BLOG #5: The Obvious Question: If HBOT works, why aren’t we using it?

Wounded warriors endure a range of “interventions” and “treatments” inside the Warrior Transition Units, Wounded Warrior Battalions, at the DVBIC and the NICoE and Intrepid Spirit Centers, as well as inside the VA and at various facilities under contract to the VA. While a percentage of brain wounded speak well of the care they receive, a large percentage of warriors with mental health issues endure a pattern inside the VA: try almost anything. Don’t ask WHY the suicide rate is going up and why most brain-injured veterans abandon the VA for their failure to treat and heal their brain wounds.The VA does some brilliant work, but not with respect to healing brain wounds. Until Congress acts and invokes accountability-with-penalties — not more repetitive hearings and studies — and reprograms the $$$ to treat brain wounds with alternative methods, the DOD/VA/Army will continue to avoid wound healing for the brain-wounded.

 

The bureaucracy continues to neuter political appointees and even science. They outlast them. HBOT evidence shows that virtually all successfully-treated brain injured – over 80% of those treated — quit taking almost all their medications and that ideation of suicide is virtually eliminated. Lives improve. Yet people in authority over military and VA medicine responsible for brain injuries do not think like CEOs –market-based solutions. Instead they wait for the next election and handing the “intractable” problem off to the next appointee: an epidemic of over 20 suicides a day.

 

So the Question has to be asked: with all the mounting bad news, and additional monies that don’t pay off in any breakthroughs, and clear and compelling science that demonstrates the safety and efficacy of hyperbaric oxygen therapy (HBOT) in thousands of cases worldwide, why won’t DoD/VA/Army/medicine use a proven treatment? [A longer treatment of this complex issue is here.] Here are a few of the most egregious reasons for failure to learn and act.

 

Fundamentally, military medicine does not focus on the wound to the brain, focusing instead on palliating symptoms. Army medicine – medicine in general – does not appreciate that a brain wound is a “soft tissue” wound. [Short explanation here.] Doctors and wound care clinics have non-controversial, insured HBOT protocols for wound healing, but fail to apply them to brain wounds. [They even fail to use them on approved, covered diseases like diabetic foot ulcers, but that’s another Blog.] Part of the intransigence is due to training: most doctors have never studied hyperbaric medicine and are unaware and unread in the last ten years’ worldwide research. You can see it with just the Concussion Protocol. Nothing in any protocol for a Concussion is active intervention to do wound healing. The protocol is “watchful waiting” and hoping the patient recovers with “the tincture of time.”. A concussion is a brain wound and can be treated as such. Increased oxygen is always called for in wound healing, particularly in a closed space like the head where inflammation reduces blood flow and oxygen delivery. Additional good news about HBOT for brain wound healing is that almost all patients get off almost all their prescribed drugs.

 

Disbelief in the scientific data. Over seventeen peer-reviewed studies using HBOT to treat TBI and PTSD show conclusively that hyperbaric oxygenation for those conditions is safe and effective. HBOT-treatment “improves symptoms and quality of life compared with local care management of PCS without chamber intervention . . . .” and “no new treatments for persistent blast or impact-related postconcussion symptoms have been identified, despite the extensive investment to date [Note: ~$186M] The evidence remains weak and inconsistent for both pharmacological (e.g., stimulant or cholinergic augmentation) and nonpharmacological (e.g., cognitive rehabilitation) interventions [the two most-used interventions]. These findings reinforce the argument that effective interventions do not yet exist within the present structure of care or that routine post-concussion interventions within the DoD or VHA may even have iatrogenic effects [e.g., an iatrogenic illness is an illness that is caused by a medication or physician. i.e., current interventions are making patients worse.] HBOT, on the other hand “was a healing environment.”

 

The suicide epidemic and the tens of thousands of bad paper discharges are not recognized as potentially caused by brain wounds. Discussions of the suicide epidemic,particularly during stand-downs and in strategy papers, emphasize alertness about behavior, but medicine does not do a root-cause analysis. Brain injury, and the drugs prescribed to deal with the symptoms of brain wounds, contribute to ideation of suicide. Undiagnosed brain wounds – frequently masked as “PTSD-only” diagnoses – have been identified as a secondary result of BLAST injury in DOD-studies, yet over 300,000 “PTSD-only” diagnosed service members have never been reevaluated for TBI. Thus, some assume that brain wounded patients really are just psychologically weak.

 

COST: Researchers are paid hundreds of millions of dollars to study the problem, not to solve it. Thus, they are predisposed to doubt that HBOT works. It is an egregious misallocation of dollars to spend so much on dubious research that hasn’t paid off while claiming how cost-prohibitive it is to to treat and heal the brain. For less than 2% of the cost of NOT using HBOT, medicine could pay to use HBOT under strict protocols. An untreated brain wound costs taxpayers over $40,000 per year, every year. HBOT costs a fraction of that. Further, the researchers put in charge of studies are not HBOT specialists. Thus, as many of us have learned, doctors who bother to take the time to investigate current research get, at best, conclusions that HBOT is controversial and unproved. At worst, it is still pooh-poohed by the Army as just one more risky waste of time and money; VA contractor researchers want to believe that their studies have “put the final nail in the coffin of HBOT.” And yet, increasing numbers of brain injured worldwide are being treated and helped to heal — over 7,500 and counting in over 103 Coalition clinics in 32 states. Luckily for some, a few doctors in the VA are prescribing HBOT for TBI, and invoices for the services are being paid.

 

Big Pharma. It is so much easier to just palliate the problem rather than heal it. Easier to write a Rx for drugs — many of them warning of the risks of suicide — than to admit the drugs may be driving the suicide risk higher. A 2010 Army study found that one-third of its soldiers were on prescription meds. Nearly half of those — 76,500 soldiers — were taking powerful and addictive opiate painkillers. A study to be released later this year by the TreatNOW Coalition catalogs how the opioid crisis began in the VA. The number of patients treated by VA is up 29 percent, but narcotics prescriptions are up 259 percent. And while the actual numbers are proving difficult to obtain, among all veterans receiving VA services nationally in a single year, 2005, a VA researcher calculated 1,013 had died of accidental drug overdoses — double the rate of the civilian population, when accounting for age and gender.

 

Eisenhower warned about the military-industrial complex. Today, he would call it the military, industrial, academic, research, contractor, pharma, insurance/health care complex. This thing has just gotten so BIG, with billions of research dollars sloshing around to feed the cycle. There is no patent on oxygen and no profit in fixing the problem with something so inexpensive. Alternative medicine practitioners have to get outside it to really treat patients and get them healthy, but they can’t do it with the controls and formularies mandated by the DOD/VA/Army and the Insurance regulations to which they are beholden.

 

Medicine is inherently conservative and reluctant to change. The government’s record on admitting mistakes is not good for the service member or public. Think Agent Orange, Gulf War Syndrome, radioactive fallout, secret wait-lists, scandalous cost overruns at every level, demonstrated incompetence, and a perverse set of self-dealing relationships with researchers who ignore the established science, data and laws of physics, chemistry, physiology, biology and biochemistry. But anyone familiar with research and the pace of medicine’s acceptance of change should remember the words of Arthur Schopenhauer (1788-1860): “The truth goes through three stages: first, it is ridiculed, then it is violently opposed, and then, it is accepted as self evident.” Max Planck put it succinctly: “Science advances one funeral at a time.” Though he was talking about nay-saying scientists, he never imaged the irony that he might have been talking about over 20 suicides a day.

 

SUMMARY: Put simply: Standard of Care interventions in DoD/VA/Army/general medicine may be exacerbating brain wound problems. Their protocols are not working. The suicide rate among service members is again rising, with over 102,000 suicides. But HBOT does work. It virtually halts suicidal ideation and gives the wounded their lives back. Yet the DoD/VA/military, indeed medicine in general, will not approve the use of HBOT for brain wounds. What is going on? What can be done?

 

Next in BLOG #6: Special Operators at Increased Risk of Suicide