Pentagon reluctant to provide therapy for TBI
After a lengthy investigation, ProPublica’s T. Christian Miller and NPR’s Daniel Zwerdling found that, in their words, the “battle over science and money has made it difficult for wounded troops to get a treatment recommended by many doctors for one of the wars’ signature injuries.”
They’re writing, of course, about traumatic brain injury, a consequence of roadside bombs in Afghanistan and Iraq. Their work revolves around a method of treating TBI and rehabilitating victims that has gained wide acceptance among civilian physicians and health plans but has not been embraced by the military’s insurance provider.
During the past few decades, scientists have become increasingly persuaded that people who suffer brain injuries benefit from what is called cognitive rehabilitation therapy — a lengthy, painstaking process in which patients relearn basic life tasks such as counting, cooking or remembering directions to get home.
Many neurologists, several major insurance companies and even some medical facilities run by the Pentagon agree that the therapy can help people whose functioning has been diminished by blows to the head.
Tricare provides health insurance for about 4 million active duty and retired soldiers, and “despite pressure from Congress and the recommendations of military and civilian experts,” it still refuses to cover cognitive rehabilitation therapy for the thousands of American soldiers afflicted by TBI.
Five of the 12 largest insurers cover the therapy, and an expert panel has recommended that the military do the same.
For its part, Tricare points to an assessment it conducted that put the effectiveness of cognitive rehabilitation therapy into doubt. I’ll let Miller and Zwerdling take it from there.
An investigation by NPR and ProPublica found that internal and external reviewers of the Tricare-funded assessment criticized it as fundamentally misguided. Confidential documents obtained by NPR and ProPublica show that reviewers called the Tricare study “deeply flawed,” “unacceptable” and “dismaying.” One top scientist called the assessment a “misuse” of science designed to deny treatment for service members.
The therapy would cost $15,000 to $50,000 per soldier, and the reporters found that, in private, Pentagon officials had expressed concerns about the massive cost of providing it to every suffering soldier. A few soldiers with political connections or ultra-motivated family members have managed to get the therapy, but its essentially off limits for most folks covered by Tricare.
Finally, a quick parenthetical mention answers a question that most health reporters are asking at this point. How did they get those internal studies and documents?
HINT: It involved finding a slightly less formal way to fulfill some of their FOIA requests.
(NPR and ProPublica obtained a copy of the ECRI reports through the Freedom of Information Act. However, Tricare denied access to reviews of the reports. ProPublica and NPR have appealed the request, but obtained copies of the reports and information on the reports from sources.)
Bagram airfield a leading lab for trauma medicine
NPR’s Quil Lawrence reports that Afghanistan’s Bagram airfield, the primary stop for seriously wounded soldiers before they’re stabilized and transported to Germany or America for long-term care, has served as an opportunity for forging broad advances in emergency medicine.
“At the beginning of this conflict, we were taking the best trauma medicine from the civilian sector, and we brought it to Iraq and Afghanistan,” says U.S. Air Force Col. Chris Benjamin, the hospital commander. He says now his doctors tell him it’s the other way around.
“Here we are seven, eight years later, taking what we’ve learned in these conflicts to teach them the advances that we’ve made with this data collection here in theater,” he says.
Thanks to body armor and advances in battlefield trauma like the increased use of tourniquets, more soldiers are arriving alive, but with serious, traumatic injuries. When they pass through Bagram, the volume and severity of their wounds “continues to yield new data that are helping to save lives in ways that were impossible only a few years ago,” Lawrence writes.
Story on soldiers’ aches and pains wins member a Mid-America Emmy
Filed under: Government, Health journalism, Member news
A story inspired by a session at Health Journalism 2009 earned member Meryl Lin McKean the 2010 Emmy for Health/Science News at the Mid-America Emmy Awards this year. McKean is the medical reporter at WDAF-Kansas City. Her story looked beyond casualty rates to the everyday aches and pains that come as a result of active military service in Iraq and Afghanistan. The video is no longer available, but the accompanying text demonstrates the scope and severity of such problems.
Soldiers return to a border checkpoint in the Khowst province of Afghanistan. Photo by The U.S. Army via Flickr
A V.A. report found that nearly half of the returning vets from Iraq and Afghanistan have bone, joint or tissue injuries. At Kansas City’s V.A. Medical Center, 17% of the vets seen in the new post-deployment clinic have those injuries. That’s still far higher than in non-vets.
“This age group between 18 and 30 — you might expect five percent at the most,” says Bob Fletcher, V. A. Physician’s Assistant.
Fletcher says the problems are clearly related to the combat load. And the problems for many vets will continue. Those problems include include arthritis pain and stiffness, the inability to hold certain jobs that require much movement, and possible dependence on pain medication.
PTSD or personality disorder? It matters to soldiers
Filed under: Government, Health journalism, Health policy, Studies
The AP’s Anne Flaherty has put together a story that illuminates the Army’s refusal to admit that it could have misdiagnosed (and discharged) hundreds of soldiers who may have had PTSD or traumatic brain injury instead of a personality disorder. Keep in mind that a discharge for “personality disorder” means no veterans’ benefits and a lifetime of stigma. A diagnosis of PTSD or injury, on the other hand, means treatment will be covered by the government.
Photo by isafmedia via FlickrThe Army, for its part, has decided there’s nothing unusual about the following chain of events (taken from Flaherty’s story):
- The Army “discharged about a 1,000 soldiers a year between 2005 and 2007 for having a personality disorder.”
- In 2007, The Nation’s Joshua Kors writes a cover story exposing the Army’s apparent habit of diagnosing soldiers with a personality disorder instead of considering the possibility of PTSD or traumatic brain injury.
- Soon after, “the Defense Department changed its policy and began requiring a top-level review of each case to ensure post-traumatic stress or a brain injury wasn’t the underlying cause.”
- Sure enough, “the annual number of personality disorder cases dropped by 75 percent.”
- At the same time, the number of post-traumatic stress disorder cases has soared. By 2008, more than 14,000 soldiers had been diagnosed with PTSD — twice as many as two years before.
- Army officials “reviewed the paperwork of all deployed soldiers dismissed with a personality disorder between 2001 and 2006″ and said they “did not find evidence that soldiers with PTSD had been inappropriately discharged with personality disorder.”
MSNBC tells of earthquake amputees, soldiers
In the aftermath of the Haiti earthquake, an MSNBC team has set out to cover, through a variety of media, an American prosthetic group working at a rural hospital to fit limbs to hundreds of earthquake amputees. At the same time, the team is sharing personal essays written by American soldiers who lost limbs in Iraq and Afghanistan. It’s an unusual post-disaster focus that has yielded some impressive stories.
Here are a few of the most notable dispatches:
- The natural ease with which young children adapt to prosthetics (And share with each other | While their families struggle to cope)
- An American helicopter pilot adapts after losing limbs in Afghanistan.
A housing community set up for prosthetics patients after the Haiti quake - Fitting prosthetics to Haitian patients whose limb loss dates back to long before the earthquake.
- Making and fitting a new limb
- The life of one of the doctors fitting all those prosthetics in Haiti
More vets come home as result of psychiatric issues
On Shots, NPR’s Health Blog, Nadja Popovich reports on a recent Johns Hopkins study that found, more troops were evacuated from Iraq and Afghanistan in 2007 for mental health problems than for combat injuries.
The increase comes despite the military’s increased focus on combating mental health problems among American soldiers. The largest number of evacuated soldiers are still those diagnosed with “noncombat-related injuries, such as muscle and joint problems that come from carrying equipment,” but psychiatric evacuations are a growing and complex problem.
American paratroopers in Afghanistan. Photo by U.S. Army Spc. William E. Henry via Flickr… those suffering from mental health issues had a remarkably low rate of returning to full duty. “Psychiatric conditions have the lowest return to duty rates among any diagnostic group aside from combat injuries,” (study leader Steven P. Cohen, an associate professor of anesthesiology at the Johns Hopkins School of Medicine and a colonel in the U.S. Army Reserve) wrote. “But the effects are much worse, because psychiatric conditions worsen the prognosis for all other conditions.”
“Patients with PTSD — as a rule — have multiple other complaints,” he continued. “Studies have shown that most people with persistent PTSD have ongoing musculoskeletal, neurological and constitutional complaints that are unlikely to respond to treatment.”
Related AHCJ articles
Interviewing ‘profoundly affected’ soldiers
Tips for interviewing service members returning from Iraq, the Middle East or Afghanistan
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