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Agent Orange déjà vu
By Ret. Brig. Gen. Stephen N. Xenakis - 06/08/11 07:44 PM ET
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The New England Journal of Medicine recently published findings
that confirmed damage to the brain from improvised explosive
device (IED) blasts suffered by soldiers. In a companion editorial, a Harvard
neurologist forcefully concluded that the problem deserves “the utmost
attention.” On Sunday of Memorial Day weekend, Candy Crowley of CNN
interviewed the Vice Chief of Staff of the Army, Peter Chiarelli, who said that
still “more research” was needed into the conditions plaguing soldiers. Veterans
who also appeared on the show complained about the hurdles they must
overcome to get even basic treatment.
After many years and billions of dollars, the tragic story we have seen in past
wars is repeating itself: a unique and debilitating disorder from combat is
answered by delays and hand-wringing by military leadership while our
wounded warriors suffer.
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The simple answer is that not
much has been done in
providing new treatments or
expanding current programs.
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Blast concussions, and the
associated conditions, have
become the “Agent Orange
syndrome” of Iraq and
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Afghanistan and a serious
public health problem.
For those of us who lived through the Vietnam era, the complaints of soldiers
and the recalcitrance of the military are reminiscent of the failures to address
the damage from Agent Orange. Just like their Agent Orange predecessors,
soldiers exposed to thousands of blasts over 10 years of combat still have to wait
“until the science shows” the evidence for the pathology.
Meanwhile, they receive inadequate treatment, endangering them further and
making their reintegration as productive members of society even less likely.
Not to mention the collateral damage of the suffering endured by their families
and friends.
That is tragic and wrong.
Good treatment has been either delayed or denied because of professional
neglect. Medical personnel have had available treatments for the effects of IED
blasts, but failed to use them. These treatments may not always “cure” the
conditions, but they have alleviated many of the worst symptoms.
In 2004, I saw soldiers, some double amputees at Walter Reed Army Medical
Juan Williams
Center, who were obviously suffering with mild traumatic brain injury.
Judd Gregg
Christian Heinze
By 2007, I accompanied the newly appointed chairman of the Joint Chiefs to
Karen Finney
Fort Sill in Oklahoma, and soldiers told us they knew “the difference between
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their PTSD and blast effects.”
After I shared this information, the leadership of military medicine responded
with depressing predictability: “evidence was lacking” of a direct effect on the
brain from the blasts. A senior neurologist sniped that it made little difference
because we had no treatments for the problems. That attitude is disgraceful; but
most importantly, it is simply not true.
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Ironically, the “lack of evidence” has reinforced the prejudice that soldiers’
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complaints are psychological or a question of character. Articles challenged
early findings of brain injury by correlating the effects of IED blasts to
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cognitive rehabilitation, diagnostic tests and other treatments because of a “lack
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of evidence.” Only now, after 10 years of war, have a few of these tests been
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started. Some DOD and Veterans Affairs centers are treating more TBI patients
— but not nearly enough.
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The immediate challenge is help the warriors now, and not wait decades for the
golden nuggets from new research to show results. Too many battle-scarred
soldiers are returning to their communities — hoping to get an education and
find a job in a tough economy — but sabotaged by invisible injuries from their
repeated tours of duty.
The DOD and VA today must develop and expand health programs, leveraging
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current treatments with promising new therapies. We hear about “doing a
better job,” but these are empty promises lacking funding and strategic
planning. Those of us who’ve seen this before recognize that because IED blasts
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thousands of those who suffer will never receive help.
Nations get called to fight wars. But wars are followed by public health
epidemics.
What a shame that we might neglect another generation of heroes. If we
continue to do this, can we ever ask young people to fight for us again?
Xenakis is a child and adolescent psychiatrist and a retired Army brigadier general.
He is in clinical practice and the founder of a nonprofit conducting research on brainrelated diseases.
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