Scientific Review Kicks Off to Weigh Treatment for Brain-Injured Soldiers
The National Institutes of Medicine convened the first of what’s expected to be a series of public panels to help determine whether cognitive rehabilitation therapy could help heal troops who suffered traumatic brain injuries in Afghanistan and Iraq.
The Institutes of Medicine kicked off its yearlong study of cognitive rehabilitation therapy on Monday, a process that will help the Pentagon decide whether its health plan will cover the treatment for troops who have suffered brain injuries in Iraq and Afghanistan.
We've previously reported that Tricare, which covers troops and many veterans, relied on a controversial study to deny coverage for the treatment, which helps rewire soldiers' brains to perform basic tasks such as memorizing lists and following orders. Tricare said the study showed there wasn't enough evidence to support paying for the treatment, which can cost more than $50,000 per soldier. The Pentagon says nearly 200,000 troops have suffered traumatic brain injuries since the wars began, though our own reporting shows the numbers are probably a lot higher.
The IOM panel of experts will review scientific literature and ultimately render a decision on whether it supports the efficacy of cognitive rehabilitation therapy. If the experts reach this conclusion, they will hardly be the first to do so. In April 2009, a consensus panel assembled by the Pentagon said the therapy works, especially for soldiers suffering more severe forms of brain injury. Other groups, such as the Brain Injury Association of America, have weighed in to support it. Even some major private insurance companies pay for it.
The head of the IOM panel, Georgetown University neurologist Ira Shoulson, pointedly quizzed Tricare on this issue at Monday's session, asking what the current review would produce that previous reviews had not.
Capt. Robert DeMartino, Tricare's director of behavioral health, said he hoped the panel would be able to pinpoint what types of cognitive rehabilitation works best, and what kind of civilian doctors and clinicians were best qualified to provide it. He noted that stories published last year by ProPublica and NPR have cast a "shadow" over the issue, prompting congressional committees and lawmakers to pressure Tricare to provide cognitive rehabilitation therapy.
"For us, we know that we're in a field like a gray zone," said DeMartino, who addressed the panel by speakerphone. "We want to make sure the [treatments] that work are the ones we are going to use."
The IOM review will continue through the end of the year, and the panel expects to convene other public sessions to help them arrive at a determination.
The military has failed to diagnose brain injuries in thousands of soldiers returning from overseas.
The Story So Far
Traumatic brain injury is considered the “signature wound” of soldiers fighting in Iraq and Afghanistan. Official military statistics show that more than 115,000 soldiers have suffered mild traumatic brain injuries since the wars began. Shock waves from roadside bombs can ripple through soldiers’ brains, causing damage that sometimes leaves no visible scars but may cause lasting mental and physical harm.