Wednesday, March 13, 2013

Forbes: Whistleblower Accuses Government Of Neglecting Suicidal Veterans And Suppressing Science

Source: (Rebecca Ruiz reporting)

3/13/2013 @ 3:52PM |3,149 views

Whistleblower Accuses Government Of Neglecting Suicidal Veterans And Suppressing Science

Injuries incurred by service members are cover...
(Photo credit: Wikipedia)
A leading epidemiologist says that the Department of Veterans Affairs, charged with caring for millions who have served their country, neglected assisting suicidal veterans who participated in longitudinal studies and never released important research data on the exposure of Gulf War, Iraq and Afghanistan veterans to toxins, inhalational hazards and burn pits.
Dr. Steven S. Coughlin, a former principal investigator at the VA’s Office of Public Health, is testifying before Congress today that supervisors threatened to remove him from a study when he asked for mental health providers to contact the suicidal veterans. Some veterans were eventually contacted, but others were not, according to Coughlin.
“I urge this Committee to direct VA to immediately identify procedures to ensure that veterans who participate in VA large-scale epidemiologic studies receive appropriate follow-up care so that this tragedy is not repeated,” he said in testimony provided to me.
The hearing, held before an investigative and oversight panel of the House Committee on Veterans’ Affairs, is taking a broad look at the care provided for Gulf War veterans. In addition to Coughlin, among those testifying are experts on Gulf War Illness, a chronic multi-symptom condition that is characterized by headaches, fatigue, widespread pain, gastrointestinal problems and cognitive difficulties. It is estimated to affect as many as 200,000 Gulf War veterans, and critics of the VA argue that the agency has focused on stress-related causes for the illness instead of wartime environmental exposures.
In a statement, the VA said that it “has a decades-long history of conducting world-class research studies that meet accepted and rigorous scientific standards. Research on the health of Gulf War Veterans has been and continues to be a priority for VA. The Department depends on this research to inform our decisions and guide our efforts in caring for Gulf War Veterans. All allegations of malfeasance are taken seriously and are investigated fully.”
‘A Bureaucratic Mess’
Coughlin, who resigned his position as a senior epidemiologist in December 2012, said that former service members participating in two separate longitudinal studies were not initially or ever contacted upon reporting suicidal thoughts or behavior in response to survey questions.
As the principal investigator on a 20-year study of 30,000 Gulf War veterans, Coughlin claims his requests made last year to have mental health providers contact the study participants were met with retaliation from superiors. Coughlin said he was asked to retract email complaints about the protocol to the VA’s institutional review board chair and the VA Office of Inspector General. He also claimed that a “written admonition” was placed in his personnel file and that supervisors threatened to remove him from the study.
After a few months, Coughlin said he was finally permitted to involve mental health providers in the study; a team of social workers and psychologists placed 1,300 follow-up phone calls to more than 900 veterans who had reported suicidal behavior. As of January 31st of this year, Coughlin told me, 48 had been referred to the Veterans Crisis Line for immediate help.
Coughlin said that, to his knowledge, suicidal veterans of a separate, larger study were rarely contacted. This 10-year project, known as the NationalHealth Study for a New Generation of U.S. Veterans, follows 30,000 Afghanistan and Iraq veterans and 30,000 veterans who served elsewhere during the same time period. One-third of those veterans responded to a 16-page survey about their health status and about 10 percent said they were suicidal. The majority never received a follow-up call from a VA health care provider or study clinician, according to Coughlin.
Coughlin said his supervisors never explained why they resisted adding mental health interventions to the studies. He told me that the situation is a “bureaucratic mess.”
Coughlin, who helped write the ethics guidelines for the American College of Epidemiology, said the VA Office of Public Health uses “uneven” methods for safeguarding the human welfare of its study participants. “In some studies, they have had very good procedures,” he said. “But some are very outdated and people are falling through the cracks.”
‘Failures and obstructive actions’
Coughlin also alleged that the VA’s Office of Public Health [OPH] has yet to publish the findings of the $10 million New Generation survey conducted in 2009 and 2010. An exploratory analysis of that data, Coughlin said, showed a relationship between exposure to burn pits and asthma and bronchitis. Coughlin said he was told by a supervisor not to look at data regarding inhalational hazards and hospitalizations and doctors’ visits.
“If the studies produce results that do not support OPH’s unwritten policy, they do not release them,” said Coughlin.
The New Generation study also included detailed information on Gulf War veterans and their exposure to pesticides, oil well fires, and pyridostigmine bromide pills. Many researchers and Gulf War veterans have argued that these exposures are linked to the multi-symptom chronic condition known as Gulf War Illness. These data have not been released, according to Coughlin.
“Unfortunately, we yet do not know the cause, but a complex combination of environmental hazards, exposures, and individual genetic characteristics may be behind these symptoms,” said Dr.Victoria J. Davey, chief officer of public heath for VA in written testimony. Davey also highlighted several Gulf War Illness initiatives undertaken by the VA, including a decade-long research and referral program known as the War Related Illness and Injury Study Centers that provides specialized care for Gulf War veterans.
Anthony Hardie, a veteran who has Gulf War Illness, told me that some of these initiatives are admirable and effective, but that he believes there are serious problems in the VA’s approach to developing treatments and research. In written testimony for the hearing, Hardie said that “VA staff quietly and unilaterally gutted and whitewashed” a strategic plan to develop new treatments last year. Hardie served on a federal advisory committee involved in developing the plan.
In response to the VA’s revision of the strategic plan, the group of experts and advocates wrote a damning assessment of VA’s failure to “mount even a minimally effective program, while promoting the scientifically discredited view that 1991 Gulf War veterans have no special health problem as a result of their service.”
In particular, the advisory group argued that VA continues to misrepresent scientific research on Gulf War veterans’ health and has yet to pursue a robust plan for treatment research as recommended by a 2010 Institute of Medicine report.

The advisory committee recommended that VA identify the individuals responsible for the “failures and obstructive actions” and remove them from positions of authority.
“Until this occurs,” they wrote, “we see no prospects for meaningful progress in VA Gulf War illness research.”
In its statement to me, the VA said that it “agrees with Gulf War Veterans that there are health issues associated with service in the Gulf War…We will continue to learn and examine ways to improve treatment, process claims, and better care for these Veterans.”
This story will be updated as testimony is given. 

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