base to keep privately owned firearms and ammunition locked in separate containers," he wrote.

So, Cox wrote, the NRA and Oklahoma Republican Sen. Jim Inhofe collaborated on language in the defense bill that prohibits the secretary of defense "from issuing any requirement, or collecting or recording any information relating to the otherwise lawful acquisition, possession, ownership, carrying, or other use of a privately owned firearm, privately owned ammunition, or another privately owned weapon by a member of the Armed Forces or civilian employee of the Department of Defense on property not owned or operated by the DOD. It also requires, within 90 days, the destruction of any existing registration information prohibited by the Act."

According to data quoted in the CNAS report, 48 percent of military suicides in 2010 took place with personally owned weapons. "Multiple studies indicate that preventing easy access to lethal means, such as firearms, is an effective form of suicide prevention," authors Harrell and Berglass wrote.

The defense bill is not yet law. It was passed in May by the House but awaits final action in the Senate.

Although this year's NRA gun rights provision was little noticed when it was first included, the CNAS recommendations about its repeal could bring new attention to the issue if senators decide to try to act on the defense bill.

Senate majority leader Sen. Harry Reid, a Nevada Democrat, has said generally he'd like to move on the legislation before the end of the year, but it isn't clear when.

In addition to repealing the gun information portion of the bill, Harrell and Berglass wrote that poor communications, data collection, unhelpful policies and the lingering stigma around mental health care all have left the military services and the Department of Veterans Affairs on their heels as they try to prevent more troops from taking their own lives.

Even though there is no single solution, not acting also is not an answer, they said. "From 2005 to 2010, service members took their own lives at a rate of approximately one every 36 hours," they wrote.

"While suicides in the Air Force, Navy and Coast Guard have been relatively stable and lower than those of the ground forces, U.S. Army suicides have climbed steadily since 2004. The Army reported a record-high number of suicides in July 2011 with the deaths of 33 active and reserve component service members reported as suicides. Suicides in the Marine Corps increased steadily from 2006 to 2009, dipping slightly in 2010. It is impossible, given the paucity of current data, to determine the suicide rate among veterans with any accuracy. However, the VA estimates that a veteran dies by suicide every 80 minutes."

© Copyright 2011 Military.com. All rights reserved.

[buglerbilly]

Injured US Marines to get 'lollipop' instead of morphine

US Marines badly wounded in Afghanistan may get a "lollipop" with a powerful pain killer from now on instead of the traditional shot of morphine, according to the Marine Corps.


The Fentanyl lollipop offers medics a faster way to ease the pain of a battlefield injury

9:48PM GMT 01 Nov 2011

The new treatment offers an alternative to the morphine needle "you see in the World War II movies," with medics jabbing a syrette into a soldier's leg or arm, Captain Brian Block said.

The Fentanyl lollipop offers medics a faster way to ease the pain of a battlefield injury as the drug can be absorbed more rapidly through a lozenge in the mouth than from a needle injected into a muscle, Captain Block said.

"The absorption is actually faster through the blood vessels in the mouth. You don't have to worry about shock which will constrict the blood vessels in a major muscle in a leg or an arm," Captain Block added.

After US Marine special operations forces used the new sucker successfully, commanders ordered the lollipop to be distributed to medics throughout the Marine Corps, he said.

The marines started delivering the lollipop to medical corpsmen about two months ago, he said.

"Some medics have it now. And it will continue to be fielded until it's out there for everybody," he said.

The lollipop also gives medics more control over the dosage, as the lozenge can be withdrawn at any moment, unlike a shot of morphine, he said.

"If the patient goes into shock or if there's a reason that you need to limit the dosage that you're giving to them, you can just pop it out of the mouth in a way that you couldn't (with the syrette).

"Once the morphine's in, the morphine's in."

Like other medicine distributed to military medics, the lollipops are subject to strict controls and will not be handed out directly to troops on the battlefield, he said.

"We'll take the appropriate steps to maintain accountability and maintain that they're being used appropriately," he said.

Medics in Afghanistan will still have the option of employing the morphine syrette, a small needle on a collapsible tube.

And for the moment, the painkilling sucker will come in only one flavour – "berry," he said.

[buglerbilly]

MRI scanner centre opens in Bastion Hospital

An Equipment and Logistics news article

2 Nov 11

The UK-led Anglo/American Role 3 hospital at Camp Bastion, Helmand province, has celebrated the opening of its first magnetic resonance imaging (MRI) scanner centre.


The recently opened magnetic resonance imaging scanner centre at Camp Bastion Hospital
[Picture: via MOD]

The advanced imaging machine will enhance the hospital's ability to diagnose and care for personnel who have experienced a variety of injuries, including concussions, traumatic brain injury and other head injuries:

"This machine adds diagnostic capability to our concussion rehabilitation centre so that service members with anything from concussions to serious head injuries can be scanned," said Lieutenant Colonel Martin Bell, Deputy Medical Director for Regional Command (South West) [RC(SW)].

"This can ultimately provide us with a much better idea of how to treat them."

By design, the MRI is an advanced sort of X-ray machine. Using radio waves and magnetic fields, the machine produces transparent images of organs, bones and musculoskeletal tissue inside the body.

The arrival of the MRI scanner will enable a more in-depth treatment of injured personnel in theatre:

"Everything we do here at Camp Bastion is in an effort to provide the highest standard of care that we can to our wounded warriors," said Commander Carol Betteridge Royal Navy, Role 3 Hospital Commanding Officer.

"Not only will this help us with an increased clinical capability but it will be able to provide us with any sort of research that we may need while treating a patient here."

The MRI scanner centre was ceremoniously opened for business with the cutting of a ribbon, conducted by Commander Betteridge and Major General John A Toolan, Commander of RC(SW).

Following words from General Toolan and the cutting of a celebratory cake, the MRI scanner centre became operational.

[buglerbilly]

China Military Accepting Bigger Recruits, Tattoos

November 02, 2011

Associated Press|by Christopher Bodeen

BEIJING - China's military is accepting recruits who are heavier and have more visible tattoos, conceding to rising prosperity and individuality among the nation's young.

In keeping with a drive for better-educated recruits, the military is also opening up to university students willing to take time off to serve, offering them an additional 6,000 yuan ($944) annually to subsidize their educational costs and guaranteeing that their university places will be there for them when they return to campus.

The changes announced by the Defense Ministry on Wednesday took effect during the People's Liberation Army's current winter recruitment drive. The People's Liberation Army is the world's largest, with 2.3 million people in uniform.

The ministry said would-be recruits will no longer be rejected for having face or neck tattoos as long as the body art doesn't exceed 3/4 inch.

The changes also allow for body weight up to 25 percent greater or 15 percent lower than the military's standard, in contrast to the former limits of 20 percent greater and 10 percent lower.

Prohibitions on ear piercings will also be eliminated, as long as the holes are not too obvious.

The reforms reflect how China's educated youths are becoming increasingly selective about jobs at the same time as the military rapidly modernizes. As in the West, increased food consumption and more sedentary lifestyles are producing recruits who are less fit and more choosy about the physical activities they engage in.

With China's enormous population and huge amounts of excess rural labor, the army in the past could afford to be highly selective in whom it admitted, requiring recruits to meet strict standards for height and weight and automatically tossing out those with less than perfect vision or other slight physical defects.

While China's growing economy offers numerous alternatives, military pay and benefits have been improving in line with double-digit annual percentage increases in the defense budget. The armed forces also retain a privileged position in communist society, and a military background can lead to careers in security, local government, and other areas, so serving remains a relatively attractive choice.

While China maintains a draft, the army has been essentially all-voluntary for many years as so many young men sought to join. Rejection rates among those taking the basic physical exams have run at about 70 percent in past years.

The U.S. military changed its policy for recruits in 2006 to ban any tattoos above the collar, including on the neck, head, or face, as well as those anywhere on the body of an extremist, sexist, racist, or indecent nature. The rules set no limits on piercings, but forbid earrings and other such body decorations except in some cases for female soldiers.

Chinese soldiers are required to be slightly taller than U.S. recruits, with a minimum height of 5 feet, 3 inches (162 centimeters) for men, as opposed to 5 feet for Americans.

While American male soldiers can weigh between 97 and 259 pounds, depending on age and height, the People's Liberation Army calculates its standard weights only by height, starting at 115 pounds

© Copyright 2011 Associated Press. All rights reserved.

[buglerbilly]

Lasers Power Pentagon’s Next-Gen Artificial Limbs

By Katie Drummond November 3, 2011 | 6:30 am



The Pentagon’s already got brain-controlled prosthetics, and they are a major improvement over old-school artificial limbs. The devices are far from perfect, however. They rely on metal implants, which aren’t compatible with the body’s tissues, and they can only transmit a few signals at a time — turning what should be a simple movement into a Herculean task.

Now, DARPA-funded researchers are convinced they’ve found a way to make prosthetics truly life-like: laser beams.

A team led by experts at Southern Methodist University is making swift progress towards prosthetic devices that rely on fiber-optics, and would offer a wearer the kind of seamless movement and sensation experienced with a flesh-and-blood limb.

“Already, we’re tantalizingly close,” Dr. Marc Christensen, the program’s leader, tells Danger Room. “We haven’t seen anything that’s been a deal-breaker yet.”

It all started in 2005, when researchers at Vanderbilt realized they could trigger a nerve using infrared light. The finding catalyzed a handful of research projects investigating the prospect of laser-powered prostheses, and DARPA last year doled out $5.6 million for the creation of the Neurophotonics Research Center, led by SMU, for the development of prosthetic devices powered by infrared lasers.

A fiber-optic prosthetic for a human patient would likely be a cuff — loaded with optical cables — affixed at one end to a prosthetic, and attached at the other to the body’s severed nerves. Those are a decade off, but already, researchers say they’ve nearly climbed the project’s biggest hurdle: Developing sensors with enough sensitivity to detect — and trigger — the infinitesimally small perturbations of a single activated nerve.



That’s thanks to Professor Volkan Otugen, director of SMU’s Micro-Sensor Laboratory. He developed entirely new micro-sensors for the project. The soft spheres are a few hundred microns in diameter — small enough to fit hundreds onto a single optical fiber — and the consistency of Jell-O. That unique composition would make the sensors compatible with the body’s tissues, unlike metal implants that can cut into delicate tissue, wear down within years, and risk being rejected by the body. And one optical fiber can transmit a ton of signals at a single time and even stimulate a single neuron, making a bundle of them able to transmit exponentially more signals, much faster, with way more specificity, than systems relying on electrodes.

Let’s say you were trying to grab a coffee cup. Even a bleeding-edge, brain-based prosthetic would only offer a few degrees of movement, and because electrical signals are relatively slow, you couldn’t move as quickly as someone with a real arm. “It would be akin to bench-pressing 250 pounds to lift a mug,” Christensen says.

With a fiber-optics prosthetic, touching the cup would catalyze optical fibers to pulse a specific message out of infrared light through the hundreds of micro-sensors, which would stimulate sensory nerves that could then — as they do with a flesh-and-blood arm — transmit the specific, nuanced sensory message to the brain. The brain would then send feedback to the arm’s motor nerves, which would trigger specific movements in those trusty micro-sensors. Those movements change the pattern of infrared light circulating in and out of the sensors, which triggers highly specific muscle movement.

“It’s the same way the internet put thousands of phone calls on one wire,” Christensen says of the method, which he expects to test in mammals next year. “Right now a prosthetic can pick up or transmit maybe two signals. We think we can turn that number into thousands.”

Photos: U.S. Army; Southern Methodist University

[buglerbilly]

Congressman: The Military’s Burn Pits Screwed Our Soldiers

By Katie Drummond November 3, 2011 | 3:23 pm



A few months after he came home from Iraq, the Sergeant started having trouble breathing, and noticed numbness in his feet and hands. The military doctors he saw blamed his smoking habit: At 27-years-old, he’d been indulging in half a pack a day for five years. The Pentagon swore that the noxious smoke emanating from the military’s open-air burn pits — massive heaps of household trash, computer parts and even human waste that were used at bases in Iraq until last year, and are still being used in Afghanistan — weren’t at all responsible.

“We all knew that huge plumes of smoke going into the air, all the time, can’t exactly be good for you,” says the Sergeant, who requested anonymity because he fears reprisal from his commanding officers.

Now, one congressman wants the Pentagon to start paying attention to the accumulation of ailments. Rep. Todd Akin today announced a new bill that’d create a database of military personnel afflicted with health conditions they blame on burn pits.

“I have worked with a number of my constituents who were exposed to burn pits while serving in the military,” Rep. Akin, a Republican from Missouri, said in a statement. “The health consequences have been severe.”

Indeed, the Sergeant, who has since been diagnosed with a degenerative neurological disorder and chronic respiratory infections, isn’t alone: Thousands of recently returned troops are coming down with myriad ailments, including respiratory problems, cancer and neurological defects, that many suspect were caused by the pits.

Akin’s announcement comes only three days after the publication of a new federal report, issued by a committee at the Institute of Medicine, that should have shed some light on whether the substances in the burn pits were responsible for a host of health ailments, including respiratory problems, neurological conditions and even increased rates of cancer, that are afflicting recent veterans.

Instead, researchers came up empty-handed: They detected 53 toxins in the air around Joint Base Balad, home to the military’s largest pit, but couldn’t determine which came from the burn pits and which were from other sources, including toxic dust storms and local industry emissions — largely because, they noted, the military had compiled so little documentation on the burn pits, such as what was burned and when, that it was impossible to generate any meaningful conclusions.

“The committee requested but did not obtain documentation from the DoD [Department of Defense] on the volumes and types of materials burned specifically at [Joint Base Balad],” the report reads. “Insufficient data [means] it is not possible to say whether these emissions could cause long-term health effects.”

That thousands of soldiers were breathing in hazardous chemicals now seems to be a given — even the Institute of Medicine report acknowledges that, whether from burn pits or elsewhere, toxins clouded much of the air overseas. But whether or not subsequent illnesses are because of burn pits remains a mystery, and that’s largely because the military doesn’t have any data on who was stationed near the pits and whether or not they’re now suffering any ailments.

Akin’s database would change that: He wants the registry modeled after that created in 1978 for soldiers exposed to Agent Orange, and operated by the Department of Veterans’ Affairs.

And because much of the necessary data can’t exactly be obtained retroactively, a database of soldiers, their deployment dates and locations and their symptoms is the last chance for researchers to collect any tangible information — and, by monitoring health ailments and looking for patterns, someday determine exactly what caused the soldiers’ various conditions.

The bill has already garnered widespread support: Senator Tom Udall, a Democrat from New Mexico, will introduce a companion bill in the Senate. Veterans advocacy groups, including the American Legion and the National Military Family Association, are also endorsing the database. John Wilson, a volunteer with the Disabled Veterans Association, called it “an opportunity to do what we didn’t for Agent Orange.”

“For those in Vietnam, we could have saved a lot of suffering, a lack of health care, a lack of compensation, if we’d had this kind of rigor earlier on,” Wilson tells Danger Room. “We don’t need another generation of vets to experience what they did.”

Unfortunately, the passage of the bill doesn’t exactly guarantee that today’s troops will fare much better: The registry wouldn’t include regulations on compensation or treatment, which, more than three decades after Vietnam, remain unresolved points of contention in Congress.

Photo: U.S. Army

[buglerbilly]

The bionic leg that gave my life a lift: Amputee fitted with limb that lets him cycle, walk backwards and even go SKIINGIt has 10 settings varying from cycling and cross-country skiing to golf

£50,000 cost includes prosthesis, fitting appointments and six year warranty

Matthew Newbury is first UK patient fitted with the leg prosthetic system

By Jessica Satherley

Last updated at 12:19 AM on 10th November 2011


Matthew Newbury, the first UK patient to receive a new bionic prosthetic leg system 'Genium'

He lost a leg in a motorcycle accident but property developer Matthew Newbury has no trouble scaling the ladders and scaffolding on his building sites.

He is the first Briton to be fitted with the latest state-of-the-art bionic limb and says it has transformed his life.

Mr Newbury, who lost his left leg above the knee, has had prosthetic replacements before but none have allowed him to move as freely as the £50,000 Genium.

He can even ski and walk backwards.

'The difference is just vast,' said Mr Newbury, 30.

'With my old leg, a lot of the time I'd be walking gingerly, avoiding tripping up, but now I can walk with much more confidence, I can climb stairs in a much more natural way.

'But the best thing is I'm not tired all the time. I have my life back. I can go out for drinks and dinner until late without feeling exhausted.'

He is so happy with his 'super limb' that he says it works better than his right leg, which survived the 1997 accident but was badly damaged.

Mr Newbury, of central London, was 15 when the motorbike he was a pillion passenger on was struck from behind.
He spent more than 18 months in hospital and rehabilitation.

In 2004 he was awarded £2.1million compensation, as well as more money for his accommodation needs – and blew some of the cash on a Porsche with the number plate HA5 1 LEG.

He also used it to set up a building company and he is now said to be worth more than £9million.

The combination of motion and speed sensors and advanced computing mean that the Genium, made by German firm Otto Bock Healthcare, can detect small changes in movement and direction.

This makes it better than other models at changing the rigidity of the knee, providing better balance and stability.

Cycling, skiing, golf and table tennis are all possible.




New lease on life: Matthew's leg's new technology means he can programme the limb to suit the day's activities


Accident: Mr Newbury was aged 15 when he lost his left leg after a motorbike he was a pillion passenger on was struck from behind by a Land Rover

In Mr Newbury's case, his leg will allow him to work the pedals on his light aircraft. He can also get around his own building sites.

Even simple tasks such as crossing the road have become easier for him.

He said: 'I am now able to walk, ride and navigate life without a second thought.'

His prosthetist, Richard Nieveen, of ProActive Prosthetics in Elstead, Surrey, said: 'It is very encouraging to see Matthew so well with this new knee and we will be watching his progress with great interest.'


How the leg works

Read more: http://www.dailymail.co.uk/health/article-2059303/Amputee-Michael-Newbury-fitted-Genium-bionic-limb.html#ixzz1dI11E2Ov

[buglerbilly]

Pentagon Regrowing Soldiers’ Muscles From Pig Cells

By Katie Drummond November 9, 2011 | 3:29 pm



A few pig cells, a single surgery and a rigorous daily workout: They’re the three ingredients that patients will need to re-grow fresh, functional slabs of their own muscle, courtesy of Pentagon-backed science that’s already being used to rebuild parts of people.

The research team behind the project, based out of the University of Pittsburgh, has made remarkably swift progress: Mere months after starting their first-ever clinical trial, they’ve already operated on four soldiers and are now training groups of surgeons from across the country in perfecting the approach. If progress continues at this pace, the trial will wrap in 24 months and the technique will become “a standard of care for orthopedists and trauma surgeons,” according to Dr. Stephen Badylak, head of the initiative.

It isn’t quite salamander territory, but it’s astonishingly close. The Pittsburgh team’s research means that, within this decade, the thousands of soldiers who’ve suffered major muscle loss during this decade’s wars can overcome devastating impairment — a life sentence of chronic pain, disability and no viable treatment short of amputation — and experience at least a 25 percent improvement in physical function. For civilians, the impact would incalculable. The kinds of trauma and health problems that now cause amputation, from car accidents and fires to cancer or diabetic peripheral vascular disease, would no longer cause irreparable damage.

Badylak and colleagues at the University of Pittsburgh’s McGowan Institute for Regenerative Medicine are only one of several groups leading far-out research projects that are part of the Pentagon’s Armed Forces Institute of Regenerative Medicine (AFIRM), a massive, $250 million undertaking meant to quickly usher regenerative medicine into the mainstream. Already, military brass have fast-tracked clinical trials for “bone cement” to replace metal screws and plates and accelerated the sophistication of face and hand transplants — a handful of which have now been conducted in the United States.

The tantalizing prospect of regrowing tissue using Badylak’s technique first made headlines in 2007, when he announced the successful regrowth of a small portion of fingertip using a concoction based on cells derived from a pig’s bladder. His approach with muscle tissue is similar: Surgeons start by implanting what’s called an extracellular matrix, a sort of “cellular glue,” whose key components are growth factor proteins from pig bladders. Those proteins trigger the body’s own stem cells to flock to the area and initiate the process of tissue growth and wound repair — which adult muscles normally wouldn’t do. Combined with an intensive rehab program to essentially “exercise” the nascent muscle, the body is able to restore not only basic muscle tissue, but the tendons and nerves that are necessary for function.

“The patient needs to do their part, and that involves a lot of work — we aren’t just putting a cast on the leg and waiting,” Badylak said. “But these soldiers coming in with 60, 70 percent muscle loss, they’ll do anything to get their lives back.”

Now, only four years after Badylak’s fingertip achievement suggested his technique could restore lost tissue, his team is celebrating a notable milestone: The first patient enrolled in their trial, a veteran who lost the majority of the anterior tibial muscle in his lower leg during an IED attack, has today graduated from the requisite six-month rehabilitation program that follows surgery. “He’s doing great,” Badylak says of the unnamed patient, who has yet to be identified. “What would have been an amputation is now somebody with a limb that works much, much better than it did after the injury.”

And if this patient’s results are anything like those of Marine Corporal Isaias Hernandez, a U.S. soldier who served as Badylak’s veritable guinea pig in 2008, after he returned from deployment missing 70 percent of his right quadriceps, the procedure is no doubt poised to transform medicine.

“I’ve been losing weight and playing sports,” Hernandez said earlier this year, adding that he expected to re-enlist and deploy again. “It feels pretty good.”

More will soon have the chance to undergo the treatment: The Institute is still recruiting soldiers and veterans missing at least 25 percent of the muscle mass in a given area — described as “a massive loss” by researchers — or qualify for limb amputation. Given that more than 50 percent of injuries in Iraq and Afghanistan have resulted in this kind of devastating tissue damage, they should have no shortage of eager volunteers.

“From what we’re seeing, it works,” Badylak said of the technique. “And there’s a huge need here. So of course, we’re being as aggressive rolling it out as we can.”

Photo: courtesy of McGowan Institute for Regenerative Medicine

[buglerbilly]

Missing Limbs, More Suicides, No Jobs: 9 Battles for Today’s Vets

By Katie Drummond November 11, 2011 | 6:30 am



The wars in Iraq and Afghanistan were in many ways acutely different from their predecessors. This time, American soldiers were fighting in urban settings, dodging improvised explosives and often searching for enemies indistinguishable from civilians.

With a new kind of war come a new host of challenges for those who fought in it. Fewer fatalities has led to more life-long injury, an economy in crisis will translate to fewer jobs and less federal funding, and the use of unconventional weaponry is already apparent in the prevalence of invisible, untreatable mental wounds.

No Longer Fatal, Injuries Become Life Sentences

More soldiers than ever are surviving their injuries: Last year, 7.9 percent were fatal, which represents an all-time low for the American military. But the mangled limbs, burned flesh, shredded muscles and missing body parts that once guaranteed death now need to be patched up - And despite improvements, the results are far from ideal.

The military has invested upwards of $100 million into cutting-edge prosthetics, from research into brain-controlled limbs to the development of synthetic skin. They've also thrown $250 million into regenerative medicine to help repair some of the damage. Still, a prosthetic that's as good as the real thing is likely a decade off, while new body parts will no doubt take even longer. "I’m not satisfied we’re doing it rapidly enough," Joint Chiefs of Staff Chairman Admiral Mike Mullen said last year. "10 years doesn't satisfy any of us."

Photo: U.S. Air Force



Less Stigma, But Still More Suicides

Now more than ever, the military is talking about suicides. In 2010, an Army task force released a massive report, including 250 recommendations, on reducing suicides among soldiers and veterans. “The hard part is eliminating the long-standing stigma, breaking down the invisible barrier," Army Gen. Peter Chiarelli said. "I do not believe we are losing this battle."

That's up for debate. A stunning 18 veterans commit suicide every day, another 1,000 attempt suicide every month, and suicides among this generation's active-duty soldiers and vets frequently break their own monthly records.

Photo: U.S. Marines



A Government Low on Money, A Country Low on Jobs

The VA's budget is set to increase slightly in 2012, but it's still a reflection of lean times for the federal government. The budget, proposed at $132 billion, won't go nearly as far as it needs to in covering the growing expenses of American veterans, which are estimated to hit $55 billion spread over the next 10 years for medical care of today's vets alone.

And vets won't have an easy time paying their own way. Around 12.1 percent of veterans who deployed after 2001 are currently unemployed. That rate continues to rise, even as joblessness in the U.S. takes a turn in the right direction and the federal government launches new initiatives to help vets and their spouses find work.

Photo:Barmony Flickr



Uploaded by povborders on Oct 12, 2011

http://www.pbs.org/pov/wheresoldierscomefrom

Having been in many trucks which were struck with improvised explosive devices (IEDs) while serving in Afghanistan, Matt "Bodi" Beaudoin now suffers from tramautic brain injury, or TBI. Bodi explains what it's like to live with TBI, how he deals with it, and how it is different from other brain injuries.

'Where Soldiers Come From' will air November 10, 2011 on PBS. Check local listings.

Traumatic Brain Injuries Foreshadow Lifelong Illness

An estimated 200,000 troops have suffered a traumatic brain injury since 2002 -- but since military officials still can't accurately diagnose the condition, and often ignored symptoms among soldiers, that number is likely much higher.

Granted, the Pentagon is investing billions into better diagnostic tools and treatments for TBIs, rates of which soared because of exposures to IED blasts. But for this generation of veterans, the damage might already be done: In addition to neurological symptoms like confusion and vision loss, vets with TBI are also more vulnerable to dementia, Parkinson's and other degenerative brain ailments -- most of which can't be treated, either.

Video: PBS



State of the Unions

We can be grateful that fewer military families are mourning a loss from this decade's wars. But living with a dad, sister, uncle or wife who's endured combat has its own implications for today's households.

Recent research suggests that military kids are more likely to suffer learning disabilities, behavioral disorders and violent tendencies. Military spouses are vulnerable to alcohol and drug abuse, as are veterans themselves. And as a couple, they're twice as likely as civilians to divorce and four times more likely to contend with domestic violence.

Photo: U.S. Air Force



The Singular Struggles of Women

They've gone to war before, but never like this: Women still aren't sanctioned to take combat roles, but thousands in Iraq and Afghanistan experienced it nonetheless. The wars "advanced the cause of full integration for women in the Army by leaps and bounds," Peter Mansoor, a retired Army colonel, said in 2009.

As veterans, these women now face unprecedented challenges. One 2010 study estimated that 15 percent experienced sexual trauma overseas, while a recent Pentagon report found that female vets were twice as likely as men to develop combat-related PTSD, but less likely to seek treatment. Not to mention that for women, a return from war often means reconciling life as a former soldier with life as a mother.

Photo: U.S. Marines



A Pandemic of Pill-Popping

A combination of chronic pain and mental health symptoms mean thousands of soldiers have been prescribed narcotic pain-killers, psychotropics, sleeping pills and other addictive, often dangerous drugs: 14 percent of Army soldiers have been proffered an opiate pain-killer, and 73 percent of the Army's accidental deaths in 2010 were blamed on prescription medication overdoses.

For many of those coming home with a bottle of pills, the habit can be tough to shake. At least 25 percent of injured soldiers in one warrior transition unit were hooked on prescription meds, according to an Army inspector general report, and 31 percent of those at Walter Reed were using both prescription and street drugs.

Photo: Texas National Guard



Plenty of Ideas for PTSD, But No Cure

Arguably the signature wound of the wars in Iraq and Afghanistan, post-traumatic stress disorder affects at least 20 percent of all soldiers deployed since 2001. And symptoms like insomnia, rage and depression are, despite a swath of prescription meds doled out by VA doctors, largely untreatable.

At least, for now. The Pentagon has invested millions into all kinds of research that aims to find a better remedy for PTSD. So far, the military has studied dozens of treatments, including fear-erasing drugs, yoga, virtual reality therapy and meditation. Sadly, they still aren't open to everything: Marijuana, one substance that's got a lengthy track record helping vets calm down, has yet to get the green-light.

Photo: U.S. Pacific Command



Lungs Clouded With Chemicals

Today's veterans might also be up against their very own Agent Orange. Open-air burn pits, used to incinerate household trash, computer parts and human waste at most bases in Iraq and Afghanistan, are now being linked to a host of serious health ailments.

But we might never know what -- whether burn pits, toxic dust storms or chemical agent exposure -- caused the conditions, which so far include neurological disorders, cancers and chronic respiratory infections. A recent Institute of Medicine report noted that it was impossible to determine the source of airborne toxins overseas, because of "a lack of data" collected by the Department of Defense.

Photo: U.S. Air Force

[buglerbilly]

This is the Blizzard Heat Pack...........I'm not sure IF its the same thing but the principle certainly is................

Army medic creates award-winning 'Band-Aid' to keep soldiers warm on the frontline

By Nadia Gilani

Last updated at 2:09 PM on 12th November 2011


Revolutionary: Reservist Major Robert Dawes devoted hours of time to create the Blizzard Heat pack

An army medic has won a national military award after inventing a revolutionary new wound dressing for soldiers on the front line.

Reservist Major Robert Dawes devoted hours of his spare time on creating the Blizzard Heat pack.

The ground-breaking design keeps soldiers warm and stops bleeding from major injuries.

Maj Dawes is credited with introducing it to frontline operations in Afghanistan along with new airway equipment and blood-clotting dressings.

And now the trainee anaesthetist has been named Healthcare Reservist of the Year at the Military and Civilian Health Partnership Awards.

The 43-year-old, from Hedge End, Hants, was nominated for saving countless lives through his 'awe inspiring dedication to patients'.

His work has also been praised for changing the way both the military and medical worlds look at different airway management when treating patients.

Andrew Robathan, Minister for Defence Personnel, Welfare and Veterans, said: 'The quality of care available to our Armed Forces is quite remarkable.

'These awards are about honouring the best of the best, people who, often in the most demanding of circumstances, are delivering exceptional healthcare'.

Maj Dawes has completed two tours of Afghanistan with the 144 Parachute Regiment Medical Squadron, part of the 16 Medical Regiment based in Colchester.

He is a doctor at Southampton General hospital as well as a volunteer for charity BASICS Hampshire, providing emergency treatment for critically ill patients.

He was also one of the volunteers who flew out to Haiti to help search for survivors after the earthquake in January last year.

Heath Minister Simon Burns said: 'Our armed forces make an extraordinary sacrifice for us all and deserve first call medical care - whether deployed on operations, at home or in later life.

'I am delighted that the exceptional care given to them is recognised by these awards'.


Wounded: A British Army medical emergency response team treat a soldier in Afghanistan

Earlier this year a ground-breaking research centre that will bring medical techniques employed on the battlefield to NHS patients opened at the Queen Elizabeth Hospital, Birmingham, where all injured service personnel are treated after being evacuated from Afghanistan.

Military trauma injuries tend to be different from civilian trauma injuries as they are primarily blast wounds.

Battlefield surgeons must also cope with wound contamination caused by dirt being forced into injuries.

It is hoped that the National Institute of Health Research (NIHR) for surgical reconstruction and microbiology, which opened in January will boost survival

Read more: http://www.dailymail.co.uk/news/article-2060675/Army-medic-creates-award-winning-Band-Aid-soldiers-warm-frontline.html#ixzz1dabu4vTF

[buglerbilly]

Jab using body's painkillers could help 500,000 in pain

Hope for cancer patients whose suffering can no longer be eased by morphine

Ian Sample Washington DC

The Observer, Sunday 13 November 2011


The new therapy could help those who no onger benefit from traditional painkillers. Photograph: Alamy

Doctors in the US have begun a clinical trial of a gene therapy that uses the body's natural painkillers to bring relief to patients who cannot be helped with conventional drugs. They hope that a single injection could provide relief for up to six months in people whose pain is so severe that morphine and other frontline drugs have little effect or cannot be used because of their side-effects.

The trial was launched after a pilot study this year of people with intractable cancer pain showed the therapy was safe. The therapy smuggles a gene into sensitive nerves beneath the skin that makes the cells release natural chemicals that alleviate pain.

Dr David Fink, who is leading the research at the University of Michigan, said that the trial was the first to investigate if the technique was effective in humans.

"We have started with people who are in pain from terminal cancer, but the approach is applicable for intractable pain from inflammatory conditions, such as arthritis of the hip and any number of other situations," he said.

Half a million people in the UK experience chronic pain, often when their nerves are damaged by cancer, diabetes, surgery or disease, according to the Neuropathy Trust. The constant pain leads to sleeplessness and depression that can be devastating. The therapy uses a form of herpes virus that is modified to prevent it from replicating and causing illness when injected into the body. The virus is engineered further to carry a gene that produces a natural painkiller called enkephalin.

When the virus is injected into the skin, it finds its way into nearby peripheral nerves – those outside the brain and spinal cord – and makes them produce enkephalin for a month to six weeks. Other work by Fink's team suggests this could be extended by up to six months.

The injection allows doctors to target specific parts of the body that are in pain, rather than prescribing a drug that affects the whole body. Patients given high doses of morphine for severe pain can suffer broad and debilitating side effects, including lethargy, confusion and constipation. Fink reported a small trial to investigate the safety of the treatment in April this year. Ten patients with intractable pain were given injections. Those who received high doses reported feeling less pain than those who had medium doses. Those who had low-dose injections felt no benefit.

The latest trial will compare tens of patients who have the injections with a control group that receives a placebo jab. Fink, who outlined the trial at the Society for Neuroscience conference in Washington, expects to have results at the end of the year.

Andreas Beutler, a specialist in chronic pain at the Mayo Clinic in Minnesota, said Fink's work was impressive. "There is a clear clinical need in patients with intractable chronic pain and other diseases involving the peripheral nervous system, such as hereditary neuropathies, where current treatments, while helpful, are failing," Beutler said.

Scientists will be particularly interested to see if the herpes virus used manages to evade the human immune system indefinitely. The latest version was designed to stay active for only a few weeks and has been tested only in a small group of patients at full dose. Long-term effects involving the immune system may not have been apparent.

If the gene therapy is found to ease pain without causing serious side-effects, the virus that Fink has developed could potentially be used to deliver other genes to the nervous system.

[buglerbilly]

Wounded Warrior makes most of setback by relying on resiliency

November 14, 2011

By Neal Snyder, U.S. Army Installation Management Command


Col. Greg Gadson tries out the first set of battery-powered "bionic" prosthetic knees, called Power Knees, in April 2010.

FORT SAM HOUSTON, Texas (Nov. 14, 2011) -- Col. Gregory D. Gadson made the story of his personal obstacles into a steppingstone as he took the U.S. Army Installation Management Command's senior leadership through a discussion of resiliency Oct. 31.

Gadson, director of the Army Wounded Warrior program, described the path he's taken since losing most of both legs to a roadside bomb in Iraq in 2007, speaking to attendees of the monthly IMCOM Headquarters Leadership Development Program.

"Resiliency is not something you pick up," Gadson said. "Resiliency is not something you pull out of your pocket. It's something you have to work on every day. It's about how you deal with life."

Gadson joined the Army to play on the West Point football team. A field artillery officer, he served in every major conflict of the past two decades: Kuwait (Desert Shield and Desert Storm), Bosnia-Herzegovina, Afghanistan and Iraq, where he encountered an improvised explosive device.

He shared lessons learned since traveling that Iraqi road.

"There are no shortcuts in healing. It's a process," he said. "As dramatic as it is physically, it's much more challenging emotionally and intellectually. What I found out is life is not about what we don't have; it's about what we have. I feel so fortunate to be here and the opportunity to continue serving."

Gasden has earned two advanced degrees. He personally tests and advocates for new prosthetic technology. He will take command of the Fort Belvoir garrison in July.

"I don't like to give energy to things that are negative," Gadson said. "Saying, we will not fail is different than saying, we will succeed. It's a possibility that A, B and C might happen, but don't give energy to the negative. Be aware, but don't give it your energy.

"Of all the things I wanted to do, I didn't want to fall. I came to accept that falling would be a part of my life and I didn't need to be afraid or embarrassed about it. I analyzed it and decided what I would do. Would I let it stop me, or would I accept it? Ultimately I accepted it," he said.

"Don't ask why. Ask what. Don't ask why is this happening. Instead of asking why, ask what. Why isn't important."

[buglerbilly]

Vet to Feds: Enough Stonewalling, Give Us Pot for PTSD

By Katie Drummond November 16, 2011 | 6:30 am



I had a very good friend that had MS but managed to survive for a lot of years depsite this. One thing he did suffer at various times, especially towards the end, was acute discomfort if not severe pain. MJ was the ONLY thing that gave him relief without taking very heavy dosages of painkillers which can have their own problems...........someone wants to smoke it, let them IF they have a medical reason to do so.............I know someone now who smokes to relieve almost-permanent pain from having his back smashed in a bike (Harley) accident, now in a wheelchair. His shithead neighbour shops him to the Police every month at least, real good Born Again Christian posing as a shithead...my disgust knows no bounds...........

By the time Sgt. Ryan Begin obtained his medical marijuana card last March, he’d already hit rock bottom.

During his second deployment to Iraq in 2004, Sgt. Begin was evacuated to Maryland’s Bethesda Naval Hospital after enduring an IED attack that left him with a stump for a right arm. The years that followed were a haze of prescription drugs, arrests, overdoses and stints in several mental institutions.

“My life went downhill from the moment I came back from Iraq,” Begin, now a 31-year-old veteran, tells Danger Room. “Doctors at Bethesda had me on so much, and on such high doses of everything, that I didn’t even know what was a symptom and what was a side effect.”

At one point, Begin, diagnosed with PTSD shortly after coming home, was taking more than 100 pills a day. So many that he would stuff dozens of bottles into a backpack to lug everywhere he went. Now, he’s cut his dependency on prescriptions to zero. Their replacement? Five joints a day.

“Using marijuana balances me out,” he says. “It takes those peaks and valleys of PTSD and it softens them. It makes my life manageable.”

Begin’s now launched an online petition asking the feds to change their course on marijuana as a treatment for PTSD. In September, the first-ever study proposed to evaluate marijuana as a potential treatment for PTSD was blocked by officials at the National Institutes on Drug Abuse (NIDA). With an estimated 37 percent of this generation’s vets afflicted with PTSD, and a dearth of effective treatment options available, Begin thinks pot deserves, at the very least, a single study.



Over 12,000 people in 40 states have signed his petition so far, most of them in the past three days. And Begin has been inundated with e-mails from vets who are both supportive and curious. “If I come out and admit ‘this works for me,’ they want to know whether it’ll work for them,” he says. “That’s why we need research.”

Dr. Sue Sisley, an assistant professor of psychiatry at the University of Arizona College of Medicine, agrees. She’s the researcher behind the proposed study, which would evaluate the impact of various strains of weed, smoked or vaporized for two-month periods, on 50 veterans who’d been diagnosed with PTSD. For two years, Sisley’s been pulling together documents to get the okay from federal agencies.

Earlier this year, FDA officials finally gave her the green light. But unlike any other illicit drug that’s used in medical studies (MDMA or LSD, for example), marijuana can only be accessed from one place: A massive storehouse operated by NIDA. A panel at that agency in September declined Sisley’s proposal, citing her relative inexperience in treating PTSD patients along with “a host of safety issues” they anticipated from allowing patients to smoke up outside a medical facility.

“At this point, I can’t help but think they simply don’t want to move forward,” she tells Danger Room. “Maybe they figure if they stall long enough, we’ll give up and go away.”

But in Begin’s case, as well as that of thousands of troops and vets, significant safety issues already accompanied legal, VA-vetted prescriptions. During his six-year stint on prescription meds doled out by VA doctors, Begin was largely unemployed and in and out of prison for assault charges and probation violations. In 2009, he took 90 Valium and was hospitalized, and subsequently institutionalized. Months later, he did the same thing with Klonopin, an anti-anxiety medication, and had his stomach pumped — before being sent home with a new prescription for the same drug.

“The son that left for Iraq was not the son that came back,” Anna Begin, Ryan’s mother, tells Danger Room. “Let me put it as simply as I can: Every single day, my son was suicidal.”

Last March, Begin saw a civilian doctor and was prescribed medical marijuana for chronic pain, largely caused by the upward of 30 surgeries to the arm and elbow that he’d had since 2004. Not only did the weed relieve Begin’s aches, but it soothed the anxiety, insomnia, rage and instability he associated with PTSD. When his VA doctor refused to offer up more prescriptions while Begin was smoking pot (“He said ‘pills or pot, you can’t have both,’” Begin recalls), he made an easy choice.

“I just didn’t want to be shoved full of pills anymore,” he says of his decision, which now sees Begin smoking four or fives joints a day. “I know this works for me.”

Begin even credits marijuana with his renewed vigor for activism: He’s spent the past 30 days camped out at the Occupy Augusta demonstration in Maine, in part to advocate for the legalization of marijuana and the addition of PTSD to the state’s list of qualifying conditions for medical weed. “There’s absolutely no way I’d be out here, surrounded by people, talking all day, without the marijuana,” he says. “I’d be at home, in bed, instead of out trying to help.”

Begin suspects that marijuana would work for other veterans, and it’s an idea that animal studies, human trials with synthetics and myriad anecdotal reports already reinforce. But with nary a human study to bolster the idea, it’s unlikely that PTSD will qualify patients for marijuana anytime soon. Indeed, the California Medical Association recently became the first major medical group to advocate for pot’s legalization, largely because its medicinal efficacy can only be established “once it is legalized and more research is done.”

Even Begin’s mom would rather see her son on pot than prescriptions.

“When I don’t hear from him for a few hours, I don’t have to wonder if he’s killed himself,” Anna says. “Marijuana saved my son’s life.”

Photo: courtesy of Roger Leisner (“The Maine Paparazzi”) at Radio Free Maine

[buglerbilly]

Darpa: Do Away With Antibiotics, Then Destroy All Pathogens

By Katie Drummond November 21, 2011 | 6:30 am



Last year, federal officials warned that Americans were on the verge of “a post-antibiotic era.” And that’s exactly what the Pentagon’s far-out research agency is after.

As long as they’ve got a replacement at the ready, of course. In the military’s latest round of small business solicitations, Darpa is making a long-shot request for an all-out replacement to antibiotics, the decades-old standard for killing or injuring bacteria to demolish a disease. In its place: the emerging field of nanomedicine would be used to fight bacterial threats. The agency’s “Rapidly Adaptable Nanotherapeutics” is after a versatile “platform capable of rapidly synthesizing therapeutic nanoparticles” to target unknown, evolving and even genetically engineered bioweapons.

It’s the latest of several Darpa programs to improve we deal with bacterial infections, viruses and bio-threats. The agency is already funding tobacco-based vaccine production, prescient viral infection detectors and insta-vaccines to inoculate against unknown pathogens.

Right now, antibiotics work by interfering with bacterial function or their spread. Some meds target a ton of different pathogens, while others are more highly specified. Both varieties, however, are increasingly vulnerable to bacterial resistance — bacteria that carry a genetically enhanced ability to thwart the medication survive, and continue to spread, rendering that medication useless. It means even if scientists develop new antibiotics, which they continue to do, the meds will be “prone to the same issues and may ultimately meet a similar fate” as their once-potent peers. Not to mention that where “engineered” bacterial threats are concerned, most conventional antibiotics would be useless from the get-go: Genetic tinkering can turn even benign gut bacteria into lethal, untreatable bioweapons.

Instead, Darpa wants researchers to use nanoparticles — tiny, autonomous drug delivery systems that can carry molecules of medication anywhere in the body, and get them right into a targeted cell. Darpa would like to see nanoparticles loaded with “small interfering RNA (siRNA)” — a class of molecules that can target and shut down specific genes. If siRNA could be reprogrammed “on-the-fly” and applied to different pathogens, then the nanoparticles could be loaded up with the right siRNA molecules and sent directly to cells responsible for the infection.

Replacing a billion dollar industry that’s been a medical mainstay since 1940? Far fetched, sure, but researchers already know how to engineer siRNA and shove it into nanoparticles. They did it last year, during a trial that saw four primates survive infection with a deadly strain of Ebola Virus after injections of Ebola-targeted siRNA nanoparticles. Doing it quickly, and with unprecedented versatility, is another question. It can take decades for a new antibiotic to be studied and approved. Darpa seems to be after a system that can do the same job, in around a week.

Then again, if anybody can design a new paradigm for medicine, and a new way to mass-produce it, our money’s on the military. After all, we’ve got them to thank for figuring out how to manufacture the medication that got us into this mess in the first place: penicillin.

Photo: U.S. Air Force

[buglerbilly]

Army Dropping Controversial Anti-Malaria Drug

November 21, 2011

Associated Press|by Thomas Watkins

LOS ANGELES -- Almost four decades after inventing a potent anti-malarial drug, the U.S. Army has pushed it to the back of its medicine cabinet.

The dramatic about-face follows years of complaints and concerns that mefloquine caused psychiatric and physical side effects even as it was used around the globe as a front-line defense against the mosquito-borne disease that kills about 800,000 people a year.

"Mefloquine is a zombie drug. It's dangerous, and it should have been killed off years ago," said Dr. Remington Nevin, an epidemiologist and Army major who has published research that he said showed the drug can be potentially toxic to the brain. He believes the drop in prescriptions is a tacit acknowledgment of the drug's serious problems.

Over the past three years, the Army slashed by almost 75 percent the amount of mefloquine it prescribes, even as it sent thousands more Soldiers to malaria-prone Afghanistan.

The decrease in doses followed two orders from military and Pentagon leaders in 2009. One, from the Army's surgeon general, ordered the branch to limit its use to specific circumstances. Other branches, however, continue to favor mefloquine.

"We are constantly looking to ensure we are taking care of [Soldiers] the best we can," said Army Col. Carol Labadie, the service's pharmacy program manager. "If that means changing from one drug to another because now this original drug has shown to be potentially harmful ... it is in our interests to make that change."

Army researchers started developing mefloquine toward the end of the Vietnam War and began using it widely after it was licensed by Roche Pharmaceuticals under the brand name Lariam in the early 1990s.

It gained support among the fighting forces because it works in areas where mosquitoes developed resistance to an earlier treatment, chloroquine, and requires just one tablet a week, not the daily dose needed with other medications.

For years, the Army downplayed veterans' criticism of the drug and insisted its protection against malaria easily outweighed the small risks.

Some users complained the pill caused varying degrees of psychiatric symptoms ranging from nightmares, depression and paranoia to auditory hallucinations and complete mental breakdowns. Army literature says such symptoms occur at a rate of between one per 2,000-13,000 people. Critics, including Nevin, contend the number is far higher.

Family members have even blamed the drug for their loved ones' suicides.

Retired Navy Capt. Gary Foster said he cut his career short in part because of the effects of taking mefloquine in 2008 and 2009.

"I began to suffer short-term memory loss, not able to recall what I had done earlier," he wrote in an email. "I also had more bouts of anxiety, and I cannot for the life of me tell you why."

In February 2009, Army Surgeon General Eric Schoomaker sent a policy memo to doctors saying it should be used only if Soldiers could not tolerate doxycycline, a general antibiotic effective at preventing malaria.

In September 2009, Ellen P. Embrey, who at the time was deputy assistant secretary of defense overseeing health affairs, sent a letter similar to Schoomaker's. This time, it was directed across all military branches.

A small but vocal group of anti-mefloquine campaigners seized on the memos as vindication.

"I was stunned," said retired Navy commander Bill Manofsky, who said he sustained permanent damage to his sense of balance after taking Lariam in Kuwait in 2002 and has been a persistent critic of the drug.

"It's like you scream into a hurricane until you are hoarse," he said. "We knew we were right."

Roche says it stopped selling Lariam in the U.S. in 2008 because of the availability of generics and alternative therapies.

Roche spokesman Christopher Vancheri said in an email he could not comment on the military's stance on mefloquine, but noted that the drug continues to be available in over 50 countries.

In 2008, the Army dispensed 8,574 courses of the drug. In 2010, it fell to 2,054. At the same time, the Army increased fivefold the number of doxycycline prescriptions -- to more than 80,000 -- reflecting the increasing number of Soldiers deployed to Afghanistan.

Spending followed a similar pattern, with the Pentagon buying almost $1.8 million of mefloquine in 2009, enough for about 10,000 yearlong courses. The amount dropped to $1.5 million last year. So far this year, the military has only spent about $50,000.

It's not clear how many of the tablets have been dispensed.

The Navy and Marine Corps have actually slightly increased their mefloquine prescriptions over the past three years, from about 1,200 in 2008 to nearly 2,000 last year. Numbers could be higher still because prescriptions filled overseas are frequently not counted.

The Air Force, which has long banned its pilots from using the drug, has been decreasing its usage over the past two years.

Capt. Christopher Clagett, who directs the Navy's Department of Preventive Medicine, said his service's view is that mefloquine remains one of his best tools to prevent malaria. He said it is much cheaper than the most effective drug, Malarone, and can often work better than doxycycline.

"It would be imprudent and would place our personnel at the far greater risk of malaria to abandon an effective anti-malarial due to unsubstantiated allegations of chronic effects," Clagett wrote in an email, "than to continue the judicious and selective use of an imperfect, but nevertheless effective and valuable medication."

In August, U.S. Sen. Dianne Feinstein wrote to the secretaries of Defense and Veterans Affairs, urging them to strengthen safeguards for the use of the drug. The VA last month stripped mefloquine from the advice section on its website while it reviews recent research into the drug's side effects.

Nevin, the Army doctor, has riled superiors with public attacks on mefloquine, calling it "probably the worst-suited drug for the military." He noted that its side effects can closely mirror symptoms of stress disorders related to combat, making diagnosis of neurological problems difficult.

"It is a story of the military bureaucracy gradually and reluctantly coming to terms with a tragic, possibly catastrophic, decades-long series of errors and missteps," Nevin said.

© Copyright 2011 Associated Press. All rights reserved.

[buglerbilly]

Spray On Skin Kit Could Heal Wounds Faster

Analysis by Christina Ortiz

Mon Nov 21, 2011 08:05 PM ET



The idea of spray-on skin conjures up memories of Halloween costumes past. But in the case of ReCell, it’s actually a kit that can do a lot of good. The ReCell Kit has been developed to treat burns, wounds, hyper or hypo pigmentation caused by disease and to improve the look of scars by Avita Medical. It works by harvesting a patient’s keratinocytes and melanocytes, the building blocks of skin cells, and putting them in a suspension solution that allows them to multiply. Because the cells are from the same patient, there is no risk of rejection or disease.

An area of about 80 times as large as the original sample can be produced in under a half hour. After that, the new cells are sprayed over the burn where they will multiply even more. The company claims this type of application will result in less scarring (as compared to skin grafts) and make the skin look as if it were never damaged, especially in younger patients. The kit has been approved for use in Europe, Australia and Canada, but is still undergoing clinical trials in the United States.

Via: Gizmodo

Credit: Avita Medical

[buglerbilly]

Darpa’s New Tool for Diagnosing Disease? Semen

By Katie Drummond November 21, 2011 | 5:00 pm



Imagine if giving docs a single drop of semen was all it took to keep you healthy. Your dream could soon become a reality, as the Pentagon pushes for every male soldier to hold his health, quite literally, in the palm of his hand.

In a solicitation released last week, Darpa, the Pentagon’s far-out research agency, is asking for technology that’d replace good old diagnostic standbys — a vial of blood or cup of urine, for example — with “a portable format” that’s about the size and weight of a credit card. The initiative is one part of the agency’s $25 million Autonomous Diagnostics to Enable Prevention and Therapeutics (ADEPT) program, that aims to provide soldiers with veritable “on-demand” health care. Basically, Darpa wants diagnosis and treatment that troops can administer themselves, instead of relying on medics or waiting to make it to a combat hospital. This is the first of the program’s undertakings, but Darpa also plans to invest in quickie diagnostic tests and on-the-go immunity boosters.

It might be the first phase of a bigger project, but Darpa’s initiative is hardly going to be an easy undertaking. Right now, biospecimens like urine or semen are collected and stored in relatively large sample sizes and in sterile conditions. Not to mention that collecting most samples requires lab technicians and other trained experts (or, at the very least, a generous stack of specialty magazines). These kinds of logistical limitations are a major problem for military health care — especially when illness strikes somewhere remote.

Darpa’s pocket-sized biospecimen gizmos would overhaul the entire process. A soldier would collect his or her own biospecimen, which suggests that semen, urine, hair or spit would be prime contenders for the project. Then he or she would rub it onto a card that “allows stable shipment to a distant site for analysis … with minimal degradation of biomarker integrity.” The solicitation doesn’t mention any fancy uploading or data transmission abilities, so presumably Darpa, for all its high-tech ambition, imagines the specimen cards shipped off to labs through the old-fashioned mail.

Still, the cards could offer valuable insight into the health of soldiers. Saliva tests can diagnose hormonal imbalances and thyroid problems, for example, and a splash of semen can show elevated white blood cell levels that signal infection. Not to mention that researchers are rapidly making inroads into using simple biospecimen tests for a multitude of other diagnoses, from cancer to brain injury.

Depending on the specimens the card is designed to collect, Darpa wants researchers to figure out how that sample could stay sterile “under conditions that are absent of power, temperature control or other inputs.” Dried blood spot (DBS) cards, which are often used in developing countries to test for Vitamin D deficiency or infant HIV, are the closest existing technology to Darpa’s goal. But even decades after their development, the cards remain seriously flawed: Blood specimens can only be preserved at certain temperatures, the cards are susceptible to contamination and, of course, samples require a needle prick.

Obviously, Darpa-funded scientists will have their work cut out for them. But if successful, the project could do more than just make diagnosing anything, anywhere, a possibility for soldiers and civilians. Darpa hopes to improve treatment, by allowing doctors to remotely track a patient’s response to medication, and clinical trials, by giving researchers access to specimens taken from soldiers in combat. Not to mention that for some illnesses, and at least where male soldiers are concerned, there’s also the prospect of a little extra stress relief.

Photo: U.S. Air Force

[buglerbilly]

Horse therapy helps wounded Soldiers at Fort Sill

December 1, 2011

By Ben Sherman, Fort Sill PAO


Jan Smith, Spirithorse Chisholm Trail Center owner, talks with Sgt. Paul Hill about a problem that one of her therapy horses is having with his hoof.

FORT SILL, Okla. (Dec. 1, 2011) -- Horseback riding can be fun recreation, and it is also great therapy for wounded warriors at Spirithorse Chisholm Trail Center near Comanche.

Jan Smith, Spirithorse owner and equine therapist, established the program in May to provide therapy for Soldiers suffering from the trauma of combat.

"For some of the Soldiers who are familiar with horses, it's a way to get back in touch with that, and for those who are not familiar with this it is a way to have a new experience. And you know, these horses just enjoy being with the Soldiers," she said.

Smith started working with children with disabilities in 2007 and found that horses were good therapy for children. So it was a logical progression when she decided to start helping wounded warriors through a program she calls "Horses for Heroes."

"I've always had my horses," Smith added. "It's definitely my passion, and my husband feels the same way. We just enjoy being with the Soldiers and it is our honor to have them here. I figured that I could do this and give back to these Soldiers. And that's when I found my niche."

Smith started working with Dr. Tina Small, a pain management doctor at Reynolds Army Community Hospital, who works with Soldiers in the Warrior Transition Unit, or WTU, at Fort Sill. They both believe that working with horses has a positive effect on Soldiers dealing with trauma.

"Medical facilities are recognizing the value of equine and animal therapy because it's known that therapies like this make a person calmer and more relaxed. This lowers the blood pressure and means they don't have to take as much medicine." Small said.

Sgt. James Boyce, 609th Forward Support Company, 168th Brigade Support Battalion, was the first Soldier to come to the Spirithorse center. For him the horses have been a positive influence.

"Jan has such a big heart and Doctor Small, too. It's great to not always be in an office," Boyce said. "When you go into an office and talk to a doctor, sometimes it's just not calm. For people with anxiety and pain, to be able to come out here, is great. When I pass through those gates, it's no phone, no distractions, no nothing."

"I'm free, my mind is free, and I get to be with the horses," Boyce continued. "Even if I don't ride them, I can just walk around and not really think about the military and just focus on myself. Best of all, the horses don't judge you."

Smith has eight horses that she uses in the program, but since she is currently the only certified equine therapist, she usually has only one or two horses in the arena at a time so she can keep an eye on things.

Smith watched as Sgt. Paul Hill placed a blanket, then the saddle on one of the horses. For Hill, "Horses for Heroes" gives him a chance to relax and reduce some of the stresses he feels from to his injuries.

"I just like coming out here and being with the horses. I love working with them. I wish the Army still used horses on a regular basis," Hill said with a chuckle.

Hill previously served with the Marines and then enlisted in the Army, where he was working with a unit retrieving tanks and trucks damaged by improvised explosive device, or IED, blasts in Afghanistan.

After Hill finished saddling up the horse, Smith came over to give him some directions.

"Sergeant Hill, I'm going to let you walk this one for a while," Smith said. "Just walk alongside him and go real slow."

After leading the horse around the arena, Hill said to Smith, "If I had known the horses needed work on their hooves, I would have brought my tools."

"Well, maybe you can bring them when you come out next week," Smith responded.

Small stood by the arena gate and watched as other Soldiers worked with Smith. To her, the time these Soldiers spend with the horses is so much more than just physical exercise.

"It helps them relate to each other. They all may be in the same unit, but they really didn't talk to each other or have anything in common, but now they do," Small said, "It gives them a more common ground other than the battlefield and going to the doctor's office. It gives them something good and positive to relate to when they talk to each other," she added.

"When you're injured all of the things add up, even the smallest things. These guys in the WTU, you almost have to literally drag them out of their rooms," said Master Sgt. Christopher Mackey. As a Soldier in the Warrior Transition Unit, Mackey knows firsthand the stresses of injury.

"I finally got out of my shell, and it took about four years to do that, to get out and start socializing. I'm hoping that these guys don't take that long, and that we have enough programs through MWR and organizations like Spirithorse, that we can come out and enjoy. These are things that can help Soldiers cope and get themselves back where they need to be mentally and physically," Mackey added.

Smith has plans to build an indoor arena so her therapy work can go on no matter what the Oklahoma weather may bring.

"We just have to have an enclosed arena to be able to work in the winter and especially in the summer. If we have an indoor facility, we can open our program to provide more opportunities to help the Soldiers. When these Soldiers come out here they can just forget everything else that's bothering them at the time. It just gives them a refreshing experience, to look forward to something positive for the next week," Smith said. "This isn't the cure-all but it is definitely better than any medication that I could prescribe for anybody.

"However, I hope it's addictive, and they become dependent on it," Smith added with a smile.

[buglerbilly]

New brace salvages limbs, mobility, morale

December 8, 2011

By Elaine Sanchez, American Forces Press Service





SAN ANTONIO (Dec. 8, 2011) -- A wounded warrior limped into Ryan Blanck's office at the Center for the Intrepid here one day with a plea for help.

The doctors at Brooke Army Medical Center had saved the service member's leg after a combat injury, but due to the pain, he couldn't walk comfortably, let alone run.

Blanck, a leading prosthetist at the state-of-the-art rehab center, found himself in an unfamiliar position -- at a loss.

"There wasn't a go-to option," he said, referring to devices for wounded warriors with lower leg injuries.

So Blanck created one. He designed the Intrepid Dynamic Exoskeletal Orthosis, or IDEO, a streamlined, energy-storing brace that delivers nearly instantaneous results. Now, most troops with salvaged limbs who wheel or limp into his office walk out a short time later, pain and limp-free.

The injured warriors are impressed by the results. When they strap on the brace for the first time and start walking, Blanck said, some stumble midway across the room, but not due to discomfort.

"They're uncontrollably weeping," he said. "It's the first time they've walked without pain in two or three, or seven years in one guy's case."

BRACE PROVES TO BE 'GAME CHANGER'

Blanck's creation is a lightweight, streamlined carbon-fiber device that can be tucked under a pant leg and into a boot or sneaker. It comprises a cuff that wraps around the leg just under the knee connected to a footplate by carbon-fiber rods.

The brace works by offloading the limb and allowing the patient to operate the lower limb in a way that avoids pain, he explained. When a service member's heel strikes, the device stores energy through the gait cycle, then delivers it back to propel the foot forward.

"That's the concept behind it all; energy storage and power," he explained.

Prior to IDEO, Blanck noted, "there wasn't a combination device that would allow offloading, adequate range restriction and then power generation."

The device is proving a "game-changer" for service members with salvaged limbs, said Johnny Owens, a CFI physical therapist who is working hand-in-hand with Blanck in treating IDEO-fitted warriors. "We're seeing immediate changes we don't usually see."

Owens said the device also is single-handedly helping to turn the tide on a trend of wounded warriors opting for delayed amputations -- amputations several months after injury. He attributes the trend to the slow, and sometimes frustrating, recovery for troops with lower leg injuries.

"Prior to all this, limb salvage was a little bit of an unknown," Blanck explained. "You couldn't tell a patient, 'you're going to run.'"

But amputees, depending on the situation and barring other injuries, can regain significant functions about six months after amputation, he noted. Meanwhile, limb salvage patients sit on the sidelines watching their amputee battle buddies walking or running as their own progress proceeds painfully slow.

Frustrated by their limitations, some troops with salvaged limbs opted for late amputations.

"It's enticing," Owens said. "You're in pain, but if you cut your leg off, you can run. Many invested a year or two in recovery and then decided to cut [a limb] off. It was psychologically frustrating to see these guys work so hard and then just cut it off."

Thanks to IDEO, these troops now have another option, he said, that enables them to not only walk, but run, sprint and jump.

RETURNING TO SERVICE

Word is spreading of IDEO and its astounding results, and Blanck now is fitting troops from around the country with his device. After hearing of Blanck's and Owens' success, 1st Lt. Matthew Anderson traveled here from his unit at Fort Carson, Colo., hoping for similar results.

Anderson, an infantry platoon leader, was injured in October 2010 while on a dismounted combat patrol in Kandahar, Afghanistan. As his unit cleared a building, he stepped on a landmine.

"It felt like a jackhammer hitting my ankle," he recalled. The explosive shattered his heel into a dozen pieces.

The doctors salvaged his limb, but the injury left Anderson in pain and with a pronounced limp. While he was able to start walking again after about six months, this strapping, life-long athlete figured his running days were over.

It took Blanck just a few minutes to prove him wrong. With the IDEO, Anderson was walking comfortably within minutes and running within days.

"It put the biggest smile on my face," the infantry platoon leader said. He had stopped by the CFI early one morning so Blanck could make adjustments to his device and fit him for another.

"I went from walking with a severe gait issue and a limp to walking normally," Anderson said.

Blanck finished his adjustments, and Anderson pulled a sneaker over the foot plate and walked across the office with a smooth stride.

Once he got the brace, "I could run on it, jump vertically, laterally shuffle," Anderson said. "Things that there's no way I'd be doing with that much speed, efficiency or lack of pain."

"For a guy that's in his late 20s that's always been a jock athlete, being hampered by these injuries is pretty tough mentally," he continued. "When you're given the option to get back into it, it's huge. It means a lot to me."

Anderson soon will return to duty at Fort Carson. Of the nearly 200 cases they've seen, Owens noted, more than 30 have returned to service and 11 have combat deployed.

As they test and improve the current design, Blanck and Owens also are looking into what they call a "widespread potential" for people with issues such as ankle arthritis, strokes and head, back and other injuries.

The program's success has one limitation: space. Between amputees and warriors with salvaged limbs, the CFI can get crowded at times. The pair would like to see a rehab center like the CFI, but devoted to wounded warriors with salvaged limbs. There would be no shortage of demand, Owens said, noting that for every one amputee, there are about 10 limb salvage patients.

Meanwhile, they have no plans to cut back, no matter how great the demand. Just seeing the joy in a wounded warrior's face at walking again pain-free, they said, makes every extra hour at work worthwhile.

"I never thought I'd come to work and get hugged by a 220-pound, 6-foot-4, Special Forces guy," said Blanck with a smile, "but I've had a few hugs. I loved my job before this, but this is a whole new level."

[buglerbilly]

Navy Thinks Neck Injections Might Cure PTSD

By Katie Drummond Email Author December 13, 2011 | 6:30 am


Stellate-Ganglion Block advocate Dr. Eugene Lipov, shown here with ally Capt. Anita Hickey, a Navy doctor. Photo: Katie Drummond

What if doctors could cure post-traumatic stress disorder with a single injection to the neck? One Chicago-area doctor claims he can, and has finally convinced someone in the Pentagon to give the idea a shot. And Danger Room has learned that some in the Navy believe the approach might actually work.

The freaky procedure is called stellate-ganglion block (SGB). It’s the brainchild of Chicago anesthesiologist Dr. Eugene Lipov. He’s touted the method for years, even winning then-Senator Barack Obama’s support in 2007, and he’s treated dozens of military personnel and veterans at his own clinic.

Until recently, Lipov was largely ignored by Pentagon brass and military doctors. All four of his applications for military research funding were denied. The most recent rejection came just last month.

But someone with the Pentagon’s funding review boards forgot to tell the Navy. One of its doctors is now several months into the first-ever military study on SGB — and she tells Danger Room exclusively that the method actually appears effective.

“I think of SGB as being similar to re-starting a computer, only we’re talking about circuitry of the nervous system and chemical pathways,” says Capt. Anita Hickey. Hickey is the director of Integrative Pain Medicine at the Naval Medical Center San Diego, where she’s studied a variety of new approaches to PTSD diagnosis and treatment among military personnel, including brain scans and acupuncture. “We’re seeing very positive results.”

The study is the latest evidence of the Pentagon’s increasing desperation to get a handle on PTSD — a frequently debilitating condition that effects an estimated 250,000 soldiers from this decade’s wars, and thousands more from earlier conflicts. Doctors across the country are getting Pentagon dollars to study ideas as far-out as dog therapy and “digital dreaming” software. Capt. Hickey says that the Navy alone is currently funding 82 different studies on potential PTSD treatments. So far, nothing’s proven to be a magic bullet.

You can credit — or blame — the military’s recent embrace of holistics (acupuncture is now used in combat, and several military hospitals offer yoga) for Hickey’s SGB study. Last year, a senior Naval official heard Dr. Lipov present his idea to the House Veteran’s Affairs Committee. The official brought the idea up to top Navy docs, all of whom rejected it.

Then Capt. Hickey, a doctor herself, came along. An aficionado of alt-medicine and longtime advocate for combat acupuncture, Hickey thought the concept had potential. Hickey applied to the Navy for funding, and got $100,000 — even as other military doctors gave Lipov’s proposals the thumbs-down. She’s now midway through a long-term evaluation of SGB in 42 Naval personnel diagnosed with PTSD.

Capt. Hickey said she couldn’t divulge specific data from the study. But she did say that the process is double blind and placebo controlled. One group of patients receives a placebo, and neither doctor nor patient knows what was administered. The method is the gold-standard for rigorous medical research, because it minimizes any subjective bias and helps distinguish real results from imagined ones.

“Of course, we’ve got more work ahead of us,” Capt. Hickey says. “But our team considers itself very open minded — if something works, it works. And with PTSD, we desperately need something to work.”



Lipov initially used SGB to treat hot flashes among post-menopausal women. When he dug up an old Finnish paper on adapting the procedure for PTSD, he in 2007 decided to give it a stab. Preliminary attempts worked incredibly well: SGB seemed to alleviate PTSD symptoms within five minutes, and one former Marine Corps Sergeant enthused that “I immediately felt more relaxed and calmed down. It’s been great.”

Unfortunately, Lipov wasn’t entirely sure how SGB targeted PTSD — hardly what Pentagon brass want to hear about an exciting new treatment prospect.

After subsequent research, however, Lipov in 2009 published a paper in Medical Hypothesis – a journal whose stated mission is to “publish radical, speculative and non-mainstream ideas” — describing how SGB seems to work. The injection of anesthetic, administered into a bundle of sympathetic nervous tissue in the neck, appears to turn off something called nerve growth factor. Nerve growth factor can surge during stressful experiences and promote the sprouting of nerves. That triggers chronic stress — what’s commonly known as the “fight or flight” response.

“If somebody’s circuitry is going haywire, then the anesthetic shuts it off, and reboots the system,” Dr. Hickey says.

Of course, you’d be right to think that rebooting a soldier’s nervous system sounds a little scary. And indeed, SGB isn’t without risks. The injection can trigger seizures, hit an artery or even puncture the lung, however rarely.

Those downsides might explain why the Pentagon hasn’t jumped all over SGB. Most recently, Lipov’s proposal for a $1.6 million study was rejected by the U.S. Army Medical Research and Materiel Command at Fort Detrick. Reviewers noted that the proposal was too ambitious and expensive for something that still lacked “a convincing neurobiological explanation.”

Sure, many in the military are open minded about new approaches to treating PTSD. But claiming to cure PTSD with one injection, when months of therapy and powerful prescriptions fail, hardly seems realistic. Not to mention that therapy isn’t accompanied by the risk of a punctured lung.

Still, there’s no question the military is running out of options. Giving more serious consideration to controversial ideas, such as SGB, ecstasy or marijuana, is likely only a matter of time. Lipov, for one, has no plans to stop pushing the Pentagon: He’s written a book on the procedure, and has a new study of his own, on eight veterans, being published in February’s edition of the journal Military Medicine.

Not to mention a new strategy for scoring federal research dollars.

“I’m done trying to get any money from the Pentagon, because they’ve got a broken, biased system for giving it out,” he tells Danger Room. “From now on, I’m just going to go straight to Congress and the Senate.”

Photo: Katie Drummond

Illo: Dr. Eugene Lipov

[buglerbilly]

No Fear: Memory Adjustment Pills Get Pentagon Push

By Katie Drummond Email Author December 16, 2011 | 2:00 pm



The Pentagon hasn’t come close to solving the PTSD crisis plaguing the current generation of troops. And the top brass looks like it’s ready to try anything — like a major push into a cutting-edge, controversial realm of treatment. One that’d see military personnel popping a pill to wipe away the fear they associate with traumatic memories.

The Pentagon this week announced an $11 million grant doled out to three research institutions, all of them long-time hubs for the military’s ongoing PTSD investigations. Experts at Emory University, the University of Southern California and New York-Presbyterian/Weill Cornell Medical Center will study the effectiveness of D-Cycloserine (DCS). DCS is a pharmaceutical thought to help extinguish fearful memories. It’s usually taken right before exposure therapy, a process that involves recalling traumatic experiences in an effort to nullify the menacing associations that accompany them.

“We already know that exposure therapy is an effective [therapy] for PTSD, and we want to figure out how to optimize it,” Dr. Barbara Rothbaum, who will lead the Emory team’s research, told Danger Room. “I really think that this study will move beyond the theoretical. We can rescue people.”

Exposure therapy is thought to work by allowing patients to revisit traumas in safe settings. Every time the mind remembers an event, it “rewrites” that recollection. By helping a patient rewrite traumatic memories to be less frightening, studies suggest that exposure therapy can significantly improve symptoms like nightmares and flashbacks.

Adding DCS seems to hasten that process, targeting the precise brain pathways responsible for regulating fear responses.

Researchers will look at two different kinds of exposure therapy: Virtual reality, where a patient is fully immersed in digital combat scenarios, and prolonged imaginal exposure therapy, which asks them to simply remember and recount fearful memories. A total of 300 patients, all of them veterans from Iraq and Afghanistan, will partake. They’ll undergo seven individual weekly sessions of one of the therapies. Before each session, half will receive DCS, and the rest will get a placebo.

Experts have already spent plenty of time figuring out how DCS works. It’s been around since the 1960s, when it was used to treat tuberculosis. Now, however, researchers are more excited about the drug’s potential ability to alleviate symptoms of depression, schizophrenia, obsessive-compulsive disorder and, of course, PTSD — without a lifetime of pill-popping.

“Most drugs, you dose every day,” Rothbaum says. “But DCS is only useful during exposure therapy, so you’re taking the drug right before the session. And when your series of sessions end, the medication ends too.”

DCS seems to enhance the brain’s learning process. For PTSD treatment, the drug could, ostensibly, help patients more quickly internalize that, say, driving down a suburban American highway is far different — and less dangerous — than driving on a Baghdad street. The drug also binds to receptors in the amygdala, the region of the brain that governs fear response. So by blocking out fearful reactions while a patient revisits trauma, experts think DCS can, literally, “extinguish” fear right at the source.

Emory researchers have already tried using DCS and virtual reality in humans with PTSD, fear of heights and obsessive compulsive disorder. Since 2006, Rothbaum and a team of experts have been comparing exposure therapy, used along with DCS, Xanax or placebo, in patients. “Results so far are positive,” Rothbaum says, though they haven’t finished analyzing the data.

That said, results from other human studies on DCS aren’t encouraging. Just last year, several disappointing trials using DCS were presented by researchers assembled at the International Society for Traumatic Stress Studies conference. “The early results are not as positive as we [had] hoped,” noted Dr. Charles Marmar, head of the psychiatry department at NYU, of his team’s study that combined DCS with cognitive behavioral therapy.

But even a glimmer of hope seems to be enough for the Pentagon. So far, what they’ve tried to treat PTSD — which afflicts at least 250,000 of this generation’s soldiers — isn’t working. Conventional approaches, like antidepressants and behavioral therapy, have been a massive failure. So it makes sense that military officials are increasingly open to out-there ideas: They’re already funding research into yoga and acupuncture, neck injections and “digital dream” computer programs — although promising approaches taking advantage of “illicit” substances, like marijuana and ecstasy, have thus far been nixed.

Of course, this latest study will be bigger and more thorough than its failed predecessors. It also builds on years of animal research suggesting that DCS has potential. And there’s no doubt the project is calling on some of the Pentagon’s top civilian scientists. Dr. Rothbaum has been evaluating PTSD treatments, including preliminary studies on DCS, for decades. And Dr. Albert “Skip” Rizzo, from the University of Southern California, pioneered the use of virtual reality therapy to mitigate PTSD symptoms.

Not to mention that this research team will also be conducting genetic tests on every patient. In particular, they’ll be looking at a gene dubbed “BDNF.” Experts already know that a variant of the BDNF gene can make fear extinction tougher. By comparing patient results to genes, Rothbaum says they hope to “figure out what’s the best treatment approach, and whether DCS can really rescue those patients, where maybe therapy alone can’t.”

Of course, the idea of using drugs to tweak memories isn’t without controversy: An online debate flared last year among two camps of neurologists and neuroethicists, arguing over whether the existence of such drugs would “alter something that makes us all human,” or open a Pandora’s Box of illicit use “by people doing things they’d like to forget themselves, or that they would like others to forget.”

Then again, those debates hinge on DCS, or some other memory extinguisher, actually working. DCS’s efficacy is far from proven. And earlier research efforts that tested supposed “fear-extinguishing” drugs, most notably a series of much-touted, Pentagon-funded studies on Propanolol at Harvard, have all been disappointments.

Photo: U.S. Army

[buglerbilly]

Artificial Intestines Near Reality

A new artificial intestine developed in the lab could help people missing a piece of their gut.

By Alyssa Danigelis
Fri Dec 16, 2011 07:00 AM ET

THE GIST
A tiny artificial intestine has been made in the lab using collagen and stem cells.
Scientists are now “growing” an intestine on a larger tube structure.
Their goal is to get this artificial intestine to clinical trials in three years.


A scan showing the tiny artificial intestine developed in the lab (right) and a close-up of the engineered bio-scaffold (left).
Donna Beer Stolz and Jiajie Yu

Science has given us working artificial hearts, hips, limbs and bladders, and even a trachea.

But no one has successfully created an artificial intestine, until now. A team of researchers has created a tiny one in the lab made from collagen and stem cells. They plan to scale the tube up within three years so it can be tested in human trials.

“We’re going to be taking these and inserting them into animals to see if it actually works,” said John March, an assistant professor of biological and environmental engineering at Cornell University who developed the artificial intestine structure.

March is developing the artificial intestine with Dr. David Hackam, a pediatric surgeon and scientist at Children’s Hospital of Pittsburgh, and the University of Pittsburgh School of Medicine who specializes in treating bowel disorders.

The artificial intestines could be used to help treat those with severe bowel disorders, including approximately 25,000 children worldwide born with a condition called short bowel syndrome who are missing a piece of intestine. These patients require feeding tubes, and the rate of rejection for an intestinal transplant from another human is nearly 40% after one year, according to Dr. Hackam. “Death from rejection as well as overwhelming infection remain unacceptably high,” he said.

The small artificial intestine that they have produced is based on a tissue matrix that March originally constructed to see bio-engineered bacteria working in real time without having to kill a mouse. March said he’s used several different biomaterials for the matrix. Most recently he used collagen, which he says is readily available and affordable.

Special molds were used to carefully produce the tube structure, including the tiny fingerlike projections found in real intestine lining called “villi.” The scientists plan to grow stem cells removed from a gut and seed them onto the tube. Eventually they envision using human cells so that a patient’s cells would fill the open spaces in the “gut tube reactor,” which should help prevent rejection.

“Basically the whole thing is built out of the patient’s own body,” March said. “We’re just giving it a place to grow.”

Since the tiny artificial intestine works in a test tube, the focus now is making one to test in mice, and then larger animals like pigs. It won’t be easy. Replicating soft structure of the intestine as well as the numerous villi present significant challenges.

“These finger-like projections are really quite tall and have a high aspect ratio meaning that they have a curve, and then they’re much higher than they are wide,” March said.

The projections also have an orientation, so they need to be put on a shape that guides the cells into the right place. Nanotechnology centers can produce nano-sized structures, but human villi are measured in millimeters, which requires an “in-between” engineering technology, March said.

The artificial intestine project is funded with a half-a-million dollar grant from the Hartwell foundation, an organization that funds biomedical research to benefit children. At the end of three years, the two scientists hope to have an artificial intestine ready for large animals. From there, Dr. Hackam said, they will secure additional funding for human trials.

Dr. Daniel Teitelbaum, a pediatric surgeon who teaches at the University of Michigan and directs the Intestinal Failure Program, calls Dr. Hackam and John March’s bioengineering approach unique compared to other research efforts that include stretching the intestine and growth hormone experimentation.

The challenges to making a viable artificial intestine significant, but Dr. Teitelbaum said he’s confident that the team will overcome them. “They’re bright investigators,” he said. “I’m following their work very closely.”

“People are trying to build every single organ artificially,” Teitelbaum said. “If one could really build a fully competent intestine, I think what would be incredible about it would be that this could treat thousands of patients.”

Dr. Hackam said that they have two possible approaches to make sure blood gets to the artificial intestine. One is to simulate blood vessels by modifying the tube structure. Another is to try enveloping the artificial intestine in a fatty section covering the abdominal organs that has been proven to supply blood to implants there.

[JimWH]

To be honest, the military implications of this aren't too spectacular. As a rule, if you've got heavy enough abdominal injuries to warrant significant small-bowel resection the chances of making it to a Role 3 facility soon enough to survive are pretty slim. The current ward are being characterized by limb and max-fac trauma.

[buglerbilly]

Doc Wounded in Iraq Speaks Out About Combat Trauma

December 22, 2011

Associated Press|by Todd Richmond



MILWAUKEE - Dr. Ken Lee lives every day with reminders of a suicide car bombing: a crescent-shaped scar on his temple, thumbs that don't work correctly, constant headaches, and legs and arms that always feel like they're on fire.

The attack in Baghdad nearly killed the Wisconsin National Guard's chief medical officer, leaving him with a brain injury and post-traumatic stress disorder so severe that the slightest provocation sent him into a furniture-smashing rage - even as he worked to diagnose and heal fellow veterans back home.

Lee eventually learned to live with his nightmares. Now as the last American troops leave Iraq, he's using his unique experience - as a doctor, patient and combat veteran - to wage a new battle to call attention to the effects of combat trauma that will be with veterans for years to come.

"I can tell my son that his dad was right in the middle of it," Lee said. "I was part of the process to make it better."

Lee, 46, emigrated from South Korea with his family when he was a child. After graduating from medical school in Milwaukee, he became a physician in the Wisconsin National Guard and landed a job with the Department of Veterans Affairs, working as a spinal cord specialist in Milwaukee.

He had just been promoted to head of spinal cord treatment when he got the call in November 2003 to head to Iraq. He left his wife and two young children and shipped out in command of Company B of the 118th Medical Battalion.

Lee treated high-value U.S. prisoners that included Saddam Hussein. He visited the deposed dictator twice to treat a sore wrist. Lee described Hussein as an educated, pleasant man who spoke decent English - but probably understood more than he let on.

The worst moments came during the Fallujah offensive as exhausted medics tried to save badly wounded Marines.

"We're seeing death in front of us," he said. "We kept absorbing it until it wasn't healthy. Some stopped eating. Some cried. I would lock myself in my room. I couldn't get hold of this feeling of despair."

Then, in September 2004, Lee made the mistake that changed his life.

He was leading a convoy when he spotted soldiers removing a bomb up ahead. Rather than speeding around them, Lee felt safe enough to stop the vehicles, climb out and help guard the rear.

Suddenly, he heard the screech of rubber on pavement. A Buick was bearing down on them. As Lee raised his rifle, the driver detonated his explosives. An orange ball of flame rolled toward him in slow motion and knocked him backward under a car.

When Lee came to, the world was red. His head was split open, and blood was pouring into his eyes. Medics performed life-saving surgery.

During months of rehabilitation back in Washington, he thought about how medical teams could better detect PTSD and traumatic brain injuries, the wounds that have defined the Iraq War. Lee offered ideas to a group at Walter Reed Army Medical Center, suggesting that screening begin as soon as the first symptoms appeared.

When he finally returned home, nothing felt right. He sat alone while his wife went to work and children went to school. For one miserable year, little things like the sound of one of his kids dropping a toy enraged him. He often retreated to the basement, where at one point he smashed the family's extra dining set. He drank himself to sleep in hopes of blocking out nightmares.

But at work, he dealt with everyone else's problems with a smile, and he excelled. He became the Wisconsin National Guard's state surgeon in 2008.

At home, Lee was on the brink of divorce. One day, while playing with his 10-year-old daughter, she commented that he never smiled anymore. Lee cried.

"I just didn't want to believe I had" PTSD, he said. "Nobody does."

Since then, he has resolved to be happy. He started thinking of the day the bomb went off as his "alive day," the day he didn't die. He celebrated it with his family by going out to eat or doing some other fun activity. At work, he continued to spread the word about detecting PTSD and brain injuries.

The Defense Department estimates that nearly 213,000 military personnel have suffered traumatic brain injuries in Iraq and Afghanistan since 2000.

An earlier report by the Rand Corp. estimated that 300,000 veterans of both conflicts suffered post-traumatic stress disorder or major depression. Less than half had sought treatment for PTSD over the preceding year, and nearly 60 percent of those reporting a probable brain injury weren't evaluated by a physician for one.

Army protocol requires soldiers returning from overseas to undergo a health assessment when they get back and again after they've been home for several months. Lee took that a step further in Wisconsin, sending medical teams to demobilization points to check on returning units as soon as they hit the ground.

"When you come home, it's hidden," said Lee, bespectacled with dark hair mowed into a crew-cut. "Why don't we do all these guys when they come back, instead of doing it when they walk into your office?"

He's also traveled the country lecturing on how combat trauma can be mental as well as physical, displaying photographs of his wounds and sharing his struggles.

As a spinal specialist, Lee doesn't treat PTSD or brain injuries directly, but he's earned a new level of respect from veterans. Many who aren't even his patients seek him out to talk.

Gus Sorenson of Sturtevant, Wis., lost the use of his legs in a 1970 car crash just days after returning from Vietnam. He has seen Lee for years and noticed a change after the doctor returned from Iraq.

"I think the word is `empathy,'" Sorenson said. "He was the patient. That experience helped the learning process. Other vets can relate to that."

Lee still can't remember appointments unless he emails them to himself. He can walk, but he has almost no feeling in his legs except a constant burning. His thumbs don't bend properly because the blast apparently jammed them against his rifle grips.

Sometimes he wakes up to find bloody spots on the sheets as tiny shards of shrapnel work their way out of his body. He's worried that his kids are still terrified of him, and he still suffers from flashbacks and nightmares.

Even after the U.S. withdrawal is complete, the U.S. will spend decades dealing with psychologically scarred veterans, Lee said.

"We have a product that comes back from war," he said. "We have to have a system to take care of it."

© Copyright 2011 Associated Press. All rights reserved.

[buglerbilly]

Inside the Pentagon’s Alt-Medicine Mecca, Where the Generals Meditate

By Katie Drummond Email Author December 23, 2011 | 6:30 am



Yoga is now a mainstay at Walter Reed and other military hospitals, and even part of routine training for personnel.

The general is surprisingly good at meditation. It’s not just the impeccable posture — that might be expected of a man long used to standing at attention. It’s his hands, which rest idly on his knees, and his combat boots, which remain planted firmly on the floor. Over the next several minutes, Lt. Gen. Eric Schoomaker, the Surgeon General of the Army, will keep his eyes closed and his face perfectly relaxed.

Few in this hotel conference room, where three dozen have assembled to mark the 10th anniversary of the Samueli Institute, a research organization specializing in alternative therapies, are able to match Schoomaker’s stillness.

Even as our first speaker implores that we “close [our] eyes … feel the chair, feel the air, feel the breath going in and out,” this motley crew of professors, bejeweled clairvoyants, military personnel and Einsteinian-haired futurists tap their toes, shuffle papers and ogle paper plates of fruit and croissants.

This might be the Pentagon’s best chance at making alt-medicine work — or at least figuring out if it even stands a chance.
“Wherever you’ve come from, wherever you imagine you’re going, you’re actually only doing it right now, in this moment.” Our meditation guru for the day, Dr. Wayne Jonas, is not only a retired Army medical officer and former director of the holistic branch of the National Institute of Health. He’s also the leader of the organization we’ve met to celebrate.

Schoomaker is here because he has a health crisis on his hands. And he’s betting on guys like Jonas to help cope with it — despite the obvious institutional schisms between Schoomaker’s organization and this one.

The Pentagon is turning to alternative medicine to help alleviate the devastating symptoms of Post-traumatic stress disorder that afflict more than 250,000 military personnel; soothe the brain trauma that’s left thousands more with tremors, speech impediments and memory lapses; and assuage the chronic pain that lingers after grueling, repeat deployments.

The Samueli Institute might be the Pentagon’s best chance at making alt-medicine work. Or, at least, figuring out if it even stands a chance.

Thanks to leadership with years of experience in military circles, not to mention a billionaire benefactor with friends in prominent places, they’ve got no shortage of resources with which to do just that. More than half of the Institute’s $13.5 million in annual funding is provided by congressional funding (or “earmarks”), the Department of Defense and Veteran’s Affairs.

The Institute is currently running 67 studies within its military program. And its research is responsible for nearly all of the Pentagon’s alternative health initiatives, including a successful yoga program at Walter Reed and the introduction of acupuncture to the combat zone.

But it isn’t all inner peace and holistic healing. The Institute was founded by a Fortune 500 billionaire with a history of financial scandal. They pay their director nearly half a million dollars each year. Almost all their military studies are funded by congressional earmarks that reek of preferential treatment. And little of their research fits the medical community’s gold standard.

In their defense, Institute leaders tell me that it makes sense for certain congressmen to offer funding for Institute research — because those same reps also advocate for alternative medicine. They tell me that their director is a talent unlike any other and their billionaire founder has a clean track record, and exhort that all their research is rock-solid.

So is this the place where seriously injured, often devastatingly traumatized soldiers can find salvation in downward facing dog? If they can at all? The prospect sounds too good to be true. And, as I learned on my own close exploration of the Pentagon’s closest alt-medicine ally, that salvation isn’t yet a sure thing.



Staff Sgt. Victor Medina, with his wife Roxana, suffered a traumatic brain injury in Iraq.

‘We Have Failed Soldiers’

The wounds suffered in this decade’s wars are unlike those of previous conflicts. And despite millions in research funding and dozens of new procedures and protocols, the military’s struggled to make them much better.

Ironically, soldiers are suffering these new ailments because more of them are making it home. The survival rate of soldiers injured in Iraq and Afghanistan is greater than 93 percent. Compare that to a 76 percent rate in Vietnam, or 69 percent rate in World War II, and it’s clear that military medicine has made impressive strides in keeping wounded soldiers alive.

Army Staff Sgt. Victor Medina is but one example. Over the course of three deployments to Iraq and Afghanistan, Medina’s convoys were struck by IEDs a handful of times.

Specially designed vehicle armor saved him from injury — until June 29, 2009. As his convoy performed a routine patrol in Iraq, Medina’s side of the vehicle was hit by an explosive projectile.

“Mostly I just remember a blur and a lot of confusion…. Later, I was told I’d lost consciousness,” Medina tells me. “I really thought I was dying.”

In earlier wars, Medina very well might have. But a medic accompanying his convoy offered immediate help. Medina was in a trauma clinic mere hours later, undergoing diagnostic tests and getting checked for injury. This rapid, thorough care saw Medina diagnosed that very day with a moderate traumatic brain injury — and later flown back to Fort Bliss by Medevac helicopter when his health deteriorated.

But with an unprecedented number of survivors, military docs are seeing epidemic rates of three health problems. Post-traumatic stress disorder, a condition characterized by depression, insomnia and rage, afflicts more than 250,000 of today’s soldiers. Traumatic brain injuries (TBIs) like Medina’s, which lead to memory lapses, moodiness and learning problems, affect thousands more. And chronic pain, caused by everything from herniated spinal discs to nerve irritation following amputations, is a mainstay among soldiers and veterans.

For these ailments, the Pentagon doesn’t have surefire fixes. And unfortunately, their efforts to better treat the conditions have been hampered by missteps.

Military leaders have been vilified for inadequate record-keeping, mismanaged research funds and an over-reliance on brain injury and PTSD tests that often don’t work. “We have failed soldiers,” retired Col. Mary Lopez, who used to manage the Army’s TBI testing, told ProPublica last year. “It is incredibly frustrating because I can see first-hand the soldiers that we’ve missed, the soldiers that have not been treated, not been identified, [or] misdiagnosed.”

Actual medical care is sometimes even worse. For all three conditions — PTSD, chronic pain, and TBI — prescription drugs are the primary mode of treatment. Narcotic painkillers, antipsychotics and sleeping pills have been handed out in record numbers.

But if anything, the drug abuse and addiction borne of that strategy is becoming a medical problem of its own: 73 percent of accidental deaths among military personnel last year were linked to prescription drugs. One such fatality, that of Sgt. Chris Bachus, elicited headlines simply due to the stunning quantity of pill bottles found near Bachus’ body — 27 different ones — after his overdose.

For mental health woes, military doctors also offer therapy. But even the best has a middling success rate, and retains fewer than 50 percent of enrolled soldiers.

Of course, research funded by the Pentagon has made significant progress in unraveling PTSD and TBI. Experts are developing a massive database of brain injuries, working to determine whether brain scans or blood tests can spot either condition, and even investigating neurological indicators that a soldier is vulnerable to mental health problems before deploying. A new collaborative network, the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, has been set up to provide cutting-edge, comprehensive research and leadership to guide military clinics and hospitals treating soldiers and veterans.

None of that progress, however, is likely to show tangible results in time to help today’s soldiers.

The DCoE’s first director, Brig. Gen. Loree Sutton, quickly made a sharp turn toward alt-medicine: In its first year of existence, the center budgeted several million for the study of just about any non-traditional therapy — from yoga to bio-energy — that showed even an iota of promise in healing the wounds of this generation’s war.

“This new theme is a big departure for our cautious culture,” Dr. S. Ward Casscells, the Pentagon’s assistant secretary for health affairs, said at the time. “We are struggling, [and] we are increasingly willing to take a hard look at even soft therapies.”



Dr. Wayne Jonas, right, leads his staff in thrice-weekly meditation sessions.

Double-Blind

Of course, before military doctors could prescribe yoga over Prozac, the Pentagon had to show that it worked. They needed research.

Practitioners of alternative medicine don’t exactly have a lot of that. The gold standard of medical research, a double-blind and placebo-controlled trial, is a lot easier to conduct when comparing sugar pills to potent pharmaceuticals than when comparing yoga to stretches that aren’t, well, actual yoga.

Still, a body of supporting evidence — both scientific and anecdotal — is growing. Scientists are using cutting-edge neurological scans, including MRIs, to show that meditation incurs significant brain changes, including a reduction of the amygdala, a region of the brain associated with anxiety and stress and thought to be one of the loci of PTSD.

And experts at top hospitals, including Georgetown and Harvard, have demonstrated that yoga curbs stress hormones and reduces self-reported levels of chronic pain. As for acupuncture, it’s arguably the most studied of the three: A recent meta-analysis of dozens of studies concluded that acupuncture really can outdo placebo where pain relief is concerned, and a groundbreaking study released just this week concluded that acupuncture therapy curbed blood levels of neuropeptides triggered by the “fight or flight” response.

The stories from soldiers and veterans who’ve benefited from alt-medicine are even more compelling than the research.

For CJ Keller, a former Marine who spent eight months deployed to Iraq, yoga became “the perfect medicine” to alleviate pain and quell insomnia and anxiety. “A lot of us might think yoga’s too flaky,” he tells me. “But you need a lot of discipline, focus and concentration. There are parallels.” Keller’s so convinced that yoga can help military personnel and veterans, he this summer completed teacher training and now offers a free class for veterans at Baltimore’s Charm City Yoga.

Tony Bailes, a former Army combat medic, found relief in acupuncture. Even with prescription painkillers, his back pain was persistent. So Bailes tried acupuncture. “My back pain was gone” in two weeks, he says. Bailes, like Keller, found the experience so remarkable, he’s decided to pursue a career in acupuncture.

The science and the stories make it clear: Something about alt-medicine is working.

But many of the studies on alt-medicine aren’t. Where meditation is concerned, for example, the National Center for Complementary and Alternative Medicine in 2008 warned that although research into alternative practices had improved, “most clinical trials on meditation are generally characterized by poor methodology,” and that the same was true for other alternative therapies, making it tough to determine their legitimacy one way or the other.



[I]The Army's Surgeon General, Eric Schoomaker, addresses conference attendees.

The Samueli Institute, founded in 2001, wants to change that. The organization’s mandate is to conduct rigorous studies on alternative therapies, find the ones that work, and usher them into the mainstream.

Initially, the Institute’s studies were mostly oriented toward civilian medicine. Susan Samueli, the wife of Fortune 500 billionaire and Broadcom founder Henry Samueli, started the Samueli Institute after her three kids suffered allergic reactions to antibiotics. She switched the entire family to holistic medicine, and says she felt strongly that the therapies deserved more serious recognition.

But Susan’s not an accredited physician. If her pet project was going to take off, it’d need a more reputable representative. So Susan hired Dr. Wayne Jonas. With a lengthy history in the Armed Forces and a former top job at the National Institutes of Health, Dr. Jonas was a seasoned, well-respected researcher. He also gave more credit to alternative medicine than did most doctors.

“I had seen things work; amazing things,” Dr. Jonas, who conducts staff meditation sessions at the Institute three mornings a week, tells me of patients who helped will their own recovery, saw improved outcomes through prayer or even mitigated lifelong pain using acupuncture. “It may not yet be written down in a five-star medical journal. That doesn’t render it illegitimate.”

With Dr. Jonas aboard, the Institue scored its first — and incredibly bizarre — Pentagon contract.

In 2001, Darpa asked Jonas and his colleagues to re-evaluate a collection of controversial research by Dr. Jacques Benveniste, which not only claimed that water molecules had active memories, but that they could recall the presence of substances dissolved to infinitesimally small concentrations in their midst. The finding seemed to explain a basic tenet of homeopathy, in which remedies are created by dissolving extremely minute amounts of a curative ingredient into water.

Benveniste even stated that those “memories” could be digitized and transferred via email. In other words, homeopathic cures on every home computer.

In what should have surprised no one, the Institute concluded that “digital effects were not reproduced by our investigators.”

But the research did yield one finding for Jonas. He realized that alt-medicine would likely garner plenty of interest from the military community — and the Institute would make an ideal hub for the Pentagon to explore it.

To make that happen, he hired longtime military clinician Joan Walter, who for 10 years had worked with the traumatic brain injury program at Walter Reed Medical Center. Walter in 2005 became the director of a new branch at the Institute, aptly named “Military Medical Research.”

“When I was offered a position here, they knew there was a natural fit with the military,” Walter, a brusque and poker-faced rock of a woman, tells me. “It was up to me to figure out how the Institute could best serve what the Pentagon’s needs were.”

Her leadership would accelerate the Institute’s relationship with Pentagon leaders. A series of meetings spawned three distinct realms of research collaboration between Samueli experts and military doctors: Chronic pain relief, PTSD and TBI, and performance optimization in combat.

“All three are areas of utmost importance in the armed forces,” Walter says. “And all three are areas where, they know and we know, the military hasn’t found adequate solutions.”

Before long, Walter had started up several research projects at various military hospitals and clinics. Her relationships with Walter Reed leaders led to one of the first-ever studies on yoga for PTSD symptoms, done collaboratively between Walter Reed doctors and Samueli researchers. The hospital’s subsequent yoga program was introduced in 2006, and has since been widely replicated at other combat hospitals.



A group of soldiers strike a pose, as Samueli researchers explain the benefits of muscle contraction and stretching to release stress.

iRest

On a break from the conference, I walk down the main drag in Alexandria, Virginia, to find the Institute itself.

Sequestered on the sixth floor of a nondescript brick edifice, it’s a maze of beige walls and neutral rugs, artificial plants and conventional artwork. Only two features remind me that I’m not, in fact, meandering through a lawyer’s office: an enormous, framed portrait of Henry and Susan Samueli in the lobby, and a gargantuan poster on one wall that lists dozens of military research projects conducted by the Institute.

I happen upon Matt Fritts’ office down one of many zig-zagging hallways. Opulently decorated with Tibetan prayer flags, statuettes and meditation paraphernalia. I’ve found the guy who runs yoga research.

“Our mission is to take these ideas that have been dismissed, and see whether there’s any merit to them,” Fritts, formerly of the NIH and an avid yogi (he was recruited by the Institute from his part-time gig as a local yoga teacher), tells me. “If there isn’t, we’re open to acknowledging that.”

Maybe so. But between the guided meditation sessions, the prayer flags, and the unrelenting talk about the power of alt-medicine, the Samueli staff don’t exactly appear to be skeptics.

Objective or not, the Institute has made marked progress in adding academic heft to alt-medicine. Its first decade focused on preliminary studies, meant to collect evidence showing that procedures like meditation and acupuncture actually worked. Research leaders with the Institute would plan research agendas, often in collaboration with military clinicians, secure funding, and then typically partner with a military base or hospital — including Brooke Army Medical Center or sometimes a VA facility — to conduct on-location research.

Yoga, thanks largely to the Institute, is today widespread in military hospitals. Fritts is now working on a new yoga-meditation hybrid, called “iRest,” that’s showing promising results in alleviating PTSD symptoms.

Acupuncture is another realm where the Institute’s had marked success. In 2006, it led a peer-reviewed pilot study that found acupuncture could decrease pain levels by 23 percent, compared to patients receiving standard care, among injured Air Force personnel. Meanwhile, Institute leaders were working alongside Col. (Dr.) Richard Niemtzow to develop a protocol for war-zone acupuncture.

Now, military leaders readily embrace medical acupuncture for pain relief and PTSD treatment. At Joint Base Andrews, Maryland, doctors run the military’s first full-time acupuncture clinic, where they use the therapy to alleviate pain among Air Force pilots, who often can’t pop narcotic painkillers before flights.

“[Acupuncture is] one treatment that’s absolutely ready to be rolled out everywhere,” (Col.) Dr. Richard Petri, a doctor at Fort Bliss and an advocate for alternative medicine, tells me. “There’s been rigorous research, in combat and out. We know it works.”

Other Institute research has led military doctors to similar conclusions. Their 2005 clinical trial on yoga, for one, offered 18 soldiers the chance to partake in 10 weeks of classes. The findings concluded what myriad studies since then have too: Yoga can significantly reduce self-reported symptoms of post-traumatic stress, including rage, insomnia and anxiety.



Acupuncture, once considered bunk medicine, is now widely used at military clinics.

Prescription Placebos

Some of the Institute’s research, however, hasn’t been so fruitful. Myriad studies have long dismissed, derided and downright mocked the idea of homeopathy, but Samueli researchers still investigate homeopathic processes to this day. Institute researchers also investigate the merits of placebos, “the physics of consciousness,” biofield therapy and psychic healing.

“I’m convinced there are mysteries we haven’t solved yet,” Dr. John Ives, a former NIH researcher who now works at Samueli investigating far-out science, tells me. “We’re going to keep looking into these areas until we know, for sure, one way or the other. Right now, I’d say the jury is still out.”

Some Samueli researchers plan to keep pushing the limits of out-there investigation. Others, meanwhile, will be busy implementing successful findings: The Institute’s biggest priority over the next decade is to transform research into real programs for soldiers and veterans.

Fritts, for example, is currently conducting a nationwide survey of every military medical clinic, to find out what treatments they offer. From there, he and his colleagues will zero in on locations that remain reliant on conventional medicine, and recommend holistic programs.

And in 2012, much of the alt-medicine the Institute endorses will become even more common in the Army. Alongside Samueli teams, Army brass have approved several comprehensive pain management centers that use modalities like massage, yoga and acupuncture in addition to conventional treatment. Four will be established in the coming year, with dozens more in planning stages. And the Institute has already been contracted to evaluate the first-ever clinic, established at Tripler Army Medical Center, for efficacy.

But despite an organizational mandate to uphold rigorous research standards, and a large volume of published studies and papers, the Institute doesn’t do much of the placebo-controlled, double-blind research that’s upheld as the gold-standard of medical study.

They told me that’s because such trials are “a methodology designed for drug research,” rather than alternative therapies.

Rather, the Institute’s approach has relied largely on comparative effectiveness research, the process of measuring a therapy of interest (yoga, for example) against another available therapy (such as painkillers). Such an approach “more accurately and realistically assesses the benefits of introducing one or more new therapies to the existing options,” Institute leaders told me.

Furthermore, they don’t think placebos are entirely useless. “It has been demonstrated that almost all medical interventions benefit from the placebo effect,” they tell me. “To the extent that the placebo effect can enhance healing, we should include it in our research, rather than control for it.”



Henry Samueli, front right, presents George W. Bush with an Anaheim Mighty Ducks jersey.

Friends in Need

After the conference’s first round of panels, attendees pause for bathroom breaks and green tea. As Schoomaker and Wayne Jonas shake hands warmly, chatting like old friends, it’s abundantly clear that the Institute has won the Pentagon’s resounding endorsement.

But how the Institute managed to win such favor might have to do with its patrons: Henry Samueli, ranked #263 on the Forbes 400 List and worth an estimated $1.7 billion, is not only a successful business man (and the owner of the Anaheim Mighty Ducks). He also knows how to play politics.

Samueli doles out plenty in campaign contributions: Over $25,000 to Rep. Jim Moran and $40,000 to Rep. Peter Visklosky, among around a dozen others. Both men have earmarked generous sums for the Institute: Moran with $1.6 million for the Institute’s military research in 2010, and Visklosky with the same amount in 2008.

“The past Congressional supporters of the Institute are individuals who are committed to some of the same ideas as the Insitute,” Samueli representatives told me via e-mail. “It should not surprise anyone that Dr. Samueli has chosen to support these members in their campaigns, just as any other citizen might choose to support the campaigns that advocate for issues that matter to them.”

For a time, though, the Institute did see a dip in contributions. In 2007, Samueli pleaded guilty to partaking in a $2.2 billion stock fraud scheme orchestrated by Broadcom executives. Charges were dismissed two years later because of what U.S. District Judge Cormac Carney dubbed “shameful” prosecutorial intimidation tactics, but many Reps either returned campaign money or “cut ties” with the exec.

In 2010, however, they made a comeback: According to the Center for Responsive Politics, the Institute reaped $7.6 million in congressional earmarks, all of them for Pentagon-related studies. Samueli’s representatives tell me the figure was closer to $6.6 million.

The Institute also pays Dr. Jonas disconcertingly well: Last year, he earned a salary of $471,000. That’s quadruple the payday for leaders of charities this size, according to Sandra Miniutti at Charity Navigator.

“We do not see salaries of the level of Mr. Jonas until we approach charities that are much, much larger,” she tells me. “You might want to ask them about that.”

I did. The Institute told me that they calibrate salary using metrics that include more than just charity size. Not to mention that Dr. Jonas “is internationally acknowledged as both an expert and leader in the fields of complementary and alternative medicine and research…as well as the credibility of working within the Army as a physician.”

“[His] uniqueness as a CEO is evident,” Institute representatives told me via e-mail, “And his compensation should be understood within the context of the impact and mission the Institute seeks to achieve under his leadership, rather than by comparison to other charities with similar budgets.”

No matter how they get their funding, there’s no question that Institute research has helped plenty of military personnel. Staff Sgt. Medina, for one, underwent 16 months of conventional rehab — physical and speech therapy, cognitive exercises, prescription drugs — but still suffers serious TBI symptoms that include a persistent stutter, headaches and memory lags.

He now swears by frequent acupuncture, massage therapy and meditation. “A human touch can sometimes do more than drugs,” he tells me of his routine, which was recommended to him by Col. Petri at Fort Bliss.

It’s troubling to wonder whether grateful soldiers and vets, like Medina, might be the byproduct of politics and perfect timing; an influential business tycoon and a bloated appropriations budget.

Then again, Medina doesn’t much care. He feels better now than he has since before the accident, and is no longer taking the pain medication he once relied on.

“Doctors don’t know how to cure traumatic brain injuries yet,” he says. “I had to accept that I can’t be cured. But what I’ve learned, what I’m so thankful for, is that I can be healed.”

Photos: U.S. Army; Samueli Institute; Samueli Institute: Samueli Institute; U.S. Navy; White House Archives

[buglerbilly]

Afghanistan and Iraq veterans set to pile pressure on health service

Armed forces cuts could see thousands more combat veterans needing help to cope with range of mental illnesses

Nick Hopkins

The Guardian, Wednesday 28 December 2011


British soldiers in Helmand province, Afghanistan. A report in the Lancet showed 4% of those serving in the war zone reported suffering from probable PTSD. Photograph: Gaz Faulkner/PA

Cuts to the armed forces could lead to thousands more combat veterans from Iraq and Afghanistan needing help to cope with a range of mental illnesses, including post-traumatic stress disorder, a charity has warned.

With the British army being cut by a fifth between now and 2020, and the navy and air force shrinking too, the numbers leaving military service are rising fast. This could put an extra burden on the NHS to care for battle-scarred troops, according to Combat Stress.

The charity says many personnel are unable to acknowledge they have a problem and that it takes 13 years on average before a veteran will seek help voluntarily, by which time they may have done further damage to themselves as well as their families.

It fears the problem could become acute because of the cost-cutting redundancy programme started by the Ministry of Defence earlier this year, and has called on the government and doctors to do more to support veterans once they have left service.

The charity's chief executive, Commodore Andrew Cameron, said: "Much more needs to be done by front line clinicians and GPs to help veterans' suffering from mental illnesses.

"More needs to be done to proactively identify [them]. Service personnel leaving the armed forces should be more thoroughly screened for PTSD [post-traumatic stress disorder] and other mental illnesses and GPs should be better informed about which of their patients have served in the armed forces and the possible effects of battlefield trauma.

"We cannot allow the many servicemen and women who will leave the armed forces next year who may be suffering from trauma-related mental wounds to go unnoticed and untreated."

The charity has been providing support to veterans suffering from mental health issues since 1919 and is currently helping 4,800 people, including 228 who served in Afghanistan and 589 who served in Iraq. Two of the veterans are teenagers.

Last year a report published in the Lancet indicated that 4% of those serving in Iraq and Afghanistan reported suffering from probable PTSD, and 19.7% symptoms of common mental disorders such as anxiety. It also raised concerns over the misuse of alcohol.

The study said there was "no evidence the number of deployments was associated with an increase in the reporting of probable mental disorders" and that the mental health of the armed forces was not deteriorating. However, it said this finding was "surprising".

Combat Stress believes many veterans refuse to admit they may have a problem, even for studies where they are responding anonymously.

It claims that if last year's report is accurate, there are potentially thousands of men and women who will need help of some kind in the coming years.

One veteran, James Saunders, 42, told the Guardian he was first diagnosed with PTSD more than 10 years after leaving service in the early 1990s.

"My life became a train crash," he said. "I lost everything in that time. It didn't occur to me that I could be suffering from PTSD. The doctors in the NHS didn't seem to have any idea how to deal with me. There is a stigma attached to mental illnesses … many servicemen and women will leave the military unaware that they may need help."

An MoD spokesman said the military already had a range of initiatives to help troops in service, and that the government had earmarked £7m in additional funding "over the next four years to help ensure that veterans with mental health problems get the very best care".

"The MoD works to identify and treat the early signs of mental distress through its Trim [Trauma Risk Management] system. In Afghanistan a team of community psychiatric nurses and consultant psychiatrists are on hand to help troops talk through any problems they may have and to provide any care and treatment needed."

[buglerbilly]

Idea to Take 'D' Out of PTSD Studied

January 16, 2012

Houston Chronicle|by Lindsay Wise



The president of the American Psychiatric Association says he is "very open" to a request from the Army to come up with an alternative name for post-traumatic stress disorder so that troops returning from combat will feel less stigmatized and more encouraged to seek treatment.

Dr. John Oldham, who serves as senior vice president and chief of staff at the Houston-based Menninger Clinic, said he is looking into the possibility of updating the association's diagnostic manual with a new subcategory for PTSD. The subcategory could be "combat post-traumatic stress injury," or a similar term, he said.

"It would link it clearly to the impact and the injury of the combat situation and the deployment experience, rather than what people somewhat inaccurately but often assume, which is that you got it because you weren't strong enough," Oldham said.

The potential change was prompted by a request from Gen. Peter Chiarelli, the Army's vice chief of staff, who wrote to Oldham last year, suggesting APA drop the world "disorder" from PTSD.

"Calling it a disorder contributes to the stigma and makes it so some folks -- not all, but some folks -- don't get the help they need," Chiarelli said.

The general doesn't like to use the word disorder. "It's not a dirty word, but I think it's misused here," he said. "I don't think that the post-traumatic stress that Soldiers experience is a disorder. It's not something that happens just to weak people or people that are somehow inclined to be affected by horrible things that they see or are required to do. I think it causes an actual injury to the brain and how the brain works."

Early discussions

After receiving Chiarelli's letter, Oldham wrote back to say he appreciated his concern, but dropping the word disorder might not be the best way to go. He said he was eager to work with Chiarelli to see what APA could do.

The general invited Oldham to the Pentagon to discuss the situation. They met for about an hour and a half on Dec. 9. Oldham agreed to bring the general's suggestion to the APA work group tasked with reviewing PTSD for the next version of the association's Diagnostic and Statistical Manual of Mental Disorders, the classification book used by psychiatrists in America. APA is finalizing the fifth edition of the manual, due in May 2013.

Oldham cautioned the discussion is very preliminary but speculated that a new subcategory like "combat post-traumatic stress injury" might work.

Although Chiarelli still would prefer to lose "disorder" entirely, he said a new subcategory would be a start. "I'm frustrated with how long this is taking, to be honest," he said.

The general pointed out that PTSD has had many names over the years, from shell shock to battle fatigue. "It's been called all kinds of different things and somehow we decided to go with PTSD and I think that's just wrong," he said.

Chiarelli's campaign to change the name of PTSD is part of the Army's effort to reduce alarming suicide rates among Soldiers. Statistics released last month identified 260 potential suicides in 2011. Of that total, 154 were active-duty Soldiers, 73 were National Guard troops and 33 were reservists.

Silence over stigma

Stigma is a major problem. A study published in the Archives of General Psychiatry in October found that Soldiers were two to four times more willing to report PTSD, depression, and suicidal thoughts if they were allowed to answer a survey anonymously, rather than put their names on a routine post-deployment screening form.

Of the Soldiers who screened positive for PTSD or depression, 20 percent said they weren't comfortable answering honestly on the routine form. The study concluded that the Army's screening process misses most Soldiers with significant mental health problems.

Dr. Harry Croft, a psychiatrist in San Antonio, said the findings jibe with what he hears from veterans he treats for PTSD.

"Even though the rules, as I understand them, say you don't get kicked out if you get diagnosed with PTSD, depression or any other issues, a lot of veterans say, 'I knew damn well if I answered the questions right my chance to get promoted was gone,' " Croft said.

Croft has mixed feelings about changing the name of PTSD. He understands the concern about stigmatizing troops but thinks whether the condition is called PTSD or something else will have little effect on the suicide rate.

"Rather than concentrate on what we call it, we need to concentrate more on how to help warriors coming back from the combat zone, because I don't think the name we give it will have much of an impact on the 18 suicides a day and all the other problems that we see," Croft said. "That's putting a Band-Aid on a much bigger wound."

Chiarelli says his main concern is getting Soldiers into treatment, so if calling post-traumatic stress a disorder keeps them from seeking help, then the wording needs to change, the sooner the better.

"You can have the very, very best treatments in the world, but if you can't get people take advantage of them, they don't do any good," he said.

© Copyright 2012 Houston Chronicle. All rights reserved.

[buglerbilly]

War's Lessons Being Applied to Ease Combat Stress

January 19, 2012

Associated Press|by Julie Watson

CAMP PENDLETON, Calif. -- When the Marine unit that suffered the greatest casualties in the 10-year Afghan war returned home last spring, they didn't rush back to their everyday lives.

Instead, the Marine Corps put them into a kind of decompression chamber, keeping them at Camp Pendleton for 90 days with the hope that a slow re-entry into mundane daily life would ease their trauma.

The program was just one of many that the military created as it tries to address the emotional toll of war, a focus that is getting renewed attention as veterans struggling to adjust back home are accused of violent crimes, including murder.

While veterans are no more likely to commit such crimes than the general population, the latest cases have sparked a debate over whether they are isolated cases or a worrying reminder of what can happen when service members don't get the help they need.

"This is a big focus of all the services, that we take care of our warriors who are returning because they have taken such good care of us," Navy Secretary Ray Mabus said, pointing out that tens of thousands of veterans return home to lead productive lives.

Some, however, fall on hard times, getting into trouble with the law. Others quietly suffer, with their families and friends trying to pull them out of a depression.

In the latest high-profile criminal case involving an Iraq war veteran, a former Camp Pendleton Marine is accused of killing four homeless men in California. His family said he was never the same after his 2008 deployment. In Washington state, an Iraq War veteran described as struggling emotionally killed a Mount Rainier National Park ranger and later died trying to escape.

Suffering from combat stress is an age-old problem. What's new is the kind of wars that troops fight now. They produce their own unique pressures, said psychologist Eric Zillmer, a Drexel University professor and co-editor of the book "Military Psychology: Clinical and Operational Applications."

The war on terror "is very ambiguous, with no front lines, where you can't tell who the enemy is. During the day, he may be a community leader and, at night, a guerrilla fighter. You never know when an assault takes place. It's very complicated, and people feel always on edge," he said.

Add to that, multiple deployments that tax the central nervous system, said Zillmer: "The human brain can only stay in danger mode for so long before it feels like it's lost it. It gets exhausted." He compared going into combat like "diving to the depths of the ocean and when you have to go back to the surface you have to decompress.

"It's the same process," he said. "It's almost a biological process."

A 2009 Army report concluded that the psychological trauma of fierce combat in Iraq might have helped drive soldiers from one brigade to kill as many as 11 people in Colorado and other states. The study found the soldiers also faced "significant disruptions in family-social support."

The military's stubbornly high suicide rate has proven that more help is needed, and that is why it has been investing in helping troops transition back from war zones.

Few units know war's pain more than the 3rd Battalion, 5th Marine Regiment. The Camp Pendleton battalion nicknamed "The Dark Horse" lost 25 members in some of the heaviest fighting ever seen in Afghanistan. More than 150 Marines were wounded. More than a dozen lost limbs.

The Marine Corps brass, concerned about the traumatic deployment's fallout, ordered the entire 950-member unit to remain on the Southern California base after it returned home. The 90 days was the same amount of time crews aboard war ships usually spend upon returning home.

During that time, the Marines participated in a memorial service for their fallen comrades. They held barbecues and banquets, where they talked about their time at war. Before the program, troops would go their separate ways with many finding they had no one to talk to about what they had just seen.

Mental health professionals are monitoring the group, which has since scattered. They say it is too early to tell what kind of impact keeping them together made. Combat veterans believe it likely will help in the long run. The Marines have ordered combat units since then to stick together for 90 days after leaving the battlefield.

"They share a commonality because they've gone through the same thing, so it helps them to come down," said Maj. Gen. Ronald Bailey, the commanding general of one of Camp Pendleton's most storied units, the 1st Marine Division.

"I can tell you from experience that this will help," said Bailey, who served in Iraq and Afghanistan.

The new practice is one of a slew of initiatives ushered in by the new commandant, Gen. James Amos, who has made addressing mental health issues of Marines a top priority. He was concerned by the branch's suicide rate, which has ranked among the highest of the armed services.

Commanders have tried to remove the stigma that seeking help is a sign of weakness. The Marines have set up hotlines and designated psychologists, chaplains and junior troops to identify troubled troops. "We've been in this 11 years and the medical staff and Marine officials are better educated now on dealing with combat stress," Bailey said.

All service members also now undergo rigorous screening of their mental stability both before and after they go to battle.

While Veterans Affairs and Department of Justice have said veterans don't commit more crimes per capita than others, the VA has launched efforts to help veterans in trouble with the law receive help rather than just be locked up.

Since 2009, the VA has had a legal team review cases to see if the best remedy is treatment instead of incarceration. States also have been establishing special veterans courts to do the same. Some say combat stress is also being used by criminals trying to get a lighter sentence.

Veterans agree the military has made great strides in the past few years but they say the help has come too late for many.

Paul Sullivan, executive director of the Washington, D.C.-based National Organization of Veterans' Advocates, said the military only started administering medical exams of service members before and after deployments to Iraq and Afghanistan in 2007 to identify problems early so they can be treated more effectively and less expensively.

"It's good their implementing it now, yes, however, what's the military going to do with all of the veterans the military didn't examine?" he asked. "That's the problem."

Associated Press writers Amy Taxin in Santa Ana, Calif., Dan Elliott in Denver and Kevin Freking in Washington, D.C., contributed to this report.

© Copyright 2012 Associated Press. All rights reserved.

[buglerbilly]

UK MOD receives mobile CT Scanner

30 January 2012 - 17:59 by the Shephard News Team



The UK Ministry of Defence (MOD) has received its first truly deployable CT Scanner, which was handed over by Marshall Land Systems. Marshall Land Systems made the announcement in a 30 January 2012 company statement.

The Philips Brilliance 64 CT Scanner has been integrated into a Marshall Double Expandable Matrix Shelter by Marshall Land Systems.

The equipment has been designed to survive the rigours of being deployed in operational theatre; and will be used to ‘materially improve the chances of survival of members of the UK and its allies armed forces, and the civilians they protect, should they be unfortunate enough to suffer major blunt trauma injury’.

[buglerbilly]

How dementia drugs could be used by the military

Army leaders in various countries have trialled compounds that can keep soldiers awake and alert – or send them to sleep

Ian Sample, science correspondent guardian.co.uk,

Tuesday 7 February 2012

This article was published on guardian.co.uk at 00.01 GMT on Tuesday 7 February 2012. It was last modified at 00.05 GMT on Tuesday 7 February 2012.


The pilot of a F/A-18 Hornet fighter jet prepares to take off from a US aircraft carrier. Some American military authorities allow the use of amphetamines by those operating single or two-seater aircraft. Photograph: Koji Sasahara/AP

Drugs that reduce anxiety, tiredness and memory loss – all associated with the treatment of dementia – could be used "off-label" as cognitive enhancers by military personnel, according to a Royal Society report.

While caffeine and nicotine are used routinely to reduce fatigue and improve attention, British armed forces prohibit other stimulants in training or on operations. The US air force still allows amphetamines in some cases, such as where single or two-seater aircraft are involved.

The military in several countries have tested modafinil, a drug licensed to treat sleepiness in narcoleptics, and found it effective at maintaining performance in the sleep-deprived. Other drugs might help personnel learn faster by improving their attention and working memory, the report states.

More controversial are those drugs that could be used against opponents. The report highlights a natural compound called oxytocin that is released during childbirth, lactation and orgasm, and is involved in trust and bonding. Drugs based on oxytocin might potentially make adversaries more trusting and willing to give up information, though the report is cautious not to overstate the effects.

The report goes on to raise the prospect of drugs that could knock adversaries out. In 2002, Russian special forces used an anaesthetic, thought to be fentanyl, to subdue tens of attackers who held more than 800 people hostage in a Moscow theatre. The drug killed more than 100 in the building, highlighting the dangers of the approach.

The difficulty in making an effective knock-out drug will be hard to overcome, the report states, becauseany drug that reliably incapacitates is likely to kill in higher concentrations.

The report calls on the UK government to clarify its interpretation of the Chemical Weapons Convention, which bans chemical weapons, including drugs that cause temporary incapacitation, but has an exemption that allows the use of toxic chemicals for domestic law enforcement.

The authors say the coalition has recently shifted its interpretation of the convention, suggesting that incapacitating chemicals are permitted for law enforcement.

[buglerbilly]

Neuroscientists to Top Brass: Mess With Minds… Carefully

By Katie Scott, Wired.co.uk Email Author February 7, 2012 | 1:55 pm



A working group led by the Royal Society has warned the scientific community and the Government to tread carefully when entering the ethical minefield that is the use of neuroscience.

A report published today by the Royal Society tackles the divisive issue of the potential uses of neuroscience research by the military or security forces — whether to improve the performance of our troops, to “diminish” the performance of the enemy or, perhaps most controversially, in law enforcement.

The paper, entitled Brain Waves Module 3: Neuroscience, conflict and security, is one of four that have been published looking at the current and potential impact of neuroscience on society and policy, the law, and education.

This, the final report to be released, looks at the neuroscience research that is already being deployed by the military and what is being developed.

In a military context, the report authors have looked at the potential and current uses of neuroscience in every step of a soldier’s career, from recruitment to rehabilitation after injury. There are neuroimaging techniques that could help determine the best recruit for the role based on their propensity for risk-taking or specific skills that could help them train in a specialist area, for example, reconnaissance.

It also discusses the benefits of using brain stimulation technology to improve learning; and neuropharmacological agents to enhance cognition or attenuate effects of sleep deprivation, or treat post-traumatic stress disorder. The potential of neural interface systems (NIS) — a person controlling a computer with their mind — could go beyond “the restoration of function to individuals with sensory or motor deficits” (such as Braingate), says the report. “The ability to control a machine directly with the human brain could, for example, provide the potential to remotely operate robots or unmanned vehicles in hostile territory.”

However, NIS could also be deployed on a smaller scale as sensory enhancers, add the authors. They state: “For example, research has been conducted on the ability of individuals to feel the heat and distance of an object of interest in a room by a simple procedure involving a small magnetic implant on a fingertip or anywhere else on the human body. Placing a small coil of wire around the finger can cause the magnet to vibrate. If the coil is connected up to an external sensor then signals from the sensor will alter the vibrations of the magnet, which are detected by the recipient.

“In this way a sonar sensor or an infrared sensor can be used to operate with the magnet — hence the recipient ‘feels’ how far away an object is or remotely ‘feels’ how hot an object is. Unobtrusive neural interfaces like these sensory implants might provide an edge to the law enforcement fields in small but tangible ways.”

However, a clear emphasis from the authors, who include psychologists, life scientists and international security experts, is the legislation that needs to be put into place to protect civilians and military personnel alike. In particular, the report calls for governmental clarification on a recent interpretation of the Chemical Weapons Convention’s (CWC) law enforcement provision, which, as the paper details, “suggests that the use of incapacitating chemical agents for law enforcement purposes would be in compliance with the CWC as long as they were in types and quantities consistent with that permitted purpose”.

Rod Flowers was chairman of the working group that produced the paper and is Professor of Biochemical Pharmacology at Queen Mary University of London. He says: “We know that neuroscience research has the potential to deliver great social benefit — researchers come closer every day to finding effective treatments for diseases and disorders such as Parkinson’s, depression, schizophrenia, epilepsy and addiction. However, understanding of the brain and human behaviour coupled with developments in drug delivery also highlight ways of degrading human performance that could possibly be use in new weapons, especially incapacitating chemical agents.

“This is why it is so important that UK government is clear about its reasons for the changes made to its interpretation of the law enforcement exemption in the CWC. It’s absolutely crucial that countries adhering to the CWC address the definition of incapacitating chemical agents under the CWC at the next Review Conference in 2013.”

Flowers also argues that neuroscientists need to be aware of the potential dual usage of their research at an early stage of their training. “The neuroscientists conducting this research also need to be aware that knowledge and technologies used for beneficial purposes can also be misused for harmful purposes,” he argues.

Key will be communication between scientists and those in power. The paper says: “The UK government…should improve links with industry and academia to scope for significant future trends and threats posed by the applications of neuroscience.” The authors also call for the bodies such as the World Medical Association to study “the legal and ethical implications of biophysical degradation technologies (such as directed energy weapons) targeted at the central nervous system”.

Ethical issues aside, Flower questions whether the resources being used for neuroscience research for potential military applications might not be better deploted elsewhere: “The application of neuroscience research in the development of enhancement and degradation technologies for military and law enforcement use raises significant ethical considerations. Support for this type of research is potentially diverting funding and resources away from other important social applications such as the treatment of neurological impairment, disease and psychiatric illness. This is why it should be subject to ethical review and as transparent as possible.”

Photo: U.S Army

[buglerbilly]

Amputation Cases Among Troops Hit Post-9/11 High in 2011

February 10, 2012

Stars and Stripes|by Chris Carroll

WASHINGTON -- More U.S. troops lost limbs in 2011 than in any previous year of fighting since the 9/11 attacks, recently published Pentagon data show.

The grisly toll, 240 cases of deployed troops with at least one arm or leg amputated, appears to mainly reflect the ongoing troop surge in Afghanistan, along with an increased emphasis on foot patrols in areas where insurgents are active.

Amputation cases were up from 196 in 2010 and exceeded the previous high of 205 during the 2007 Iraq surge, according to figures published this month by the Armed Forces Health Surveillance Center. The Marine Corps was hit hardest by far, with 129 Marines suffering amputations in 2011. The Army, which has more troops in the country, had 100 amputation cases. Six sailors and five airmen also lost limbs.

But there’s a flip side to the grim statistics, officials say. The rising numbers are also believed to reflect recent advances in battlefield first aid, medical treatment and protective gear that make the current conflict “the most survivable war in the history of combat,” according to Adm. William Gortney, director of the Pentagon’s Joint Staff, speaking Jan. 31 at the Military Health System Conference in Washington.

In previous wars, or even several years earlier in the current one, some of the amputation cases would likely have been battlefield fatalities, said Col. Jonathan Jaffin, chief of the Army Surgeon General’s Dismounted Complex Blast Injury Task Force. From 2010 to 2011, though amputations increased, total U.S. troop deaths in from combat fell to 368 from 437, according to the Defense Manpower Data Center.

“These are grievous injuries, yes, but when you see them back here with their families having survived, these guys are all grateful to be alive,” Jaffin said.

The task force also found an increase in severe injuries in recent years. It sounds bad, Jaffin said, but actually means that troops are surviving worse injuries than before. Better and more widely distributed protective gear, including groin-protecting armor that many troops began receiving in 2011, are helping stop injuries to vital organs that previously could have proved fatal, Jaffin said.

First-aid knowledge among the rank and file has increased, and ground troops in Afghanistan now carry tourniquets they are trained to use if a limb is severed, he said.

“We’ve heard anecdotally that some of the guys are going out on patrol with tourniquets already in place, so if they get hurt, all you have to do is pull them taut,” Jaffin said.

Once injured troops reach the hospital, the level of care that’s evolved over a decade of war is world-class, said a Navy doctor who served in Afghanistan.

“I could accurately say it’s the most effective trauma system on the planet,” said Navy Capt. Mike McCarten, who in 2010 and 2011 commanded a NATO Role 3 hospital in Kandahar, one of three in the country with a full spectrum of medical care.

Improvised explosive devices caused the majority of amputations McCarten saw at the hospital, he said. Roughly half of the injured troops had a limb or limbs blown off in the field, and the rest arrived with arms and legs too mangled to save.

“It was at least several times weekly, and at some points it was several times daily,” he said.

Survivability has increased because the U.S. military has been closely monitoring and studying medical outcomes throughout the current wars, and the lessons learned are being put into use. Perhaps the most effective lesson learned was the importance of first aid, he said.

“The work being done at the Role 3 hospitals is magnificent, but really a lot of credit for that survival goes to medics and hospital corpsmen on the battlefield,” McCarten said. “[Injured troops] would come to us with two or three tourniquets on two or three amputated limbs, and they actually didn’t have bad blood pressure because of the care they received in the field.”

[buglerbilly]

A Kit Up Inside Look at “Goat Lab”

by Brandon Webb on February 21, 2012



This is a heavily controversial topic. The article you are about to read was written by a former Navy SEAL medic (it’s shared with his permission) who was trained by the Army’s course at Ft. Bragg, NC. In the SEALs, we called it the 18 Delta course, but as Jack would tell you, it’s called something else. Enjoy what Wired Magazine’s Danger Room left out and let us know what you think.

-Brandon

When Killing Animals Saves Lives

In the darkness, the SOF medic can’t see because the flashing strobe has taken his night adapted eyesight away. He blindly feels slowly and methodically along the body for the exit wound behind the back. Then he feels it, the warm blood from the bullet wound touches his fingers and heightens his senses, a little gush with every heart beat pushes blood out of the gaping hole.

The gunfight in the background has been muted as far as he’s concerned, He’s only committed to saving the life of his teammate right now. He can feel the warm spit hit his face in the darkness as someone yells “Ten mikes to extract!” He slowly nods his head and feels for a pulse. He gets a steady thump (pause), thump (pause), thump; not quite as fast and weak as it was in the beginning; his friend has stabilized for now,

Another life saved, he thinks to himself.

The medic tries to push out the thoughts and images of so many friends lost last deployment to IEDs, He sharpens his mind’s eye and feels a sense of relief and accomplishment knowing he has saved another life.

Suddenly, the bright lights come on! He looks down to see his friend lying on the floor, only he’s looking at a gun shot goat. Welcome to Goat Lab.

The word is out that the US Military engages in ‘live tissue training’. For those of you out there that think we’re revealing some classified material here, just spend a little time around the internet and you’ll find that Fox has reported on it as well as Stars and Stripes, the LA Times, and many other news sources. If the super sleuths at PETA (People for the Ethical Treatment of Animals) can figure it out, it can’t be that hard.

“We have the best trained and most prepared combat medics in the world.”

Former students at 18 Delta Special Forces Combat Medical School might reference it as ‘Goat Lab’, but let’s not forget the brave goats, pigs and cats (they simulate infants) that have also sacrificed their lives so that others may live. The practice of using animals as training aids for combat medics and forward operators (among others) has spurred intense controversy and legislation that is pending on the further ability to use animals as ‘patients’.

I’m an animal lover, I always have been. When I was asked as a little kid what I wanted to be when I grew up, the answer was always the same: a veterinarian. All animals, too, even cats (for all you cat haters out there). I always appreciated how cats, even after being separated from their mother at birth, still have a natural instinct to hunt and kill. I like animals more than most people, really, and would much rather hunt people than some rare sheep high in the mountains of a former Soviet republic. It’s more sporting. People can shoot back.

But when it comes to using animals to help train our Combat Medics, soldiers, and forward operators, I’m all for it. (For the record, I’m not bashing hunting… I love me some venison, elk, pheasant…..)

There is currently a Bill before Congress, H.R. 1417, the Best Practices Act, sponsored by Southern California’s very own Rep. Bob Filner, which, in summary is trying to amend Title 10, United States Code, to require the Secretary of Defense to use “only human-based methods for training members of the Armed Forces in the treatment of severe combat injuries”. (As I understand it, it is still sitting with the House Armed Services Committee.)

The Bill suggests that it is an “imperative” to replace live tissue training and calls the use of live tissue training “outdated and inferior” relative to simulators and moulage training, Excuse my French, but this is utter bullsh*t.

“until you’ve cut through living tissue on a creature whose life is depending on your timely and successful procedure to survive, you’ve never really done it”

The reason the 18 Delta medics and now other SOF units have been using this method before and throughout the GWOT is because it works. We have the best trained and most prepared combat medics in the world, and they have and will continue to save lives because of the use of caprines and other animals in training.

The reason that this works is multifold, You can simulate performing a surgical crycothyrotomy on a mannequin a dozen times, but until you’ve cut through living tissue on a creature whose life is depending on your timely and successful procedure to survive, you’ve never really done it. Being able to tent the skin in the dark, slick with real blood, with smoke and explosions all around you, and get the tactile sensation of your scalpel through real flesh, the whoosh of air when you punch through the crycothyroid membrane and secure your endotracheal tube and Ambu Bag (if needed) isn’t something you can use a dummy to simulate, and moulage just doesn’t quite cut it either.

I realize that there are some very high tech (and very expensive) simulators on the market and being prepared to be brought online with the US Mil, but in my opinion, and until proven otherwise, will still be found wanting. Additionally, it tests the operator. 18 Delta is still part of the Q Course for aspiring Green Berets, and to put someone under pressure in a realistic combat training scenario with their ‘patient’ spurting blood from an arterial wound tests the mettle of that individual,

It’s all well and good to work through a moulage or simulator scenario and come away covered in fake blood, but the real thing changes your perspective, When you are attempting to stop an arterial bleed and every second you can feel and see the heart pumping out the lifeblood of a living creature, your heart rate rises, and despite the fact that you are working on an animal, you find yourself caring.

Kit Up wants to know what you think?

-Brandon

Read more: http://kitup.military.com/2012/02/goat-lab-an-inside-look-sofrep.html#ixzz1n6gxPHG8
Kit Up!

[buglerbilly]

Blasts to the Head ‘Primed’ Brains for PTSD, Study Says

By Katie Drummond Email Author February 22, 2012 | 4:19 pm


Photo: U.S. Air Force

The “signature wounds” of the wars in Iraq and Afghanistan — post-traumatic stress disorder and traumatic brain injury — are both rooted in traumatic events. Until recently, though, military docs mostly treated them as two different health problems: one physical, the other psychological. That approach might be poised to change, thanks to a new study, which shows that injuries to a specific part of the brain “primed” it for PTSD’s psychological ailments.

Post-traumatic stress disorder is widely known as the psychological condition that’s followed soldiers home from Iraq and Afghanistan. The connection between war and PTSD is simple enough: Soldiers undergo a traumatic experience, if not several, overseas. Those traumas stay with them, and seem to have a profound impact on their stress hormones and brain chemistry. The result? Symptoms like nightmares, paranoia and angry outbursts.

In comparison, traumatic brain injuries (TBIs) seem extremely different. These injuries are caused by a physical trauma — an IED attack, for example — that actually rattles the brain inside the skull. Subsequent brain damage can cause everything from vomiting and headaches to long-term loss of sensation and speech impediments.

Scientists have known for a while that TBIs and PTSD are connected. One 2008 study concluded that 44 percent of personnel with a TBI also suffered from PTSD, compared to 9 percent of those without physical injury. Of course, the link seems obvious: It follows that driving a Humvee that’s suddenly blown to pieces will rattle the skull and also trigger psychological distress.

But researchers now suspect that the link goes even further: They’ve concluded that the physical blow from a TBI changes a key part of the brain, making a soldier more at risk of developing PTSD in the future.

Scientists at the University of California at Los Angeles, led by Dr. Maxine Reger, this week published a study that uses rats to examine the relationship between TBI and PTSD.

They first divided the animal subjects into two groups. The researchers used physical force to cause TBIs among the rats in one group. Those in the other group were left unscathed.

Then the team waited two days before exposing the rats to fearful experiences. The point of waiting was to separate the physical trauma (the TBI) from the psychological. Researchers wanted to know whether, days later and during an entirely different experience, a TBI would have any impact on PTSD risk.

Lo and behold, rats in the TBI group did react differently to fearful stimulus. In fact, they exhibited “inappropriately strong fear,” according to Dr. Michael Fanselow, one of the researchers involved in the study. Rats with healthy noggins, however, exhibited more appropriate reactions.

“It was as if the injury primed the brain for learning to be afraid,” he said in a statement.

At the core of the finding is one brain region, called the amygdala. Scientists already know that this tiny bundle of neurons is extremely vulnerable to damage during a brain-rattling event that causes a TBI. The amygdala is also one of the most important brain areas where PTSD is concerned, because it regulates fear response.

After their experiments, the team analyzed brain tissue from the amygdala of several rats. Among rats afflicted with a TBI, the amygdala had significantly more receptors for neurotransmitters that are involved in the learning process. In other words, a TBI somehow causes these receptors to multiply, meaning that there are more of them available to be activated by neurotransmitters. So when a person is exposed to a scary event, their amygdala is, oddly enough, more capable of learning fear.

In a human context, the study’s findings (roughly) suggest the following: If two soldiers are exposed to the same psychologically scarring event, the soldier who suffered a TBI last month would be more likely to develop PTSD than his colleague.

Of course, it’s not that simple. Scientists already know that all sorts of other factors, from genetics to childhood environment, affect a soldier’s risk of developing PTSD. And even if TBIs are a risk factor, they aren’t the only one — not everyone who gets PTSD, whether soldier or civilian, also suffered a traumatic brain injury sometime in the past. Likewise, not all TBI sufferers eventually end up with PTSD.

That said, the study could break new ground in the Pentagon’s efforts to treat, diagnose and prevent PTSD and TBI. Thus far, the military hasn’t had much luck unraveling either one. Figuring out how and where the two illnesses are tangled together might be a good place to start.

[buglerbilly]

Prosthetics Breakthrough Might Fuse Nerves With Fake Limbs

By Katie Drummond Email Author February 27, 2012 | 6:30 am



Prosthetic limbs, like this one, might one day be as lifelike as the real thing. Photo: Sgt. Ray Lewis/Bouhammer.com

A replacement limb that moves, feels and responds just like flesh and blood. It’s the holy grail of prosthetics research. The Pentagon’s invested millions to make it happen. But it’s been elusive — until, quite possibly, now.

The body’s own nerves are arguably the biggest barrier towards turning the dream of lifelike replacements into a reality. Peripheral nerves, severed by amputation, can no longer transmit or receive any of the myriad sensory signals we rely on every day. Trying to fuse them with robot limbs, to create a direct neural-prosthetic interface, is no easy task.

But now a team of scientists believe they’ve overcome that massive barrier. Their research is still in the early stages. But if successful, it’d yield artificial arms and legs that can move with agility; discern hot from lukewarm from freezing; and restore even the subtlest sensations of touch.

“We think the interface problem is key to enabling the neuro-prosthetic concept,” Dr. Shawn Dirk, one of the researchers behind the finding, tells Danger Room. “And solving that is how we’re going to give amputees their bodies back.”

Dirk, alongside colleagues at Sandia National Laboratories, the University of New Mexico and the MD Anderson Cancer Center, set out to develop a synthetic substance that could act as a scaffold — that is, an artificial structure that can support tissue growth — successfully merging severed nerves with robotic limbs.

Of course, researchers have already made plenty of efforts to directly integrate nerves and prosthetics. But, according to Dirk, they typically “didn’t use technology that was compatible with nerve fibers,” which are tightly bundled and flexible. “Nerves need to grow and move around; they’re not going to integrate well with a stiff interface.”

Yes, the material comprising the scaffold had to be flexible and fluid, but it also needed to be extremely conductive. Nerve signals are highly localized, and also very, very subtle. An effective neural-prosthetic interface would need to transmit thousands of different signals per second to mimic the behavior of a real limb and its relationship to the brain and body.

To create that ideal interface, Dirk and his colleagues developed their own biocompatible polymers, meant to mimic the properties of nerve tissue. The material is also porous, so that nerves can extend through it, and lined with electrodes, to vastly enhance conductivity.

When surgeons placed the scaffolds onto the severed leg nerves of rats, it didn’t take long before the rats’ own nerve fibers started to grow through the scaffold and fuse back together. Even better, the synthetic material wasn’t rejected by the rats’ immune systems.

“There was a very limited inflammatory response,” Dirk says. “That’s important, because we’re looking for an interface that won’t be rejected by the body. We want something that can last years, decades, and hopefully entire lifetimes.”

The finding marks a huge, huge improvement over previous research efforts. Even Darpa, the Pentagon’s far-out research arm and a leader in prosthetic science, couldn’t seem to figure out a direct neural-prosthetic interface that was adequately sensitive and had a lifespan longer than a few months. In 2010, the agency asked for new research proposals that’d solve both those problems.

And while new prototype prosthetics have some incredible abilities, none of them include a direct interface. In fact, they’ve been designed to avoid one altogether. One Pentagon-funded project used “targeted muscle reinnervation surgery” to develop prosthetics that transmit signals from a bundle of nerves in the chest. Another, led by Johns Hopkins scientists, uses brain-implanted micro-arrays to transmit cues to an artificial limb.

A direct neural-prosthetic interface still remains years away. But if this polymer holds up in subsequent tests, it’ll mean prosthetics far more lifelike than even the most impressive artificial limbs currently in development. Most importantly, in the words of Darpa, prosthetics hooked right into the nervous system “would incorporate the [artificial] limb into the sense-of-self.”

[buglerbilly]

New Tool Could Help Pinpoint TBI

March 02, 2012

Associated Press|by Lauran Neergaard



WASHINGTON - The soldier on the fringes of an explosion. The survivor of a car wreck. The football player who took yet another skull-rattling hit. Too often, only time can tell when a traumatic brain injury will leave lasting harm - there's no good way to diagnose the damage.

Now scientists are testing a tool that lights up the breaks these injuries leave deep in the brain's wiring, much like X-rays show broken bones.

Research is just beginning in civilian and military patients to learn if this new kind of MRI-based test really could pinpoint their injuries and one day guide rehabilitation. It's an example of the hunt for better brain scans, maybe even a blood test, to finally tell when a blow to the head causes damage that today's standard testing simply can't see.

"We now have, for the first time, the ability to make visible these previously invisible wounds," says Walter Schneider of the University of Pittsburgh, who is leading development of the experimental scan. "If you cannot see or quantify the damage, it is hard to treat it."

About 1.7 million people suffer a traumatic brain injury, or TBI, in the U.S. each year. Some survivors suffer obvious disability, but most TBIs are concussions or other milder injuries that generally heal on their own. TBI also is a signature injury of the wars in Iraq and Afghanistan, affecting more than 200,000 soldiers by military estimates.

Not being able to see underlying damage leads to frustration for patients and doctors alike, says Dr. Walter Koroshetz, deputy director of the National Institute of Neurological Disorders and Stroke.

Some people experience memory loss, mood changes or other problems after what was deemed a mild concussion, only to have CT scans indicate nothing's wrong.

Repeated concussions raise the risk of developing permanent neurologic problems later in life, a concern highlighted when some retired football players sued the National Football League. But Koroshetz says there's no way to tell how much damage someone is accumulating, if the next blow "is really going to cause big trouble."

And with more serious head injuries, standard scans cannot see beyond bleeding or swelling to tell if the brain's connections are broken in a way it can't repair on its own.

"You can have a patient with severe swelling who goes on to have a normal recovery, and patients with severe swelling who go on to die," says Dr. David Okonkwo, a University of Pittsburgh Medical Center neurosurgeon who is part of the research. Current testing "doesn't tell you what the consequence of that head injury is going to be."

Hence the increasing research into new options for diagnosing TBI. In a report published Friday in the Journal of Neurosurgery, Schneider's team describes one potential candidate, called high-definition fiber tracking.

Brain cells communicate with each other through a system of axons, or nerve fibers, that acts like a telephone network. They make up what's called the white matter of the brain, and run along fiber tracts, cable-like highways containing millions of connections.

The new scan processes high-powered MRIs through a special computer program to map major fiber tracts, painting them in vivid greens, yellows and purples that designate their different functions. Researchers look for breaks in the fibers that could slow, even stop, those nerve connections from doing their assigned job.

Daniel Stunkard of New Castle, Pa., is among the first 50 TBI patients in Pitt's testing. The 32-year-old spent three weeks in a coma after his all-terrain vehicle crashed in late 2010. CT and regular MRI scans showed only some bruising and swelling, unable to predict if he'd wake up and in what shape.

When Stunkard did awaken, he couldn't move his left leg, arm or hand. Doctors started rehabilitation in hopes of stimulating healing, and Okonkwo says the high-def fiber tracking predicted what happened. The scan found partial breaks in nerve fibers that control the leg and arm, and extensive damage to those controlling the hand. In six months, Stunkard was walking. He now has some arm motion. But he still can't use his hand, his fingers curled tightly into a ball. Okonkwo says those nerve fibers were too far gone for repair.

"They pretty much knew right off the bat that I was going to have problems," Stunkard says. "I'm glad they did tell me. I just wish the number (of missing fibers) had been a little better."

The new tool promises a much closer look at nerve fibers than is now possible through a technique called diffusion tensor imaging, says Dr. Rocco Armonda, a neurosurgeon at Walter Reed National Military Medical Center.

"It's like comparing your fuzzy screen black-and-white TV with a high-definition TV," he says.

Armonda soon will begin studying the high-def scan on soldiers being treated for TBI at Walter Reed, to see if its findings correlate with their injuries and recovery. It's work that could take years to prove.

Other attempts are in the pipeline. For example, the military is studying whether a souped-up kind of CT scan could help spot TBI by measuring changes in blood flow inside the brain. The National Institutes of Health is funding a search for substances that might leak into the bloodstream after a brain injury, allowing for a blood test that might at least tell "if a kid can go back to sports next week," Koroshetz says.

He cautions that just finding an abnormality doesn't mean it's to blame for someone's symptoms.

And however the hunt for better tests pans out, Walter Reed's Armonda says the bigger message is to take steps to protect your brain.

"What makes the biggest difference is everybody - little kids riding their bicycles, athletes playing sports, soldiers at war - is aware of TBI," he says.

© Copyright 2012 Associated Press. All rights reserved.

[buglerbilly]

Army Suicide: Tip of the Service’s “Mental Health Iceberg”

By Mark Thompson | @MarkThompson_DC | March 9, 2012



Nearly half of the Army’s suicides may have been caused by the wars in Afghanistan and Iraq, a new Army assessment of the problem says. Tracing the roots of suicide is always an inexact science, but the authors conclude:


Rates of suicide in the US Army increased more than 80% from 2004 to 2008. They thereby surpassed comparable civilian rates of suicide, which remained relatively stable during this time period. This increase, unprecedented in over 30 years of US Army records, suggests that approximately 40% of suicides that occurred in 2008 may be associated with post- 2003 events following the major commitment of troops to Iraq in addition to ongoing operations in Afghanistan.

The study, Mental health risk factors for suicides in the U.S. Army, 2007-8, was published this week in Injury Prevention, a British medical journal. Its key author is Dr. Michelle Canham-Chervak of the U.S. Army Public Health Command.

http://timemilitary.files.wordpress.com/2012/03/inj-prev-2012-bachynski-injuryprev-2011-040112.pdf

The study also questions Army officials’ claims that because one of every three who kills him or herself has never deployed, the wars didn’t have anything to do with that suicidal subset:


In the present study, 31% of suicides were committed by soldiers who had never deployed, implying that psychopathology and stress other than combat exposure may contribute to suicide incidence in this population. Predeployment stress, such as anticipatory anxiety and preexisting trauma, may play an important role.

The study combed through reams of Army data to find that as suicide nearly doubled in the ranks, so did rates of mental illness:


The overall rates of mental illness among active duty soldiers also nearly doubled since the major commitment of troops to Iraq and Afghanistan, mirroring the increase in rates of suicide from 2003 to 2008. This suggests a possible association between the increase in mental health disorders and suicide in a population under severe stress. The 2008 rate indicates that more than one fifth of all active duty soldiers had an ambulatory visit for a mental health disorder, implying a prevalent public health problem.

The increase in suicide rates may be viewed as the tip of the ‘mental health iceberg’. While suicide remains a relatively rare event, its increase signals more prevalent underlying mental health problems among soldiers in the US Army. The parallel during the years 2003-8 suggests that army operations during this time period may have affected the nature and extent of mental health problems, including suicide.

Read more: http://battleland.blogs.time.com/2012/03/09/army-suicide-tip-of-the-services-mental-health-iceberg/#more-68672#ixzz1ohMKU5iA

[buglerbilly]

Afghan Shooting Highlights Military’s God-Awful Track Record on Brain Injuries

By Katie Drummond Email Author March 14, 2012 | 1:27 pm


Soldiers at Joint Base Lewis-McChord, undergoing part of a grueling two-week training program for field medical staff. Photo: U.S. Army

What spurred one American soldier to allegedly massacre 16 Afghan civilians earlier this week? That’s a complicated question, and one that could take military investigators months or years to figure out.

What is known, among sparse details, is that this soldier suffered a traumatic brain injury (TBI). That factor will no doubt play a role in the military’s investigation, and it offers yet another reminder of the military’s awful track record in diagnosing and treating that ailment, widely known as one of the signature wounds of the wars in Iraq and Afghanistan.

In my years reporting on TBIs among soldiers and vets, it’s become increasingly apparent that problems in TBI management start even before a soldier deploys, and persist — often with devastating results — long after he or she comes home. “We got hit a lot of times in Iraq, [so] I definitely got rattled around,” Staff Sgt. Victor Medina, a soldier afflicted with TBI, told me in 2010. “It wasn’t until the fourth time we got hit, and I blacked out, that anyone took me to get looked at.”

Medina later relied on alternative therapies like massage and acupuncture, in part because it was so tough for him to get adequate care at Fort Bliss, where he was stationed. “One doctor told me I was making it all up,” he said, of symptoms like stuttering and blinding headaches that followed the TBI he suffered during a massive IED explosion in 2009.

He’s hardly the only soldier to feel inadequately cared for by military docs.

Indeed, the military’s mismanagement of TBIs over the past decade is nothing short of astonishing. Military docs have failed to diagnose soldiers who showed clear symptoms of injury. Potentially thousands of medical diagnoses for TBI have been all-out lost. Soldiers sometimes wait months to start TBI treatment. Most importantly, scientists still don’t even know what TBIs do to a person’s body, brain or long-term mental health.

An estimated 200,000 soldiers have suffered from a TBI over the past decade. At least, as far as the military can tell. Even after the Pentagon in 2007 injected $1.7 billion into better management of TBIs, military docs still can’t accurately diagnose the injuries during a soldier’s deployment or upon his or her return to base.

Right now, the military typically uses a three-phase screening test to spot TBIs in personnel. One baseline test is taken before deployment, another after a possible TBI has been sustained during deployment, and a third when a soldier returns home.

But, as highlighted in a 2010 ProPublica/NPR investigation, those tests are hopelessly flawed: One screening test failed to spot 40 percent of TBI cases among military patients. Another was described as “basically a coin flip,” by Lt. Gen. Eric Schoomaker, the former Army Surgeon General.

And a better replacement has yet to be found. Both the Army and the Navy have touted breakthrough TBI diagnostic measures — the Army’s is a blood test, the Navy’s is an online exam — that later proved to be wildly overhyped. The Navy’s test actually doled out more false positives than the military’s current screening program, while the Army’s blood test hasn’t even undergone clinical trial.

Even if a soldier is diagnosed with a TBI, there’s no guarantee that the diagnosis will make it into his permanent medical records. That’s because the handheld systems used overseas to track injuries often broke. In other instances, they couldn’t connect to adequate bandwidth to transmit a given diagnosis. As a result, plenty of TBI diagnoses have been lost: One unpublished Army survey, reviewed by ProPublica, noted that 75 percent of soldiers suffering from a brain injury had no record of ever sustaining one.

Treatment for TBI among soldiers is yet another major problem. Over the past decade, media reports that soldiers with TBIs were forced to fight for care have trickled out with frightening consistency. The Washington Post’s 2007 investigative series on Walter Reed, for example, dug up myriad instances of neglect and inadequate treatment of ailing soldiers, including those with brain injuries.

In the years to follow, soldiers with TBI have continued to express frustrations about many of the same problems. Indeed, military medical records show that soldiers still often wait weeks or months to undergo therapy. This, even though a panel of experts convened by the Pentagon recommended that a patient’s TBI treatment be initiated as soon as possible, so as to minimize long-term damage.

Madigan Medical Center, where the solder alleged to have opened fire on civilians this week was treated, is no exception to such lapses. A recent Army investigation, for example, concluded that doctors had inappropriately downgraded the PTSD diagnoses of 280 soldiers, rendering them eligible for fewer benefits and less treatment. And of course, doctors at Madigan had the same problems with diagnosis and treatment as colleagues elsewhere — a lack of effective tools and concrete knowledge.

These gaps in knowledge even extend beyond diagnosis and treatment, right down to the physiology of TBI itself. Even the symptoms of TBI can be incredibly diverse, tough to spot, and sometimes emerge months after an injury is sustained. The most well-known symptoms include confusion, headaches and difficulty reading or speaking. Other soldiers, however, suffer nausea and fatigue. And there’s also a clear link between TBIs and violent, aggressive behavior — which is frequently noted in the military’s own TBI treatment guidelines.

In addition to a puzzling, scattershot array of symptoms, Pentagon-funded scientists still aren’t sure how brain injuries affect the brain, both in the short and long term. Researchers even suspect — though they aren’t sure — that TBIs “prime” the brain for post-traumatic stress disorder, the other signature wound of this decade’s wars. PTSD symptoms, of course, often include problems like hyper-arousal, irritability or outbursts of rage.

With so many questions that persist about how to treat a TBI, it’s hard to know when a soldier suffering from one can be safely redeployed — like the Staff Sergeant who allegedly went on this week’s rampage — or if they even can at all.

“I am trying to find out basically whether there was a premature ‘OK’ on this guy,” Rep. Bill Pascrell, founder of a congressional task force on brain injuries, told Reuters today. “If this soldier fell through the cracks, does that mean others have?”

It’s not known yet how big a role this soldier’s brain injury played in this week’s tragedy. But there’s no question that for 10 years, the military has failed to adequate diagnose and treat these ailments. And that other soldiers with TBIs have, indeed, fallen through the cracks.

[buglerbilly]

Army Reviewing Reversed PTSD Diagnoses

March 21, 2012

Military.com|by Matthew Cox

Diagnosis by Accountant, that'll make you feel better.................:voodoo

The Army's Surgeon General has ordered a review of mental health facilities that evaluate post-traumatic stress disorder after reports that a screening team at Joint Base Lewis-McChord reversed more than 40 percent of the PTSD diagnoses of patients being considered for medical retirement since 2007.

An Army Medical Command investigation of the forensic psychiatry unit at Madigan Army Medical Center has revealed that screeners reversed the diagnosis of roughly 300 patients being treated for PTSD, said Sen. Patty Murray, D-Wash., voicing her concern Wednesday to senior Army leaders testifying at a Senate Appropriations Committee hearing.

The investigation found that screeners took "the cost of mental health care into account" when they evaluated these patients' previous diagnosis, said Murray, describing her shock in light of the Army's attempts to deal with PTSD throughout a decade of war.

"It really is very troubling to sit here after 10 years; after many, many hearings and many, many questions to find out that this has been occurring," Murray said.

Lewis-McChord has already been spotlight recently after one of its soldiers, Staff Sgt. Robert Bales, was arrested in connection with the deaths of 16 Afghan civilians in Kandahar. Bales was on his fourth tour to the war zone, having served three tours in Iraq.

Officials have made no direct connection between the recent Afghan massacre and the reversal of PTSD diagnoses at Lewis-McChord.

Army Secretary John McHugh and Chief of Staff Gen. Ray Odierno told Murray and other lawmakers that situation at Lewis-McChord would not be tolerated.

The Surgeon General has ordered the Army's Inspector General to examine similar facilities across the service.

"At this point, we don't see any evidence of this being systemic, but … we want to make sure that where this was inappropriate, it was an isolated case and if it were not to make sure we address it as holistically as we are addressing it at Madigan," McHugh said.

Part of the IG investigation will seek to ensure that all psychiatric facilities are following standardized diagnostic procedures, McHugh said.

"We have a very standardized system; it's a system that is utilized in [Department of Veterans Affairs] evaluations … and we are restating to all of our providers that this is the diagnostic protocol that they will follow. And equally important is that fiscal considerations are not in any way a part of the evaluation; it is simply unacceptable."

Odierno stressed the Army's leadership "should be patient advocates, and that is the mindset we need to work on changing -- to make sure everybody understands that … we are trying to get the best for our soldiers," he said.

© Copyright 2012 Military.com. All rights reserved.

[buglerbilly]

Troops Stressed to Breaking Point

March 21, 2012

Washington Times|by Rowan Scarborough

A recent Army health report draws an alarming profile of a fighting force more prone to inexcusable violence amid an "epidemic" of post-traumatic stress disorder (PTSD), the mental breakdown attracting speculation as a factor in a massacre of Afghan civilians this month.

Based on an exhaustive study of nearly 500,000 soldiers, reservists and veterans, the report finds that troops are more likely to commit suicide and violent sex offenses, and notes that as many as 236,000 suffered from PTSD since the beginning of the wars in Afghanistan and Iraq.

For military analysts, the reason is the nightmarish experience of sustained combat: Soldiers have been fighting the longest war in U.S. history, with frequent stressful deployments and compressed rest time back home.

"The real issue here, which I've been tracking for a long time, is 10 years of combat," said military analyst Robert Maginnis, a retired Army officer.

"I see these kids who have been in combat year after year after year. It is taking a real toll, not only medical, but being able to sort out their lives. What this kid caved to I think could be an epidemic. It is really long term what we are doing to a generation of volunteers."

ArmyStaff Sgt. Robert Bales, 38, is accused of killing 16 Afghan civilians on March 11 in a nighttime shooting spree through three villages near his base. He has been detained at Fort Leavenworth, Kan., since Friday.

His attorney, John Henry Browne, said late Monday that Sgt. Bales remembers very little about the night during which he is accused of killing the villagers and burning some corpses.

Combat stress

Sgt. Bales, of Lake Tapps, Wash., had gone on three, yearlong deployments to Iraq, encountering heavy fighting and witnessing death and destruction.

His experience and those of thousands of his colleagues are common in what has become not only the longest war but also the unkindest for troops, in terms of rest time in theater.

Fighting insurgents and terrorists in Afghanistan and Iraq has been a nearly nonstop exercise in patrols, raids and firefights with no real battle lines. Even at a forward operating base, soldiers can be hit by a rocket, a suicide bomber or an Afghan who turns and starts shooting Americans.

The Army report, "Generating Health and Discipline In the Force," notes that the average infantryman in World War II in the South Pacific experienced a total 40 days of combat during the entire war.

"In contrast, the [operational tempo] in Iraq and Afghanistan over the past decade has remained persistently high, providing very few opportunities for individuals to rest, either physically or mentally," the report says.

Among the professionals taking note of the Army's "epidemic" of post-traumatic stress disorder are the lawyers who end up defending soldiers who commit irrational acts.

Take the case of ArmySgt. Joseph Bozicevich.

On his second tour of combat in Iraq, Bozicevich turned his gun on his squad leader and another sergeant, killing them both at a base south of Baghdad in 2008.

Prosecutors argued that he snapped when the two sergeants criticized his performance, and a military jury last year convicted him of two counts of premeditated murder.

His attorney, Charles Gittins, cited a PTSD diagnosis in arguing that his client should be spared the death penalty. The jury sentenced him to life in prison.

"The stress of the combat environment and witnessing death and destruction on a daily basis can be psychologically damaging," Mr. Gittins told The Washington Times.

"When war fighters make repeated deployments, the chances of incurring serious psychiatric symptoms skyrockets and is reflected in the thousands of cases of PTSD diagnosed both in the military and by the [Department of Veterans Affairs] among the veterans of Iraq and Afghanistan."

Neal Puckett, another prominent military defense lawyer, said: "It's been my experience in representing Marines and soldiers since the war began in late 2001 that frequent and extended deployments can wear down an individual's patience and tolerance for boredom as well as for danger."

"I believe that veterans of three, four and even five deployments are markedly different than the people they were before their first tour," Mr. Puckett said. "The services have been concerned about this for several years, but I believe they have failed to effectively deal with it."

Distrust all around

In Sgt. Bales' case, military officials have said he was drinking alcohol before the rampage, and records show he owes $1.5 million in a decade-old arbitration ruling that found him guilty of securities fraud.

Mr. Browne, the attorney who met Sgt. Bales for the first time Monday, said his client gave a powerfully moving account of what it is like to be on the ground in Afghanistan.

"You read about it. I read about it. But it's totally different when you hear about it from somebody who's been there," Mr. Browne told the Associated Press. "It's just really emotional."

Last year, a behavioral scientist attached to the U.S. command in Kabul issued a report, "A Crisis of Trust and Cultural Incompatibility." Author Jeffrey Bordin culled the findings of both American and Afghan focus groups to conclude that each side distrusts the other.

One soldier said of Afghan security forces: "We are always sensitive to their religious practices, but if there's a work project that needs to be done, you can count on it also being their prayer time."

A previous study of Afghan civilians in eastern portion of the country near the Pakistani border revealed a "widespread level of extremist religious thought," including a belief that suicide bombers are martyrs.

The report said one reason often cited by Afghan civilians for siding with insurgents over government troops is "the latter's propensity to seize their little boys at checkpoints and sexually assault them."

Mr. Bordin also uncovered deep distrust of Afghan civilians. American soldiers, he wrote, "were repulsed by the abuse and neglect they observed in how children are treated in Afghan society. U.S. soldiers largely reported that they did not care for Afghan civilians due to these factors as well as their suspected sympathies for the insurgents."

The command authorized Mr. Bordin's field study after six U.S. soldiers were killed by an Afghan insider in what the study later said was "one of the worse mass-murder incidents ever suffered by U.S. military forces."

Seven U.S. service members were killed by Afghan security personnel during last month's protest of American soldiers burning Korans that detainees had used to pass messages.

Before the Army completed its landmark "Generating Health and Discipline" research, it conducted a so-called "red book" assessment because of the high number of suicides and PTSD cases.

The Army said the red book "discovered a growing high-risk population of soldiers engaging in criminal and high-risk behavior with increasingly more severe outcomes including violent crime, suicide attempts and suicide, and accidental death."

Last year, 280,000 soldiers sought help from behavior health practitioners, the Army says.

© Copyright 2012 Washington Times. All rights reserved.

[buglerbilly]

For Military Psych Boards, There Is (Almost) No Insanity Defense

By Katie Drummond Email Author April 5, 2012 | 6:30 am


Before he's tried for the alleged murder of 17 Afghan civilians, Staff Sergeant Robert Bales will undergo a sanity board hearing to evaluate his mental health. Photo: DVIDS

Before he sets foot in a military courtroom to be tried on 17 counts of premeditated murder, Staff Sergeant Robert Bales will face a different kind of judgment. Called a sanity board hearing, it’s meant to decide whether Bales is mentally fit to stand before a jury, as well as what role (if any) his mental health played in his alleged massacre of Afghan civilians.

It happens before the trial. But it might be just as complex, and controversial, as the courtroom proceedings themselves.

Bales’ lawyer, John Henry Browne, announced late last week that U.S. Army prosecutors were moving ahead with a sanity board hearing. The process, exclusive to military legal cases, is designed to accomplish two things. One, determine whether a defendant is mentally sound enough to understand the charges against him, and participate in his own defense. Two, evaluate the accused’s mental health during the months, days and minutes preceding the alleged crimes.

So what will Bales’ sanity board look like? According to experts who’ve participated in sanity boards, and lawyers whose clients have undergone them, Bales will be subjected to a range of psychiatric tests and interviews, designed to examine every aspect of his psyche. Furthermore, he’ll face an incredibly high bar: A sanity board finds fewer than 1 in 100 defendants unfit to stand trial, and fewer than 1 in 200 not responsible for their actions by reason of mental defect. A court-martial jury agrees with even fewer of those diagnoses — convicting defendants who’ve essentially been deemed insane (at least at the time of their alleged crimes) by sanity boards.

The bar for insanity is so high, in fact, that some legal experts expressed concerns to Danger Room that mentally ill suspects “are slipping through the cracks” of the military’s justice system. More specifically, they cite a tendency for sanity boards to convene before an adequate investigation of the alleged crimes has been completed — and rush through hearings without examining all of the evidence. Largely, these experts speculate, the intent is to minimize focus on the failings of the military’s mental health system.

The alleged actions of Staff Sergeant Bales strike many as inexplicable, irrational, and, maybe, downright crazy. His sanity board, odds suggest, will conclude something different. And assuming Bales’ lawyer is plotting to play the mental health card to keep him off death row, the track record of the military’s sanity boards is very bad news for both of them.


PFC England, photographed here with guards and her defense team, was found fit to stand trial for torture and abuse at Abu Ghraib in 2003. Photo: Spc. L. B. Edgar/US Army

Depressed, Anxious, Childlike … and Still Fit for Trial

As a child, PFC Lynndie England suffered years of physical abuse. She was diagnosed with mutism — an anxiety disorder wherein patients don’t speak aloud in public – as well as post-traumatic stress from those years of torment. As an adult, PFC England endured a long struggle with clinical depression.

In 2003, after she was accused of torture and prisoner abuse at Abu Ghraib prison, England underwent a sanity board hearing. She was found fit for trial, without any mental defects that may have mitigated her responsibilities for the Abu Ghraib atrocities. A psychologist working for the defense team, however, described England as “childlike” and said she’d been “thinking about suicide” when the crimes were committed.

Similar circumstances surround the cases of former Sgt. Hasan Akbar, already on death row for killing two fellow officers during the U.S. invasion of Iraq, as well as Maj. Nidal Hasan, facing the death penalty for fatally shooting 13 people at Fort Hood in 2009. Both underwent sanity board hearings, and were found fit to stand trial.

All three are paradigmatic examples of just how rigid a sanity board’s requirements for insanity often are.

‘Marital problems don’t make somebody go out and kill 17 people.’

The boards are comprised of military personnel with expertise in psychology, psychiatry and neurology. Usually, a board consists of three people, at least one of whom is a forensic psychiatrist. The board can administer a battery of psychiatric tests. They can complete hours of interviews with the suspect over three different days. They sometimes review sworn statements from other people, along with a suspect’s medical, criminal and service records.

The tests that a defendant undergoes will depend on the situation. But Capt. (ret) Dr. Thomas Grieger, a forensic psychiatrist who has consulted on more than 80 court martial cases, offers a few common examples. Among them is a psychopathy test, like the Hare Psychopathy Checklist. A list of 20 characteristics and traits, like glib, superficial charm, shallow affect, and lack of remorse, encompass the test, which is completed by a psychiatrist after interviewing the patient.

Then there’s a neurocognitive assessment, most often RBANS (Repeatable Battery for Assessment of Neuropsychological Status). This one is a pen-and-paper test that asks a patient to remember lists of words, redraw geometrical figures and name pictures of objects, among other simple tasks. It’s used to diagnose problems like traumatic brain injury (TBI), which Bales is alleged to have suffered and which prior research has linked to violent behavior.

Clinicians can also administer the Wisconsin card sort, a matching game widely used to diagnose schizophrenia and assess a patient’s executive function. A patient receives a stack of cards, and is asked to sort them according to certain metrics, like number, design or quantity. Clinicians continue to change the sorting rules, in an effort to determine whether patients can effectively re-learn instructions.

That battery of tests is designed to boost the objectivity of the sanity board’s findings. But Dr. Grieger concedes that the board’s rulings inevitably depend on the opinions of its members.

“Even though these are ‘objective’ tests, they are still subject to the interpretation of different examiners,” he acknowledges.

The rest of the sanity board hearing depends even more on the interpretations of those examiners. They’ll often review sworn statements from witnesses who recount the days preceding the alleged crime, and individuals observing the suspect in detention. “We’d want to know if the suspect was acting out of the norm, if [factors like] their hygiene and social behavior were striking people as unusual,” Dr. Grieger says.

The board can also look at the suspect’s medical, criminal and service records. For Bales, those records leave a mixed impression: He’s several times been accused of violent behavior, including one charge of misdemeanor criminal assault. But Bales is also a highly commended service-member, having received several honors during his three tours.

More interesting than what is evaluated during a sanity board, however, might be what’s not — especially where Bales is concerned. A sanity board typically doesn’t investigate a suspect’s personal life, including their relationships or their financial records. Sworn statements from family members, like wives and kids, are rarely included in a board’s review. So while plenty of media coverage and even military statements have emphasized Bales’ marital woes and financial boondoggles, those issues won’t factor into evaluating his mental fitness.

“Marital problems,” Dr. Grieger says, “don’t make somebody go out and kill 17 people.”


Members of a sanity board aren't only looking to spot mental illnesses. They're looking to spot defendants pretending to have those illnesses. Photo: U.S. Military Commissions

Spot the Lies

While they weigh a bevy of evidence, the board is also tasked with another overarching goal: Figuring out whether or not a defendant is lying about their psychiatric symptoms.

“You need to be very suspicious of the defendant,” Dr. Grieger says, adding that in his three decades of experience, he’s never run across a single defendant trying to fake a psychiatric problem. “It’s in their best interest to have that insanity diagnosis.”

On that last part, at least, most can agree. If Bales, or any other military defendant undergoing court martial, is found unfit to stand trial, he’ll be granted a reprieve that’s at least four months long. During that time, a defendant is sequestered to a psychiatric hospital in an effort to restore mental health.

Or, if a sanity board concludes that the defendant suffered mental ailments at the time of the alleged crime, the findings will bolster a defense team’s efforts at achieving a reduced sentence — years in prison rather than the death penalty, for example.

For those very reasons, some of a board’s interviews with the defendant are focused on parsing truth from lies. Most sanity boards start by asking a defendant to back-track several weeks before the event in question. “How had they been sleeping, what kinds of combat experiences had they had, did they take medication?” Dr. Grieger says.

After that, the board zeroes in — asking the defendant to take them, minute by minute, through the 24 hours preceding the alleged crime. “Where did they go, who did they talk to, even what did they eat,” Dr. Grieger says. “The idea is to look for inconsistencies, between what they say and what other witnesses have said.”

Sanity boards even have a test to offer lie-detection back-up. The SIRS (Structured Interview of Reported Symptoms) is an interview that’s designed to catch inconsistencies, fabricated symptoms or exaggerations. For example, 85 percent of patients who experience genuine auditory hallucinations endure two kinds: Those that command them to do something, and those that don’t. Someone who “alleges an isolated command hallucination” as the cause for their crime, therefore, should be “viewed with suspicion,” according to a 2005 report from the Journal of Family Practice.

The intent behind those in-depth interviews and exams is two-fold. If a defendant has bizarre recollections surrounding their alleged crimes, or recollections that differ starkly from those of other witness, experts would evaluate whether those lapses indicated a mental defect — like an acute psychotic episode, for example. But the board members are also trying to catch downright mistruths.

“Maybe they’ll say, ‘I had symptom X and symptom Y’,” Dr. Grieger says. “But if four other people don’t recall anything out of the ordinary, then you need to seriously question the legitimacy of that defendant’s testimony.”


Assuming he's found fit to stand trial, Bales will stand before a jury of his military peers. Photo: U.S. Air Force

What It Takes to Be Insane

It’s unusual that a sanity board will decide that a defendant isn’t responsible for their crimes because of a mental defect. Getting a court martial jury to agree with that assessment of insanity? Even more unusual.

PFC David Lawrence is one example. In 2010, he was accused of murdering a senior Taliban commander who’d recently been captured by U.S. forces. Upon examination by a sanity board, it was evident that Lawrence had recently been experiencing severe mental health problems. One week before the shooting, he’d spent five days at a combat stress clinic, citing “mental anguish.” He was subsequently prescribed two psychotropic medications and returned to duty.

The board concluded that PFC Lawrence suffered from schizophrenia and PTSD, and, therefore, “was unable to appreciate the nature and quality or wrongfulness of his conduct at the time of the alleged criminal misconduct.”

Military prosecutors still tried PFC Lawrence for premeditated murder, and he’s now serving a 10-year prison sentence. “My concern is that they…put him in prison, where he won’t get the treatment he needs,” Brett Lawrence, the defendant’s father, told the Colorado Springs Gazette.

Indeed, a court martial jury tends to hold defendants to an even higher threshold for insanity than a sanity board itself. That’s somewhat surprising, because according to Dr. Grieger, the sanity board bases their assessment on the following “very tight standard.”

“It comes down to whether you knew that killing people is wrong,” he says. “Not just the particular people you killed. Not just those 17 Afghans. You really have to have not known what you were doing, at all.”

In Bales’ situation, assuming no pertinent information about his prior mental health emerges, such a scenario seems unlikely. Both of the ailments thus far linked to Bales by his lawyer — PTSD and TBI — are irrelevant to sanity board panelists. “Typically, [those illnesses] wouldn’t render someone incompetent or insane,” Dr. Grieger says. “They really wouldn’t factor in for the panel.”

Rather, “even if did have psychiatric illness at the time of the killings,” the Staff Sergeant still probably understood that “if you load an M4, point it at a person, and pull the trigger, that person has a good chance of dying,” Dr. Grieger says. Such an understanding might be enough to send Bales to death row.


Maj. Nidal Hasan, pictured here, has been found fit to stand trial by a military sanity board. His trial is expected to start in June. Photo: Wikipedia

[B]‘People Do Fall Through the Cracks’

According to some experts, though, sanity boards are hardly as rigorous as they ought to be, and — especially in high-profile cases — are often rushed processes that rely on inadequate information. Largely, the experts allege, that’s because military brass want to minimize the focus on their own failings where mental health is concerned.

“They don’t want it to emerge that a defendant had undetected mental health problems,” says Col. (Ret.) John Galligan, the defense attorney for Maj. Nidal Hasan. “The military doesn’t want their mental health community, or their failings, to be under the microscope.”

‘The military doesn’t want their mental health community, or their failings, to be under the microscope.’
Col. Galligan says that Maj. Hasan, himself a former Army psychiatrist, is a paradigmatic example of a sanity board’s failings. “With Hasan, we asked that his sanity board not be composed of military personnel,” Galligan says. “There was an undeniable bias, where sanity board members would want to take the focus away from any problems inside the military’s psychiatric community. Of course. That was their own community.”

Galligan’s request was denied. Maj. Hasan was last year evaluated by a panel of military experts, and found sane and fit to stand trial.

Where Bales is concerned, Galligan expressed concern that the sanity board might be moving ahead too quickly — before an adequate number of sworn statements and testimony can be collected. “Before a board can make a full determination, they should have access to a full investigation,” he says. “There’s no way they already have all the data they need.”

Dr. Amador, agrees. In addition to serving as the psychiatrist for PFC England’s defense team, he’s worked with the lawyers representing Maj. Hasan and Zacarias Moussaoui, the so-called “20th hijacker” from Sept. 11th. He says he’s noticed a troubling trend among sanity boards. “They take a snapshot of a defendant,” he says. “They should be taking a video.”

Amador often spends years evaluating a client — two years for PVT England, more than three for Maj. Hasan. Sanity boards, of course, can’t devote that much time to each case. But Amador worries that “people fall through the cracks” when a sanity board spends merely a few days trying to make a psychiatric diagnosis.

“Sanity boards can only detect the grossest, most obvious mental illnesses, where someone can’t even fake normal,” he says. “The standard of evaluation is incredibly low, but the bar for insanity is extremely high.”

According to Dr. Grieger, however, detecting the grossest of mental illness is precisely the sanity board’s job — because anything less wouldn’t change a defendant’s culpability.

“The goal is to determine if a serious psychiatric condition was present at the time of the alleged incident,” he says. “It is not to ascertain the facts of the events.”

[buglerbilly]

Walter Pincus, Fine Print

GAO report offers a window into the lives of wounded warriors

By Walter Pincus, Friday, April 6, 12:09 AM

The dark effects of 10 years of warfare on injured fighters — drugs, anger, fear, frustration — are on display in a report on the Marine Wounded Warrior Battalion at Camp Lejeune, N.C., released by the Government Accountability Office.

The document, released last Friday, is a reminder of how far away the suffering of these men and women and their families is from the consciousness ofmost Americans.

As the report notes, however, some Americans are even willing to take advantage of those who have sacrificed and suffered in the name of defending the homeland. The culprits range from illegal-drug dealers to some so-called charitable groups that, as the report politely put it, “sometimes do not have the best interests of Warriors at heart.” The report mentioned that a few unnamed agencies “had expressed disappointment that TBI [traumatic brain injury] patients did not ‘look the part.’ ”

Many times, “visiting non-military organizations wanted to see a ‘poster child’ of a wounded Marine and they would offer donations for the selected personnel and not the unit as a whole,” the battalion chaplain told the GAO.

Some organizations would call in “looking for ‘visibly wounded’ Marines (burn victims, amputees) to participate in their events.” Some Marines complained to the GAO about “the ‘petting zoo’ environment created when certain non-profit agencies came to visit.”

The worst offenders simply had to be kept out of the barracks, according to the report. The Lejeune unit had to institute a screening process to guard against the exploitation of wounded Marines.

The Marine Wounded Warrior program began in April 2007, after the Walter Reed Army Medical Center neglect scandal. It was meant to coordinate medical and non-medical care for ailing and injured Marines, combat-wounded or not, and their families. The goal was to help get the service personnel back to active duty or help them make the transition to civilian life.

With a regimental headquarters set up at Quantico, Va., two Marine Wounded Warrior Battalions were established, one at Camp Lejeune in North Carolina and the other at Camp Pendleton in California. Overall, the program has aided some 27,377 Marines.

At the time of the GAO visit in September 2010, there were 194 Marines in the Camp Lejeune Wounded Warrior Battalion, many suffering from post-traumatic stress disorder (PTSD), TBI or spinal cord injuries. Of the group, 130 were wounded in the theater of operations. Serious problems, such as TBI and PTSD, were handled at the Naval Hospital Camp Lejeune and through the Tricare network locally.

A support team was established for each wounded Marine. The team included a non-commissioned officer as a section leader, a civilian medical case manager, a military or civilian primary-care manager, and a civilian recovery care coordinator who acted as the primary point of contact.

Overall, the GAO found that the management and staff at the battalion and Naval Hospital at Camp Lejeune “were fully dedicated to providing the best available care and services.”

But they faced “significant challenges.”

Misuse or abuse of prescription medications, sedatives, painkillers and illegal drugs was a big problem. Most of the battalion’s Marines “were on serious medications” and many were “predisposed” to addictions, according to the battalion’s senior officer. There was no real control of medication distributed by military and civilian providers, so combating drug abuse became a top priority. That included establishing regular and surprise drug screenings.

There was a sense that the rules on drug abuse were more lenient for combat-wounded Marines and Purple Heart recipients than for others, which set a “bad tone” within the barracks. One Warrior told the GAO that he thought nothing was done to those caught with drugs “because no one wanted to be the guy that kicked out a Marine for drugs.”

To mitigate the problem, video cameras were installed in the barracks to deter thefts of prescription medication and illegal drugs. More recently, a new policy has established “proper medication accountability of each Marine,” according to a December 2011 letter to the GAO from the battalion commander.

Keeping people busy between medical appointments was difficult. Making various programs mandatory — internships, reconditioning programs and other structured activities — left some Warriors feeling “they were being ‘messed with,’ which created some anxiety,” according to one person interviewed by the GAO.

Another issue for the wounded Marines was the amount of time spent waiting for decisions about their futures. The disability evaluation system involves a medical evaluation board, a physical evaluation board, disability determinations, an appeals process and a final disposition. The process can take as long as two years. Just the medical evaluation process for a wounded Marine at Lejeune was taking 245 days, the GAO said. On a broader basis, it found that for 22 percent of Wounded Warrior Marines, final decisions still were not final three years after their original injury.

Of 696 Marines who passed through the Camp Lejeune battalion between April 2007 and September 2010, only 36 returned to active duty. Another 324 were discharged to civilian life; six died; three were forced out of the service; eight reservists returned to their units, and two reservists were discharged.

Believe it or not, 317 were still in transition.

Those numbers give life to a quote from one Warrior: “Everyone seems so depressed, angry and stressed, and they just want to get out of here.”

Remember: This is just a small part of what has happened to the 1 million service personnel sent to war over the past decade.

[buglerbilly]

Darpa to Troubled Soldiers: Meet Your New Simulated Therapist

By Katie Drummond Email Author April 20, 2012 | 6:30 am



Uploaded by AlbertSkipRizzo on Feb 10, 2012
This video provides a short description of the SimCoach project. An online intelligent virtual human agent designed to break down barriers to care in Service Members, Veterans and their Significant others.

The Pentagon hasn’t made much progress in solving the PTSD crisis plaguing this generation of soldiers. Now it’s adding new staff members to the therapy teams tasked with spotting the signs of emotional pain and providing therapy to the beleaguered. Only this isn’t a typical hiring boost. The new therapists, Danger Room has learned, will be computer-generated “virtual humans” programmed to appear empathetic.

It’s the latest in a long series of efforts to assuage soaring rates of depression, anxiety and PTSD that afflict today’s troops. Military brass have become increasingly willing to try just about anything, from yoga and reiki to memory-adjustment pills, that holds an iota of promise. They’ve even funded computerized therapy before: In 2010, for example, the military launched an effort to create an online health portal that’d include video chats with therapists.

But this project, funded by Darpa, the Pentagon’s far-out research arm, is way more ambitious. Darpa’s research teams are hoping to combine 3-D rendered simulated therapists — think Sims characters mixed with ELIZA — with sensitive analysis software that can actually detect psychological symptoms “by analyzing facial expressions, body gestures and speech,” Dr. Albert Rizzo, the lead researcher behind the project, tells Danger Room.

For now, the system, called SIM Sensei, is being designed for use at military medical clinics. A soldier could walk into the clinic, enter a private kiosk, and log on to a computer where his or her personal simulated therapist — yes, you can pick from an array of different animated docs — would be waiting. Using Kinect-like hardware for motion sensing, a microphone and a webcam, the computer’s software would take note of how a patient moved and how they spoke. The video above offers a demonstration of what a SIM Sensei would look like, and how they’d interact with a patient.

SIM Sensei won’t replace human clinicians. Instead, it’ll supplement them, and help military clinics prioritize which patients need care most acutely, and which can wait to see a flesh-and-blood doctor. If a soldier talking to the SIM exhibits minor symptoms, the Sensei might help him or her schedule an appointment to see a human therapist in two weeks’ time. But if the Sensei detects “red flags” in an individual’s behavior — vocal patterns that signal depression, for example — the SIM could schedule that patient to see a doctor immediately.

“Let’s say you have a more serious case, where it becomes evident to the Sensei that a patient is exhibiting major depression or might be a suicide risk,” Dr. Rizzo tells Danger Room. “The computer could immediately call for a human doctor to come take over.”

The initiative is a collaborative effort between the University of Southern California’s Institute for Creative Technologies (ICT) and Cogito Health, a spin-off company developed by MIT researchers. It’s also the next phase of an ongoing Pentagon-funded project, called SIM Coach, that’s designed for soldiers to use within the privacy of their own homes but doesn’t incorporate any analysis of a soldier’s body language or vocal tone.

ICT has deep experience with virtual therapy. Under Rizzo’s leadership, the institute was the first to develop immersive programs that allowed patients afflicted with PTSD to revisit combat scenarios. The programs have been widely lauded, and are now used by more than 60 military medical clinics across the country.

Cogito’s role, on the other hand, raises something of a red flag. The company was developed out of the lab of MIT scientist Alex Pentland. He’s the number-cruncher whose “reality mining” spurred Darpa to throw millions into a dubious program to mine social data and then yield conclusions about U.S. progress in Afghanistan, known as Nexus 7. The initiative, as Danger Room reported exclusively last year, has been something of a disaster.

Cogito is also grounded in data mining. But the company’s aim is to evaluate a single person’s well-being, rather than an entire community’s. The company will incorporate its bespoke software suite, called “Honest Signals,” into the new Darpa program. It “assesses cues in an individual’s natural speech and social behavior” to spot potential mental health problems, according to a statement that Cogito e-mailed to Danger Room. The company declined to offer studies on the efficacy of “Honest Signals,” but did point to a book — co-written by Pentland — on that very subject.

Rizzo acknowledges that pulling accurate data out of an individual’s face, voice and other such metrics remains a remarkable challenge. “We’ve got some heavy lifting ahead of us,” he says. But he’s also extremely confident that Pentland and Cogito are well equipped with data that can turn SIM Sensei into a success. “These guys are bright as hell,” he says. “They’re pioneers in the field, and they’ve got an amazing capacity to detect the smallest problems that pop up in someone’s behavior.”

That said, the SIM Sensei idea is also bogged down by another downside. Computer-based therapy, in comparison to face-to-face treatment, is inevitably impersonal.

Studies on the efficacy of telemedicine (therapy via video chat with a human therapist), where PTSD or depression are concerned, have been mixed. But in an interview with PBS published last year, Stars and Stripes reporter Megan McCloskey summed up the shortcomings of such therapy for mental health conditions. “Many of those who need more intensive counseling … don’t like the impersonal nature of talking to a TV screen,” she says. “For some, telemedicine doesn’t meet their needs and adds to their sense of isolation.”

Cyber therapy would be even more vicarious. Soldiers will talk to a videogame character, rather than a real person, through their computer screen.

But a robust virtual option would give soldiers, many of whom still shy away from face-to-face mental health treatment, the option to seek solace in a more anonymous alternative. Eventually, Rizzo and his colleagues hope to see SIM Sensei available for soldiers within the comforts of their own home, rather than a military clinic.

“A lot of people still don’t want to stop by the clinic and meet with a real person,” he says. “Technology is ripe for us to leverage. I’m extremely confident that we can use it, leverage it, to help people who otherwise wouldn’t get better.”

[buglerbilly]

Defence failed Diggers

Dylan Welch, Liz Hannan

April 21, 2012


"Some members are falling through the gaps and not receiving the support they are entitled to [and] require" ... a review.

It's a problem for all Nations involved in both Iraq and Afghanistan. The best we can do is learn and not repeat the same bloody mistakes we may have made as far back as Nam and even further............

AUSTRALIA'S Defence hierarchy spent almost a decade failing veterans severely wounded in Iraq, Afghanistan and other hot spots around the globe, with a new document revealing scores of wounded Diggers ''falling through the gaps''.

The 280-page review of the Support for Injured or Ill Project, conducted from August to December 2010, will be publicly released by the Defence and Veterans' Affairs departments on Monday after a freedom of information application by the Herald.

The review found that while Defence had been good at providing immediate and trauma medical care to wounded, injured and ill members, there had been serious inadequacies in the processes of rehabilitation, compensation and, in many cases, transition to civilian life.

By late 2010, many of the 200 soldiers and sailors wounded in Afghanistan alone were, at times, being in effect abandoned because of a mire of bureaucratic and institutional failings. The number of wounded in action from the decade-long war is now 219, with 32 dead. The toll from the six-year engagement in Iraq is three dead and 27 wounded in action.

''Some members are falling through the gaps and not receiving the support they are entitled to [and] require,'' the review states. It found that the families of some wounded Diggers had, in effect, been locked out of the process, despite the fact that they were often bearing the brunt of the physical and emotional after-effects of the soldier's wounds.

A lack of communication between Defence and Veterans' Affairs, which manages issues of compensation and support after a Digger has left the services, was also a problem.

''To achieve sustained improvement … these initiatives firstly require organisational commitment to and implementation of more systemic change within Defence and transformational change to a new partnership and understanding between Defence and DVA,'' the review states.

The review made 31 recommendations. Among them were the complete overhaul of: inadequate information technology systems that failed to record case management effectively; the Defence review board, which decides whether a soldier should be retired; and the glacially slow claims processing system.

Last year a former Special Air Service soldier, Anthony Oliver, went public with his disillusionment after suffering spinal injuries in the Black Hawk crash off Fiji in 2006. While the army paid for all his medical treatment, Mr Oliver was troubled by the personnel who dealt with his discharge and compensation. ''The organisation is structured to deal with World War II veterans and hasn't evolved,'' he was reported as saying at the time.

Since the 2010 SIIP review, Defence has begun a complete overhaul of processes and created more streamlined systems and enhanced co-operation between it and Veterans' Affairs.

The Chief of Army, Lieutenant-General David Morrison - whose three-year term ends in 2014 - will stake his legacy on continuing to improve the rehabilitation of wounded soldiers and the rate at which they return to duty. In an interview with the Herald, he conceded the army was ''relearning the lessons that were part and parcel of Australia's last major conflict, the Vietnam War'', especially because of the complex rehabilitation needs of soldiers maimed by the increased use of improvised explosive devices.

The existing practices for the care, recovery, rehabilitation and transition back into work - military or civilian - were ''not perfect'', he said.

Read more: http://www.smh.com.au/national/defence-failed-diggers-20120420-1xcfs.html#ixzz1sdLvZ8sY

[buglerbilly]

Baptism of fire: I'd never seen a gunshot victim

April 22, 2012


Daily battle ... Captain Anthony Sayce and Captain Antony McNamara in Tarin Kowt, Afghanistan. Photo: Alex Ellinghausen

The long road to recovery for Australia's wounded Diggers in Afghanistan begins in the first minutes and hours. National security correspondent Dylan Welch reports from Tarin Kowt on the medics who serve on the front line.

Captain Anthony Sayce is on the front line of the nation's medical mission in Afghanistan. He has seen the horrors of war - but last month it became personal.

On March 23, as he went about his duties in the coalition's medical facility in Tarin Kowt, the Australian army doctor reflected on the fact that he had yet to treat one of his countrymen.

''It's certainly something that I've thought about, I hope that it doesn't happen,'' Captain Sayce said then.

Three days later, that hope was dashed when a teenager detonated a suicide bomb next to a reconstruction patrol of Australians and Americans. AusAID staffer David Savage was critically injured.

Within an hour of the blast, Mr Savage was wheeled into one of the resuscitation bays at Tarin Kowt, where he was given life-saving treatment. And while he was the first Australian of the year, it is almost certain he will not be the last.

Captain Sayce has been working in the medical facility in the Tarin Kowt military base for the past two months in Afghanistan's Oruzgan province, where Australian troops have been fighting since 2006.

When The Sun-Herald spoke to him, he had seen two local men die on the operating table and treated 17 critically injured Afghan soldiers and police officers. With little fighting through the long, cold Afghan winter, it was the calm before the storm. The snow now melted, the spring fighting season has begun.

Yesterday, The Sydney Morning Herald revealed there had been serious inadequacies in the level of rehabilitation and compensation for severely wounded veterans over the past decade. A review of veteran support, obtained after a freedom-of-information request, found some were ''falling through the gaps'' and not getting the support they are entitled to.

But it found Defence had done a good job of providing immediate and trauma care for the wounded.

Captain Sayce's colleague, Captain Antony McNamara, tells of his introduction to the realities of trauma work in Afghanistan was a local five-year-old girl. She was the same age and size as his daughter.

''It was an IED blast to a civilian vehicle,'' he recalls. ''It was a family. There was a couple of kids, some grandparents [who survived] as well as an uncle or an aunt deceased onsite.''

The girl, while suffering fragmentation wounds, was not seriously injured. But this was the first truly confronting moment for Captain McNamara since his tour began.

Both men are doing their jobs in the most difficult of environments. From sub-zero temperatures in the winter to plus 50-degree days in summer - and the ever-present dust - Captain McNamara and his team battle each day against a steady tide of horrific war wounds.

And for Captain Sayce: ''I had never seen a real gunshot wound until I got here. Because they're not all that common in Australia. To actually see it first-hand is certainly an eye opener.''

Despite a long career in emergency medicine and years of training, he found the first few patients confronting. ''The only correlation I can draw is with motor vehicle accidents I saw back in Australia. It's just a completely different pattern of injury.''

The main role of the military medical staff at the Tarin Kowt Role 2 facility - NATO ranks medical facilities from 1 to 4 in order of quality of care - is to stabilise patients for ''cas-evac'' to the Role 3 facility in Kandahar, a 30-minute helicopter flight south. The most badly wounded go on to the American Role 4 facility in Landstuhl, Germany.

''The NATO system is essentially built utilising air assets,'' explains Tarin Kowt's chief surgeon, US Navy Commander Forest Sheppard. ''You have this linear line and with concentrated medical assets like nodes along the pipeline. And we really are the first surgical node.''

Before reaching Tarin Kowt, every wounded Australian soldier will have received potentially life-saving care, or care under fire, explains the Australian army medical platoon commander, Lieutenant Clint Grose. ''That care under fire is paramount [for] saving life. If it's done properly - bleeding's stopped and air is flowing - if those things are done properly on the battlefield it gives the casualty a good chance down the track.''

Australian wounded are brought to Tarin Kowt, where they are guaranteed an Australian doctor.

''If it's an Australia casualty we'll come any time, day or night, to resuscitate. For our casualties, the members out there, it's so they see a familiar face,'' Lieutenant Grose says.

That said, staff at the Tarin Kowt Role 2 facility do not exercise exclusivity but treat everyone wounded in the province - from wounded International Security Assistance Force soldiers, the Afghan National Security Forces, local civilians and even wounded Taliban fighters brought back from the battlefield.

''It can be difficult, especially where you [are] taking care of good people and bad people and you don't always know the difference,'' says a US Navy casualty doctor, Lieutenant Commander Jeff Ricks, who works at the Role 3 medical facility in Kandahar.

''But I like to think of my job as the best job, because I'm always right. I don't really care if they're good or bad, I don't sort people by good or bad, I sort people by who's in more need of treatment.''

Like many Americans in Afghanistan, Commander Ricks has also served multiple tours of duty in Iraq and has endured situations that would make even the toughest civilian doctor blanche. His first tour was with the marines in 2004 to 2005 and he was based in Fallujah during the Al-Fajr offensive of November 2004, which was described as the bloodiest single battle during the Iraq War. The coalition toll: 107 soldiers killed and 613 wounded. He worked in a tiny medical facility which amounted to little more than a sick bay.

''The first two days weren't that bad, but on [the third day] we got overwhelmed and we ended up receiving over 20 casualties to our facility. For three days I had over 20 in-patients ranging from eye injuries to one guy who was shot in the head. He was fine but shot in the head.''

Commander Ricks pauses and considers what he has just said, before laughing wryly: ''I guess 'fine' is a relative concept, hey.''

Read more: http://www.smh.com.au/national/baptism-of-fire-id-never-seen-a-gunshot-victim-20120421-1xeb0.html#ixzz1sj7CyFCD

[JimWH]

Thanks to the announced withdrawal I suspect I'll miss an opportunity to serve in that facility. Damn it.

[buglerbilly]

Army Wants PTSD Clinicians to Stop Screening for Fakers

By Katie Drummond Email Author April 23, 2012 | 3:38 pm


After a spate of controversies over inaccurate PTSD diagnosis techniques, the Army has released new guidelines meant to prevent doctors from screening for "malingerers," who are faking their symptoms. Photo: U.S. Air Force

In a big reversal, the Army has issued a stern new set of guidelines to doctors tasked with diagnosing post-traumatic stress disorder (PTSD) among returning soldiers. Stop spending so much time trying to spot patients who are faking symptoms, the new guidelines instruct. Chances are, they’re actually ailing.

The 17-page document has yet to be made public but was described in some detail by the Seattle Times. In it, the Army Surgeon General’s Office specifically points out — and discredits — a handful of screening tests for PTSD that are widely used by military clinicians to diagnose a condition estimated to afflict at least 200,000 Iraq and Afghanistan veterans.

http://seattletimes.nwsource.com/html/localnews/2018041659_ptsd22m.html

The Army Surgeon General finds great fault with a dense personality test popular with clinicians that ostensibly weeds out “malingerers,” as PTSD fakers are known.

But the results of what’s known as the Minnesota Multiphasic Personality Test are flawed, according to the report. PTSD sufferers often exhibit anxiety, insomnia, flashbacks and depression — all of which, some doctors believe, can be discounted under the test. The test devotes a large swath of questions to catching apparent exaggerations of symptom severity, seemingly inconsistent answers, or reported symptoms that don’t mesh with the typical signs associated with an illness.

“The report rejects the view that a patient’s response to hundreds of written test questions can determine if a soldier is faking symptoms,” the Seattle Times summarized. Where PTSD is concerned, that’s especially true. The condition is accompanied by symptoms that can differ markedly between patients: Some are hyperactive, others are lethargic; some exhibit frenetic rage while others are simply sullen and depressed.

“And,” the Times continued, “[the report] declares that poor test results ‘does not equate to malingering.’”

Those tests were the standard of care at Madigan Army Medical Center — which is a big deal. Located in Tacoma, Washington, Madigan isn’t just one of the military’s largest medical installations. It’s home to a forensic psychiatry team tasked with deciding whether soldiers diagnosed with PTSD were sick enough to qualify for medical retirement. In March, the Army launched an investigation of the Madigan team after Madigan’s screening procedures allegedly reversed 300 of the PTSD diagnoses among soldiers being evaluated.

The reversals resulted in some soldiers being diagnosed with “personality disorders” and others left with no diagnosis at all. Madigan allegedly used the tests to save money by limiting the number of patients who’d qualify for retirement. “We have to ensure we are not just ‘rubber stamping’ a soldier with the diagnosis of PTSD,” reads a memo from an unnamed Madigan psychiatrist that leaked last month. “We have to be good stewards of the tax-payer dollars.”

The Surgeon General’s attempts at strengthening its PTSD diagnostic tactics might come as a relief to veterans. But they might also be more than a little too late. Shortly after the scandal at Madigan emerged, subsequent reports of similar shoddy diagnostics at Walter Reed, Fort Carson and Fort Bragg trickled out as well, including more allegations of soldiers being pinned as malingerers by military docs.

“Leading off, trying to say it’s isolated, doesn’t really pass the common-sense test,” Patrick Bellon, executive director of Veteran’s for Common Sense, told Stars and Stripes earlier this month. “Clearly, something is not right.”

[buglerbilly]

Sources: VA Wastes Millions Treating Medicines as ‘Prosthetics’

April 27, 2012

Military.com|by Bryant Jordan



The Veterans Health Administration wastes millions of dollars each year abusing the law that governs the way it buys biological medicines for wounded veterans, sources tell Military.com. VA officials say they believe they're doing nothing wrong.

At issue are biological medicines, or "biologics," which are made from human bone, tissue and fluids of donated cadavers. They're used in medical procedures ranging from knee surgery and burns to cancer treatment and gene therapy.

By defining such medicines as "prosthetics," sources say, VHA takes advantage of a decades-old law exempting procurement of artificial limbs and devices from all other laws. That means VHA officials can pass over the disabled veteran-owned small businesses that otherwise have priority in getting VA contracts, and even shortchange taxpayers by not bringing in a vendor-paid fee written into federal supply schedule contracts.

Just by failing to competitively bid for the biologics, the Department of Veterans Affairs is overspending anywhere from $40 million to $50 million a year, say the sources. They spoke to Military.com on the condition they not be identified because they worried about reprisals from VA leaders.

"All these ‘prosthetics' charges come out of the [VA's] medical appropriations budget. It's money that could be used for other things," said one of the sources, a former VA contracting officer with more than 20 years' experience. "For every $1,200 you save, you could bring another veteran into the health care system. You could treat another veteran on an outpatient basis."

The second source represents a small company that has sold biologics to the VA, but the source believes it and other smaller operations are frozen out of most business. The VHA is able to do that under a 1959 law that permits non-competitive purchases of prosthetics by any process that VHA decides is proper, "without regard to any other provision of law."

Both sources say that law not only results in higher cost of product, but betrays the VA's obligation and commitment to give priority to small businesses owned by service-disabled veterans.

"By using [U.S. Code] 8123 [the agents] don't need to do market research for Veteran Small Businesses … they don't need to search the VA GSA Advantage website to see if the items they are buying are on federal contract, they don't need to shop for best value or requests discounts," the vendor representative said. "They simply hide behind 8123."

The practice also means greater overhead for VA operations. Contracts made outside the federal acquisition regulations and Veterans Affairs acquisition regulations schedules means the VA does not collect a fee that subsidizes department operations. The "industrial funding fee" -- currently less than 1 percent of the total contract award -- is paid by the vendor and used to defray the costs of VA contracting officials' salaries.

What VA does not collect in fees must come from its annual budget, said the former contracting officer, who estimated that the funding fee today brings about $40 million a year into the VA.

VHA's designation of biologics as prosthetics has already drawn the attention of Congress. The House Veterans Affairs plans to look into it at a hearing scheduled for mid-May, according to a committee staffer.

Some subcommittee staff members, along with senior VA and Defense Department officials, have already clashed with the VHA over the system, Military.com's sources said.

During a meeting this month, VA officials critical of VHA's use of 8123 blasted Philip Matkovsky, VHA's assistant deputy undersecretary for health for administrative operations, for not following the federal employee guides on procurement. Matkovsky reportedly infuriated officials by saying those regulations don't apply because VHA considers biologics to be prosthetics, the procurement of which is exempt from the usual contract schedules.

A VHA spokesman offered no comment on the meeting when contacted by Military.com, but said biologics meet "the very core definition of ‘prosthetic appliance,' since they are used to replace a damaged or missing anatomical part," including, VHA says, tendons and tissue.

VHA referred Military.com to its handbook, which defines prosthetic appliances as "aids, devices, parts or accessories which patients require to replace, support, or substitute for impaired or missing anatomical parts of the body … artificial limbs, terminal devices, stump socks, braces, hearing aids and batteries, cosmetic facial or body restorations, optical devices, manual or motorized wheelchairs, orthopedic shoes, and similar items."

But those are all artificial devices, Military.com's sources say.

"None of the items listed [in the handbook] are biologics … which are not artificial and come from cadaveric donors," the vendor representative said.

That VHA's overpayment for traditional prosthetics was revealed in a VA Inspector General's report that dealt with artificial limbs. It found that the contracting officers were not negotiating with vendors for prices or discounts, and largely left it up to VHA's small army of purchasing agents -- untrained in contract law -- to procure prosthetics with little oversight.

According to the IG, VHA in 2011 spent about $54 million on prosthetic limbs. Weaknesses and lack of oversight resulted in the VHA being overcharged by about $2 million a year, it said, and would face about $8 million more in overcharges in the next four years unless the system were fixed.

According to Military.com's sources, the same procurement pattern exists with biologics, whose procurements are made by the same purchasing agents. They appear use their knowledge of federal purchasing guidelines to stay just outside of limits that would invite further scrutiny.

A 1985 law set $25,000 as the limit for "small purchases" that agencies could make under noncompetitive processes. In some situations the minimum is much higher, but under federal regulations, according to the former contracting officer, any purchase more than $25,000 requires a description of the process used in awarding it, such as the request for quotation or solicitation.

A list of acquisitions obtained by Military.com reveals numerous instances of multiple buys from the same vendor on the same date. In one instance, a VHA buying agent made 18 separate purchases, all for exactly $24,900, and all dated Oct. 1, 2010, from the same vendor for supplies categorized as medical and surgical instruments, equipment, and supplies, according to the listing.

Another group includes 17 purchases, again for the same date and in the same amount, but this one for office furnishings.

With few exceptions, nearly all of the 1,200 purchases on the list -- which came from the New York-New Jersey area -- were for $24,500, $24,800, $24,900 or $24,980. Fewer than 100 were for more than $25,000.

The total expenditures were nearly $28 million, most for medical supplies and services, but also some coded for office furnishings, hardware and more. Fewer than 100 of the 1,000-plus transactions are specifically identified as single-bid contracts.

All others -- whether for medical, dental or office supplies -- indicate they were executed after the agent received exactly 14 offers, a fact that the former contracting officer says should raise suspicion that the entries are rubber stamped. He is also suspicious of the consistency of the contract dollar amounts.

"The fact so many transactions fall into four specific dollar amounts, all rounded in even dollar amount units just below $25,000, raises a flag," he said. "Of special concern is many of these transactions were conducted on the same day, with the same vendor, suggesting for whatever reason [they] were intentionally kept below $25,000."

Also, $25,000 is the purchase cardholder limit on any transaction or contract, he said, and suggested that the multiple, identical orders were fragmented to keep them from going over the threshold of the card and the rules requiring a description of the awarding process.

The source said the Competition in Contracting Act specifically prohibits the dividing up or separating a purchase or contract order to skirt the competitive process.

The VHA reporting agent who compiled the list did not reply to Military.com's calls or emails. According to the former contracting officer, the reporting agent likely is the coordinator for the purchasing agents throughout the relevant area.

"The VHA is a creature of habit and operates in a very complacent environment," the vendor representative said in an email. "Unlike a private hospital, where spending is under heavy scrutiny as every nickel spent must be at best negotiated price to ensure the hospital makes a profit, VA is funded by you and me, sir, and these purchasing agents simply do what's quickest and easiest."

[I]© Copyright 2012 Military.com. All rights reserved.

[buglerbilly]

Via Soldier Systems blog....

Tactical Operations Manikin

April 29th, 2012

As of late, there as been a lot of push back on live tissue training. The Tactical Operations Manikin (T.O.M. Man) from Innovative Tactical Training Solutions may be just the solution.



Published on Apr 18, 2012 by adstactical

ADS and ITTS present Tactical Operations Manikin (T.O.M. Man): a rugged patient care simulator capable of surviving the harsh environment and treatment of tactical trauma training. The T.O.M Man manikin is designed to move like a human and simulates massive bleeding in a combat environment. Features include remote (FOB) control allowing the instructor to add surprise elements, talking, breathing, bleeding, breath sounds include sucking chest wounds, respiratory distress, massive bleeding, needle decompression, tourniquet, wound packing, surgical airway. Breathing is controlled by recovery position for Care Under Fire. Several areas of massive and minor bleeding throughout the main arteries and face are managed via a single controller that provides a number of features to support TAC Med and TCCC training with "live responses".

Contact ADS today for more information:
(866) 845-3012 or http://www.adsinc.com

T.O.M. Man is a rugged patient care simulator capable of repeatedly surviving tactical trauma training and is designed to move like a human and simulates massive bleeding in a combat environment. Features include remote control allowing the instructor to add surprise elements, talking, breathing, bleeding, breath sounds include sucking chest wounds, respiratory distress, massive bleeding, needle decompression, tourniquet, wound packing, surgical airway. Breathing is controlled by recovery position for Care Under Fire. Several areas of massive and minor bleeding throughout the main arteries and face are managed via a single controller that provides a number of features to support TAC Med and TCCC training with “live responses”.



ITTS is an innovative company run by a former USAF PJ. One of the best things about the T.O.M. Man is that it can be customized for your particular needs. In fact, it weighs between 130-150 lbs which goes a long way to mimicking a human’s size and weight which means T.O.M. Man can support a wide variety of training.



ITTS products are available for unit and agency purchase through www.ADSinc.com.

[buglerbilly]

Oxford Docs: We Can Prevent PTSD … With Tetris

By Katie Drummond Email Author May 1, 2012 | 6:30 am


According to a new study out of Oxford, these soldiers might be doing more than just moving on-screen tiles. Photo: U.S. Army

In recent years, the military’s top brass have funded some truly bizarre approaches — from neck injections to Reiki — in an effort to treat symptoms of post-traumatic stress afflicting today’s soldiers. Turns out, they could’ve just equipped troops with Game Boys.

At least according to one research team out of Oxford University, who claim that Tetris — yes, the ubiquitous, tile-stacking videogame of your youth — can actually prevent PTSD-related flashbacks. Those harrowing moments of recall are among the most devastating symptoms of the condition, which is estimated to affect at least 25 percent of soldiers coming home from Iraq and Afghanistan.

In a study presented last week at the British Psychology Society Annual Conference, a team led by Oxford psychiatry expert Dr. Emily Holmes concluded that when played soon after exposure to trauma, Tetris served as “a cognitive vaccine” that seemed to “inoculate against the build-up of flashbacks.” Why? Because the process of playing Tetris, the team hypothesizes, places demands on one’s brain that interfere with its ability to form and retain the traumatic memories that later emerge as flashbacks.

To reach that conclusion, the team exposed 60 study participants to “a film of traumatic scenes of injury and death.” Thirty minutes later, participants were divvied into three groups: A lucky third of the group played Tetris, while their peers either took a 10-minute computerized trivia quiz or “sat quietly” doing nothing much at all. Participants were then freed from the lab, and asked to keep a week-long journal logging any traumatic flashbacks of the film.

According to the researchers, participants who had played Tetris reported significantly fewer flashbacks than their fellow study participants. More specifically, Tetris-players suffered an average of two flashbacks, those given no task suffered an average of 4.5, and those who took a trivia quiz were afflicted with eight flashbacks.

“The insights from these studies support the possibility that … Tetris,” the study reads, “may be a post-trauma intervention to reduce the flashback symptoms of PTSD.”

Not quite. First of all, the “trauma” relied upon by these researchers — according to their study, that “traumatic film” was comprised of car crash and surgery footage — is hardly comparable to what a soldier experiences during combat. And a study pool of 60 people, over a one-week period, falls far short of the kind of thorough research necessary to validate a prospective treatment.

Plus, even if the approach does eventually prove viable among soldiers, it’ll only be useful for those who’ve very recently been exposed to trauma: The study relies on interfering with initial memory formation and storage, which occurs within a span of around six hours following a given experience. Soldiers and vets who’ve been struggling with PTSD for years or even decades, on the other hand, likely won’t enjoy any benefit.

That said, this research — which the team has been conducting since 2009 — does deserve some degree of credit. After all, it’s in a similar vein to cutting-edge neuroscience that’s currently investigating how memories might be tweaked to prevent or treat PTSD. A promising collaboration between researchers at Emory and the University of South California, for example, is testing the merits of virtual-reality exposure therapy combined with the pharmaceutical D-Cycloserine (which is though to enhance the brain’s learning process). Researchers hope the combo will change how a soldier’s brain rewrites traumatic memories, making those memories less frightening.

This Oxford team is, instead, trying to prevent the brain from storing those memories in the first place. And that idea, crazy as it sounds, does have some merit: If during the six-hour period the brain requires to store a memory the storage process is interfered with — especially, research suggests, by a visual-cognitive task (like Tetris) — the brain will be less able to retain a given recollection.

Surely, it’ll require much more research before Tetris becomes a bonafide PTSD deterrent. And a tip for researchers as they plot their next investigation: Tetris is ultra-compatible with another, oft-touted PTSD treatment. Combining them? Just might do the trick.

[buglerbilly]

Tell The Army Where It Hurts: Military Wants ‘Objective’ Pain Diagnosis

By Katie Drummond Email Author May 4, 2012 | 11:00 am


In pain, but can't articulate just how bad it hurts? The military's looking to change that, with the development of new technology to objectively diagnose discomfort. Photo: U.S. Marines

For centuries, doctors have pretty much relied on a universal, and incredibly flawed, technique to diagnose a patient’s pain: “One a scale of 1 to 10, how bad does it hurt?”

Now the Army’s looking to upend that archaic strategy entirely, by developing a system that gives doctors an exact measurement of just how intense a patient’s pain actually is. In their latest call for research proposals, the Army’s Medical Research and Material Command asking for an “Objective Method for Pain Detection/Diagnosis,” that would take a soldier’s own assessment of their discomfort — the current gold-standard of pain evaluation — out of the equation.

Instead, the Army envisions some kind of gadget (a biomarker measurement device or an imaging system are among the ideas they propose) that’d “measure the intensity of pain” to give docs a better idea of how aggressively they ought to treat it.

If such a device could be realized, it’d no doubt come in very handy for doctors trying to get a grasp on what kind of distress a soldier is experiencing. After all, the military’s current standards for pain assessment are much like those in the civilian world — self-reported ratings, along with a patient’s nebulous descriptions of aches, stabs and twinges. Unfortunately, statements like “It hurts really bad,” and “it kind of throbs,” aren’t particularly helpful. Especially given that pain thresholds and perceptions differ markedly between patients. But the system would be even more essential, the Army notes, when soldiers “cannot reasonably ‘self-report’,” because they’re too traumatically injured or too sedated to speak up.

An objective pain detector, of course, would likely be used with marked frequency among soldiers in Iraq and Afghanistan, where acute and chronic pain have become increasingly common, especially among those ravaged by several deployments. One 2009 survey of soldiers evacuated with injuries from Iraq found that 60 percent ranked their pain as “severe.” And with more soldiers than ever surviving initial wounds, more of them are coping with the pain accompanying injuries that used to be fatal.

Soldiers are also, as Army brass have admitted, being overmedicated where pain relief is concerned — a problem that has increasingly led to dependency and even fatal overdoses. In 2009, for example, military docs wrote 3.8 million prescriptions for painkillers, which marked a fourfold increase in those prescriptions compared to 2001. Even worse, 25 percent of soldiers admitted to abusing prescription drugs (mostly painkillers) in an Army survey distributed that same year. So being able to determine whether an injured soldier really needs that morphine, and how much of it, might help Army docs prevent at least some of the troubling issues associated with narcotic painkillers and ailing soldiers.

That said, a device capable of objective pain detection is much, much easier said than done. Researchers have been touting new methods of objective pain diagnosis for decades, including zany methods like thermography (using a scan of body heat to assess pain) and the Emotional Freedom Technique (tapping certain points on the body to spot discomfort). Not surprisingly, none of those approaches have panned out. But more recent work, including a brain-scanning technique developed by Stanford scientists last year and biomarkers being investigated at Massachusetts General Hospital, seem extremely promising. That said, they’re also still in the early stages.

And if none of those prospects work, Danger Room’s got at least one suggestion for another expert in the field. His name is Sting. And he is, undisputedly, the king of pain. (Also: the king of this reporter’s heart.)

http://www.youtube.com/watch?v=0mgSCKXSp9M

[buglerbilly]

Psychiatrists Pondering PTSD in Philadelphia

By Elspeth Cameron Ritchie | May 4, 2012



Next week is the American Psychiatric Association’s annual meeting in Philadelphia, the largest yearly gathering of its kind. It’s exciting because of the prominence military matters are going to get. Last year there were perhaps 15 military-related sessions at the meeting in Hawaii. This year, there’s going to be twice as many dedicated to military mental health issues.

As you might expect, there will be a lot of focus on diagnosing and treating PTSD. But there are also sessions on what it is like to work as a civilian at a military base, personal reflections of psychiatrists who have worked in war zones, research on the long-term effects of combat exposure from the experts at the Rand Corp., and a symposium on complementary and alternative treatments, including acupuncture and the use of therapy dogs (yes, my pet subject).

Retired Army general Peter Chiarelli, who served as the Army’s No. 2 officer until January, will be part of a discussion on whether PTSD should be re-labeled post-traumatic stress injury or just post-traumatic stress. It’s a debate on nomenclature that has been going on for at least 100 years. Remember shell shock, battle fatigue and combat stress reactions?

I know most readers will not be attending. But I wanted to alert folks that the APA is really putting their best foot—or paw– forward on this subject.

The APA is also heavily involved in the White House Joining Forces initiative and the Give an Hour program (links). Their efforts make me proud to be a member.

Full disclosure: I have helped put the military sessions together, but gain nothing financially from it. But I do gain emotionally from knowing that the civilian psychiatrists are engaged in the struggle to take care of our military members and veterans. As I have said many times before, it is not just a military or Veterans Affairs issue, it is a national one.

Read more: http://battleland.blogs.time.com/2012/05/04/psychiatrists-pondering-ptsd-in-philadelphia/#more-73302#ixzz1txHk3KxZ

[buglerbilly]

New name for PTSD could mean less stigma


Alex Wong/GETTY IMAGES - “No 19-year-old kid wants to be told he’s got a disorder,” said Gen. Peter Chiarelli, who until his retirement in February led the Army’s effort to reduce its record suicide rate.

By Greg Jaffe, Sunday, May 6, 7:58 AM

It has been called shell shock, battle fatigue, soldier’s heart and, most recently, post-traumatic stress disorder, or PTSD.

Now, military officers and psychiatrists are embroiled in a heated debate over whether to change the name of a condition as old as combat.

The potential new moniker: post-traumatic stress injury.

Military officers and some psychiatrists say dropping the word “disorder” in favor of “injury” will reduce the stigma that stops troops from seeking treatment. “No 19-year-old kid wants to be told he’s got a disorder,” said Gen. Peter Chiarelli, who until his retirement in February led the Army’s effort to reduce its record suicide rate.

On Monday, a working group of a dozen psychiatrists will hold a public hearing in Philadelphia to debate the name change. The issue is coming to a head because the American Psychiatric Association is updating its bible of mental illnesses, the Diagnostic and Statistical Manual of Mental Disorders, for the first time since 2000.

The relatively straightforward request, which originated with the U.S. Army, has raised new questions over the causes of PTSD, the best way to treat the condition and the barriers that prevent troops from getting help. The change also could have major financial implications for health insurers and federal disability claims.

Chiarelli took on the problems of PTSD and suicide after two tours in Iraq and pressed harder than any other officer to change the way service members view mental-health problems. His efforts, however, have not resulted in a reduction in suicides.

Dropping ‘disorder’

PTSD refers to the intense and potentially crippling symptoms that some people experience after a traumatic event such as combat, a car accident or rape. To Chiarelli and the psychiatrists pressing for a change, the word “injury” suggests that people can heal with treatment. A disorder, meanwhile, implies that something is permanently wrong.

Chiarelli was the first to drop the word “disorder,” referring to the condition as PTS. The new name was adopted by officials at the highest levels of the Pentagon, including Defense Secretary Leon E. Panetta. But PTS never caught on with the medical community because of concerns that insurers and government bureaucrats would not be willing to pay for a condition that wasn’t explicitly labeled a disease, disorder or injury.

Some psychiatrists suggested post-traumatic stress injury as an alternative, and Chiarelli heartily endorsed the idea.

The question for the working group of doctors debating the change is whether the nightmares, mood swings and flashbacks normally associated with PTSD are best described as an injury.

Those in favor of the new name maintain that PTSD is the only mental illness that must be caused by an outside force.

“There is a certain kind of shattering experience that changes the way our memory system works,” said Frank Ochberg, a professor of psychiatry at Michigan State University.

The intensity of the trauma, whether it is a rape, car crash or horrifying combat, is so overwhelming that it alters the physiology of the brain. In this sense, PTSD is more like a bullet wound or a broken leg than a typical mental disorder or disease. “One could have a clean bill of health prior to the trauma, and then afterward, there was a profound difference,” Ochberg wrote in a letter backing Chiarelli’s request for a change.

Psychiatrists who oppose the change argue that PTSD has more in common with bipolar or depressive disorder than a bullet wound.

“The concept of injury usually implies a discrete time period. At some point, the bleeding will stop. Sometimes the wound heals quickly, sometimes not,” said Matthew J. Friedman, executive director of the Department of Veterans Affairs National Center for PTSD. A disorder can stretch on for decades.

Although everyone is equally susceptible to a gunshot wound, not everyone exposed to trauma suffers from PTSD. Genetics, military training and even the cohesion in a soldier’s platoon all play a role in determining whether a combat experience results in PTSD or simply a bad memory, experts said.

“The word ‘disorder’ reflects the fact that some people are more vulnerable than others,” said John Oldham, president of the American Psychiatric Association.

Treatment for the malady often includes remembering the traumatic event under controlled conditions until it loses its power.

Origins of PTSD

PTSD made its first appearance in the diagnostic manual’s third edition, which was published in 1980. The doctors who lobbied for its inclusion viewed it as a measure that would finally legitimize the pain and suffering of Vietnam War veterans.

Before the creation of the PTSD diagnosis, Vietnam War-era hawks saw troops suffering from such symptoms as weaker than their World War II-era colleagues. “The view was that they should just suffer in silence,” said Charles Figley, director of Tulane University’s Traumatology Institute. The antiwar doves often portrayed Vietnam War veterans as crazy, deranged and dangerous.

“PTSD was a validation that what the Vietnam veterans were reporting was true, and it connected them to other veterans in other wars and other people who had experienced trauma,” Figley said.

Political fallout

The name-change debate is also being influenced by bureaucratic politics. In 2008, the military considered awarding the Purple Heart to troops suffering from PTSD, but ultimately decided that brain science had not advanced far enough to prove that people were suffering from the condition.

A change to “injury” would make it easier to revise the award criteria, advocates of the name change say.

“To be injured in the service to your country is entirely honorable in the military culture,” said Jonathan Shay, a psychiatrist who specializes in treating the psychic wounds of war and has worked closely with the U.S. military. “To fall ill is not dishonorable, but it is unlucky.”

A shift to “injury” could make it harder for service members to collect permanent-disability payments for their condition from the government, some experts warned. “When you have an injury, you follow a treatment regimen and expect to get better,” Figley said. “This change is about medicine, but it is also about compensation. We are talking about hundreds of millions of dollars.”

Finally, the name change has unearthed other sensitive arguments about the best way to prevent PTSD in the military.

“The whole history of psychiatry is to change the names of conditions. If the problem doesn’t go away, we change the name,” said Bessel van der Kolk, a professor of psychiatry at Boston University. “It makes us feel momentarily better. But it doesn’t change anything.”

If the Army really wanted to protect soldiers, it would limit the number of tours that troops are permitted to do in Afghanistan, van der Kolk said. Medical studies have suggested that a soldier’s resilience is depleted with each battlefield tour. “As long as you have repeated deployments, you will have devastating effects on people,” he said.