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June 28, 2008

"Disposable Heroes" - Washington Times and ABC News Investigates Drug Testing on Veterans

Disposable Heroes On June 16th, the Washington Times, which has been following the "Chantix harm to veterans" story doggedly, and ABC News, produced an investigative piece called "Disposable Heroes," about the drug testing that takes place on veterans, sometimes with lethal consequences.   That interactive piece is linked here. (Ironically, earlier this week, we posted an entry about veteran' similar exposure, this time from the Vietnam War, that is still coming to light.  That post is linked here.)

Here's the lead from the Washington Times' story, by Audrey Hudson:

The government is testing drugs with severe side effects like psychosis and suicidal behavior on hundred of military veterans, using small cash payments to attract patients into medical experiments that often target distressed soldiers returning from Iraq and Afghanistan...

In one such experiment involving the controversial anti-smoking drug Chantix, the Department of Veterans Affairs (VA) took three months to alert its patients about severe mental side effects.  The warning did not arrive until after one of the veterans taking the drug had suffered a psychotic episode that ended in a near lethal confrontation with police.

If you want to find other entries in the Washington Times' extensive coverage of Chantix and veterans, use this link here, which will produce a list of the articles, or go to their website, linked here, and do a search for "Chantix".  Be forewarned, however. Although the information on the website is well worth learning, the Washington Times has an especially cumbersome user interface, irrespective of browser.  Get ready to enable popups, and then, even so, only be able to pull up the stories with great difficulty.  Someone really needs to improve that...)

June 24, 2008

Needless Trauma: What Vietnam Vets Still Don't Know about Their Service Could Hurt Them

Official_photo_of_Mike_Thompson_lowresSaw this recent press release from a California congressman, who himself is a decorated Vietnam vet, and wondered about the pain that comes from NOT knowing the full extent of what you've been exposed to, as you were serving your country.  For the particulars, keep on reading:

– Today (June 12), Congressman Mike Thompson (D-CA) took another step toward helping veterans who were unknowingly tested with chemical and biological weapons in the 1960s and 70s.

The House Subcommittee on Disability Assistance and Memorial Affairs held a hearing on a Thompson-authored bill that would give these veterans health benefits and compensation for illnesses resulting from “Project 112” weapons tests. Thompson hopes this hearing will ultimately push his bill toward consideration by the House.

Project 112, which included ship-based Project SHAD, was conducted between 1963 and 1973 by the Department of Defense (DoD) and other federal agencies. The DoD now admits that during these projects, unknowing military personnel were involved a number of chemical weapon tests such as VX nerve gas and Sarin nerve gas and were exposed to biological weapons such as E. Coli, Tularemia (Rabbit Fever) and Q fever.

“First the government denied the tests existed. Then they said the tests happened but were harmless. Now they admit dangerous substances were used on our military personnel, yet they still refuse to give them care for their illnesses,” said Thompson. “We can’t change the past, but we can begin to right this wrong by giving these men the proper healthcare and compensation they earned.”

HR 5954, introduced by Thompson and Congressman Denny Rehberg (R-MT) in May, provides veterans of Project 112 a “Presumption of Service Connection.” This means the Department of Veterans Affairs (VA) presumes the relationship between service and a health condition, making the veterans involved eligible for medical benefits and/or compensation for their conditions. For example, veterans exposed to Agent Orange during the Vietnam War are already given a “Presumption of Service Connection.”

“I understand security classifications and the sensitivity of our operation,” said Jack B. Alderson, a retired Lt. Commander from the U.S. Navy Reserves and resident of Thompson’s district. “However, these were not volunteers but service personnel ordered to do a dangerous job and they did it, and did it well, now their nation needs to take care of them.”

In 1964, Alderson was the officer in charge of five U.S. Army light tug boats that were used to test chemical and biological weapons. The tug boats acted as sampling stations and targets for disseminated weapon clouds.

After the DoD admitted to Thompson that the tests did exist and included harmful agents, they released more than 6,000 names of military personnel used in the tests. However, the GAO reported in February that the DoD had halted their efforts to disclose additional names and many veterans remain unaware that they were even involved. The Thompson-Rehberg legislation would require the DoD to hand over all the names to the VA, which must then notify the veterans.

The Thompson-Rehberg legislation has been endorsed by the Vietnam Veterans of America, Veterans of Foreign Wars, American Legion, Disabled American Veterans and Paralyzed Veterans of America.

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CONTACT: Anne Warden at (202) 225-3311, (703) 338-4480 and anne.warden@mail.house.gov.

For a link to Congressman Thompson's office, click here.

June 23, 2008

PTSD Drugs: Better Living through Chemistry, or Purely Popping Pills for PTSD's Psychological Ills?

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There was a story in the news recently about four young combat veterans in West Virginia, all seemingly in decent physical condition beforehand, who nevertheless all died in their sleep recently.  Besides combat PTSD, one thing the vets all had in common was the cocktail of drugs they were taking: Paxil, Klonopin and Seroquel.  (The Charleston, West Virginia Gazette-Mail reported this story on May 24, 2008 - it's linked here.)  An investigation is pending, but the story obviously raises the question: what are vets with PTSD being prescribed, and is it really working, or what's best?  (Continue reading, and you'll learn more about those specific medications as well.)

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Where to go for information about PTSD medications?  Here are a few, carefully-chosen selections, and their pros and cons - as appropriate:

Jonathan Shay, M.D., Ph.D., well-known VA psychiatrist and outstanding veterans advocate, has written before about medications used to treat combat PTSD, and his impressions of them.  He wrote the material for a lay audience, in the version that's kicking around on the Web, in several different locations, and although it has been quoted by many as gospel, it's more than 12 years old by now (first published in 1995), and that's much too much time that's elapsed to consider that information really current. (The Dr. Shay list, "About Medications for Combat PTSD,"  is linked here.)  So that information is interesting for background -- and particularly for Dr. Shay's explanation of how things work and/or what makes a good PTSD medication, and what doesn't -- it out of date and should not be considered current. 

There's another list on the Web -- a table, really -- that's much more current (2006), and it lists the drug names, brand names, and how the drugs are thought to work with PTSD.  That list is linked here.  It may be a little difficult to read if you're coming to the topic cold, but perhaps not.

Some other suggestions:

If you have access to a public library or academic library, you can check out the PDR -- the Physician's Desk Reference -- and read up on a drug's profile, side effects, warnings, etc.  But since you're already on the Web, we can assume, reading this -- try going to PDRHealth.com, linked here-- and read up on the prescription drugs prescribed for PTSD.  Of the three drugs mentioned earlier, Paxil is linked here; Klonopin is linked here; and Seroquel is linked here.  You can also do a straight search for any OTHER drug used in PTSD treatment, or one with possible interactions with a drug used for PTSD, at the same site, by searching within prescription drugs by name (e.g., Zoloft, Chantix, etc.), at the general search interface, linked here.

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But the information in the PDR, whether on the Web or in the desk reference, is going to dry and technical, though worth reading -- pretty much exactly like the fine print that's packaged with the medications themselves. What you're probably going to want to know more about is what in software is called "the user experience" -- how other patients like you have experienced the medications.  For that you will need to turn to some other sources.

For what amount to "user reviews," try PsychCentral, or Revolution Health, both of which have increasingly robust user communities who will comment on their own experiences of the medications.  (Of course, not all their users taking medications for PTSD have PTSD from combat trauma, so be aware that their cases may be substantially different.)  Combined with the technical information about the drug's effects, side-effects and warnings (see links, above), it might be helpful in creating a broader picture of what the user experience is like:

Dr. John Grohol's PsychCentral website:  Paxil (Paroxetene) is linked here; Klonopin (Clonazapam) is linked here; and Seroquel (Quetiapine fumarate) is linked here. A general search through the medication library is linked here.

AOL Founder Steve Case's Revolution Health:  Users in the "User Community" provide "Community Ratings" on various medications.  The items on PaxilKlonopin, and Seroquel are linked here (click on any of those hyperlinks to take you to the community ratings), or, use a more generic search here, and look for the tab beneath that says "Community Ratings." (We will be blogging more about Revolution Health shortly.)

Don't forget books as well.  Mark Goulston, M.D.'s Post-Traumatic Stress Disorder for Dummies (2007), linked here, is very recent, and contains a whole chapter entitled, "The Role of Medication in Treating PTSD".

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You'll also want to learn as much as you can -- though this is primarily your healthcare provider's reponsibility, yet it's in your best interests to care about this as well -- about possible interactions, if you're taking a number of medications; as well as thinking through carefully whether the risks involved are ones you want to agree to, such as the potential that a medication -- bizarrely enough, prescribed for PTSD or depression -- may actually increase risk of suicide. (An example of news coverage about this is linked, here.)  Strange, and perhaps unavoidable, but true.

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Use caution whenever evaluating information about medications, especially as a non-professional, but at the same time, don't "just" believe what a healthcare provider tells you: be sure to check it out for yourself or your family member, at reputable sites like the ones mentioned above.  Your health is in your hands, so while you want and should actively solicit the expert advice of healthcare providers familiar with PTSD -- and don't settle for less :-), at the same time, YOU are the one who's going to be bearing the brunt of anything that goes wrong, so be sure to do your own due diligence and figure out what the possible side-effects, interactions, and unpleasant experiences might be for you, before you commit to a course of treatment.  You and your healthcare provider can be partners -- that's the new model -- not just "master" and "servant," or "priest" and "parishioner."  Take an active, informed role in your own healthcare, particularly where medications are concerned. 

June 19, 2008

What the VA Needs Is "The Odwalla Effect"

VA Be Like OJ [If this blog were a newspaper, which it isn't, this particular blog post would be an editorial -- found in the opinion section, separate from the rest of the paper.  The editorial section is where the editor "puts together" what the news means to him or her, and sets out a point of view, about what we should do or feel, think or believe about something, based on what else has been in the news lately, that they've been keeping people up to speed on.  It's the opinion section, essentially -- but from the editorial management's point of view.]

Here's ours:

Kathie Costos has a great series of posts over at her blog, linked here, but there's one in particular we'd like to talk about - and we'll leave you the link to it in a minute, so you can read it for yourself.  First, the discussion.  Kathie is conducting a question and answer session with Paul Sullivan, head of Veterans for Common Sense, clearing up "rumors" about the veterans' lawsuit against the VA.  Sullivan's answers are clear and to the point, and contain some fairly galvanizing statements, pro or con.

[I should insert the caveat here, in an effort to be balanced, that I DON'T believe the VA is "all bad," nor do I imagine Costos or Sullivan does.  Every once in a while you DO read about people who are extremely thankful and grateful for the care they're received through the VA - I read an item the other day where a veteran was reminding us that they have one of the best healthcare systems in the world.  True.  But that also brings up a question of which metric you're using, since while they are succeeding in some areas, they are clearly failing in others (and those are the areas which are making the news, frustrating veterans and families, and where they're being sued.)  Highly competent, concerned and caring individuals DO work for the VA -- many of the leading lights of care in the PTSD segment in particular have come from, or worked with, or still do work with, the VA.  People who are tremendously significant in the history of caring for veterans in an extremely high quality, enlightened, empathic way -- so people like that DO work for the VA, and always have.  Look through the "Experts" section on this blog, and see how many people have an affiliation with the VA, past or present: Ray Scurfield, Shad Meshad, Jonathan Shay, as well as others, all come to mind. (For the record, these people were probably "born" (wonderful) not "made" (wonderful) by their association with the VA as caregivers, but still -- they worked there and in some cases, still do.  And God knows, the VA heavily reads this website -- even at odd hours -- including very late at night, on weekends, on national holidays -- times when the rest of America is out grilling a hotdog with their family, throwing a ball in a park, or just snoozing the night away -- so clearly there are some very dedicated individuals there, trying to learn all they can in order to deliver better care to those who are suffering.  (Though they may also be reading to keep up with public opinion, to see which way the wind blows...)

I do sometimes wonder when I see what the VA is searching for, on this site, because it either seems kinda elementary (like they should know about it already), or a little "weak" in the efficacy of treatment department (like things that are waaaaaaaaaaay down the totem pole or triage pile of things to actually try with a demographic of patients who are suffering greatly). To give you an idea of what I'm talking about, frequent searches -- and the topics change regularly -- by the VA include such things as "spirituality for PTSD," "does recreation help?" and things like that, where, really, yes, even if they do -- they're only adjuncts and pretty far down the list at that, compared to more likely things that seem worth trying or are known to have some benefit.  But maybe I should just be patient, and it's more a case of "if you build it, they will come."  Maybe there's a huge lag time afoot, where if the information is laid out there, eventually the searches will catch up -- on the VA's part, that is.]

(Huge digression -- but the point is, the VA's not all bad, and that's NOT the point of suggesting they change, which it certainly seems like they should.)

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Deep in the Q&A between Costos and Sullivan is this exchange, with the comment of importance highlighted:

Do you know about the Freedom of Information request to the VA by CREW and VoteVets?(Which we blogged about earlier here, by the way.)

Yes. It is too bad that VA still plays games with FOIA. VA should be forced to turn over the information. Embarrassing information is never a reason to deny a FOIA, as VA frequently does.

Alrighty now.  That was the warmup (the foregoing).  Here's the pitch:

If the VA wants to control the flow of embarrassing information about it -- such as the Katz and Perez emails have provided us with -- there's one extremely simple way to do it.  It's NOT hiring a PR firm that specializes in crisis management and controlling the spin.  That's morally and ethically disgusting -- when contrasted with the concept of just changing -- and, it's ridiculously expensive -- a true waste of money that could be better spent on taking care of veterans and their families, with the needs the VA already knows about. And by promoting good works, like those of combat veteran Jay White, at the VA Center in Hartford, Connecticut, which we blogged about here.  Those ALSO make the news and contribute to public opinion, though everyone knows, and it's unfortunate that it's true, bad news travels first.  (And bad news here is definitely the Katz and the Perez emails, and the lack of putting patients first they describe, not to mention the rash of veterans suicides, etc.) Denying patients adequate care?  There's just no way to put a positive enough spin on that.  And the extent of the media coverage has been such, yup, we pretty much all know about it by now, if we even remotely care to.  Game over.  What needs to happen next is what happened with the Odwalla juice company -- what the VA desperately needs is the Odwalla effect.

Years ago, Odwalla was a new company with a great product: fresh juice, delivered nationally.  I knew someone whose three college friends had started it, and because of that, I guess I paid attention to what it was, and when I had the chance, tried the juice.  It was great, and for a while, everybody I saw who wasn't carrying some bottled water, seemed to be carrying a container of their juice.  They had, and still have, a number of blended juices, as well as the straight-up orange and apple.  And they had a novel, and in hindsight quite unwise, approach.  Their juice was unpasteurized, which they felt was needed to keep the juice as fresh-tasting and delicious as possible, but which also carried some known health risks, because pasteurization kills bacteria.  Children (particularly babies) and the elderly, as well as a few other groups (those recovering from illness and surgery, etc.) have weaker immunities -- in other words, are more susceptible to bacteria.  And I don't remember that Odwalla plastered their juice labels with big warnings about: "Warning! Our lack of pasteurization makes this juice likely unsafe for children and the elderly!".  They probably just made their juice, concentrated on getting it to market, and hoped people toasted each other with its deliciousness.  But over time, the inevitable happened: a few people who tasted their fresh, delicious (and unpasteurized) juices got sick - and, horribly - died.  And some of the affected were children, which the American public finds of course especially heartbreaking, and worthy of media attention.

In an instant, it seemed -- everyone turned on Odwalla, the juice and the company.  It went from being a media darling, to an object of abhorrence and fear.  How could they have let their juice kill people -- young children, even?  Horrifying...  Based on the immediate and complete backlash in the press and public opinion, I easily imagined Odwalla going under, and my friend's three college friends being put of work, and skulking away in public disgrace.

What happened next was amazing, though: and it shows you the power of good, and of doing the right thing.  (There's a conflicting story on the Web, but if you read the date on it, it's from 1999, which is ridiculously old news -- before the Odwalla success story of managing its PR happened, and before the company was later sold to Coca Cola - another evidence of its success. Plus, the guy who wrote it is by no means is a PR specialist, nor does he even seem to understand how PR works. I did work in PR, though I'm no expert on crisis management - I do get how it works.)  Odwalla didn't go bankrupt, didn't go out of business, didn't leave the marketplace in shame and disgrace.  What DID they do?  Simple as could be, and oh so powerful:

They accepted responsibility.  They apologized and paid the families' bills.  And they changed their process, so more people wouldn't be hurt by it.  They were wrong; they admitted it; they did what it took to make it right; and they changed.

In other words -- EXACTLY what the VA needs to do.

By now, we all know what the problems are, if we've cared at all to listen and learn.  They're kinda obvious.  And no amount of re-spinning the truth is going to make the problem go away.  All the media attention and lawsuit has done is show us the gaps in the system, the problems with care.  And because most caring, compassionate, fair-minded Americans care MORE about their veterans - we "get" the price they've paid -- than we do about hearing excuses and spin -- there's only one real solution here.  Admit the problem(s), apologize to those you've affected (veterans, their families, and the rest of us, who while less directly involved, are nevertheless put off by what we've learned), and fix the process.  Let tomorrow be vastly different from today, because you're starting to work -- really work -- on the problem, now.  The problem that we -- you, me, veterans, their families, the media, Veterans for Common Sense, the IAVA, the Disability Rights Project, Paul Sullivan, Kathie Costos -- all know exists.

Lack of pasteurization, denying veterans care -- and, if you'll allow me -- O.J. Simpson have all have been linked to killing people.  But in a contest between two kinds of OJ -- Odwalla and Simpson -- please, VA, we beg of you: show yourselves to be more like Odwalla, and less like Simpson. Fess up, come clean, do what's right by veterans and their families, make it right.  Now more than ever, what the VA seriously needs to re-create good public opinion is not denial, spin and blocking legitimate FOIA requests, in case something embarrassing gets revealed -- it's a simple thing called "the Odwalla Effect."  Also known as, doing the right thing, for the right reason, makes public opinion bounce right back.

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Editor's note: Kathie Costos' Q&A with Paul Sullivan of Veterans for Common Sense about the veterans' lawsuit is linked hereKathie Costos' blog, "Wounded Times," is linked here. Veterans for Common Sense is linked here.

NPR Local Affiliate KQED's Story about VA Being Sued over Veterans' Healthcare

NPR Logo According to a story aired today on KQED -- a San Francisco public radio and television station, and NPR affiliate -- Berkeley, California's Disability Rights Advocates recently filed a lawsuit "that could affect thousands of veterans returning from Iraq and Afghanistan. They allege that the Department of Veterans Affairs is unable to provide timely mental health treatment for returning veterans. It describes a backlog of 600,000 claims for vets seeking care — some dating all the way back to the Vietnam War." To listen to the approximately five minute story, click here.  (And yes, this is the lawsuit that's produced the incendiary emails that have lately been in the news, including the infamous "shhh..." one about veterans suicides, which we blogged about earlier, here.)

Editor's Note: For more information about the veterans access to healthcare lawsuit in Federal court, as provided by the Disability Rights Advocates website, click here.

June 15, 2008

Mind Body Medicine: Healing the Wounds of War

When I started this blog over two years ago now, I was hoping that somehow James S. Gordon, M.D., and the Center for Mind-Body Medicine which he founded in Washington, DC, would somehow get involved in the prospect of bringing mind-body medicine to the troops.  Gordon is a Harvard-trained psychiatrist, with impeccable credentials, who has a lifetime interest in expanding patient care into new areas, particularly Complementary and Alternative Medicine (CAM), and mind-body medicine in particular.  (Mind-body medicine is a shorthand way of re-combining the two "halves" of medicine perhaps unjustly sundered in an arbitrary Cartesian mind-body split.  Much of Eastern thought, rather than Western, never saw them divided at all.)  In a previous lifetime, where I interviewed luminaries in the natural medicine field, Gordon was a favorite interviewee - smart, genial and with a very forward-thinking grasp of what mind-body medicine could accomplish.  Gordon, who was featured in the Bill Moyers series on PBS, Healing and the Mind, was a frequent lecturer at the Smithsonian Institution in Washington, DC, and for years had served as the head of the White House Commission on Complementary and Alternative Medicine.  He is also a Clinical Professor in the Departments of Psychiatry and Family Medicine at Georgetown University Medical School.

But more to our purposes, when war broke out in Kosovo, he and the Center for Mind-Body Medicine (CMBM) took their methods into the region, creating a program called "Healing the Wounds of War," to help war-torn schoolchildren and their caregivers manage the trauma they had undergone, through a sustained, devastating conflict.  What I was hoping -- and I kept checking the CMBM website periodically to find out -- was that they would leapfrog off their successes with PTSD in Bosnia and Kosovo, and Israel and the Middle East, and develop something geared to PTSD in servicemembers, and the conflicts in Afghanistan and Iraq.  For years, nothing was obvious (yet), but here's some of their success with children in Kosovo.  Notice what symptoms the program helped with, how impressive the statistics are, and make the conceptual leap to how this might help with combat veterans and/or their families:

The clinical efficacy of the CMBM program with traumatized children has been repeatedly demonstrated. In a pilot study in which high school teachers in the Suhareka region of Kosovo used the CMBM model, levels of posttraumatic stress disorder in high school students were reduced from an average of 88% to 38% in only six weeks (read the research, published in Journal of Traumatic Stress, April 2004, linked here). Participants have also reported the following documented effects of CMBM trainings, including: the alleviation of their own stress and trauma; decreases in anxiety and depression; increased optimism; decreased anger; and increased capacity to help others.

You can read more about the program's specific successes, here.  Or, you can read a general overview of the program and what's involved, here.  You can also read Dr. Gordon's bio, here.

June 06, 2008

The Dose-Response Relationship with PTSD: More Combat = More PTSD, Earlier Study Shows

"If you aim for simplicity, you must first master complexity" -- said the 17th century Chinese painter, Wang Kai. Almost 400 posts in on this blog, I still enjoy the moments when something profoundly complex like combat trauma is nevertheless reduced to something quite simple to understand.  Here's one such observation: the more combat one is exposed to, the greater the chances of experiencing PTSD.  Makes sense, doesn't it?  Although we've talked about that concept recently on this blog -- with a great graphic that shows the linear relationship quite profoundly, that entry linked here -- here's another, earlier study that says the same thing, in an article linked here.

Researchers who went back and analyzed two conflicting, large-scale studies of PTSD -- one done by the Centers for Disease Control (CDC), the other the National Vietnam Veterans' Readjustment Study -- found, among other things, that although "most veterans who experienced very highly traumatic events did not develop PTSD," still, the more war trauma a veteran experienced, the higher a veteran's odds of developing PTSD.  Researchers called this the "dose-response relationship," and said their work, going back over the two major studies and attempting to reconcile their findings, found that it was "even stronger than previously reported."

SOURCES: Dohrenwend, B.P. Science, Aug. 18, 2006; Vol. 313: pp. 979-982. McNally, R.J. Science, Aug. 18, 2006; Vol. 313: pp. 923-924.

Pick Up the Phone, Hon - That's the VA Calling!

In a seemingly odd, but -- one would hope -- nonetheless proactive move -- the Department of Veterans Affairs (VA) is now placing outgoing calls to in a nationwide campaign to inform and connect returning combat veterans with the services the VA provides.  The calls, which are being outsourced to a provider called EDS, are initiated by the VA and follow a very specific, and laudable intention,  In a PR blurb published on the Web at TCRNet, the following information was provided about the program:

The Combat Veteran Call Center is expected to make more people aware of health care and benefits eligibility for veterans of the wars in Iraq and Afghanistan. It’s the first task order awarded under the General Services Administration’s $2.5 billion USA Contact contract vehicle, according to EDS.

Calls to veterans began on May 1 and plans include reaching out to nearly 570,000 recent wartime veterans over the next six months. The campaign will initially focus on roughly 17,000 veterans who, based on their wartime injuries or illnesses, are considered candidates for care management.

The second phase will include contacting about 550,000 Operation Iraqi Freedom and Operation Enduring Freedom veterans who have not yet enrolled for VA health care services."