VA Reluctantly Agrees to Provide HBOT to Veterans with PTSD

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In a carefully crafted message, “The Department of Veterans Affairs announced this week that it would begin offering hyperbaric oxygen therapy (“HBOT”) to some veterans with post-traumatic stress disorder, despite a lack of evidence that it works or being approved by the Food and Drug Administration as a treatment for PTSD.”

HBOT Therapy

The news was released by “Stars and Stripes” on November 30 in an article titled “VA to offer unproven hyperbaric oxygen therapy to vets with PTSD.”

The article is hardly a ringing endorsement of HBOT.  More to the point, Secretary Shulkin reportedly said on Wednesday that “the VA must ‘explore every avenue’ and ‘be open to new ideas.’”

Well, HBOT may be “new” to the VA, but this therapy has been around for decades and is used successfully around the world to treat patients with brain trauma.  The VA stigma exists because Dr. David Cifu and many other bureaucrats within the VA continue to push a stale agenda of ineffective and often dangerous therapies that don’t work.

In fact, this is one of the major reasons that Veterans with PTSD and TBI have sought treatment outside the VA.   Talking heads at the VA would like Veterans and the public to believe that HBOT is “snake oil,” but there is a long and detailed clinical trail of evidence that suggests otherwise.

Arguing that HBOT is “not FDA or DoD approved” rings a bit hollow after the President’s Report on Fighting Drug Addiction and Opioid Abuse states that “the modern opioid crisis originated within the healthcare system.”   

Let’s face it:  What do you do when evidence-based medicine is proved wrong?   Well, in this case, the Federal government will provide “the healthcare system” with billions of taxpayer dollars to fix the mess they largely created.   Sounds absurd, but you don’t even have to read the small print.

While SFTT is thrilled that Dr. Shulkin has decided to part ways with the orthodoxy of failed VA therapies to treat Veterans with PTSD, it will be years before all Veterans will receive the lifesaving benefits of HBOT.   Furthermore, it is likely that the VA and DoD will again manipulate test protocols to produce treatment outcomes that produce inconclusive results.

Will HBOT work in all cases?   Of course not, but life-changing outcomes are far more likely with HBOT than the only two failed programs currently offered by the VA:

  • Prolonged Exposure Therapy (“PE”) and,
  • Cognitive Processing Therapy (“CPT”)

In any event, we hope that doctors within the VA system will not be so dismissive of HBOT that it leads to another Veteran suicide like Eric Bivins.  For those who want a first-hand look into the travesty of the VA system, follow this painful trail of systemic abuse by Eric’s widowed spouse, Kimi.

Our brave Veterans deserve more and SFTT would like to thank Secretary Shulkin for taking this important first step.

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Veteran Drug Courts Are Now Needed More than Ever

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Over five years ago, SFTT met with Judge John Schwartz,  one of the early pioneers in the Veteran Court system.  Discussing the rationale for Vet Courts, Judge Schwartz stated the following “We offer hope to these troubled veterans who have served our country so valiantly.  It’s simply common sense.”

Today, Vet Courts are needed more than ever to help Veterans recover their lives.   Indeed, when one reads that the “the modern opioid epidemic originated within the healthcare system,” one must be simply oblivious to the plight of Veterans if we choose to penalize them once again.

Homeless Veteran

Drug Courts began to emerge in the nineties to deal more effectively with a growing drug problem in the United States.  As SFTT wrote earlier,

“Since the mid-1990, the US judicial system has recognized the need to deal with drug-related criminal activity and have established some 2,600 Drug Treatment Courts in the United States.  Drug treatment courts are specialized community courts designed to help stop the abuse of drugs, alcohol, and related criminal activity. Non-violent offenders who have been charged with simple possession of drugs are given the option to receive treatment instead of a jail sentence.   These programs have proven to be remarkably successful for reducing the level of recidivism in our prison system.

Capitalizing on the infrastructure and success of the Drug Treatment Courts, some 50 or so Veteran Courts (now reportedly 300) have sprung up across the United States to deal with veterans who have committed a crime while suffering from substance abuse.  In many cases, these troubled vets have the support of other Vets (often from the Vietnam era) who “mentor” their military colleagues through the rehabilitation process.

This descriptive video from Justice for Vets provides a useful overview of why our Veterans deserves a better choice than incarceration:

Thanks to Judge Schwartz and other inspired leaders in our judicial and police system, Veteran Courts have expanded all across the United States.  Nevertheless, NPR reported earlier this year that many more Vet Courts are required.  Specifically, NPR noted that some states still do not have a Vet Court and that North Carolina has only 3 when the evidence suggests that we require 17.

As SFTT and others have reported in the past, Veterans with PTSD and TBI have been largely neglected by the Department of Veterans Affairs (“the VA”).  Veterans suffering from brain trauma often resort to substance abuse to curb pain and many resort to crime to support their habits.  Should we penalize these brave Veterans for our collective failings to provide our Veterans with the support they deserve?

SFTT would like to thank the many Veterans and volunteers in the legal profession who give of their time to support our Veterans through an often confusing legal system.

When communities reach out to help these brave warriors, our society is enriched. From our perspective, it’s simply a matter of doing the right thing!  We owe these brave young men and women big time!

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SFTT Offer “Thanks” to our Brave Military on Thanksgiving

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SFTT joins millions of Americans in offering our thanks this Thanksgiving to the Veterans and active duty personnel who valiantly defend our freedoms.

US military Thanksgiving

As we all sit down to enjoy the traditional Thanksgiving turkey, SFTT is reminded of those who have sacrificed their lives for our country and the many Veterans who continue to suffer from the silent wounds of war.

While the battlefield war may be over, tens of thousands of Veterans suffer the effects of brain trauma.  The effect of this debilitating injury not only affects the Veteran, but their family and loved ones who act as caregivers.  While one would like to think that we are close to finding a life-changing solution for Veterans who suffer from PTSD and TBI, no credible solution appears imminent.

Some promising new therapies have surfaced in recent years, but the Department of Veterans Affairs (“the VA”) seems stuck in a time-warp defending outdated and failed programs.  SFTT remains hopeful that the VA will come to its senses and begin adopting some successful third-party programs that have worked wonders for Veterans.

Hiding behind the mantra of “evidence-based medicine” sounds good, but loses its luster when the evidence strongly suggests that the VA programs have failed.

Our Veterans and their loved ones need solutions now!

As 2017 draws to a close, SFTT would like to thank a few people and organizations that have made a difference in the lives of Veterans this year.  By no means is this an all-inclusive list, but one that offers our Veterans a path to recovering their lives:

Paul Harch and Hyperbaric Oxygen Therapy

Dr. Paul Harch is one of the leading practitioners of Hyperbaric Oxygen Therapy or “HBOT.”  HBOT is a commonly used therapy provide patients with oxygen administered under pressure in a series of “dives” in an HBOT chamber.  Used widely around the world for decades, HBOT has been shown to stimulate brain cells and help reverse the symptoms of PTSD and TBI.   While many Veterans have found dramatic improvement in their condition, HBOT is not recommended by the VA to treat Veterans with PTSD and TBI.

Colin and Karen Archipley of Archi’s Acres

Thanks to combat-decorated Marine Sergeant Colin Archipley and his wife, Karen, a successful fashion industry entrepreneur in her own right, Archi’s Acres provides dedicated Veterans with the skills necessary to run a successful organic farming business  in their community. With meaningful jobs in short supply for Veterans returning from multiple deployments to Iraq and Afghanistan, Archi’s Acres gives Veterans a lifeline to become entrepreneurs in a rapidly growing and eco-friendly business.

Yuval Neria and Equine Assisted Therapy

Dr. Neria is Professor of Medical Psychology at the Columbia University Medical Center and “Scientific Advisor” to Stand for the Troops (“SFTT”).  He is now deeply involved in the Man O’War Project which is the first-ever clinical research study to determine the effectiveness of equine-assisted therapy (“EAT”) and establish guidelines for the treatment of military veterans who suffer from Post-Traumatic Stress Disorder (“PTSD”).

Maj. Ben Richards and Service Dog Bronco

Maj. Ben Richards is the Director of Veterans Operations at SFTT.  Over a year ago, Maj. Richards acquired a service dog, Bronco, which has brought much needed comfort, safety and stability to his life. Sadly, the VA is “studying” the efficacy of service dogs in helping other Veterans with PTSD.  This study will not be available until 2019.

service dogs for Veterans

Dr. Henry Grayson and Neuro Pathways

 Dr. Grayson is co-chairman of SFTT’s Medical Task Force and has provided several day-long training programs to caregivers and clinical psychologists  dealing with veterans suffering from Post Traumatic Stress (“PTSD”).  The author of Use Your Body to Heal Your Mind,  Dr. Grayson presents a radical view of health and healing based on an equally radical world view that we are all intrinsically connected rather than separate and that our belief in our separateness is a causal source of emotional and physical illness. Positing the body as the recipient of our beliefs, he shows that reading and responding to the body is a reliable path to emotional and physical healing. This is a challenging read with practical help for all willing to explore beyond the borders of traditional beliefs.”

 

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Kris Kristofferson and HBOT

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After we recently learned that “the modern opioid crisis originated within the healthcare system,” it is reassuring to note that many misdiagnosed individuals are benefiting from alternative therapies.

Kris Kristofferson and Hyperbaric Oxygen Therapy

A prominent figure that recently came to our attention was Kris Kristofferson, who had been misdiagnosed with Alzheimer’s when it was actually Lyme disease.    According to his wife, the 79-year old singer “suddenly came back,” after 6 “dives” in a Hyperbaric Oxygen Therapy Chamber (“HBOT”).   Says his wife, Lisa, in an article published in the UK Daily Mail:

“We were driving back from his sixth HBOT treatment and he looks over at me and says, ‘Wow, I feel like I’m back.’ And I looked right in his eyes and I said, ‘OH MY GOD, HE’S BACK! It was like, WHOA!'”

As readers of SFTT are aware, the Department of Veterans Affairs (“the VA”) has done everything possible to discredit the use of hyperbaric oxygen in treating Veterans with PTSD and TBI.  More to the point, the VA has been pushing its own failed treatment programs (Cognitive Processing Therapy and Prolonged Exposure Treatment) in the name of “evidence-based” medicine.

When people in the medical profession argue on the basis of “evidence-based” medicine, it has much the same ring as the doctrine of “religious infallibility.”  Let’s take everything with a grain of salt, since there is still much to discover, even for those wedded to the orthodoxy of “evidence-based” medicine.

SFTT is thrilled that Kris Kristofferson is on the road to recovery.  Furthermore, we are not surprised to learn of the benefits of HBOT in treating the “real” cause of his ailing mental health.

While Mr. Kristofferson has a choice in seeking “a second opinion” and the type of therapy he prefers to treat his condition, most brave Veterans do not.  Sadly, the VA does not provide Veterans with a “second opinion.”  Also, the Va’s narrow treatment programs referred to as the “McDonaldisation of mental health care” offer no tangible benefits to Veterans or their families.

We sincerely hope that – in the not too distant future – our brave Veterans will be able to avail themselves of Hyperbaric Oxygen Therapy and other “old” and emerging treatment programs through the VA.

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Points of View: Al Jazeera on Treating Veterans with PTSD

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There was a time when many considered Al Jazeera to be a voice of Middle Eastern terrorists.   Whether it was or not is a matter of conjecture, but most would now agree that Al Jazeera has morphed into a credible news organization.

In an era of conflicting points of view, “alternative facts,” political agendas and outright lies; it is difficult to find common ground or agreement on any issue.  As such, it is surprising that Reem Shaddad of Al Jazeera has written such an insightful article on the plight of US Veterans entitled:  “The Battle Within:  Treating PTSD in Military Veterans.”

Department of Veterans Affairs

While one could nitpick some of her conclusions, it is difficult to refute the argument that within the Department of Veterans Affairs (“the VA”) “the McDonaldisation of mental healthcare is a problem.”

” . . . if you go to any VA in the country, you’re going to probably get cognitive processing therapy or cognitive behavioural treatment (actually, prolonged exposure) because those are the evidence-based practices that they use. It’s like if you go to any McDonald’s, a cheeseburger is going to be the same.”

Yep, the VA only serves two flavors of milkshakes (chocolate and vanilla) to treat Veterans with PTSD:

  • Cognitive Processing Therapy, and
  • Prolonged Exposure Treatment.

More to the point, if the VA’s two PTSD therapy programs don’t work, its doctors are likely to prescribe a cocktail of potent drugs to keep the Veteran’s symptoms in check.   This is hardly the outcome our brave warriors and their families should expect.

For an organization that prides itself on providing “evidence-based” medical treatment to Veterans, the GAO and the Rand Corporation have found that these programs resulted in negligible benefits for Veterans with PTSD.   In effect, “evidence-based” medicine seems to apply to every “alternative” therapy program other than the failed programs mandated by the VA.

As distinguished members of medical profession talk about “evidence-based” medical programs to treat PTSD, one can only wonder how warriors with the symptoms of PTSD in the distant past coped without the benefit of clinical trials.

Mind you, acupuncture seems to be have successful for some 2,000 years without the benefit of clinical trials.    The benefits of oxygen therapy programs have been around for centuries and there have been many documented therapy programs listed since as early as the 1930s.    Nevertheless, the folks at the VA – headed-up by chief spokesperson, Dr. David Cifu – still dispute the benefits of hyperbaric oxygen therapy in treating Veterans with PTSD.

Despite efforts by Reem Shaddad and many others to expose the hypocrisy within the VA,  Veterans with PTSD and TBI will need to seek help outside the VA.

SFTT is not convinced that there is a “silver bullet” to cure PTSD and TBI, but it is abundantly clear that the two PTSD therapy programs mandated by the VA are not effective.  For this reason, SFTT endorses a far wider use of alternative therapy programs to provide Veterans with a “real” choice over the VA’s failed programs.

Sure, there will be some “snake-oil” peddlers and charlatans that seek to take advantage of Veterans, but it is unlikely to be nearly as severe as the opioid epidemic perpetrated by the “evidence-based” healthcare system.

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Reflections on Veterans Day

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Maj. Ben RichardsYears ago when I was a young Army lieutenant, my reconnaissance platoon was preparing to conduct a night-time helicopter insertion far behind enemy lines to seek out intelligence critical for a large-scale operation to be conducted 48 hours later. The operation was high risk. That night as I back-briefed my Troop commander over the hood of a Humvee  in the German woods, I expressed my concern about the level of danger the platoon was facing.

My boss, an experienced cavalry scout himself who had served as an enlisted soldier and noncommissioned officer before earning an officer’s commission, replied directly: “If you get into trouble, we will roll this entire brigade to come and get you.”

At that time the war in Iraq was still over a year in the future, and the risk was largely hypothetical, but I wondered whether the Army would really risk a brigade of 3,000 to 4,000 soldiers and hundreds of armored vehicles to rescue a few men in a desperate situation. And then I didn’t think about it again.

That is until I was leading men in a real war in Iraq. In November of 2006, my Cavalry Troop was in the process of moving from Tal ‘Afar in northwest Iraq to Taji, a large operating base just outside of Baghdad. The night before our movement, a special operations team had been conducting a raid deep in the al Qaeda-controlled hinterlands of the infamous Anbar province. The raid had run into trouble and a large force of al Qaeda fighters was closely engaged with the small special operations team.

A pair of Air Force F-16 fighters scrambled to provide air support for the troops, but because the fighting had moved to such close range, they could not use their normal load of bombs without risking the lives of the men they were trying to save. With no good options, one pilot, Major Troy Gilbert, volunteered to conduct a highly-dangerous low-level night-time strafing mission in order to employ his aircraft’s 20mm cannon which could be used much closer to friendly troops.  On completing the diving attack, his plane was unable to pull out in time and crash landed in the Anbar desert.

Although he had been unable to eject, the aircraft was largely intact and it was possible that MAJ Gilbert had survived. On that chance, my Troop and over two thousand other US combat troops—an entire Army Brigade’s worth – were quickly dispatched to rescue the pilot. We had just arrived in Taji and had not even unpacked, when we sortied into the desert.

The area had never been under US control and the roads were littered with large and deadly Improvised Explosive Devices (IEDs). The going was slow and occasionally punctuated by the ambush of al Qaeda fighters. We reached the crash site and then searched the surrounding desert and villages for four days until we were able to find forensic proof that MAJ Gilbert had not survived the crash. After an extended search other soldiers were able to locate and bring home his remains.

During those nights in the desert, I remembered another night in the German woods and realized that I was helping to fulfill a promise made not just by my commander, but by millions of American soldiers over hundreds of years. The risk MAJ Gilbert accepted was extraordinary. As an experienced pilot, he was fully aware of the danger and the cost he might have to pay to save the lives of a few Army soldiers.

Our mission to find MAJ Gilbert was the most dangerous we had conducted up to that point. As we rolled out into the desert, we also knew the risks and willingly accepted them—also at a cost. In my unit, Corporal Billy Farris, also a young father, was killed in an ambush during the operation.

What stands out about Troy Gilbert and the incredible men and women I had the privilege of serving with was their belief in the infinite value of the life of another soldier.

Unfortunately, after returning home from Iraq as an “invisibly wounded” veteran with Traumatic Brain Injury and Post Traumatic Stress Disorder, that was not the ethos I found at home, particularly in the very institutions created to care for nearly one million combat-disabled veterans like me. In 2012, Pulitzer Prize-winning journalist Nicholas Kristof observed in the New York Times, “if you want to understand how America is failing its soldiers and veterans, honoring them with lip service and ceremonies but breaking faith with them on all that matters most, listen to the story of Major Richards.”

What is exceptional about Kristof’s statement is that he made it after I had been provided the top level of care available within the DOD and VA medical systems—a level of care only a few hundred service members a year were given access to. However, these alleged best efforts were only a façade.

Suffering from daily, debilitating pain and unable to function in most facets of life including interacting with my wife and our four children, I began to seriously consider suicide. That was when Stand for the Troops came to my rescue and joined me in my personal battle against the invisible wounds of war. They arranged for me to receive several months of Hyperbaric Oxygen Therapy (HBOT) from one of the leading practitioners in the country, Dr. Paul Harch at Louisiana State University (who provided the treatments for me at his own expense).

It was the first genuinely effective medical care I had received since returning home, and it has restored much of my life. Today I am a productive and contributing member of society, with a loving family and a high quality of life.

As we reflect this Veterans Day on the blessings derived from the service and sacrifice of so many men and women and their families, we begin to realize the magnitude of the task before us in living up to legacy heroes like MAJ Troy Gilbert.

I am pleased to report that there remain many great Americans, both in and out of uniform, who share the belief in the infinite value of a soldier’s life. Please join me in supporting Stand for the Troops in making sure the nearly one million veterans disabled by TBI and PTSD finally get the genuinely effective care they deserve.

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HBOT: A PTSD Therapy for Veterans that Works

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This Saturday (November 11, 2017), Fox TV will air a broadcast on how Hyperbaric Oxygen Therapy (“HBOT”) is helping hundreds – if not thousands – of Veterans with PTSD and TBI.

This special program will be aired on Veterans’ Day. The video below was prepared by The National Hyperbaric Association to demonstrate that “real” therapy is available to the tens of thousands of brave warriors suffering from PTSD and TBI.

HBOT is a proven therapy widely used around the world for patients suffering from brain trauma. Sadly, the folks at the Department of Veterans Affairs (“the VA”) are still peddling the same stale “evidence-based” therapy programs to Veterans that do not work:

  • Prolonged Exposure Therapy (“PE”) and,
  • Cognitive Processing Therapy (“CPT”)

As SFFT reported earlier, PE and CPT “have been largely ineffective in reversing brain damage to Veterans suffering from PTSD and TBI. And yet, the spokespeople steadfastly defend these therapies and argue that other therapies ‘lack evidence’ to justify their endorsement, read ‘funding.’”

“The VA has very little evidence to show that PE and CPT therapy programs have done much to reduce the incidence of PTSD symptoms among Veterans against the “gold-standard” standardized PCL-M tests currently used by the VA. The chart below illustrates the point (50 is considered base level):

Prolonged Exposure Cognitive Process Therapy

Aside from being very expensive to administer, the ‘evidence based medicine’ supporting the effectiveness of PE and CPT programs currently administered by the VA is SADLY LACKING.”

It is most interesting to note that the VA has done everything possible to discredit HBOT to promote their own failed therapies.   In many cases it has led to tragic consequences, such as the recent suicide of Eric Bivins.

What Does the VA Have Against HBOT?

It is difficult to understand the VA’s hardline against HBOT, particularly when the overwhelming statistical “evidence” clearly demonstrates that the VA’s own therapy programs are severely flawed.  Furthermore, this is the same institution that hooked Veterans on opioids (and indirectly fueled a national epidemic) based on flawed clinical trials.

Dr. David Cifu Testifying

Dr. David Cifu, the Dr. Orange of PTSD at the VA?

How many more times do we have to listen to Dr. David Cifu testify before Congress that he (read “the VA”) knows best when treating Veterans with PTSD?   It is ironic to note that in David Cifu’s quest to discredit hyperbaric oxygen therapy, his employer (Vincent Viola – once tapped to be Secretary of the Army) is alleged to treat his racehorses with HBOT.

Clearly, Vincent Viola knows a bit more about the benefits of HBOT considering that Always Dreaming won the Kentucky Derby this year.

One might ask why thoroughbreds get the benefit HBOT while Veterans are denied HBOT at the VA?  I don’t know the answer, but I suspect that the “serious” money lies in new clinical trials and “breakthrough” drugs peddled by Big Pharma.

Or is it the VA’s special take on insanity?:  Providing Veterans with the same battery of lame therapy programs and psychotic drugs, but hoping for a more positive outcome.”

It is sad to see our Veterans being sold down the river by less-than-candid mouthpieces of a rudderless VA, but the truth is as clear as the Presidential report on Fighting Drug Addiction and Opioid Abuse.  Look no further than the damning statement: “the modern opioid crisis originated within the healthcare system.”

If you think that common sense and a desire to genuinely help our Veterans with PTSD and TBI will manifest itself soon – you are likely to be disappointed.

As they say at the Beltway Racetrack, “the fix is in!”

If you genuinely want to help our brave Veterans, write your Congressmen (and women) and Senators and State and Local representatives.  Also, do take the time to learn the benefits of hyperbaric oxygen and give generously to SFTT and the National Hyperbaric Association to support our brave Veterans.

Veterans Day is more than waving the flag.  Don’t let the festering sore at the VA continue to kill hope among our Veterans and their loved ones.

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Opioid Crisis: Contributors to the Current Crisis

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The opioid crisis is real.  It is hard to believe that people dying from drug overdoses each year now exceed the total number of brave warriors who lost their lives in Vietnam.

Homeless Veteran

Regardless of one’s political affiliation, this drug epidemic must be faced with determination to eradicate this awful plague.  Yet, in looking at The President’s Final Report on Fighting Drug Addiction and Opioid Abuse, I find myself wondering how we got to this sad state of affairs in the first place.

Despite having only 5% of the world population, the US consumes 80% of the world’s global opioid supply.  More to the point, these are not disreputable drug barons south of the border peddling addictive drugs, but licensed members of the medical profession encouraging the use of lethal and addictive prescription drugs.

There have been pharmaceutical companies like the Sackler’s firm of Purdue Pharma that used their considerable marketing skills to hype the benefits and hide the risks of opioids, but the most obvious revelation is that the very institutions that should have protected our backs may have been complicit in enabling them:  the Healthcare System.

Specifically, the President’s Final Report (pages 20 – 23 with just a few summarized below) argues “that the modern opioid crisis originated within the healthcare system and have been influenced by several factors:”

Unsubstantiated claims: High quality evidence demonstrating that opioids can be used safely for chronic non-terminal pain did not exist at that time. These reports eroded the historical evidence of iatrogenic addiction and aversion to opioids, with the poor-quality evidence that was unfortunately accepted by federal agencies and other oversight organizations.

Pain patient advocacy: Advocacy for pain management and/or the use of opioids by pain patients was promoted, not only by patients, but also by some physicians. One notable physician stated: “make pain ‘visible’… ensure patients a place in the communications loop… assess patient satisfaction; and work with narcotics control authorities to encourage therapeutic opiate use… therapeutic use of opiate analgesics rarely results in addiction.

The opioid pharmaceutical manufacturing and supply chain industry:   To this day, the opioid pharmaceutical industry influences the nation’s response to the crisis. For example, during the comment phase of the guideline developed by the Centers for Disease Control and Prevention (CDC) for pain management, opposition to the guideline was more common among organizations with funding from opioid manufacturers than those without funding from the life sciences industry.

Rogue pharmacies and unethical physician prescribing: The key contributors of the large number of diverted opioids were unrestrained distributors, rogue pharmacies, unethical physicians, and patients whose opioid medications were diverted, or other patients who sold and profited from legitimately prescribed opioids.

Inadequate oversight by the Food and Drug Administration (FDA):  The FDA provided inadequate regulatory oversight. Even when overdose deaths mounted and when evidence for safe use in chronic care was substantially lacking, prior to 2001, the FDA accepted claims that newly formulated opioids were not addictive, did not impose clinical trials of sufficient duration to detect addiction, or rigorous post-approval surveillance of adverse events, such as addiction. 

Reimbursement for prescription opioids by health care insurers: Sales of prescription opioids in the U.S. nearly quadrupled from 1999 to 2014, largely paid for by insurance carriers. It is estimated that 1 out of 5 patients with non-cancer pain or pain-related diagnoses are prescribed opioids in office-based settings.

Lack of foresight of unintended consequences: As prescription drugs came under tighter scrutiny and access became more limited (via abuse-deterrent formulations and more cautious prescribing), market forces responded by providing less expensive and more accessible illicit opioids.

Public demand evolves into reimbursement and physician quality ratings pegged to patient satisfaction scores:  Prior to this year, poor patient satisfaction with pain care could lead to reduced hospital reimbursement by Medicare through Value-Based Purchasing (VBP). There are often higher costs or no specific reimbursements for alternative pain management strategies, alternative pain intervention strategies, or spending time to educate patients about the risks of opioids.

Given the scope of the problem, there is no question that urgent action needs to be taken to address this epidemic.  Nevertheless, one must question why we should entrust leadership  of that initiative to the same institutions that enabled the epidemic in the first place.

As reported earlier by SFTT in Opioids:  Bipartisan Incompetence in DC and vividly documented in the joint Washington Post and 60 Minutes Report, there are entrenched political and business interests at play.    I find it highly unlikely that they will release their grip on the brass ring with so much money at stake.

To date, there is no price tag on resolving the drug overdose crisis.  Isn’t it ironic that the same cast of characters that profited from addicting our nation, now get a chance to monetize the painful withdrawal process?  In the corporate world, we refer to this as “double-dipping,” but in politics it is simply “business as usual.”

If you honestly believe that “big government” will get us out of the drug addiction and opioid abuse crisis the government and healthcare system colluded to create, P. T. Barnum has a bridge to sell you.

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GAO to Investigate VA Over Treatment and Therapy of Veterans with PTSD

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At the request of Reps. Mike Coffman, R-CO., and Ann McLane Kuster, D-N.H., the Government Accountability Office (“the GAO”) agreed Sept. 27 that it “will review the way the Department of Veterans Affairs (“the VA”) treats patients who suffer from post-traumatic stress disorder (PTSD) and other combat-related conditions.”  In particular, the GAO will focus on “how heavily the VA relies on powerful psychotropic drugs to treat patients.”

OxyContin - Veteran Addiction

As reported in the Armed Forces News, “this decision is a victory for combat veterans everywhere who are suffering from PTSD and who have been prescribed a cocktail of very powerful drugs to mask their symptoms in lieu of other forms of interactive therapy that work to bring down the stress levels of PTSD to a point where they are no longer debilitating,” said Coffman.

While this new GAO study may come as a big relief to many Veterans with PTSD (and their families), the tragic findings will surprise few who monitor the shoddy treatment procedures provided to Veterans with PTSD at the VA .

For those expecting that this “new” GAO study will result in any improvements in the treatment our Veterans receive, I refer you to the December, 2014 GAO study of the VA with the title of “Improvements Needed in Monitoring Antidepressant Use for Major Depressive Disorder and in Increasing Accuracy of Suicide Data.”

Here is a brief summary of the conclusions reached in this GAO audit as reported by SFTT in March, 2015 in an article entitled GAO Hammers VA on Protocols for VA Suicides:

– 10% of vets treated by VA have major depressive disorder and 94% of those are prescribed anti-depressants
– 86% of audited files of vets on anti-depressants did not receive a follow up evaluation within the required 4-6 weeks
– 40% of the same group of veterans on anti-depressants did not receive follow up care within the recommended time frame
– 63% of suicide cases were inaccurately processed

This means 500,000 veterans have major depressive disorder and 470,000 of those are prescribed anti-depressants. This means it is possible that 404,200 veterans on anti-depressants are not receiving timely follow up assessments.

With data integrity breaches like this, it is no wonder GAO cited the suicide data VA relies on as “not always complete, accurate, or consistent.”
Credits: GAO Audit Shows 63% Of Suicide Cases Improperly Processed

If Representatives Coffman or McLane Kuster expect different patient outcomes, they are likely to be as disillusioned as Kimi Bivins, the wife of Veteran Eric who tragically committed suicide earlier this year.    There is little need to request a GAO study to find out how dysfunctional the VA has become.  Simply listen to Kimi describe how her husband was treated at VA facilities.
Even as far back as 2012, the VA knew that opioids were not appropriate for treating PTSD, and yet, the VA continued to provide Veterans with lethal prescription drugs knowing full well the consequences.
While SFTT could point out many similar government studies on inefficiencies at the VA, it seems to be far easier for politicians to request new studies, since they never bothered to read the existing studies or insist on much needed reforms.
Sadly, the VA has become a “law unto itself” and no amount of well-intentioned “studies” or GAO audits will do anything to turn the VA around unless politicians on both sides of the aisle take a sledgehammer to break up the VA into manageable components.   As of today, the VA is simply too large to succeed in its mission.
We can continue to study the problem, but for the sake of our brave Veterans and their families, it is time to take action!
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Equine Assisted Therapy Study for Veterans with PTSD

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Last week, I attended a delightful get together at the NewYork-Presbyterian Military Family Wellness Center in New York City.  Directors JoAnn DiFide and Yuval Neria discussed promising new initiatives designed to help Veterans and their families cope with PTSD and TBI.

Dr. Neria is Professor of Medical Psychology at the Columbia University Medical Center and “Scientific Advisor” to Stand for the Troops (“SFTT”).  Found below is a photograph of Dr. Neria together with Eilhys England, the CEO and Chairperson of SFTT.

Yuval Neria and Eilhys England

Dr. Neria leads a PTSD and Trauma Research and Treatment Program at Columbia University designed to “improve the lives of individuals exposed to trauma through premier mental health services, innovative translational research and education and training of the next generation of lead physician-scientists.”

At Columbia’s research center, Dr. Neria is spearheading several projects “aimed to advance research on the neurobiological mechanisms of PTSD and the brain’s resilience to its effects.”  In particular, SFTT was deeply involved in helping to fund a program (fMRI study) that helps traumatized individuals develop the mechanisms to distinguish between safe and dangerous situations.

More recently, Dr. Neria has become interested in evaluating the benefits of equine-assisted therapy.    The Man O’War Project is the outgrowth of that initiative and was launched in partnership with The Earle I. Mack Foundation, Columbia University Medical Center, The New York State Psychiatric Institute and the Bergen County Equestrian Center.

The Man O’War Project is the first-ever clinical research study to determine the effectiveness of equine-assisted therapy (“EAT”) and establish guidelines for the treatment of military veterans who suffer from Post-Traumatic Stress Disorder (“PTSD”).

The goal of the Man O’War Project is to “develop a manual for EAT-PTSD that can be delivered in a standardized fashion.”  In an initial test program 8 Veterans experienced a reduction in PTSD symptoms of between 26% and 74% over eight weeks in a non-riding group.

This year (2017), the Man O’War Project hopes to test 60 Veterans using a rigorous standardized clinical testing procedure and then to publish their findings in the hope of seeking grants for larger scale research projects and the dissemination of standardized training to other equine facilities that support Veterans.

With the Department of Veterans Affairs (“the VA”) “missing in action” to help Veterans with PTSD, it is reassuring to see our prominent Universities and  Medical Centers taking a vital role in helping to develop new therapy programs for Veterans suffering from brain trauma.

If you would like to learn more about the Man O’War Project please CLICK HERE.    SFTT is honored that Dr. Yuval is an important member of our Medical Task Force.  To learn more about the promising therapy programs supported by SFTT, visit our Rescue Coalition.

 

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