2009 MHRF Overview Video (Text Version)
CDMRP: Congressionally Directed Medical Research Programs, Military Health Research Forum [title graphic, part 1]
Staff Sergeant Ramone Padilla, U.S. Army: My name is Staff Sergeant Ramone Padilla, United States Army. We got deployed in May of 2007 to Afghanistan...
Richard Flores, OIF Veteran, PH/TBI Consumer Reviewer: My name is Richard Arthur Flores. I served in the U.S. Army for 5 years and 9 months. I served in the Infantry Battalion...
Captain Jon Kuniholm U.S. Marine Corps (Ret.): I'm U.S. Marine Captain Jon Kuniholm. I was deployed to Anwar Province in Iraq...
Eddie Norman, Gulf War Veteran: My name is Eddie Norman. When I first joined the military I was deployed to the Persian Gulf for the Gulf War...
Specialist Patrick Howland, U.S. Army: I'm Specialist Howland with the 1st 327 101st Airborne Division and I was in Northern Iraq, north of Tekrit...
The CDMRP... Improving the Quality of Life for our Warfighters, their Families, and our Veterans through Innovative and High Impact Medical Research [title graphic, part 2]
Padilla: We just had came back from patrol and our fire base got attacked. They led off with a RPG. I got hit and it severed my bottom left of my arm and I also got shot in the head on the right side which caused traumatic brain injury.
Kuniholm: I was wounded on a foot patrol on New Year's Day morning. The improvised explosive device began as an ambush and the explosion that mostly took off my arm killed another Marine.
Howland: I was in an IED blast, and I broke the orbital wall and orbital floor of my left eye. And I lost a good chunk of peripheral vision. And I'm almost deaf in my left ear.
Salvatore Cirone, DVM; Office of the Assistant Secretary of Defense (Health Affairs); PRMRP Joint Programmatic Review Panel Member: I think everybody in America knows that IEDs have caused a different kind of injury than we've seen in any other war, and we've done so well to save life and limb by various controlling hemorrhage processes, bandages, tourniquets, surgical procedures, evacuation processes, that people who would have died are now living.
Murray B. Stein, MD; University of California, San Diego; PH/TBI Principal Investigator: But one of the things they're often surviving with is traumatic brain injury and so that's really become one of the signature injuries of these conflicts. Similarly, you know people are surviving from other serious injuries, and any serious physical injury puts you at increased risk for post-traumatic stress disorder as well.
E. Melissa Kaime, MD; CAPT, U.S. Navy; Director, CDMRP: The Congressionally Directed Medical Research Programs funds research for diseases encountered by our military, their families and beneficiaries, and our veteran population, as well as the general population at large. In 2007, Congress added two new programs to our portfolio, that being Psychological Health and Traumatic Brain Injury.
Traumatic Brain Injury Research [transition graphic]
Louis M. French, PsyD; TBI Director; Walter Reed Army Medical Center: Traumatic brain injury in the military setting is a very complex wide ranging topic because we are actually interested in that whole spectrum of severity from the very mild concussion all the way up to the most severe brain injury, which is a huge area to cover and potentially a huge area for research.
Alex B. Valadka, MD; University of Texas Medical School at Houston; PH/TBI Principal Investigator: Mild TBI is a hugely prevalent disease and historically it really has not been appreciated and often been overlooked. If you had a normal cat scan or just complaining of having a headache or amnesia or balance problem, people kind of figured you're fine, go home, you'll sleep it off, and we're just starting to realize now the huge public impact of mild TBI.
Padilla: They say my type of injury could only get better, but the concerns to me is further down the line. I'm afraid of the long-term affect.
Valadka: Our research program is very large and complex, but it's designed into three simple goals. The first of these is to try to develop a good laboratory animal model of mild TBI. The second simply put is diagnosis. I mean, has this guy had a mild TBI? Has he had post-traumatic stress disorder? You need to know whether this person can go back to fight or whether they need to be pulled out of fighting and be sent to medical treatment. The third aim -- finally we're getting to treatment, trying to find ways to treat these service men and women. And possibilities range from basic psychotherapy, perhaps some new investigational drug treatments, and a lot of things in between.
French: We're really trying to provide the best possible overall care for these people. And we know that the best way to do that is to really take a multidisciplinary approach.
Valadka: We have a total of 22 principle investigators and 19 co-investigators in our project over five different institutions. The old days of one scientist doing something by himself or herself just don't cut it anymore. The science has become much more complex.
Psychological Health Research [transition graphic]
Kaime: One of the hallmarks of the CDMRP is involving consumer reviewers in our review processes. Consumer reviewers are usually those people affected with the disease. However, for some of our programs, we expand that definition to include reviewers that are family members or caregivers of those affected with the disease.
Penny Flores, RN, MSN; PH/TBI Consumer Reviewer: Honestly, I feel I have a privilege to be asked to be a consumer reviewer. I have a son who is a veteran from Iraq War. He was diagnosed with PTSD from the first time he came back. He was having mostly outpatient treatment and no medication. He was redeployed. His vehicle went over an IED and he suffer a concussion and a TBI. In my opinion, he looked like a ghost. He was very ashen and white, and he was so thin, you can hug him and feel all his bones.
R. Flores: I initially got involved with CDMRP about 2 years ago. I bring the actual patient to the table. It's a very different mind frame that we have. We don't like taking medications. We don't like ongoing treatment, especially when you're in the infantry. You have soldiers that count on you to be mentally tough and physically fit, and that's how come I've been able to influence some of the doctors in different ways.
Stein: Our consortium is made up of ten study sites around the country, and all of the study sites have expertise either in traumatic brain injury, post traumatic stress disorder, many have expertise in both.
Valadka: But whether there's a correlation between mild TBI and PTSD is a very controversial question. The problem is that even though the ideologies may be different they can often produce the same symptoms.
Stein: We in the first few months have been really learning to speak each other's language. We've been learning about what sort of things we don't understand across the different domains. And now I think we're really poised to put together studies that are going to bring to bear all of our expertise in answering some of these problems.
Alan L. Peterson, PhD; University of Texas Health Science Center; PH/TBI Principal Investigator: In the STRONG STAR PTSD Research Consortium, we're looking at developing and evaluating treatments for combat related PTSD for active-duty military and also for recently discharged veterans.
Stacey Young-McCaughan, PhD, RN; Colonel, U.S. Army (Ret.); PTSD Consortium Coordinator, UTHSC: We have upwards of 15 studies that are part of this consortium. Our two main studies are looking at prolonged exposure and cognitive processing therapy. The question is whereas these treatments are normally given over 8 to 12 weeks, could they be delivered in shorter time? So instead of meeting with a therapist once a week for 12 weeks, could they meet with a therapist every day for two weeks? Another one of the studies is looking at group therapy versus individual therapy.
Peterson: One of the most unique things about STRONG STAR is the fact that we really are a close collaboration with active-duty military investigators, civilian experts as well as individuals within the VA. Another unique thing about STRONG STAR is the primary population as far as our research participants are mostly active-duty military.
R. Flores: Once we submit to having post-traumatic stress disorder, it tears your heart apart because you realize that you're not as tough as you're trained you're supposed to think you are.
Peterson: We think with PTSD that early interventions are important. So we're hoping if we can catch people while they're still on active duty and treat them that we can allow a large percentage of them to be treated to the point of loss of diagnosis or to the point where they can continue to function on active duty in the military.
Gulf War Illness Research [transition graphic]
Anthony D. Hardie; Gulf War Veteran; GWIRP Integration Panel Member: I'm Anthony Hardie and I'm a consumer reviewer on the Gulf War Illness Research Program. I am myself a Gulf War veteran, that's what got me into veterans' issues in the first place, and I've had health issues since my service in the Gulf. First began with lung issues and fatigue issues and progressed from there, and now I'm one of just about 200,000 Gulf War veterans who are having pretty significant health issues related to their service.
Lea Steele, PhD; Kansas State University; GWIRP Integration Panel Chair: This is a set of symptoms that are the same in different veteran populations across different studies and they basically include chronic headache, gastrointestinal problems, cognitive difficulties, memory problems, as well as skin rashes, respiratory problems. And this group of symptoms does not fit neatly into our concepts of disease.
Norman: When I first joined the military I was a very healthy person, and I don't know what happened. I experience tightness of the muscles, cramps, severe muscle weakness. I can't sleep at night. All we do is just try to make it through the day, as good as possible.
Steele: In recent years this program has been managed by the Congressionally Directed Medical Research Programs Office and this... this program has been focused on identifying treatments for Gulf War Illness as well as diagnostic markers for Gulf War Illness.
Hardie: In November of 2008, the Research Advisory Committee on Gulf War Illnesses came out with this report. And the headline across the country read, "Gulf War Illness is Real." That's no mystery for Gulf War veterans. Gulf War veterans have known that all along.
James N. Baraniuk, MD; Georgetown University; GWIRP Principal Investigator: My approach at this point is to take the RAC information and say, "How can I better define what is Gulf War Illness? How can I take that information that we're gathering and develop a new concept of the overall pathophysiology that is part of Gulf War Illness and separates them from the healthy veterans?"
Hardie: Up to the present, many of these veterans have been treated symptomatically. And if you can imagine treating a disease where you're never getting at the underlying cause, you're only just trying to ameliorate the symptoms. It's been a very difficult situation
Baraniuk: By creating that distinct pathophysiology, we anticipate we'll be able to get insights into new drug treatments, new neuromechanisms that may be active in these people or activated and hopefully set the stage for ourselves and others to move forward for new diagnostics, new treatments for what exactly they have right now.
Peer Reviewed Medical Research [transition graphic]
Cirone: The purpose of the Peer Reviewed Medical Research Program is to do research that Congress considers to be extremely important to the American public.
Kaime: Congressional language for this program is very specific giving us specific topic areas that they want addressed and we get a new list of topics each year. Some of these topics may include things like alcoholism, childhood cancer, epilepsy, and lupus, to eye injury, nutrition and osteoporosis.
Ronald J. Triolo, PhD; Case Western Reserve University; PRMRP Principal Investigator: We received a grant to design an advanced orthosis that would help people with complete spinal cord injuries to walk long distances, stand for extended periods of time, and negotiate steps. All of these things are impossible with conventional orthoses and impossible for people with paralysis.
Cirone: We bring together stakeholders and experts from all over to see what is currently available in research and find out where are the gaps, what really needs to be done.
Triolo: This specific project combines novel braces with electrical stimulation of the paralyzed muscles, and the notion is that most conventional braces lock the joints into one fixed position. We're still at a very early stage. But these prototypes are giving us invaluable opportunities to explore what will work, what won't work, what the best approaches are, and where the dead ends are, so that we can streamline the process in the future once we figure out the best approaches to take.
Kaime: The beneficiaries of the PRMRP program are our service members, their spouses and children, our veteran population, and the civilian population in general.
Mark A. Tommerdahl, PhD; University of North Carolina, Chapel Hill; PRMRP Principal Investigator: The specific problems that we're looking at in this research is in autism. So the thing that we're looking at is trying to understand the cortical mechanisms in autism, as well as provide a new tool, a portable diagnostic tool, that will aide clinicians and clinical researchers a better way for actually diagnosing the problem. What we're doing now actually bridges a lot of information that's been collected over many decades in a way that can be actually useful in the clinic, in terms of diagnosis and understanding efficacy of treatment. Currently, the primary focus of this research funding is in the area of autism, but it has large ramifications for other neurological disorders as well.
David Watson, PhD; Major, U.S. Air Force; PRMRP Joint Programmatic Review Panel Member: One of the topic areas for the Peer Review Medical Research Program is ALS, or Amyotrophic Lateral Sclerosis, or Lou Gehrig's disease.
Li Niu, PhD; University of Albany; PRMRP Principal Investigator: ALS is a progressive neurological disease. The average life span for the ALS patient is about three years and it's fatal. So far there's no cure. There's only one drug but it's not really effective. That's where our work comes in. We hope to contribute to developing new compounds or drug candidates. In this case it would be an inhibitor of AMPA receptors.
Watson: In our returning veterans from Gulf War we've seen a rise in ALS that we really don't know why that's the case. So there are a number of proposals this year, which are looking at potential causes for ALS. But more importantly, I think we have an opportunity to look at how ALS is diagnosed and potential treatments for ALS
Niu: We have already demonstrated in a proof of concept experiment that we can successfully develop RNA inhibitors against glutamate receptors that certainly rivals-in terms of potency-wise-any other compounds that have ever been developed at this moment. We have also developed this confirmation selective RNA inhibitors as well. Hopefully we can continue to be successful in our long grant which is to develop very good compounds that could be tested in animal clinical trials and will be new therapy for ALS research and now be our goal.
The CDMRP...Striving for Solutions [transition graphic]
Kaime: All of us know that our warfighters are on point every day giving sometimes the ultimate sacrifice for our country. It's our responsibility to give them the best medical care possible. In order to do that, we need to do research to find the better tools, the better medicines, the better procedures to support our warfighters.
Cirone: It is my belief, and I believe this very strongly, that we select the best protocols that are most relevant to the Department of Defense and that have the highest scientific merit and review.
Niu: When I first started I wrote the same grant proposal and I submit it to NIH. I got very good review. Some of the words if I may-I still remember them-that if this is successful it probably would be a conceptual or technical breakthrough. However the drawback is that I didn't have a whole lot of preliminary data. Then I submitted the same proposal, literally same proposal to DoD and I got funding. And today we already have one patent already pending and we have developed probably the most potent empire receptor inhibitor ever been documented.
Tommerdahl: The CDMRP is very different from other federal funding agencies in that it basically rewards creativity and high-risk type health ventures.
Young-McCaughan: CDMRP has always looked to fill unmet needs. And it's not a competition-it's how best to get to the answers.
Hardie: As a consumer, I've developed the utmost respect for the scientists who are involved in these projects. They're not simply just pursuing their scientific interests or pursuing what they might otherwise be doing in their careers, but they're also making a difference for the men and women who have risked their lives on behalf of this country and are now suffering from those experiences. They're true patriots and I've been just deeply impressed by the scientists who are willing to get involved with this program, and I can't say enough, I can't say thank you enough.
CDMRP: Congressionally Directed Medical Research Programs, Military Health Research Forum [title graphic]