Veterans with PTSD: The VA Way or the Highway

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It is easy to find fault with the Department of Veterans Affairs (“the VA”), particularly when it comes to Veterans with PTSD.

Department of Veterans Affairs

Secretary of Defense, Robert McNamara, tried to employ body count statistics to assess our progress in the war in Vietnam.  Similarly, the VA has erected a statistical house-of-cards to deceive Veterans and their loved that the VA has the answers for Veterans coping with PTSD and TBI.

Like McNamara, the VA “knows what is best for Veterans” and has erected insurmountable statistical barriers to prop up their failed strategies.  In effect, the VA is telling Veterans:  “It is my way or the highway!

Paraphrasing a joke: “The VA uses statistics as a drunk uses a lamppost — For support rather than illumination.”

Sadly, it is no laughing matter when we consider the thousands of combat Veterans suffering from PTSD and TBI.  More importantly, reflect on the often tragic consequences for their families and loved ones.

While Congress and the public continue to be seduced by the steady stream of assurances that the VA provides the best possible care to Veterans with PTSD and TBI, the FACTS tell a far different story.

FAKE NEWS from the VA on Veterans with PTSD

Found below is a video of Dr. David Cifu, Senior TBI Specialist at the VA, testifying before a Congressional Committee:

The VA continues to push a stale and failed agenda that states that the only two effective treatment therapies offered by the VA are:

– Cognitive Behavioral Therapy (“CBT”)and,

– Prolonged Exposure Therapy (“PET”).

As these “therapy” programs have failed miserably according to independent studies (see below), the VA has “coped” with the problem by prescribing a lethal concoction of prescription drugs which treat the symptoms of PTSD rather than deal with the underlying problem.

And we wonder why we have an opioid epidemic in this country?

REALITY CHECK at the VA

While Dr. David Cifu continues to entertain a Congressional Committee on the efficacy of the VA’s protocols, experience for yourself one woman’s harrowing experience with the VA which eventually led to husband’s suicide:

The story of Kimi Bivins is not the exception to the type of treatment Veterans with PTSD receive at the VA. Based on many similar stories, the VA is failing our Veterans and their loved ones.

I encourage readers to read Kimi’s harrowing description of what actually takes place at a VA facility.

While the folks at the VA casually dismiss anecdotal stories, VA claims that Veterans receive the best therapy possible is simply not supported by the evidence.

No less of an authority that the National Academies of Sciences (Medical Division) reported in a 2014 study entitled “Treatment for POSTTRAUMATIC STRESS DISORDER in Military and Veteran Populations,” that CBT and PET barely made a statistical dent in providing Veterans with PTSD any lasting improvement in their condition.

Consider Maj. Ben Richards‘ compelling evidence documenting the failed experiments at the VA in helping Veterans with PTSD.

Standing behind a well-entrenched bureaucracy of statistical inaccuracies and dogma, the VA goes out of its way to discredit other treatment alternatives. Consider this bitter “scientific” debate between Dr. Cifu and Dr. Paul Harch on the efficacy of hyperbaric oxygen therapy or HBOT in treating PTSD and TBI.

Finding a Middle Ground for Veterans with PTSD?

With so little known about the brain and how to treat trauma, it seems absurd for the VA to insist that they have all the answers.  The evidence clearly suggests that the VA doesn’t have a clue.

Nevertheless, the VA argues that “alternative therapies” that do not pass scientific scrutiny and FDA approval will not be endorsed by the VA.  As we have seen countless times – from body armor testing to hyperbaric oxygen studies – the DoD uses test protocols that deviate from accepted standards.

If the tests are flawed, one is likely to draw the wrong conclusions!

For the vast majority of Veterans with limited economic means, the VA is effectively making life and death decisions based on flawed testing and a reluctance to embrace other treatment alternatives.

This is probably done with the intent of protecting Veterans from charlatans and snake oil peddlers, but doesn’t it also block Veterans from receiving promising therapies from legitimate sources?

When dogma or “approved” therapies become the LAW, then it seems unlikely that much progress will be made to help our brave Veterans recover their lives.  The VA would do well to encourage Veterans to seek alternative therapies and provide an interactive sounding board for Veterans to voice their opinions on these programs.

Honesty and transparency and a willingness to accept mistakes is the sign of a responsive institution.   Today, the VA hides behind a dogma based on self-delusion and falsehood.

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Veteran Suicides: The VA Releases “New” Statistics

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The Department of Veterans Affairs (“the VA”) recently released a report showing state-by-state disparities in suicide rates among Veterans.  Sadly, the data tracks Veteran suicides rates through 2014 leaving a significant time gap in determining whether the trend in 20+ veteran suicides a day is improving.

Veteran Suicides

(U.S. Army photo by Stephen Baker)

The news media has been quick to seize on some of the notable anomalies in the data, some of which is highlighted below from PBS news:

  • Suicide among military veterans is especially high in the western U.S. and rural areas;
  • Suicide rates in Montana, Utah, Nevada and New Mexico averaged 60 per 100,000 individuals compared to the national average of 38.4 (overall in the West was 45.5);
  • Women veterans had a suicide rate 2.5 time higher than for female civilians;
  • A VA study (last year) found that veterans who received the highest doses of opioid painkillers were more than twice as likely to die of suicides than those receiving the lowest doses;  
  • 65% of Veteran suicides were age 50 or older. 

It is difficult to generalize from this somewhat dated report other than to say that Veteran suicide rates are considerably higher than the national average.

Furthermore, it would appear that the VA’s propensity to dispense potent prescription drugs – primarily opioids – may have contributed to high suicide rates among Veterans.

Just who is to blame for the opioid epidemic sweeping the United States?  Finger-pointing suggests that many are to blame for the epidemic, but new candidates emerge daily.

For instance, the New York Times recently reported that insurance companies may need to shoulder part of the blame for opioid abuse.  Why?

“Opioid drugs are generally cheap while safer alternatives are often more expensive.

“Drugmakers, pharmaceutical distributors, pharmacies and doctors have come under intense scrutiny in recent years, but the role that insurers — and the pharmacy benefit managers that run their drug plans — have played in the opioid crisis has received less attention. “

Nevertheless, some institutions took measures far earlier to stem addictive drug treatment.   For instance, Mother Jones reports that: “Partnership HealthPlan, the main public insurance provider for Medi-Cal patients in rural Northern California, discovered an alarming trend: Many counties where Partnership operated had among the highest rates of opioid prescribing and overdose in the state. Hydro­codone was the top-prescribed medication among Partnership patients, who include more than 570,000 Medi-Cal recipients from the vineyards of Sonoma County to the redwoods on the Oregon border. In Lake County, a poor, rural area bordering Sonoma, enough opioid painkillers were prescribed in 2013 to medicate every man, woman, and child with opioids for five months, according to a report by the California Health Care Foundation.”

Unfortunately, the VA is largely unaccountable to anyone and Veterans have few affordable choices other than to rely on treatment options provided by the VA.  With a dismal track record in providing treatment for Veterans with PTSD, it is hard to see how any meaningful progress will be made by the VA in curbing VA suicides.

More disturbing is the thought that Veterans with PTSD incurred from the Gulf Wars and continued deployments in Afghanistan and Iraq will soon be approaching their 50th birthday.   If the VA statistics are credible that “65% of Veteran suicides are over the age of 50,” then we may actually see an uptick in suicide rates among Veterans.

Despite repeated assurances to Congressional Committees, Dr. David Cifu and his cronies at the VA don’t have a clue on how to treat PTSD.   Cocktails of lethal prescription drugs are clearly not the answer, but the VA’s blind insistence that Cognitive Behavioral Therapy and Prolonged Exposure Therapy are the only effective treatment programs is simply ludicrous.

Whatever the reasons, Veterans with PTSD and TBI may not really have a viable financial alternative outside the treatment barriers currently erected by the VA.

Even though the information is dated, the VA has done a good job illustrating the extent of the problem.  While one can draw many inferences from the data, it would be totally wrong to suggest that the VA has a handle on the problem and absurd to think that they have answers!

No wonder Veterans with PTSD and TBI have lost faith in the VA.

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What do the NFL and the VA Have in Common?

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Like the Department of Veterans Affairs (“the VA”), the NFL has eloquently side-stepped the effects of brain trauma caused my massive or repeated concussive events.

In a most disturbing study, the Journal of the American Medical Association has concluded that “110 of 111 NFL players were found to have chronic traumatic encephalopathy, or C.T.E., the degenerative disease believed to be caused by repeated blows to the head.”

Chronic Traumatic Encephalopathy or CTE

This should come as no surprise to most anyone who has followed repeated denials by NFL officials and team owners that repeated concussive events on the field of play lead to permanent brain damage.

Why?  The liability is simply too great and public outcry might hurt the lucrative revenue stream of the NFL, which is currently exempt from antitrust laws thanks to the largesse of Congress.

Personally, I don’t believe that the risk of brain injury will deter rabid fans from attending college or NFL games anymore than residents of Rome passed up an opportunity to attend a bloody spectacle at the colosseum.

Nevertheless, there is a strong grassroots effort to cut back on football programs for young children.  A recent news report from Tampa, Florida highlights the dilemma faced by parents whose 9 and 10 year-old children want to play contact football.

NFL Players and our Military Heroes

While NFL players have the opportunity to walk away from the sport they dearly love, the brave men and women who serve in our armed forces don’t have quite the same options.

More to the point, Veterans suffering from from PTSD and TBI have few possibilities given the VA’s limited menu of therapy options: Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT).   As the VA acknowledges, neither of these therapies has produced significant improvements in the well-being of Veterans.

To mask the their failure in treating PTSD and TBI, the VA has resorted to potent prescription drugs with unsettling side-effects.   In effect, treating PTSD and TBI has largely been a “loss loss” for Veterans with equally devastating results on their families.

What the VA and the NFL have in common is a culture of arrogance and denial based on a concerted and prolonged effort to hide the truth from those it purports to serve and protect.   In effect, the VA has told Veterans that “it is the VA way or the highway.”

Sadly, far too many Veterans have opted for the highway.

Dr. David Cifu and the Culture of Doom

Nowhere is this arrogance of the VA more manifest than in the pompous and self-serving performance by Dr. David Cifu, a consultant for the VA on PTSD and TBI, at a 2016 Congressional subcommittee:

Scholars in attendance were revolted by Dr. Cifu’s anecdotal and silly justification for why the VA’s policies and procedures for treating PTSD and TBI are so far out of touch with the latest scientific research.

Sadly, Dr. Cifu’s opinions reflect entrenched attitudes at the VA and deprive tens of thousands of brave Veterans the treatment they deserve to combat this debilitating injury.

While Dr. David Shulkin is cleaning house at the VA, he would do well to look at those like Dr. Cifu to determine if they are up to the task in reestablishing the credibility of the VA.

Veterans that talk to SFTT believe that the VA is useless in helping to address their problems with PTSD and TBI.

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Meet Maj. Ben Richards and Bronco, his Service Dog

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I had a delightful lunch yesterday with Maj. Ben Richards and Bronco, his service dog.  Also joining us for lunch were Eilhys England, Chairperson of Stand for the Troops (“SFTT”) and Dr. Yuval Neria, Director of the PTSD Research Program at Columbia Presbyterian.

Maj Ben Richards and Service Dog Bronco

I hadn’t seen Bronco (a labradoodle) before and was interested in learning how service dogs are trained.

After the dogs reach maturity – normally 6 months – they begin an intensive 5 month training program designed to familiarize the service dog with elements of supporting a human being. For instance, the dog has to learn to navigate elevators and escalators and to respond to potential danger signals which could cause panic in the dog’s human companion.

A well-trained service dog is not distracted by peripheral events like the presence of other dogs or animals and will avoid eating food that has been dropped on the floor.

After the service dog has successfully completed his training, the certified service dog is then introduced to his/her human companion.  Ben spent seven weeks in intensive training with Bronco.  According to Ben, it was about 4 hours of training a day (generally in the morning) and a few weekend sessions.

Ben and Bronco have been constant companions for almost a year.  Ben mentioned that it is the first time in 9 years he has been able to sleep without facing the door of his bedroom.  Bronco will also wake him up if he has nightmares or if thunder is approaching which might threaten sleep and trigger an anxiety attack.

Bronco has allowed Ben to feel comfortable enough to attend movies and, in fact, he went to a museum in D.C. by himself for the first time in several years.   The museum visit brought a small to Ben’s face as he recalled that it was the first time he didn’t feel like he had to process potential threats without the attendant anxiety of not being able to do so fast enough.

Ben looked great and it was wonderful to re-establish personal contact with him again.  Ben is a brave warrior who has suffered his own particular demons and is intent on helping others recover their lives from the silent wounds of wars.

Ben’s service dog 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.

What the VA should actually be studying are its own failed programs of Prolonged Exposure (PE), and Cognitive Processing Therapy (CPT) which the VA continues to tout as being so successful in helping Veterans with PTSD.

While VA administrators and consultants like Dr. David Cifu can continue to hoodwink Congressional committees with their disingenuous sales pitch, most Veterans have given up on the VA with their substandard and largely ineffectual services.

Many Veterans like Ben are gradually taking matters into their own hands despite threats by the VA to withdraw benefits.  Fortunately, many States, private hospitals and charitable institutions are rushing in to fill the void left by the VA.

Is it too much to expect that the VA step up to the plate and truly support Veterans rather than hand grants to people and institutions who are prepared to parrot a pollyanna party-line based on half-truths and downright lies?

Our brave men and women in uniform deserve better.

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Veterans with PTSD Knew that VA Opioid Prescriptions Were Wrong

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After many lives of many brave Veterans with PTSD have been lost, the State of Ohio has finally taken action against pharmaceutical drug companies for hyping opioids.

Opioids

According to the New York Times reporter,  

The State of Ohio filed a lawsuit on Wednesday against the pharmaceutical industry over the opioid epidemic, accusing several drug companies of conducting marketing campaigns that misled doctors and patients about the danger of addiction and overdose.

Defendants in the case include Purdue Pharma, Teva Pharmaceutical Industries, Johnson & Johnson, Endo Pharmaceuticals, Allergan and others.

Purdue, the maker of OxyContin, a time-release opioid, released a statement saying, “We share the attorney general’s concerns about the opioid crisis and we are committed to working collaboratively to find solutions,” and calling the company “an industry leader in the development of abuse-deterrent technology.”

As most Veterans treated by the Department of Veterans Affairs (“the VA”) are aware, opioids were the prescription of choice for Veterans suffering from PTSD.

Despite overwhelming evidence available to the VA and the Department of Defense (the DOD) that this was probably not a wise course of action, the VA persisted in treating the symptoms of PTSD with dangerous prescription drugs.

It is only now with opioid and drug addiction ravishing communities across the United States that some local and State governments are beginning to take action.  In the interim, thousands of Veterans with PTSD have suffered through over-medication with opioids by doctors at the VA.

More to the point, the VA continues to insist on dated and ineffective treatment programs for Veterans with PTSD and TBI.   Under the inept counsel of Dr. David Cifu, these same treatment therapies continue at the VA today.

It is difficult to predict when this tragic saga will end, but clearly there are no indications that the VA plans to make any substantial changes to current programs.  As such our brave Veterans will continue to receive the same flawed therapy and, most likely, a healthy supply of prescription drugs to mask the symptoms.

Where are our leaders in Congress and leaders within the VA to put an end to this tragedy?  Cynical though I am, I have a difficult time believing that Big Pharma political campaign donations would be the reason.

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Meet David Cox: Dr. “No” of VA Reform

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Meet J. David Cox, who many consider “Dr. No” of badly needed reforms within the Department of Veterans Affairs (“the VA’).

J. David Cox

J. David Cox

J. David Cox is President of the American Federation of Government Employees and is the person most likely to block any meaningful reform within the VA.  SFTT has had an eye on Mr. Cox who in the run-up to last year’s Presidential election, threatened the previous secretary of the VA with physical violence:

Cox was “prepared to whoop Bob McDonald’s a – -,” he said. “He’s going to start treating us as the labor partner … or we will whoop his a – -, I promise you,”

The new VA Secretary, Dr. David Shulkin, is rightly receiving favorable media coverage and support from both parties in Congress on his forceful new leadership.  In fact, the New York Times recently referred to Dr. Shulkin as a “Hands On, Risk-Taking ‘Standout.'”

The New York Times reports the following example of Dr. Shulkin’s responsiveness (and common sense):

After he first took the job, he grew concerned that the agency was not doing enough to prevent suicide after a news report showed high rates among young combat veterans. Suicide prevention leaders told him that they would put together a summit meeting to respond, adding that it would take 10 months.

Dr. Shulkin told them to get it done in one month. When his staff members pushed back, he pulled out a calculator and began quietly tapping, then showed them that during the delay, nearly 6,000 veterans would kill themselves. They got it done in a month.

“For me it was a very important day,” he said, remembering the meeting. “It taught our people you can act with urgency, and you can resist the temptation to say we work in a system that you can’t get to move faster. I think they learned that you can.”

Indeed, SFTT has greatly admired the decisiveness with which Dr. Shulkin has attacked two chronic problems with the VA:  A bloated infrastructure and the lack of authority to manage the VA’s large workforce.

While Congressional Republicans and Democrats have largely agreed on an “accountability” bill to support the firing of VA employees, J. David Cox argues that:

“Trampling on the rights of honest, hard-working public-sector employees is not the solution to holding bad employees accountable for their actions,” American Federation of Government Employees National President J. David Cox said. He said the bill would set up different standards for VA employees and other federal workers.

In fact, just recently it was reported that “a federal appellate court overturned the firing of Sharon Helman, who presided over a Phoenix VA Health Care System that left veterans waiting for weeks or even months for care while phony records were kept to show the agency was meeting its wait-time goals.”

Dr. David Shulkin, VA Secretary

While I hope that Dr. Shulkin has the fortitude to implement the bold changes he has outlined, the entrenched bureaucracy represented by David Cox and others, such as David Cifu, will continue to undermine his efforts.

The VA has simply grown too large to manage effectively.  Dr. Shulkin is right in arguing that the lives and well-being of Veterans are far more important than defending the rights of a few “bad apples” within the VA.  David Cox should embrace the vision of Dr. Shulkin and act in a manner which reflects well on the work ethic of the vast majority of VA employees.

Veterans, Veteran organizations and our elected officials should provide Dr. Shulkin with a clear mandate to bring about the much needed reform within the VA. Our Veterans, their family and friends and an appreciate public deserve no less.

J. David Cox would do well to join forces with Dr. Shulkin in this effort rather than taunt him.

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Hyperbaric Oxygen Therapy (HBOT) to Treat Veterans with PTSD

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Veterans and casual observers continue to be mystified why the Department of Veterans Affairs (the “VA”) continues to insist on failed therapy programs to treat Veterans with PTSD.

Dr. David Cifu, the senior TBI specialist in the Department of Veterans Affairs’ Veterans Health Administration, argues that Veterans treated with Cognitive Behavioral Therapy and Prolonged Exposure Therapy are receiving the best therapy possible to treat PTSD.   There is no reliable third-party verification to support Dr. Cifu’s bold assertion.

More to the point, Dr. Cifu dismisses  other treatment alternatives arguing that there is no scientific basis to support them.  In particular, Hyperbaric Oxygen Therapy (HBOT) has been singled out for particular disdain by Dr. Cifu.

Specifically, the VA concluded their trial “study” with the following observations:

“To date, there have been nine peer-reviewed publications describing this research,” Dr. David Cifu, VA’s national director for physical medicine and rehabilitation recently told the Oklahoman. “All the research consistently supports that there is no evidence that hyperbaric oxygen has any therapeutic benefit for symptoms resulting from either mild TBI or PTSD.”

Frankly,  there is voluminous scientific evidence that HBOT is both a viable and recommended treatment alternative for Veterans suffering from PTSD and TBI.

Hyperbaric Oxygen Therapy (HBOT)

Hyperbaric Oxygen Therapy or HBOT is available at many privately-owned hospitals in the United States and around the world.  There is compelling scientific evidence that HBOT reverses brain damage.

In fact, HBOT is the preferred therapy of  the Israeli Defense Forces (“IDF”) for service members with head injuries.  Frankly, this assertion alone trumps any argument to the contrary by Dr. Cifu.

In its most simple form, HBOT is a series of “dives” in a decompression chamber (normally 40) where concentrated oxygen is administered under controlled conditions by trained physicians.  There is clear and conclusive evidence that brain function improves through the controlled application of oxygen.  In effect, it stimulates and may, in fact, regenerate brain cells at the molecular level.

HBOT Brain Functionality Over Time

In addition, HBOT is far cheaper to administer than currently approved programs at the VA.   Maj. Ben Richards argues that all Veterans with PTSD and TBI could be treated with HBOT for less than 10% of the VA budget allocated for pharmaceuticals.

More to the point, the annual VA treatment costs for Veterans with PTSD and TBI are roughly $15,000. For this annual expense, many Veterans could receive HBOT.

Dr. Figueroa asks, What are we Waiting For?

Almost 3 years ago, Dr. Xavier A. Figueroa, Ph.D., in an article entitled “What the <#$*&!> Is Wrong with the DoD/VA HBOT Studies?!!” clearly sets forth a compelling scientific argument why Veterans with TBI and PTSD should be treated with HBOT.

Found below is a summary of Dr. Figueroa’s conclusions (footnotes removed):

A large fraction of the current epidemic of military suicides (22+ service members a day take their lives) are more than likely due to misdiagnosed TBI and PTSD. Although the DoD and VA have spent billions (actually, $ 9.2 billion since 2010) trying to diagnose and treat the problem, the epidemic of suicide and mental illness are larger than ever. Drug interventions are woefully inadequate, as more and more studies continue to find that pharmacological interventions are not effective in treating the varied symptoms of TBI or PTSD. In many cases suicide of veterans have been linked through prescribed overmedication.

HBOT is a safe and effective treatment with low-to-no side effects (after all, even the DOD accepted the safety of HBOT back in 2008). Access to HBOT is available within most major metropolitan centers, but the major sticking point is money. Who pays for the treatment?  Those that are willing to pay for it out-of-pocket and state taxpayers picking up the tab for brain-injured service members forced back into society without sufficient care (or forced out on a Chapter 10, when it should have been treated as a medical condition).

The continued reports of studies like the DoD/VA sponsored trials allow denial of coverage and provide adequate cover for public officials to claim that more study needs to be done. As we have seen, the conclusions of the authors of the DoD/VA sponsored studies downplay the results of effectiveness. There are sufficient studies (and growing) showing a strong positive effect of HBOT in TBI. More will be forthcoming.

The cardinal rule of medicine is “First, Do No Harm”. With HBOT, this rule is satisfied. Now, by denying or blocking a treatment that has proven restorative and healing effects, countless physicians and organizations, from the VA to DoD, Congress and the White House, could be accused of causing harm. Never mind how many experiments “fail” to show results (even when they actually show success). Failure to replicate a result is just that…a failure to replicate, not a negation of a treatment or other positive results. You can’t prove a negative and there are many clinical trials that do show the efficacy of HBOT.

The practice of medicine and the use of HBOT should not be dependent on the collective unease of a medical profession and the dilatory nature of risk adverse politicians, but on the evidence-based results that we are seeing. Within the VA, there are hard working physicians that are trying to change the culture of inertia and implement effective treatments for TBI and PTSD, using evidence based medicine. Unfortunately, evidence-based medicine only works when we accept the evidence presented to us and not on mischaracterized conclusions of a single study (or any other study). Our veterans, our citizens and our communities deserve better than what we are currently giving them: bad conclusions, institutions too scared to act in the interests of the people it serves and too many physicians unwilling to look at the accumulated evidence.

Indeed, it is time to for Dr. Shulkin to rid the VA of Dr. Cifu and embrace cost-effective treatment therapies which provide some hope for Veterans with PTSD and TBI.

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Gun Control and Veteran Suicides: Is Research Lacking?

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Like most everyone, the gun control debate is front and center on both sides of the political spectrum.  Sadly, very few – if any – of proposed changes to existing gun control laws would have a major impact on Veteran suicides.

ptsd

I recently came across an interesting article published in the Washington Post entitled “The reasons we don’t study gun violence the same way we study infections.”    The gist of the article is that well over half (actually 62%) of gun-related deaths in the United States reported by CDC are suicides.  Sadly, very little money is allocated to the study of suicides.  Some of these reasons stem from restrictions on gun research, but a chronic lack of funding suggests that other topics receive the lion’s share of research money.

The article, written by Carolyn Johnson,  states the following:

There are a few reasons for the gun violence research disparity. First, there are legislative restrictions on gun research. For two decades, the Centers for Disease Control and Prevention has been prevented from allocating funding that could be used to advocate for or promote gun control. Although that doesn’t explicitly exclude all research on gun violence, it is said to have had a chilling effect on funding.

Aside from political pressure, there is a more philosophical one in which injuries are treated differently than disease. Injuries are a public health issue, but the debate over gun research often becomes mired in a debate over whether a person who intentionally wants to hurt himself or another person will do so, with or without a firearm. Research is also often driven by where researchers see the biggest scientific opportunity to come up with a cure or therapy, and infections or cancer may simply be easier to study than gun violence using traditional tools.

One of the complications of a study like this is that it uses broad categories to look at spending trends. For example, if the majority of gun violence is suicides, it might make more sense to study suicide, regardless of whether it involves a firearm. But suicide, too, has been chronically underfunded compared with its health burden. The number of deaths annually from breast cancer are now about the same as suicide. But breast cancer research received $699 million in NIH research funding in 2016; suicide and suicide prevention received $73 million.

While it is difficulty to draw too many conclusions from Ms. Johnson’s article, it would appear that cure or therapy-related research “may simply be easier to study than gun violence using traditional tools.”   In other words, simple evidence-based studies seem to attract more funding rather than complex studies, such as suicide prevention.

Using Ms. Johnson’s analysis, it is not surprising that the VA feels more comfortable funding marijuana studies which help Veterans cope with the symptoms of PTSD rather than treat brain injury.  In fact, over the last 15 years, the VA has done little – if anything – to treat Veterans with PTSD.

Citing a National Institute of Health 2014 study of the VA, Maj. Ben Richards points out that despite the most sophisticated therapy provided by the VA the average PCL-M score to assess Post Traumatic Stress has fallen only 5 points.  In fact, PCL-M scores for “treated” Veterans is still well above the 50 benchmark considered adequate by the military.

Ben Richard's PTSD VA Study

For more of Maj. Ben Richard’s analysis of the Department of Veteran’s Affairs costly and rather futile effort to help Veterans with PTSD, please CLICK HERE.

While the VA embarks on yet another study to combat the symptoms of PTSD, tens of thousands of needy Veterans are deprived of necessary research to help them reclaim their lives rather than simply cope with their problems.

A well-tested program, Hyperbaric Oxygen therapy (“HBOT”) has allowed Maj. Ben Richards to recover much of his cognitive function.  Yet, Dr. David Cifu and others at the VA still refuse to fund HBOT for Veterans with PTSD.

Veteran suicide rates are currently 22% than the normal population.  Doesn’t it make sense to provide workable therapy programs to Veterans rather than embark yet again on studies that treat symptoms rather than the problem?  Our Veterans deserve much more.

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Drs. Paul Harch and David Cifu Spar over Hyperbaric Oxygen Therapy

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Well over a year ago, Dr. Paul Harch, one of the leading experts in Hyperbaric Oxygen Therapy (“HBOT”) published an authoritative report entitled “Hyperbaric oxygen in chronic traumatic brain injury:  oxygen, pressure and gene therapy” for the U.S. National Library of Medicine (Medical Gas Research).

In this report (a lengthy extract is printed below), Dr. Harch argues persuasively over the many benefits of using HBOT in treating brain injury:

Hyperbaric oxygen therapy is a treatment for wounds in any location and of any duration that has been misunderstood for 353 years. Since 2008 it has been applied to the persistent post-concussion syndrome of mild traumatic brain injury by civilian and later military researchers with apparent conflicting results. The civilian studies are positive and the military-funded studies are a mixture of misinterpreted positive data, indeterminate data, and negative data. This has confused the medical, academic, and lay communities. The source of the confusion is a fundamental misunderstanding of the definition, principles, and mechanisms of action of hyperbaric oxygen therapy. This article argues that the traditional definition of hyperbaric oxygen therapy is arbitrary. The article establishes a scientific definition of hyperbaric oxygen therapy as a wound-healing therapy of combined increased atmospheric pressure and pressure of oxygen over ambient atmospheric pressure and pressure of oxygen whose main mechanisms of action are gene-mediated. Hyperbaric oxygen therapy exerts its wound-healing effects by expression and suppression of thousands of genes. The dominant gene actions are upregulation of trophic and anti-inflammatory genes and down-regulation of pro-inflammatory and apoptotic genes. The combination of genes affected depends on the different combinations of total pressure and pressure of oxygen. Understanding that hyperbaric oxygen therapy is a pressure and oxygen dose-dependent gene therapy allows for reconciliation of the conflicting TBI study results as outcomes of different doses of pressure and oxygen.

Not surprisingly, Dr. David Cifu, Senior TBI Specialist in the Department of Veterans Affairs’ Veterans Health Administration, gave the standard stock answer from the spin doctors at the VA that:

There is no reason to believe that an intervention like HBOT that purports to decrease inflammation would have any meaningful effect on the persistence of symptoms after concussion. Three well-controlled, independent studies (funded by the Department of Defense and published in a range of peer reviewed journals) involving more than 200 active duty servicemen subjects have demonstrated no durable or clinically meaningful effects of HBOT on the persistent (>3 months) symptoms of individuals who have sustained one or more concussions. Despite these scientifically rigorous studies, the clinicians and lobbyists who make their livings using HBOT for a wide range of neurologic disorders (without scientific support) have continued to advocate the use of HBOT for concussion.

To Dr. David Cifu’s stock VA response, Dr. Harch responded as follows:

The charge is inconsistent with nearly three decades of basic science and clinical research and more consistent with the conflict of interest of VA researchers.  A final point: in no publication has the claim regarding effectiveness of HBOT in mTBI PPCS been predicated on an exclusive or even dominant anti-inflammatory effect of HBOT. Rather, the argument is based on the known micro-wounding of brain white matter in mTBI, and the known gene-modulatory, trophic wound-healing effects of HBOT in chronic wounding.  The preponderance of literature in HBOT-treated chronic wound conditions, is contrary to Dr. Cifu’s statement of HBOT as a “useless technology.”

As a layman, Dr. Harch’s detailed rebuttal (see FULL RESPONSE HERE) completely destroys Dr. Cifu’s “non-responsive” comment to the scientific points raised in Dr. Harch’s report.  In my view, it goes beyond the traditional “professional respect” shown by peers:  Dr. Harch was pissed off and, in my opinion, had every right to be.

Not surprisingly, Dr. Cifu has not responded to the irrefutable arguments presented by Dr. Harch.

The discussion of HBOT is not a subject of mild academic interest.  Specifically,  Veterans are being deprived of hyperbaric oxygen therapy because Dr. David Cifu and his cronies at the VA are misrepresenting the overwhelming evidence that suggests that HBOT restores brain function.

Why?  Indeed, that is the $64 question.

It is difficult to forecast how this academic drama will play out.  Nevertheless, I suspect that David Ciful will eventually be viewed by Veterans as performing a similar role within the VA as Alvin Young, aka “Dr. Orange.”

I hope and pray this is not the case.  On behalf of tens of thousands of Veterans who are denied HBOT treatment for PTSD and TBI by the clumsy and sloppy claims of Dr. Cifu and others within the VA, please “do the right thing” and lend your support to HBOT as a recommended VA therapy for treating brain injury.

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Dysfunctional VA or a Paradise for Veterans?: Pause for Reflection

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Stand for The Troops (“SFTT”) has long been critical of the manner in which the Department of Veterans Affairs (the “VA”) treats Veterans with PTSD and TBI.  Other critics have singled out long wait times for Veterans seeking treatment and other issues that have prompted Congressional inquiries.

Sadly, one can no longer discuss this issue dispassionately considering that many stakeholders and political candidates seem to be positioning themselves on one side of the debate or the other.  With a $170 billion budget and over 200,000 employees, a decision to make the VA more responsive to the needs of Veterans is never a black or white decision.

J. David Cox

J. David Cox

Like many others, I was appalled by the outburst of J. David Cox, the President of the American Federation of Government Employees, who threatened VA Secretary with “physical violence”

Cox was “prepared to whoop Bob McDonald’s a – -,” he said. “He’s going to start treating us as the labor partner … or we will whoop his a – -, I promise you,”

According to U.S. Rep. Jeff Miller, a Republican from Chumuckla, Florida, and the chairman of the House Committee on Veterans’ Affairs as reported in Military.com

The exchange perfectly encapsulates the corrosive influence government union bosses are having on efforts to reform a broken VA. It’s a never-ending cycle in which pliant politicians and federal agency leaders bow to the boss’s demands to preserve the dysfunctional status quo of our federal personnel system, which almost guarantees employment for government bureaucrats no matter how egregious their behavior.

The problem with union bosses like Cox is that they are more interested in protecting misbehaving VA employees than the veterans the department was created to serve.

The problem with VA leaders like McDonald is that, in their perpetual quest to placate big labor’s powers that be, the taxpayers and veterans they are charged with serving are paying the price.

Frankly, it is tough to find fault with Representative Miller’s assessment of the situation.  If we want meaningful reform within the VA to provide Veterans with the support they deserve, then we need to confront entitled thugs like David Cox and others that block long overdue change.

It will not be easy, but we must admit that the VA is fragile – if not broken – and we need to fix it to provide Veterans with the level of care they deserve.

Veterans with PTSD and the VA

As regular readers of Stand For the Troops newsletter are aware, we are keenly focused on the level of care and treatment provided to Veterans suffering from Post Traumatic Stress.

Based on our research, we have found that the care and treatment provided by the VA leads to no lasting benefit to the thousands of Veterans affected by PTSD and TBI.  We reported on this earlier, but it is worthwhile watching a video of Maj. Ben Richard’s explain the failure of the VA to provide meaningful solutions:

This sobering assessment by Maj. Richards was featured a couple of months ago in our article entitled “The VA Can’t Handle the Truth, So Why Bother.” SFTT’s goal is not to throw rocks at the VA, but to insure that Veterans get the needed treatment they deserve.

It is hardly reassuring that some Veterans find it necessary to swim with sharks as an alternative therapy for PTSD, but it is evident that the lack of responsiveness and credibility of the VA has driven Veterans to embrace other solutions.

The Big Questions for Taxpayers and Government Leaders

Will the much needed reform within the VA be held hostage by self-serving labor leaders like J. David Cox and disingenuous medical practitioners like Dr. David Cifu?

Do we have the courage to change the VA system for the benefit of our brave heroes?

Can we agree to promote VA programs that work, improve those programs that are not effective and reform or radically change existing programs and protocols that simply do not work?

For all Americans, it is time to reflect on the kind of support we truly want to provide to Veterans.

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