Tag Archives: war

Pentagon reluctant to provide therapy for TBI

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

After a lengthy investigation, ProPublica’s T. Christian Miller and NPR’s Daniel Zwerdling found that, in their words, the “battle over science and money has made it difficult for wounded troops to get a treatment recommended by many doctors for one of the wars’ signature injuries.”

They’re writing, of course, about traumatic brain injury, a consequence of roadside bombs in Afghanistan and Iraq. Their work revolves around a method of treating TBI and rehabilitating victims that has gained wide acceptance among civilian physicians and health plans but has not been embraced by the military’s insurance provider.

During the past few decades, scientists have become increasingly persuaded that people who suffer brain injuries benefit from what is called cognitive rehabilitation therapy — a lengthy, painstaking process in which patients relearn basic life tasks such as counting, cooking or remembering directions to get home.

Many neurologists, several major insurance companies and even some medical facilities run by the Pentagon agree that the therapy can help people whose functioning has been diminished by blows to the head.

Tricare provides health insurance for about 4 million active duty and retired soldiers, and “despite pressure from Congress and the recommendations of military and civilian experts,” it still refuses to cover cognitive rehabilitation therapy for the thousands of American soldiers afflicted by TBI.

Five of the 12 largest insurers cover the therapy, and an expert panel has recommended that the military do the same.

For its part, Tricare points to an assessment it conducted that put the effectiveness of cognitive rehabilitation therapy into doubt. I’ll let Miller and Zwerdling take it from there.

An investigation by NPR and ProPublica found that internal and external reviewers of the Tricare-funded assessment criticized it as fundamentally misguided. Confidential documents obtained by NPR and ProPublica show that reviewers called the Tricare study “deeply flawed,” “unacceptable” and “dismaying.” One top scientist called the assessment a “misuse” of science designed to deny treatment for service members.

The therapy would cost $15,000 to $50,000 per soldier, and the reporters found that, in private, Pentagon officials had expressed concerns about the massive cost of providing it to every suffering soldier. A few soldiers with political connections or ultra-motivated family members have managed to get the therapy, but its essentially off limits for most folks covered by Tricare.

Finally, a quick parenthetical mention answers a question that most health reporters are asking at this point. How did they get those internal studies and documents?

HINT: It involved finding a slightly less formal way to fulfill some of their FOIA requests.

(NPR and ProPublica obtained a copy of the ECRI reports through the Freedom of Information Act. However, Tricare denied access to reviews of the reports. ProPublica and NPR have appealed the request, but obtained copies of the reports and information on the reports from sources.)

Bagram airfield a leading lab for trauma medicine

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

NPR’s Quil Lawrence reports that Afghanistan’s Bagram airfield, the primary stop for seriously wounded soldiers before they’re stabilized and transported to Germany or America for long-term care, has served as an opportunity for forging broad advances in emergency medicine.

“At the beginning of this conflict, we were taking the best trauma medicine from the civilian sector, and we brought it to Iraq and Afghanistan,” says U.S. Air Force Col. Chris Benjamin, the hospital commander. He says now his doctors tell him it’s the other way around.

“Here we are seven, eight years later, taking what we’ve learned in these conflicts to teach them the advances that we’ve made with this data collection here in theater,” he says.

Thanks to body armor and advances in battlefield trauma like the increased use of tourniquets, more soldiers are arriving alive, but with serious, traumatic injuries. When they pass through Bagram, the volume and severity of their wounds “continues to yield new data that are helping to save lives in ways that were impossible only a few years ago,” Lawrence writes.

More vets come home as result of psychiatric issues

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

On Shots, NPR’s Health Blog, Nadja Popovich reports on a recent Johns Hopkins study that found, more troops were evacuated from Iraq and Afghanistan in 2007 for mental health problems than for combat injuries.

The increase comes despite the military’s increased focus on combating mental health problems among American soldiers. The largest number of evacuated soldiers are still those diagnosed with “noncombat-related injuries, such as muscle and joint problems that come from carrying equipment,” but psychiatric evacuations are a growing and complex problem.

afghanistanAmerican paratroopers in Afghanistan. Photo by U.S. Army Spc. William E. Henry via Flickr

… those suffering from mental health issues had a remarkably low rate of returning to full duty. “Psychiatric conditions have the lowest return to duty rates among any diagnostic group aside from combat injuries,” (study leader Steven P. Cohen, an associate professor of anesthesiology at the Johns Hopkins School of Medicine and a colonel in the U.S. Army Reserve) wrote. “But the effects are much worse, because psychiatric conditions worsen the prognosis for all other conditions.”

“Patients with PTSD — as a rule — have multiple other complaints,” he continued. “Studies have shown that most people with persistent PTSD have ongoing musculoskeletal, neurological and constitutional complaints that are unlikely to respond to treatment.”

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