Editorial

Using Every Resource to Care for Our Casualties

Jeffrey M. Drazen, M.D.

N Engl J Med 2005; 352:2121May 19, 2005

Article

The war in Iraq has resulted in an unprecedented number of traumatic brain injuries to U.S. soldiers. As described by Okie in this issue of the Journal, 1 these soldiers have been saved from what in the past might have been a lethal injury by a combination of new protective battlefield equipment and extraordinary resourcefulness on the part of medical first responders and military surgeons. These medical personnel have saved many lives.

Their success breeds another problem, however: how to provide the best long-term care for the survivors of these injuries. Once the bleeding has been stopped and the brain swelling has subsided, the long road to recovery begins. The military and the Veterans Health Administration (VHA) have done their best to use existing knowledge to provide wounded soldiers with the care they need to overcome their injuries. But we owe more to the wounded men and women who have sacrificed on our behalf; as a nation, we should be using all available means to aid them.

Biomedical science has made amazing advances in the development of biohybrid devices and neural prostheses such as artificial retinas. But there is much more to do, and more research is necessary if these nascent developments are to be transformed into therapies that can truly assist seriously injured military personnel. The effort will cost money and require research talent. Congress needs to allocate more resources for research specifically targeted at these problems. Given the traditional role of the VHA in caring for injured veterans, it makes sense to allocate substantial new resources to this agency's seriously underfunded research program specifically for this purpose.

The advances that have been made have come about because researchers have been able to use the best tools of modern biologic science, including nanotechnology and robotics, to achieve their goals. Sadly, one tool that holds great promise — embryonic stem-cell research — cannot be used in federally funded research. It is ironic that the same government that asked military personnel to make sacrifices and that has developed highly sophisticated methods of combat rescue has limited the research tools that may lead to better ways to repair their injuries.

A report issued by the National Research Council and the Institute of Medicine of the National Academies in late April (available at http://www.nap.edu/books/0309096537/html/) recognizes that stem-cell research is proceeding in many places but that there is not a uniform regulatory framework for the endeavor. The report proposes uniform guidelines for this work, but we should go beyond the existing patchwork of research support in the United States; this research needs to be funded and encouraged at the federal level. We need national standards, but most important, the work must go forward. Embryonic stem cells are an appropriate resource for work on the regeneration of organs and nerves. We should give our researchers the fiscal and research resources they need to potentially help wounded veterans return to full function. These men and women have given their best efforts for their country; we owe them nothing less.

Dr. Drazen serves on the Veterans Affairs National Research Advisory Council.

References

References

1. 1

   Okie S. Traumatic brain injury in the war zone. N Engl J Med 2005;352:2043-2047
   Full Text | Web of Science | Medline

Citing Articles (7)

Citing Articles

1. 1

   Mariusz Ziejewski, Ghodrat Karami. 2011. Biomechanical Perspective on Blast Injury. , 733-752.
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2. 2

   Monique Lanoix. (2010) Where angels fear to tread: Proxy consent and novel technologies. Brain Injury 24:11, 1336-1342
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3. 3

   Grant L. Iverson, Jean A. Langlois, Michael A. McCrea, James P. Kelly. (2009) Challenges Associated with Post-Deployment Screening for Mild Traumatic Brain Injury in Military Personnel. The Clinical Neuropsychologist 23:8, 1299-1314
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4. 4

   Joseph J. Fins. (2009) Being Conscious of Their Burden. Annals of the New York Academy of Sciences 1157:1, 131-147
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5. 5

   Wesley Rutland-Brown, Jean A. Langlois, Jeffrey J. Bazarian, Deborah Warden. (2008) Improving Identification of Traumatic Brain Injury After Nonmilitary Bomb Blasts. Journal of Head Trauma Rehabilitation 23:2, 84-91
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6. 6

   Murray J. Côté, Siddhartha S. Syam, W. Bruce Vogel, Diane C. Cowper. (2007) A mixed integer programming model to locate traumatic brain injury treatment units in the Department of Veterans Affairs: a case study. Health Care Management Science 10:3, 253-267
   CrossRef

7. 7

   Okie, Susan, . (2005) Traumatic Brain Injury in the War Zone. New England Journal of Medicine 352:20, 2043-2047
   Full Text