Preventing Concussions: Can Help be on the Horizon?

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Concussions and preventing concussions continues to be a hot topic in the media, particularly when parents decide whether to allow their kids to play contact sports.

Treating PTSD and TBI also receives its share of attention, but most of the media coverage seems to be focused on coping with the symptoms of brain injury rather than offer any meaningful long-term solution for Veterans with these conditions.

Far less attention is devoted to preventing concussions in the first place.  Perhaps, we should be moving forward on all fronts simultaneously.

military drugs

Just this week the FDA just approved a series to trials to evaluate ecstasy to help people cope with PTSD.

After successful preliminary trials, the FDA is moving forward with a large scale study for using Ecstasy as a prescription drug to treat post-traumatic stress disorder.

The study approved on Tuesday would be the final measure necessary before the agency could legalize the drug, according to the New York Times. If the results are favorable, the drug also known as MDMA would be available to patients as early as 2021.

While some may view this new FDA initiative with relief, I am not encouraged by yet another new drug that treats the symptoms of PTSD rather than drugs that permanently reverse brain damage itself.   As we have seen with opioids, treating symptoms opens up a pandora’s box of other medical and neurological problems, particularly when these medications are combined with other prescription drugs.

Granted, reversing brain injury is new uncharted territory, but many Veterans seem to have lost hope that permanently improving  brain “wellness”  is considered to be a high priority for either the VA or the FDA.

If this is the case – and I hope it is not – then studies focused on reducing the incidence of concussion certainly take on far more importance.  Found below is a recent Ted Talk  by David Camarillo focused on developing new protective gear to reduce concussions:

Mr. Camarillo takes issue with both the CDC and NFL models of what happens when a concussive-event occurs. Swedish scanning imagery points to something far different occurring within the brain than what is argued by conventional sources.

Could it be that existing helmet designs for the military and the NFL are based on flawed models and questionable scientific research?

I don’t know the answer to that question, but I continue to be disturbed by the conflicting messages sent out by the VA, the FDA, the CDD and the NFL.  Surely, “I don’t know,” is a far more honest answer than continued claims by those in authority that “we are making progress” in helping Veterans with PTSD or protecting NFL players.

If the flawed product were an automobile which caused a fatality, a recall notice would be issued.  How is it possible that the NFL continues to operate with impunity when the evidence strongly suggests that repeated concussions causes chronic traumatic encephalopathy (or ”CTE’)

The recent FDA “Ecstasy” trial isn’t particularly reassuring, particularly knowing that the results will not be available until 2021.

Questions that seem more relevant would be these:

– Will Dr. David Cifu continue to dictate VA protocols in treating concussive events?

– When will military helmet sensor data be released to the scientific community to help provide our brave military personnel with better helmets?

– Can the VA provide any clinical evidence that it has successfully treated and “cured” PTSD and/or TBI?

– Are more drugs the answer to treat PTSD?

I can’t answer these questions, but tens of thousands of brave men and women with PTSD and TBI deserve an answer.


Dr. Orange and Coverups at the DoD and VA

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SFTT reports frequently on the massive coverups, dishonesty and hypocrisy within the DoD and VA which continue to erode the confidence of the many thousands of men and women who have served our country so valiantly.

As we have stated on numerous occasions, SFTT takes no pleasure at all in doing so, but there appears to be no end to the deceit.  It is not all black and white – there is much good and healthy within the DoD and VA to be proud of – but their leaders do great harm to the institutions they lead by not being honest and forthright.

Priggee Cartoon from Denver Post

A recent article by Charles Ornstein of ProPublica and Mike Hixenbaugh of the Virginia-Pilot chronicles the sad story of retired Major Wes Carter who exposed the machinations of Alvin Young, aka Dr. Orange, to the terrible health costs of Vietnam Vets who had been exposed to Agent Orange.  Click on the hyperlink below to read this tragic article on how countless brave men and women are routinely sacrificed to assuage the ego of a paid consultant.

While this article is damning in-and-by-itself, Alvin Young’s template of deception is regularly used by the DoD and the VA to mask its gross incompetence and, more importantly, their failure to admit they are wrong.  In effect, “outside consultants” are regularly used by government institutions to hide the truth from both the public and the men and women they serve.

Do These Quotes Sound Familiar or Resonate with You?

Contrary to public opinion, outside consultants are often used to put distance between incompetent management and provide a layer of respectability to outright lies.  As we shall see, Alvin Young’s self-assured opinions (with the benefit of close to $7 million in incentives) are regularly used by consultants and the management of the VA and DoD.

Throughout, as an officer and later as the government’s go-to consultant, Young’s fervent defense hasn’t wavered: Few veterans were exposed to Agent Orange, which contained the toxic chemical dioxin. And even if they were, it was in doses too small to harm them. Some vets, he wrote in a 2011 email, were simply “freeloaders,” making up ailments to “cash in” on the VA’s compensation system.

In an interview and emails, Young defended his role. To date, he said, there’s no conclusive evidence showing Agent Orange directly caused any health problems, only studies showing a statistical association. It’s an important distinction, he says.

Young recently denied interfering with that research but took credit for helping to shut down a major Centers for Disease Control and Prevention study of Vietnam vets in 1987 that sought definitive evidence of a link between health issues and Agent Orange. Young said data on who had been exposed wasn’t reliable enough, though others argued that military records on spray missions and troop movements would have sufficed.

In 2006, under contract for the Defense Department, Young had produced an 81-page historical report listing everywhere Agent Orange had been used and stored outside of Vietnam, and emphasizing that even in those places, “individuals who entered a sprayed area one day after application … received essentially no ‘meaningful exposure.’” Among the scholarly references cited were several of his own papers, including a 2004 journal article he co-authored with funding from Monsanto and Dow. That conflict of interest was not acknowledged in the Defense Department report.

While some of these quotes or exposes may not resonate with you, they are precisely the same arguments that VA consultant, Dr. David Cifu uses to insist that only he knows how best to treat PTSD.  Ask yourself – or better yet, ask the VA – how many successful cases have been treated using existing VA protocols?

Similarly, why does the DoD hide behind a bevy of “disinterested” consultants and lawyers that threaten to expose the shortcomings of government issued body armor?  Is the truth too painful or harmful to someone’s career or job opportunity in the private sector?

The health and well-being of Veterans and active-duty personnel is too precious to be trusted to self-interested and opinionated demagogues. Once lost, faith in the intrgrity of our institutions is difficult to regain.



The Fragility of the VA

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I just started reading Antifragile:  Things That Gain With Disorder by Nassim Taleb.   For those who may not be familiar with Mr. Taleb, he is Professor of Risk Engineering at New York University’s Polytechnic Institute and the author of the highly acclaimed The Black Swan.

Now it may seem a bit incongruous to examine the Department of Veteran Affairs (the “VA”) through the eyes of Nassim Taleb, but there are a number of clear signs that the VA is a BIG and IMPORTANT institution that has lost its way.  In effect, the VA is FRAGILE.

Found below is a superficial but effective video summary of Antifragile, which describes the process to analyze the fragility, robustness or antifragility of “almost everything about our world.”

In Mr. Taleb’s remarkable book, he joyfully examines the human body, science, biological and economic systems, business, medicine, regulation and even psychiatric well-being from the three types of exposure: fragile, robust and antifragile.

Without belaboring the point, there are many examples which clearly demonstrate that the VA is “fragile” if not broken. In fact, one could argue that the system is already in terminal decline propped up by self-serving bureaucrats to effectively deny proper medical care to our Veterans.

Fragility of the VA

While this conclusion is seen through the lens of Nassim Taleb in Antifragile, all one needs to do to reach a similar conclusion is to scan the countless unheeded GAO reports citing the failings of the VA or pour over the numerous Congressional hearings on the VA.   True reform of the VA has simply become a platform to promote self-serving sound-bites by politicians and VA bureaucrats.

I will focus on just a few observations from Mr. Taleb’s book which – in my opinion – makes the case:

SFTT has long argued that prescribing potentially lethal prescription drugs to Veterans with PTSD is both ineffective and dangerous. Consider this position under the optics of Mr. Taleb:

” . . . only resort to medical techniques when the health payoff is very large (say, saving a life) and visibly exceeds its potential harm . . . Otherwise, in situations in which the benefits of a particular medicine, procedure, or nutritional or lifestyle modification appear small – say aiming for comfort – we have a large potential sucker problem.”

Sadly, our brave Veterans and Jane and John Doe Public have been suckered big time by the VA.

Mr. Taleb effectively describes the propensity of the VA to prescribe drugs rather than promote other alternative therapy programs.  He goes on to say that “. . . pharmaceutical companies are under financial pressures to find diseases and . . .  and are looking for disease among healthier and healthier people, lobbying for reclassification of conditions, and fine-tuning sales tricks to get doctors to overprescribe.”

Doesn’t Dr. David Xavier Cifu fit the bill as an effective lobbyist for the pharmaceutical industry?  Unless I misunderstand, Dr. Cifu is suggesting that we should treat military personnel with concussions (or worse) with drugs and get them back to duty as quickly as possible.  His argument is based on his own personal experiences of having six concussions and that this is the treatment he prescribes to his family.

Despite being shunned by others in the medical profession, Dr. Cifu could be right.   The real question we should all ask is this:  What if Dr. Cifu is wrong?  In effect, Dr. David Cifu – as a proxy for the VA – is effectively condemning thousands of Veterans to the same flawed treatment procedure.

One might ask what treating PTSD by the VA has to do Nassim Taleb’s theory about Antifragility or Incerto?  Actually, a great deal.  Mr. Taleb would argue that fragile government bureaucracies like the VA are highly susceptible to arrogance and the inability to distance themselves from the predictive but flawed models they so vigorously defend.

Mr. Taleb would no doubt argue that it is better to have many “small” therapy programs that can fail rather than expose ourselves – and the lives Veterans they claim to support – to a potentially catastrophic mis-diagnosis.

With its $180 billion budget, it is now time to unravel this bureaucratic behemoth in the hope that more robust and, hopefully, antifragile therapy can emerge from a decentralized health management approach for our Veterans.   If we don’t move in this direction soon, the lives of hundreds of thousands of brave Veterans and their loved ones could be negatively affected.

Sure, there will be mistakes, but we won’t have all our eggs in one basket.  Are you listening, Dr. Cifu?  Let’s spare the VA and the brave Veterans that rely on its services the Black Swan effect.