In other work, researchers are studying blood plasma in mice in the hopes of discovering biomarkers that could ultimately be useful for diagnosing Gulf War veterans with chronic multisymptom illness. Other projects involving animal models will address brain changes related to free radicals, therapies that target nerve tissue in the brain, and paternal reproductive risks.

 

Alzheimer’s disease

Alzheimer’s disease is a progressive, degenerative brain disease with no known cure. It is the most common cause of dementia, and eventually leads to death. Dementia is a prevalent chronic condition in veterans treated by VA. The department projects that roughly 218,000 veterans will be diagnosed with dementia in 2017, an increase of more than 40,000 such diagnoses from 2008.

In patients with Alzheimer’s disease, a protein called beta amyloid clumps up and forms hard plaques between neurons in the brain. Until recently, these amyloid clumps could be seen only after a patient died and underwent an autopsy, when brain tissue could be sliced and viewed under a microscope. VA researchers associated with the Alzheimer’s Disease Neuroimaging Initiative (ADNI) are developing new tests to determine beta amyloid levels in the body, and several such tests are already in use in clinical trials. The goal is to enable early detection, which will become more important as new treatments become available. ADNI is led by a VA researcher and funded mainly by the National Institute on Aging.

 

Pain Management

Safe and effective treatment of pain has become a critical health issue in VA, driven by the high prevalence of musculoskeletal pain in Iraq and Afghanistan veterans, the variable management of pain in older veterans with chronic diseases, and concerns about excessive use of opiates and resultant overdose deaths in veterans with chronic pain. VA has a National Pain Management Strategy to provide a system-wide standard of care to reduce suffering from preventable pain. VA researchers have played an integral role in shaping the strategy, which in turn helps to set the course for VA research and innovation in pain care.

As part of this strategy, VA researchers helped establish the VA Stepped Care Model of Pain Management. A recently funded multisite study will evaluate the effects of pain screening and assessment approaches in primary care settings. Researchers are also identifying and helping to address any disparities in veterans’ access to opioid therapy, non-medication treatments such as cognitive behavioral and physical therapies, and complementary and alternative approaches to treat or manage pain.

 

Cancer

VA researchers are conducting a broad array of research on cancers common in the veteran population. These include prostate, lung, colorectal, bladder, kidney, pancreatic, esophageal, and breast cancer, as well as lymphomas and melanomas. Researchers are conducting lab experiments aimed at discovering the molecular and genetic mechanisms involved in cancer. They also conduct studies looking at the causes of the disease, clinical trials to evaluate new or existing treatments, and research focused on improving end-of-life care, or bolstering caregiver support.

One highlight of these efforts is a new study that aims to enroll 50,000 veterans to compare colorectal cancer screening strategies. Colorectal cancer is among the most preventable of cancers. While colonoscopy is seen as the gold standard for screening, some recent findings raise questions about its effectiveness at preventing colorectal cancer deaths. A cooperative study (CSP #577 – CONFIRM) is comparing the value of screening colonoscopy to annual non-invasive fecal immunochemical testing for the prevention of colorectal cancer deaths over 10 years.

 

Complementary and Alternative Medicine

A growing number of VAMCs are offering complementary and alternative [medicine] (CAM) therapies to their patients, including yoga, acupuncture, and meditation training. VA researchers are committed to filling in scientific gaps relating to these treatments to determine which CAM therapies are truly effective, and for which conditions and populations. Studies cover a range of common and promising therapies across a range of mental and physical health problems.

VA is also collaborating with the National Institutes of Health to support studies on effective non-pharmacological approaches to pain and symptom management in veterans with co-morbid physical and mental conditions. This effort will provide a better understanding of how complementary approaches can be effectively integrated with regular care.

One study is examining the feasibility of conducting a trauma-sensitive hatha yoga intervention in female veterans with military sexual trauma and PTSD. Early findings showed that yoga may be acceptable to and preferred by many participants as an alternative to trauma-focused psychotherapy. Two other randomized controlled trials are underway to test mindfulness-based therapies: one targets suicidal thoughts, the other looks at reducing the risk of cardiovascular disease in women. Two additional PTSD studies are looking at the effectiveness of mindfulness-based stress reduction.

 

What are your goals to accomplish at VHA by the end of this administration in 2017? And what is your long-term vision for VHA? What do you want to tell our readers about the Veterans Health Administration that we have not asked you in our previous questions?

Our “Blueprint for Excellence” outlines strategies for sustaining excellence within the system. Those strategies are to:

• Operate a health care network that anticipates and meets the unique needs of enrolled veterans, in general, and the service-disabled and most vulnerable veterans, in particular;
• Deliver high-quality, veteran-centered care that compares favorably to the best of private sector in measured outcomes, value, access, and patient experience;
• Leverage information technologies, analytics, and models of health care delivery to optimize individual well-being and population health outcomes;
• Grow an organizational culture, rooted in VA’s core values and mission, that prioritizes the veteran first, engaging and inspiring employees to their highest possible level of performance and conduct; and
• Foster an environment of continuous learning, responsible risk-taking, and personal accountability.

This interview first appeared in The Year in Veterans Affairs & Military Medicine, 2015-2016 Edition.