VA Medical Care, Research & Development

[Gimpy]

I've noticed that there seems to be a disturbing trend developing among members of the veterans community that appear to favor eliminating altogether the VA Health Care system and attempting suggest that "privitization" of the health care for veterans is the way to go.

This would be a terrible mistake if it were to happen. The VA Health Care System operates a $22 billion network of more than 163 hospitals, 800 clinics, 135 specialty nursing homes, a world class research & development program and many other specialty health care and mental health clinics. It also serves as the major setting for disaster relief treatment for our nations military and citizen population in case of a major war or natural catastrophe.

I have provided the information below to help educate and inform anyone who may think the "private sector" could even come CLOSE to achieving what the VA has accomplished-------even WITH the occasional shortcomings this system may have----this nation would be much WORSE OFF without it!

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VA Research &Development : Highlighted Research Accomplishments, Past to Present

(1946)
Developed and tested effective therapies for tuberculosis following World War II. Multi-center clinical trials led to development of the Cooperative Studies Program, which has since produced effective treatments for diseases and conditions including schizophrenia, diabetes, depression, heart disease and stroke.

Established the standard for developing better-fitting, lighter artificial limbs through studies of human locomotion, enhanced surgical techniques and modernized design and manufacturing methods.

(1947)
Introduced the first mobility and orientation rehabilitation-training program for blind persons.

(1958)
Invented the implantable cardiac pacemaker, helping many patients prevent potentially life-threatening complications from irregular heartbeats.

(1960)
Pioneered the concepts that led to development of computerized axial tomography (CAT scan).

(1961)
Conducted groundbreaking work with radioisotopes that led to development of modern radioimmunoassay diagnostic techniques.

(1968)
Performed the first successful liver transplants and developed techniques for suppressing the body's natural attempt to reject transplanted tissue.

(1970)
Expanded understanding of how brain hormones interact with the endocrine system.

(1984)
Developed the nicotine patch and other therapies to help smokers give up the habit.

(1989)
Invented a computer system that provides patients on ventilators with more accurate respirator settings, fewer medical complications, and better patient outcomes.

(1990)
Contributed to development of the first standards for wheelchair prescriptions.

(1991)
Development of Functional Electrical Stimulation (FES) systems that allow patients to move paralyzed limbs.

(1991)
Demonstrated that early treatment with corticosteroids reduces damage from spinal cord injury.

(1993)
Developed and tested a new device that has lead to improved wheelchair designs by enhancing assessments of upper extremity pain in manual wheelchair users.

(1994)
Demonstrated that one aspirin tablet a day reduced by half the rate of death and nonfatal heart attacks in patients with unstable angina.

(1995)
Conducted the National Surgical Quality Improvement Program, which is instrumental in identifying ways to improve surgical care.

(1996)
Identified the gene that causes Werner's syndrome, a disease marked by premature aging.

Developed clinical practice guidelines on cholesterol screening for the American College of Physicians.

Found that an implantable insulin pump offers better blood sugar control, weight control and quality of life for adult-onset diabetes than multiple daily injections.

(1997)
Identified a gene associated with a major risk for schizophrenia.

(1998)
Identified a gene that causes a rare form of dementia, providing a potential target for treatment of Alzheimer's disease.

Found that less expensive, conservative treatment of a common type of heart attack is superior to the standard heart catheterization and balloon angioplasty.

Demonstrated that administering erythropoetin under the skin is as effective and less expensive than intravenous administration for treatment of severe anemia in hemodialysis patients.

Started the Quality Enhancement Research Initiative that is rapidly translating research results into clinical practice for conditions prevalent among veterans.

(1999)
Found that a chemical messenger and a neurotoxin can shut down neurons associated with chronic pain while leaving intact those needed for a normal pain response.

Conducted the first treatment trials for Gulf War Veterans' Illnesses. One study is testing an antibiotic, and another is testing exercise and behavioral therapy for effectiveness in treating unexplained symptoms reported by veterans.

(2000)
Showed that colonoscopy is superior to the more widely used sigmoidoscopy as a primary screening mechanism for colon cancer.

Conducted the first large clinical trial of hearing aids, showing that the devices can help the hearing-impaired in both quiet and noisy environments.

(2001)
Began the first clinical trial under the new Tri-National Research Initiative. Researchers from the VA are collaborating with colleagues from Canada and the United Kingdom to determine the optimal antiretroviral therapy AIDS and HIV infection.

Initiated a landmark clinical trial that will assess the effectiveness of implanting deep brain stimulators as a treatment for Parkinson's disease. The study will be conducted at the VA's six new Parkinson's Disease Research, Education and Clinical Centers.

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Rehabilitation Research and Development Service

Overview

Technology that gives veterans back functional independence, career opportunities that encourage rehabilitation research education-all speak to just a small part of innovation in the Rehabilitation Research and Development (Rehab R&D) Service within the VA Health Care System. An intramural program for improving the quality of life of impaired and disabled veterans, Rehab R&D is dedicated to the well-being of America's veterans through a full spectrum of research: from approved rehabilitation research projects, through evaluation and technology transfer to final clinical application. The veterans served by these programs not only help define research goals, but participate in research efforts, and often test the outcomes and ultimate usefulness of research results in their daily lives.

In order to disseminate research results, the Rehab R&D Service has committed to publishing its efforts, through outlets such as a quarterly peer-reviewed journal, an annual compendium of rehab research progress throughout the world, clinical monographs, and data sheets for technology transfer projects. Each of these activities stimulates new research ideas and keeps clinicians and consumers on the cutting edge of new ideas in disability management.

Centers of Excellence

Rehabilitation Research & Development?s Centers of Excellence are the site of rehabilitation research that attracts the brightest minds from academia, industry, and medicine into the VA focused on finding research solutions to the needs of veterans with disabilities.

Center for Aging Veterans with Vision Loss

Researchers at the Atlanta center work to improve function, independence, and quality of life of aging veterans with visual disabilities and those acquiring visual disabilities. The center focuses on vision, cognition and mobility research, and research that highlights the interaction among these areas. Research goals are to understand the mechanisms underlying impairments and disabilities and apply this understanding to the design, testing, and evaluation of rehabilitative interventions. The center is affiliated with Emory University and has relationships with the University of Georgia, Georgia Tech, and Georgia State.

Director: Ronald A. Schuchard, Ph.D.
Location: VA Medical Center, Atlanta, GA
Telephone: 404.728.5063
E-mail: Ronald.Schuchard@med.va.gov

Center for Innovative Visual Rehabilitation

The center focuses on the development of a retinal prosthesis to restore vision in patients with retinitis pigmentosa, the leading cause of inherited blindness, and with age-related macular degeneration (ARMD), the leading cause of blindness among veterans and the general population in industrialized countries. Scientists work together with clinicians to provide care and education for patients with vision impairments, especially those with ARMD. Investigators collaborate with researchers at the Massachusetts Eye and Ear Infirmary, Harvard Medical School, and the Massachusetts Institute of Technology.

Director: Joseph F. Rizzo, III, M.D.
Location: VA Medical Center, Boston, MA
Telephone: 617.573.3412
E-mail: jrizzo@meei.harvard.edu

Center for Medical Consequences of Spinal Cord Injury

The Center for Medical Consequences of Spinal Cord Injury (SCI) is located at the Bronx VA Medical Center with satellite clinical research units at Kessler Institute of Rehabilitation and Helen Hayes Hospital. Investigators are studying the use of anabolic pharmaceuticals, including anabolic steroids, to treat secondary disabilities of SCI. SCI, which affects more than 40,000 veterans nationwide, often is associated with problems related to muscular function, breathing, bowel movements, and cardiovascular health. The aging veteran population with SCI is particularly susceptible to an increased risk of many medical complications that accompany nerve interruption and immobilization.

Director: William A. Bauman, M.D.
Location: VA Medical Center, Bronx, NY
Telephone: 718.584.9000, ext. 5420 or 5428
E-mail: wabauman@earthlink.net

Center for Functional Electrical Stimulation

Researchers investigate functional electrical stimulation (FES), a technology that relies on controlled electrical current to activate paralyzed muscles to return full or partial physical function to individuals with disabilities. Accomplishments include FDA approval of a hand grasp system and commencement of clinical trials of an advanced bladder/bowel management system. Studies include the clinical development of implantable command/control systems for bilateral hand grasp, implantable systems for transfer and mobility, unassisted standing, upper arm control, and evaluation of FES therapies in the treatment of stroke-related impairments. The Cleveland FES Center is a consortium of the Cleveland VA Medical Center, Case Western Reserve University, the MetroHealth Medical Center, and the Edison BioTechnology Center.

Director: P. Hunter Peckham, Ph.D.
Location: VA Medical Center, Cleveland, OH
Telephone: 216.778.3480
E-mail: pxp2@po.cwru.edu

Center for Brain Rehabilitation Research

Investigators research and develop innovative methods of effective and efficient post acute rehabilitation for veterans with cognitive, motor, or sensory impairments due to stroke, traumatic injury, or degenerative diseases of the central nervous system. These programs incorporate approaches to develop neuro-physiological studies to enhance understanding of mechanisms of neural plasticity and to apply these findings to assist in the development of new treatments for the rehabilitation setting.

Director: Leslie Gonzalez Rothi, Ph.D.
Location: VA Medical Center, Gainesville, FL
Telephone: 352.376.1611 x 6603
E-mail: gonzalj@neurology.ufl.edu

Rehabilitation Outcomes Research Center

Funded by Health Services Research and Development and Rehabilitation Research and Development Services, Rehabilitation Outcomes Research Center (RORC) scientists enhance access, quality, and efficiency of rehabilitation services through inter-disciplinary research and dissemination activities. RORC is developing a national integrated database of individuals with stroke to assess patient outcomes, developing and testing outcomes related to newly emerging rehabilitation therapies based on principles of neuroplasticity and innovative technologies, and providing scientific evidence that promotes informed clinical policy in rehabilitation. The center is affiliated with the University of Florida and Brooks Center for Rehabilitation Studies.

Director: Pamela W. Duncan, Ph.D., Co-Director: Steve Nadeau, M.D.
Location: VA Medical Center, Gainesville, FL
Telephone: 352.376.1611 ext 4923
E-mail: pamela.duncan2@med.va.gov

Center for Functional Recovery in Chronic Spinal Cord Injury

Investigators study spasticity, pain management, recovery of motor and sensory function, and other areas of critical importance to veterans with spinal cord injury (SCI). The Miami center, a Veterans Health Administration resource for SCI research, care, and education, works to strengthen the network of VA SCI investigators and the community of clinician-scientists dedicated to helping patients with spinal cord injury and their families. The center is affiliated with the Miami Project to Cure Paralysis at the University of Miami School of Medicine, a leading SCI research center, and the Tampa VA Medical Center.

Director: Marca L. Sipski, M.D.
Location: VA Medical Center, Miami, FL
Telephone: 305.324-3363
E-mail: m.sipski@miami.edu

Center for Mobility

Researchers are studying neurologic or orthopedic impairments to restore and enhance muscle coordination in persons who have had a stroke or have sustained a spinal cord injury (SCI) and musculo-skeletal function and integrity in persons with osteoporosis, arthritis, or SCI. Nervous system coordination during complex motor tasks, as well as bone growth, maintenance, and regeneration are under study. Researchers are also investigating obstacle avoidance training with computer-simulated environments, developing an assistive robot for effective health care delivery, and differential pressure walking assistance. The center is affiliated with Stanford University and collaborates with other institutions in areas of relevance to the center's mission.

Director: Christopher R. Jacobs, Ph.D.
Location: VA Health Care System, Palo Alto, CA
Telephone: 650.493.5000 ext. 65012
E-mail: jacobs@rrd.stanford.edu

Center for Wheelchair and Related Technology

Pittsburgh investigators focus on the design, development, and evaluation of new technologies to improve the mobility of physically impaired individuals. They have made important contributions towards the design of wheelchairs, seating systems, transportation systems, and novel approaches to the delivery of assistive technology. The center has been a leader in the establishment and implementation of international standards. Rehabilitation engineering and biomechanics are important strengths of the center, as is its capabilities in conducting mutli-site studies of assistive technology. Through improved design and prescription, investigators expect to reduce the incidence of pressure sores, enhance understanding of wheeled mobility needs, reduce the incidence of repetitive upper extremity strain injuries, increase access to wheelchair and seating experts, expand and improve upon clinical knowledge, and develop better wheelchair designs and related technologies.

Director: Rory A. Cooper, Ph.D.
Location: VA Health Care System, Pittsburgh, PA
Telephone: 412.365.4850
E-mail: rcooper@pitt.edu

National Center for Rehabilitative Auditory Research (NCRAR)

The National Center for Rehabilitative Auditory Research (NCRAR) is the only VA national center of excellence dedicated to addressing the needs of veterans with auditory disorders. The center is a consortium of multi-disciplinary professionals conducting research to increase knowledge about auditory dysfunction and improve auditory rehabilitation for veterans with hearing loss. The NCRAR trains new scientists and disseminates information to clinicians, educates and informs the public about hearing conservation, rehabilitation options, and how to effectively cope with auditory disorders. The center is affiliated with the Oregon Health and Science University, the University of Oregon, and has formed collaborations with three other RR&D centers of excellence, one HSR&D center of excellence, seven VAMCs, and thirteen academic institutions. The ultimate mission of the NCRAR is to alleviate the communication, social, and economic problems that result from disorders that affect the human auditory system.

Director: Stephen A. Fausti, Ph.D.
Location: VA Medical Center, Portland, OR
Telephone: 503.273.5306/503.220.8262 ext. 57535
E-mail: stephen.fausti@med.va.gov

Center for Limb Loss and Prosthetic Engineering

Investigators study amputation prevention, lower limb prosthetic improvement, and patient outcome measurements. One of the first to routinely test aging veterans for diabetes, the leading cause of non-traumatic lower limb loss, the center has long been a resource for veterans with limb-at-risk and amputation-related problems. The center nurtures a community of clinical and basic scientists to better understand lower limb mechanics and the effect on disease, prosthetic engineering innovations, and treatment of secondary disabilities after amputation. The center measures functional treatment outcomes, tracks the positive impact of innovation, and disseminates research results. Collaborative research is conducted with the Departments of Orthopedics and Rehabilitation Medicine at the University of Washington and the Prosthetics Research Study Group.

Director: Bruce J. Sangeorzan, M.D.
Location: Puget Sound Health Care System, Seattle, WA
Telephone: 206.764.2991
E-mail: bsangeor@u.washington.edu

Center for Spinal Cord Injury and Multiple Sclerosis

For more than a decade, West Haven researchers have focused their efforts on the recovery of functional loss from spinal cord injury (SCI). Research done at molecular and cellular levels is translated into restorative therapies in the clinical domain. Studies examine the use of channel blocking agents on rehabilitation outcomes in both SCI and multiple sclerosis (MS), neuroprotective approaches to preserving neurologic function in relapsing-remitting MS, pharmacologic treatment of ataxia in MS, and transplantation of myelin-forming cells for restoration of function in demyelinating disorders. Through this work, the center builds upon and brings together the unique resources of the VA Connecticut Healthcare System, Yale University Medical School, and the PVA/EPVA Center for Neuroscience and Regeneration Research.

Director: Stephen G. Waxman, M.D., Ph.D.
Location: West Haven, CT
Telephone: 203.785.6351
E-mail: stephen.waxman@yale.edu


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The information above is only a small sampling of the overall list of accomplishments and excellence in medicine that the VA provides for us. It would be a terrible mistake to try and dismantle it and "hope" the private sector could do nearly as well!

[SuperScout]

This is all wonderful data that you posted, but in some ways, it begs the qeustion. Had the billions of dollars invested in the VA and its various and sundry R&D progams been invested in the private sector, would the same results have occurred? Probably, and I suspect, probably much quicker. Secondly, much of the R&D paid for by the VA was contracted out to private research labs, thereby adding another level of bureauracy and cost to the ultimate final product. In fact, many of the articles in your cutNpaste were written by civilian doctors, with the research being done at civilian facilities.

Naturally, the VA has a vested interest in the development of various protheses, for example, as the civilian sector had not experienced that degree of trauma to the extent felt by the military. But the thousands of other medical, pharmaceutical, and rehab discoveries and inventions funded by the private sector would dwarf all the discoveries of the VA, wonderful as they are.

We have a local veteran who requires serious rehabilitation and other care, none of which is available from the VA; his care is delivered by civilian providers, and according to his parents, far exceeds in quality anything he received from the VA before he transitioned into the private world. My own less-than-satisfactory experience with the VA, with their lackadasical attitude, grossly unsanitary facilities, inept medical staff, and no incentive to provide decent care serves only to solidify my support for a gradual privatization of the care we deserve.

[Gimpy]

"cut and paste" abilities aside.

It appears your "opinion(s)" are based on very limited personal knowledge and experience. That's why I'm attermpting to "educate" you!

I have been hospitalized in no less than three VA hospitals, all of which I would personally recommend over the 5 private hospitals I've been hospitalized in. No question. The one misfortune of medical malpractice I experienced was with a numbskull of a physician who I have found out that did MORE dammage to his patients in the PRIVATE sector than he did whlie on staff at the Atlanta VA facillity! He no longer practices medicine----partly because of my lawsuit against the VA!

No amount of rhetorical misinformation will change MY view and the view of THOUSANDS of other Veterans and members of the medical profession. The current Health Care System within the Department of Veterans Affairs is a WORLD CLASS SYSTEM worthy of the envy of nations and society around the world!

[Dragon Lady]

Okay, how about this?
What about offering an HMO package to those veterans who are not able to receive the care they need through a VA hospital? Some of our vets resided in some very remote areas and need to drive hours to see a VA doctor.

Also, it has been my most recent experience that not all services are offered at all VA hospitals.

Would it be such a bad thing to have the government pay a civilian doctor of your choice? I don't know. There have been some abuses in the past with Medicare by the very physicians that we trust with our lives. It might be something worth investigating. Maybe some type of hybred system.

And Gimpy, thanks for posting the info. It does help to put things into more perspective.

DL

[Dragon Lady]

Also, it has been my most recent experience that not all services are offered at all VA hospitals.

Case in point: Until VERY recently VA hospitals did not offer care for female vets at all. Even though we were entitled to that same care. And still I have my feminine medical needs attended to at my civilian doctor.

[SuperScout]

Excellent suggestions, and quite eye-opening, I might add that you veterans of the female persuasion are discriminated against, again.

And Gimpy, while I certainly realize that I was only presenting both personal and anecdotal experiences, the point that you missed was that practically all the wondrous discoveries that were chlked up by the VA were accomplished at civilian universities, hospitals, or R&D facilities. That's not rhetoric, but fact, so kindly unknot your panties!

Your sad story about the VA butcher who formerly worked in the civilian sector only roves my point: if he was so bad, and doubtless he was, why in Sam Hill did the VA ever hire him? Since I can't think of too many success stories that have a complete government imprimatur, I'm opting for the civilian side, and will rest assured that my civilian doctor is still far superior than anything the government could hire. And yes, I'll concede that our VA hospital system is probably far superior to that of other countries, specifically those struggling to emerge from the Dark Ages.

[Dragon Lady]

Scout,
sorry let me run off on a little side tangent here for a moment.

I have to say that I am very impressed. Not that I would ever think you didn't possess the capability, but that is by far the finest usuage of the word..."imprimatur" that I have ever seen.

(Golf Clap)



DL

[SuperScout]

Ah, shaw, shucks (adding, blushingly), you say the sweetest thangs!!

[Gimpy]

Well, lemme see here.

"Imprimatur"???........."Horse manure"!

I quote you Super, "the point that you missed was that practically all the wondrous discoveries that were chalked up by the VA were accomplished at civilian universities, hospitals, or R&D facilities "

Actually, NO THEY WEREN'T...........the VA has many "research" labs across the country fully capable and even though understaffed, quite able to do most of their R & D on their own.

I'm glad you brought up the "fact" that many renowned Universities and civilian hospitals are in "partnership" with the VA R & D efforts.

These "partnerships" are in most cases funded by GOVERNMENT GRANTS that would otherwise be UNAVAILABLE to these insitutions without the overriding obligation and committment of the VA Reseach & Development authorization process!

It IS a "team" effort of the so-called "bloated bureaucracy" as you call it, and private institutions that continue to make the VA the WORLD CLASS health care system it is.

And......................IF we could get the politicians now in office to just FUND it properly............it WILL be even better!

PS............That "funding" would do well to improve the "salary caps" now in place for VA physicians and help eliminate having to HIRE doctors like the one who screwed up on me (and my friend Packo). If the "playing field" were leveled with regards to salary and physicians compensation between the "private sector" and the VA health care system, you wouldn't see much of this anymore!

.

[Gimpy]

I'll bet you'll never guess who made the decision to STOP that "discrimination" against female veterans??

The Clinton Adminstration proposed changes in the Department of Veterans Affairs to improve health care and benefits for all women veterans in 1993.

As a result, Congress passed Public Law 102-585, and four Women Veterans' Comprehensive Health Centers were established in 1994 to develop new and enhanced programs focusing on the unique health-care needs of women veterans. An additional four centers were funded in 1994.

These Centers are located at VA medical centers in: Minnesota, Florida, Northern California, North Carolina, Illinois, Massachusetts, Southern California, and the Southeast Pennsylvania area. Many of these Centers are structured under a primary care model, which provides a coordinated approach to the provision of medical, surgical, and psychological care for women patients.

Also in 1993, the VA established a new division within the National Center for Post-Traumatic Stress Disorder (PTSD) devoted to studying the impact of military trauma on women veterans. The Women's Health Science Division, based at the Boston VA Medical Center, is the first of its kind in the country.

The Center conducts studies designed to improve the assessment, diagnosis and treatment of PTSD in women and provides training for professionals working with PTSD.

The VA's Center for Women Veterans established in 1994, and the Women Veterans Health Program specifically addresses the health care needs of eligible women veterans, providing appropriate, and timely health care at the facility level.

Women veterans are eligible for the same VA benefits as male veterans BTW. The VA can provide appropriate and timely medical care to any eligible woman veteran. In addition to routine medical care, each VA medical facility can provide eligible women veterans the following:

complete physical exams that include breast and pelvic examinations,

gynecology services,

and referral for necessary services that may not be available at that facility.

The VA medical centers have made structural changes and renovated areas to ensure privacy for women veterans. (We have one here at the Tampa VA Hospital)

Women Veterans Coordinators at each VA medical center and regional office are available to help women veterans access their benefit entitlements and counsel women veterans seeking treatment and benefits.

The VA has developed initiatives for women veterans that assure women veterans receive the benefits to which they are entitled. One of the most important of these has been the establishment of the Women Veterans' Coordinator positions. Most VA regional offices, medical centers and vet centers have a designated Coordinator to assist women veterans in accessing VA benefits and health care services.

The VA also emphasizes equal access to care and adequate privacy within the Women Veterans Health Programs. Women VA patients receive complete physical examinations upon admission, including breast and pelvic exams. Clinicians emphasize preventive health care and counseling, including contraceptive services and menopause management, Pap smears and mammography. VA Clinicians and Women Veterans Coordinators are provided specialized training and sensitivity awareness to help sexual assault victims. Additionally, the VA has been authorized to provide specialized counseling and treatment for the aftereffects of sexual trauma that occurred during military service. Their 1-800-827-1000 National toll free line is designated and advertised as the contact telephone number for veterans to receive information, assistance and referrals on issues related to sexual trauma in the military

The VA conducts research on a broad range of issues related to women's health care, including breast cancer, osteoporosis, mental health, post-traumatic stress disorder and access barriers to health care. The results of these projects have contributed to improve health care for all veterans within the VA network.

So you see............the story goes on and on about HOW the VA health care system CAN work.................if FUNDED PROPERLY!