From Swords to Test Tubes: The Million Veteran Program
A Better Military Through Genetics
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The Department of Veterans Affairs estimates that one in every four Iraq or Afghanistan vets is suffering from PTSD. It’s one reason suicide is now the leading cause of death among active-duty soldiers. \u003c/p>\n\u003cp>This crisis has led the VA to explore treatments that would have been considered decidedly from-the-fringes a generation ago. Some of that work is taking place at the Menlo Park division of the VA Palo Alto Medical Center.\u003cbr>\n\u003cstrong>\u003cbr>\n\"My little safe zone\"\u003c/strong>\u003c/p>\n\u003cp>John Montgomery is a Vietnam vet with a bushy gray mustache and a tattoo of a scorpion on each forearm. During his time here in the residential PTSD program, he’s been thinking a lot about his life before the war. \u003c/p>\n\u003cp>“We were dirt farmer kids,” he tells me. “It was the summer of 1957. We were irrigating 80 acres of cotton. My brother was yelling off in the distance and I was just laying back on a haystack…” \u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Montgomery trails off for a moment, lost in the memory. \u003c/p>\n\u003cp>“Yeah, that's my little safe zone,” he says.\u003c/p>\n\u003cp>But when he talks about Vietnam and what he saw there, something in his voice changes, ramps up. \u003c/p>\n\u003cp>The image he can’t shake – even now, nearly four decades after his return – is of Vietnamese children trying to kill him. \u003c/p>\n\u003cp>“Our society teaches us to go to school, live with our families and stuff, not to blow somebody else up,\" he says, as his voice grows louder. \"They were after you, you know?”\u003c/p>\n\u003cp>Today, after what he calls decades of failed relationships and self-abuse, Montgomery is finally getting help for PTSD, a diagnosis he hadn’t even heard of until a few years ago. \u003c/p>\n\u003cp>Part of his treatment is a twice-weekly guided meditation session. \u003c/p>\n\u003cp>On a recent afternoon, five men settle into armchairs arranged in a circle. One younger vet in board shorts and flip flops lies down on the floor. Two of the vets served in Vietnam; three younger men served in Iraq. A couple of therapy dogs, golden retrievers named Eldridge and Elaine, settle at their owners’ feet. \u003c/p>\n\u003cp>Leah Weiss -- a meditation trainer from Stanford’s Center for Compassion and Altruism Research and Education -- begins to lead. “Let’s start with three deep cleansing breaths,” she tells the men. \u003c/p>\n\u003cp>\u003cstrong>An old approach, revisited\u003c/strong>\u003c/p>\n\u003cp>What’s taking place in this room has been happening on a small scale for decades, says Stephen Xenakis. He’s a retired brigadier general who formerly oversaw the army’s medical system. \u003c/p>\n\u003cp>In the 1970s, Xenakis worked as a psychiatrist with Vietnam vets at the former Letterman Army Medical Center, in San Francisco’s Presidio. He says meditation was one of several Eastern-inspired treatments he and others were experimenting with. \u003c/p>\n\u003cp>Even back then, he says, it was clear that \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22669968\">meditation could help calm\u003c/a> the nervous systems of not just veterans, but prisoners and people suffering from trauma. \u003c/p>\n\u003cp>But getting the VA to integrate meditation into its standard treatment was tough, especially after the late 1980s, when drugs like Prozac came on the scene. The drugs were easy to study and prescribe, cheap to administer. For a lot of patients, they were very effective. \u003c/p>\n\u003cp>“I think in many ways,” he says,” these other options that we had learned were helpful back in the ‘70s kind of fell off to the wayside”. \u003c/p>\n\u003cp>In recent years, it’s become clear that drugs are no panacea. Side effects are common. And for about half of PTSD patients, the drugs don’t work at all. A recent \u003ca href=\"http://www.iom.edu/Reports/2012/Treatment-for-Posttraumatic-Stress-Disorder-in-Military-and-Veteran-Populations-Initial-Assessment.aspx\">report\u003c/a> from the Institute of Medicine concluded that \"the evidence is inadequate\" to demonstrate that SSRIs, like Prozac, are generally effective in treating PTSD. \u003c/p>\n\u003cp>Those limitations have renewed interest in other approaches, such as meditation. \u003c/p>\n\u003cp>\u003cstrong>What meditation may do to the brain\u003c/strong>\u003c/p>\n\u003cp>Back in the TV room at the Menlo Park VA, Weiss’s voice is calm, almost hypnotic. She tells the men to “bring to mind a stranger, maybe someone you pass by when you’re commuting.”\u003c/p>\n\u003cp>“Consider,” she instructs them, “that just like me, this person has had ups and downs in his or her life. Just like me, this person has had goals and dreams. Just like me, this person knows what it’s like to be disappointed, or afraid.”\u003c/p>\n\u003cp>This particular meditation -– it’s called “\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21840289\">compassion meditation\u003c/a>” -- aims at a specific and widely held hypothesis about what is happening in the brain of someone like John Montgomery, the Vietnam vet. \u003c/p>\n\u003cp>The idea is that in combat, a switch -- a fight-or-flight survival mode located in a part of the brain called the amygdala -- has been turned on, and become essentially stuck. Meanwhile, another part, the frontal cortex, takes the backseat. And that’s critical. Because this part of the brain helps us relate to other people. \u003c/p>\n\u003cp>“The frontal cortex,” says Stephen Xenakis, “is what allows us to have relationships and families, what gives us a sense that there are rules of society and morality. It's part of what is different about our brains from even other primates, and clearly other mammals.\"\u003c/p>\n\u003cp>Whether or not this kind of meditation is effective in treating PTSD is, from a scientific standpoint, still unknown. Studies have shown that repeated sessions can increase \"positive affect\" and \"social connectedness,\" both of which are deficient in PTSD patients, according to a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22669968\">2012 meta-analysis\u003c/a> on the efficacy of different kinds of meditation in treating PTSD. \u003c/p>\n\u003cp>Meditation in general, wrote the authors, \"holds some promise\" as a treatment for PTSD.\u003c/p>\n\u003cp>\u003cstrong>\u003cbr>\nAdvice from an older veteran\u003c/strong>\u003c/p>\n\u003cp>After about 20 minutes, Weiss asks the men to open their eyes and to reflect on what the meditation made them feel. \u003c/p>\n\u003cp>Most of these men have been taking part in these sessions for a couple months now. They’ve been listening to CDs with Weiss’s voice back in their rooms. They say they feel calmer, more compassionate to other people. \u003c/p>\n\u003cp>But one of them, Esteban Brojas, is newer to this. Brojas served during the Iraq invasion in 2003. In some ways, he says, it’s like he’s still there. \u003c/p>\n\u003cp>Coming back to civilian life has been “a culture shock,” he says. “You’re still with that adrenaline; you’re still hyper-vigilant.” \u003c/p>\n\u003cp>Brojas’s wife gave birth to their daughter while he was in Iraq. When he came back, he didn’t know how to hold her. “After taking someone's life? It’s hard,” he says. \u003c/p>\n\u003cp>As he speaks, Brojas’s voice starts to tremble and speed up. He rubs his hands together quickly as he rocks back and forth in his armchair. \u003c/p>\n\u003cp>“After the fact that you're going into a building and there's a grenade being popped and there's a woman and a child in there? It's hard. To come home and hold your daughter in your hands?”\u003c/p>\n\u003cp>Doreen, the therapist steps in. “I would say…” she begins, tentatively. \u003c/p>\n\u003cp>But it's John Montgomery, the Vietnam vet across the room, who knows what to do. \u003c/p>\n\u003cp>“You're not there,” he tells Brojas, firmly. “You're right here. You're not there right now. You’re in it. It'll take time. It's like a wave coming. It’ll subside.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Montgomery’s doing something he thought he had forgotten how to do: feel compassion. In a few weeks, he’ll leave this program and go back to his family – a different man, he hopes, than he was when he came here. \u003c/p>\n\n","blocks":[],"excerpt":"The crisis of mental disorders such as PTSD has forced the military to rediscover therapies that would have considered from-the-fringes a generation ago. ","status":"publish","parent":0,"modified":1370996308,"stats":{"hasAudio":true,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":43,"wordCount":1347},"headData":{"title":"Can Meditation Ease PTSD in Combat Vets? | KQED","description":"The crisis of mental disorders such as PTSD has forced the military to rediscover therapies that would have considered from-the-fringes a generation ago. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Can Meditation Ease PTSD in Combat Vets?","datePublished":"2012-10-12T21:04:46.000Z","dateModified":"2013-06-12T00:18:28.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"46030 http://science.kqed.org/quest/?post_type=audio_reports&p=46030","disqusUrl":"https://ww2.kqed.org/quest/2012/10/12/can-meditation-ease-ptsd-in-combat-vets/","disqusTitle":"Can Meditation Ease PTSD in Combat Vets?","path":"/quest/46030/can-meditation-ease-ptsd-in-combat-vets","audioUrl":"http://www.kqed.org/.stream/anon/radio/quest/2012/10/20121015scienceptsd.mp3","audioDuration":null,"audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"audioLink","attributes":{"named":{"src":"http://www.kqed.org/.stream/anon/radio/quest/2012/10/20121015scienceptsd.mp3"},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003ca href=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2012/10/PTSD.Med-image-cropped.png\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2012/10/PTSD.Med-image-cropped-300x169.png\" alt=\"\" title=\"PTSD.Med image cropped\" width=\"300\" height=\"169\" class=\"alignleft size-thumbnail wp-image-46057\">\u003c/a>\u003cbr>\nAmong veterans, mental disorders such as post-traumatic stress disorder are epidemic. The Department of Veterans Affairs estimates that one in every four Iraq or Afghanistan vets is suffering from PTSD. It’s one reason suicide is now the leading cause of death among active-duty soldiers. \u003c/p>\n\u003cp>This crisis has led the VA to explore treatments that would have been considered decidedly from-the-fringes a generation ago. Some of that work is taking place at the Menlo Park division of the VA Palo Alto Medical Center.\u003cbr>\n\u003cstrong>\u003cbr>\n\"My little safe zone\"\u003c/strong>\u003c/p>\n\u003cp>John Montgomery is a Vietnam vet with a bushy gray mustache and a tattoo of a scorpion on each forearm. During his time here in the residential PTSD program, he’s been thinking a lot about his life before the war. \u003c/p>\n\u003cp>“We were dirt farmer kids,” he tells me. “It was the summer of 1957. We were irrigating 80 acres of cotton. My brother was yelling off in the distance and I was just laying back on a haystack…” \u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Montgomery trails off for a moment, lost in the memory. \u003c/p>\n\u003cp>“Yeah, that's my little safe zone,” he says.\u003c/p>\n\u003cp>But when he talks about Vietnam and what he saw there, something in his voice changes, ramps up. \u003c/p>\n\u003cp>The image he can’t shake – even now, nearly four decades after his return – is of Vietnamese children trying to kill him. \u003c/p>\n\u003cp>“Our society teaches us to go to school, live with our families and stuff, not to blow somebody else up,\" he says, as his voice grows louder. \"They were after you, you know?”\u003c/p>\n\u003cp>Today, after what he calls decades of failed relationships and self-abuse, Montgomery is finally getting help for PTSD, a diagnosis he hadn’t even heard of until a few years ago. \u003c/p>\n\u003cp>Part of his treatment is a twice-weekly guided meditation session. \u003c/p>\n\u003cp>On a recent afternoon, five men settle into armchairs arranged in a circle. One younger vet in board shorts and flip flops lies down on the floor. Two of the vets served in Vietnam; three younger men served in Iraq. A couple of therapy dogs, golden retrievers named Eldridge and Elaine, settle at their owners’ feet. \u003c/p>\n\u003cp>Leah Weiss -- a meditation trainer from Stanford’s Center for Compassion and Altruism Research and Education -- begins to lead. “Let’s start with three deep cleansing breaths,” she tells the men. \u003c/p>\n\u003cp>\u003cstrong>An old approach, revisited\u003c/strong>\u003c/p>\n\u003cp>What’s taking place in this room has been happening on a small scale for decades, says Stephen Xenakis. He’s a retired brigadier general who formerly oversaw the army’s medical system. \u003c/p>\n\u003cp>In the 1970s, Xenakis worked as a psychiatrist with Vietnam vets at the former Letterman Army Medical Center, in San Francisco’s Presidio. He says meditation was one of several Eastern-inspired treatments he and others were experimenting with. \u003c/p>\n\u003cp>Even back then, he says, it was clear that \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22669968\">meditation could help calm\u003c/a> the nervous systems of not just veterans, but prisoners and people suffering from trauma. \u003c/p>\n\u003cp>But getting the VA to integrate meditation into its standard treatment was tough, especially after the late 1980s, when drugs like Prozac came on the scene. The drugs were easy to study and prescribe, cheap to administer. For a lot of patients, they were very effective. \u003c/p>\n\u003cp>“I think in many ways,” he says,” these other options that we had learned were helpful back in the ‘70s kind of fell off to the wayside”. \u003c/p>\n\u003cp>In recent years, it’s become clear that drugs are no panacea. Side effects are common. And for about half of PTSD patients, the drugs don’t work at all. A recent \u003ca href=\"http://www.iom.edu/Reports/2012/Treatment-for-Posttraumatic-Stress-Disorder-in-Military-and-Veteran-Populations-Initial-Assessment.aspx\">report\u003c/a> from the Institute of Medicine concluded that \"the evidence is inadequate\" to demonstrate that SSRIs, like Prozac, are generally effective in treating PTSD. \u003c/p>\n\u003cp>Those limitations have renewed interest in other approaches, such as meditation. \u003c/p>\n\u003cp>\u003cstrong>What meditation may do to the brain\u003c/strong>\u003c/p>\n\u003cp>Back in the TV room at the Menlo Park VA, Weiss’s voice is calm, almost hypnotic. She tells the men to “bring to mind a stranger, maybe someone you pass by when you’re commuting.”\u003c/p>\n\u003cp>“Consider,” she instructs them, “that just like me, this person has had ups and downs in his or her life. Just like me, this person has had goals and dreams. Just like me, this person knows what it’s like to be disappointed, or afraid.”\u003c/p>\n\u003cp>This particular meditation -– it’s called “\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21840289\">compassion meditation\u003c/a>” -- aims at a specific and widely held hypothesis about what is happening in the brain of someone like John Montgomery, the Vietnam vet. \u003c/p>\n\u003cp>The idea is that in combat, a switch -- a fight-or-flight survival mode located in a part of the brain called the amygdala -- has been turned on, and become essentially stuck. Meanwhile, another part, the frontal cortex, takes the backseat. And that’s critical. Because this part of the brain helps us relate to other people. \u003c/p>\n\u003cp>“The frontal cortex,” says Stephen Xenakis, “is what allows us to have relationships and families, what gives us a sense that there are rules of society and morality. It's part of what is different about our brains from even other primates, and clearly other mammals.\"\u003c/p>\n\u003cp>Whether or not this kind of meditation is effective in treating PTSD is, from a scientific standpoint, still unknown. Studies have shown that repeated sessions can increase \"positive affect\" and \"social connectedness,\" both of which are deficient in PTSD patients, according to a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22669968\">2012 meta-analysis\u003c/a> on the efficacy of different kinds of meditation in treating PTSD. \u003c/p>\n\u003cp>Meditation in general, wrote the authors, \"holds some promise\" as a treatment for PTSD.\u003c/p>\n\u003cp>\u003cstrong>\u003cbr>\nAdvice from an older veteran\u003c/strong>\u003c/p>\n\u003cp>After about 20 minutes, Weiss asks the men to open their eyes and to reflect on what the meditation made them feel. \u003c/p>\n\u003cp>Most of these men have been taking part in these sessions for a couple months now. They’ve been listening to CDs with Weiss’s voice back in their rooms. They say they feel calmer, more compassionate to other people. \u003c/p>\n\u003cp>But one of them, Esteban Brojas, is newer to this. Brojas served during the Iraq invasion in 2003. In some ways, he says, it’s like he’s still there. \u003c/p>\n\u003cp>Coming back to civilian life has been “a culture shock,” he says. “You’re still with that adrenaline; you’re still hyper-vigilant.” \u003c/p>\n\u003cp>Brojas’s wife gave birth to their daughter while he was in Iraq. When he came back, he didn’t know how to hold her. “After taking someone's life? It’s hard,” he says. \u003c/p>\n\u003cp>As he speaks, Brojas’s voice starts to tremble and speed up. He rubs his hands together quickly as he rocks back and forth in his armchair. \u003c/p>\n\u003cp>“After the fact that you're going into a building and there's a grenade being popped and there's a woman and a child in there? It's hard. To come home and hold your daughter in your hands?”\u003c/p>\n\u003cp>Doreen, the therapist steps in. “I would say…” she begins, tentatively. \u003c/p>\n\u003cp>But it's John Montgomery, the Vietnam vet across the room, who knows what to do. \u003c/p>\n\u003cp>“You're not there,” he tells Brojas, firmly. “You're right here. You're not there right now. You’re in it. It'll take time. It's like a wave coming. It’ll subside.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Montgomery’s doing something he thought he had forgotten how to do: feel compassion. In a few weeks, he’ll leave this program and go back to his family – a different man, he hopes, than he was when he came here. \u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/quest/46030/can-meditation-ease-ptsd-in-combat-vets","authors":["210"],"categories":["quest_4","quest_12"],"tags":["quest_252","quest_11533","quest_11531","quest_11518","quest_11532","quest_1784","quest_13203","quest_2266","quest_2328","quest_11530","quest_10531","quest_11529","quest_11528"],"featImg":"quest_46057","label":"quest"},"quest_28257":{"type":"posts","id":"quest_28257","meta":{"index":"posts_1591205157","site":"quest","id":"28257","score":null,"sort":[1323459513000]},"guestAuthors":[],"slug":"can-ptsd-nightmares-be-cured","title":"Can PTSD Nightmares Be Cured?","publishDate":1323459513,"format":"audio","headTitle":"QUEST | KQED Science","labelTerm":{"site":"quest"},"content":"\u003cp>http://www.kqed.org/.stream/anon/radio/quest/2011/12/2011-12-12-quest.mp3\u003c/p>\n\u003cfigure id=\"attachment_28265\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2011/12/Kreep_Bed_Flickr_REV.jpg\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2011/12/Kreep_Bed_Flickr_REV-300x169.jpg\" alt=\"\" title=\"Kreep_Bed_Flickr_REV\" width=\"300\" height=\"169\" class=\"size-thumbnail wp-image-28265\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">In many PTSD patients, sleep problems such as insomnia and nightmares are the most common complaint. (Photo courtesy of Flickr user <a href=\"http://www.flickr.com/photos/kreep\" target=\"_blank\">Kreep</a>.)\u003c/figcaption>\u003c/figure>\n\u003cp>Sam Brace doesn’t want to talk about what he saw when he was a soldier in Iraq eight years ago. Brace is an inpatient at a PTSD treatment center run by the Department of Veterans Affairs in Menlo Park, and that trauma is something he’s actively trying not to dwell on. But what he can’t control are his dreams.\u003c/p>\n\u003cp>\"When I was overseas we hit an IED, um…\" he says, trailing off. \"When I have a nightmare normally it’s something related to that. \"\u003c/p>\n\u003cp>In the past, scientists who study PTSD thought of nightmares and insomnia as byproducts of the disorder, side effects that could only be targeted through daytime interventions, such as cognitive behavioral therapy. But that view is changing. \u003c/p>\n\u003cp>In Sam Brace and others afflicted with PTSD, nightmares and insomnia lead to alcoholism and drug abuse, and the inability to function well during the day. Doctors who treat PTSD say that sleep is central to the disorder, and that restoring it may go a long way toward helping patients return to normal lives.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>\"Wacky\" dreams are healthy dreams\u003c/strong>\u003c/p>\n\u003cp>Steve Woodward, a psychiatrist with the National Center for PTSD in Menlo Park says the hallmark of a healthy dream is that it seems kind of random.\u003c/p>\n\u003cp>\"They’re wacky,\" says Woodward. \"They associate things that are not normally associated.\"\u003c/p>\n\u003cp>PTSD dreams, in contrast, are like a broken record: the same, real-life event, played over and over again. Woodward says he's seen patients haunted by the same true-to-life nightmare for twenty years.\u003c/p>\n\u003cp>The question scientists had was: why? Why can't people with PTSD sleep normally?\u003c/p>\n\u003cp>\u003cstrong>Healthy sleep as therapy\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"http://walkerlab.berkeley.edu/people.html\">Matthew Walker\u003c/a> is a sleep researcher at the University of California, Berkeley. One of his particular interests is in rapid eye movement, or REM. It’s the stage of sleep where a lot of dreaming occurs.\u003c/p>\n\u003cp>REM sleep is also the only time of the day that the brain stops producing a kind of adrenaline called norepinephrine. That fact struck Walker as an intriguing mystery. Why would rapid eye movement sleep suppress this neurochemical, he wondered. Is there any function to that?\u003c/p>\n\u003cp>What Walker and his colleagues \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22119526\">found\u003c/a> is that in healthy people, REM sleep is kind of like therapy. It's an adrenaline-free environment where the brain can process its memories while stripping away their sharp, emotional edges.\u003c/p>\n\u003cp>\"When you come back the next day,\" says Walker, \"yes, you can better recollect [the memory]. But also, it doesn’t trigger that same visceral reaction that you had at the time of learning.\"\u003c/p>\n\u003cp>Emotions are useful, says Walker, because they show us what really matters to us. But it's not useful to hold onto what he calls the \"emotional blanket,\" that accompanied the original event. The emotions, he says, \"have done their job. Now it’s time to hold on to the information of that memory, but let go of the emotion.\"\u003c/p>\n\u003cp>\u003cstrong>\"Broken\" REM sleep\u003c/strong>\u003c/p>\n\u003cp>Walker believes that in many people who have PTSD, REM sleep is broken. Something about PTSD either causes the brain to be overly sensitive to norepinephrine, or forces the brain to create too much of it. The brain's adrenaline system is effectively out of whack.\u003c/p>\n\u003cp>As a result, REM sleep is no longer theraputic. The PTSD brain can't process tough memories, so it just cycles through them, again and again.\u003c/p>\n\u003cp>Which begs a question: What if you could change that? What if you could make the adrenaline go away?\u003c/p>\n\u003cp>\u003cstrong>An old drug finds a new role\u003c/strong>\u003c/p>\n\u003cp>Murray Raskind directs Mental Health Services for the Department of Veterans Affairs Puget Sound Health Care System. About a decade ago, he became interested in a drug called Prazosin, which was traditionally used to treat high blood pressure.\u003c/p>\n\u003cp>Prazosin can be bought generically for about ten cents a pill. It can have the side effect of making people dizzy. For the most part, it's been supplanted by other, more recent hypertension drugs, whose effects last longer. But Prazosin turned out to have another use: It makes the PTSD brain less receptive to adrenaline.\u003c/p>\n\u003cp>As a result, as Raskind discovered, prazosin can change the way those patients dream.\u003c/p>\n\u003cp>Raskind tells the story of one of the first vets he ever treated with prazosin, a veteran Raskind calls Charles, who spent 13 months in a combat infantry unit in Vietnam.\u003c/p>\n\u003cp>What haunted Charles was one specific event from his service: Under an ambush by Vietcong forces, Charles and a fellow soldier, his closest friend, found themselves trapped in a landing zone in the jungle. Charles watched as his friend was killed by a mortar round. Fragments of the round pierced Charles' right knee, leaving him unable to run. Charles was saved at the last minute by troops in a Huey helicopter, just as Vietcong forces climbed through the wire to reach him.\u003c/p>\n\u003cp>\"This near-death experience,\" says Raskind, \"and even more distressing, the death of his best friend, whose death he felt he was unable to prevent, haunted him most nights, every week, year in and year out.\"\u003c/p>\n\u003cp>After a few weeks of Prazosin, Charles came in for a follow-up appointment. He told Raskind that he didn't think the drug was working. He was still dreaming, just about something else.\u003c/p>\n\u003cp>According to Raskind, the dream went like this: \"I'm in my fifth-grade classroom. And there’s a test, and if I don’t pass the test, I’m not gonna be promoted to the next grade. And I never even got the assignment!”\u003c/p>\n\u003cp>It was the stress dream, says Raskind, of a healthy brain, trying to work things out. \"I said 'Charles, that’s MY nightmare!'\" Raskind recalls.\u003c/p>\n\u003cp>So far the studies on prazosin have been small (abstracts can be found online, \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed?term=Thompson%20CE%2C%20Taylor%20FB%2C%20McFall%20ME%2C%20Barnes%20RF%2C%20Raskind%20MA\">here\u003c/a> and \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/20473055\">here\u003c/a> and \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/20726290\">here\u003c/a> – as well as of a 2008 round-up of data, \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/18387899\">here\u003c/a>) but promising in decreasing nightmares and helping people sleep longer.\u003c/p>\n\u003cp>Other small studies involving non-combat PTSD – people who had been victims of \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2350188/?tool=pubmed\">crime and sexual assault\u003c/a>, as well as \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/19934720\">refugees\u003c/a> – found an improvement in the quality of their dreams, and overall sleep, as well.\u003c/p>\n\u003cp>The Department of Veterans Affairs is undergoing \u003ca href=\"http://www.research.va.gov/programs/csp/csp563.cfm\">its own study \u003c/a>on prazosin in PTSD, which is taking part in 13 medical centers across the country. But is already prescribing the drug to about 15 percent of its PTSD patients -- about 70,000 people.\u003c/p>\n\u003cp>Murray Raskind, for one, would like to see that number rise.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"For us,\" he says, \"it's a simple thing that works.\"\u003c/p>\n\n","blocks":[],"excerpt":"The hallmark of a healthy dream is its weirdness. PTSD dreams, in contrast, are like a broken record, the same, real-life event, played over and over again, in some patients, for decades. ","status":"publish","parent":0,"modified":1370996846,"stats":{"hasAudio":true,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":36,"wordCount":1166},"headData":{"title":"Can PTSD Nightmares Be Cured? | KQED","description":"The hallmark of a healthy dream is its weirdness. PTSD dreams, in contrast, are like a broken record, the same, real-life event, played over and over again, in some patients, for decades. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Can PTSD Nightmares Be Cured?","datePublished":"2011-12-09T19:38:33.000Z","dateModified":"2013-06-12T00:27:26.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"28257 http://science.kqed.org/quest/?post_type=audio_reports&p=28257","disqusUrl":"https://ww2.kqed.org/quest/2011/12/09/can-ptsd-nightmares-be-cured/","disqusTitle":"Can PTSD Nightmares Be Cured?","path":"/quest/28257/can-ptsd-nightmares-be-cured","audioUrl":"http://www.kqed.org/.stream/anon/radio/quest/2011/12/2011-12-12-quest.mp3","audioDuration":null,"audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>http://www.kqed.org/.stream/anon/radio/quest/2011/12/2011-12-12-quest.mp3\u003c/p>\n\u003cfigure id=\"attachment_28265\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2011/12/Kreep_Bed_Flickr_REV.jpg\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2011/12/Kreep_Bed_Flickr_REV-300x169.jpg\" alt=\"\" title=\"Kreep_Bed_Flickr_REV\" width=\"300\" height=\"169\" class=\"size-thumbnail wp-image-28265\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">In many PTSD patients, sleep problems such as insomnia and nightmares are the most common complaint. (Photo courtesy of Flickr user <a href=\"http://www.flickr.com/photos/kreep\" target=\"_blank\">Kreep</a>.)\u003c/figcaption>\u003c/figure>\n\u003cp>Sam Brace doesn’t want to talk about what he saw when he was a soldier in Iraq eight years ago. Brace is an inpatient at a PTSD treatment center run by the Department of Veterans Affairs in Menlo Park, and that trauma is something he’s actively trying not to dwell on. But what he can’t control are his dreams.\u003c/p>\n\u003cp>\"When I was overseas we hit an IED, um…\" he says, trailing off. \"When I have a nightmare normally it’s something related to that. \"\u003c/p>\n\u003cp>In the past, scientists who study PTSD thought of nightmares and insomnia as byproducts of the disorder, side effects that could only be targeted through daytime interventions, such as cognitive behavioral therapy. But that view is changing. \u003c/p>\n\u003cp>In Sam Brace and others afflicted with PTSD, nightmares and insomnia lead to alcoholism and drug abuse, and the inability to function well during the day. Doctors who treat PTSD say that sleep is central to the disorder, and that restoring it may go a long way toward helping patients return to normal lives.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>\"Wacky\" dreams are healthy dreams\u003c/strong>\u003c/p>\n\u003cp>Steve Woodward, a psychiatrist with the National Center for PTSD in Menlo Park says the hallmark of a healthy dream is that it seems kind of random.\u003c/p>\n\u003cp>\"They’re wacky,\" says Woodward. \"They associate things that are not normally associated.\"\u003c/p>\n\u003cp>PTSD dreams, in contrast, are like a broken record: the same, real-life event, played over and over again. Woodward says he's seen patients haunted by the same true-to-life nightmare for twenty years.\u003c/p>\n\u003cp>The question scientists had was: why? Why can't people with PTSD sleep normally?\u003c/p>\n\u003cp>\u003cstrong>Healthy sleep as therapy\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"http://walkerlab.berkeley.edu/people.html\">Matthew Walker\u003c/a> is a sleep researcher at the University of California, Berkeley. One of his particular interests is in rapid eye movement, or REM. It’s the stage of sleep where a lot of dreaming occurs.\u003c/p>\n\u003cp>REM sleep is also the only time of the day that the brain stops producing a kind of adrenaline called norepinephrine. That fact struck Walker as an intriguing mystery. Why would rapid eye movement sleep suppress this neurochemical, he wondered. Is there any function to that?\u003c/p>\n\u003cp>What Walker and his colleagues \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22119526\">found\u003c/a> is that in healthy people, REM sleep is kind of like therapy. It's an adrenaline-free environment where the brain can process its memories while stripping away their sharp, emotional edges.\u003c/p>\n\u003cp>\"When you come back the next day,\" says Walker, \"yes, you can better recollect [the memory]. But also, it doesn’t trigger that same visceral reaction that you had at the time of learning.\"\u003c/p>\n\u003cp>Emotions are useful, says Walker, because they show us what really matters to us. But it's not useful to hold onto what he calls the \"emotional blanket,\" that accompanied the original event. The emotions, he says, \"have done their job. Now it’s time to hold on to the information of that memory, but let go of the emotion.\"\u003c/p>\n\u003cp>\u003cstrong>\"Broken\" REM sleep\u003c/strong>\u003c/p>\n\u003cp>Walker believes that in many people who have PTSD, REM sleep is broken. Something about PTSD either causes the brain to be overly sensitive to norepinephrine, or forces the brain to create too much of it. The brain's adrenaline system is effectively out of whack.\u003c/p>\n\u003cp>As a result, REM sleep is no longer theraputic. The PTSD brain can't process tough memories, so it just cycles through them, again and again.\u003c/p>\n\u003cp>Which begs a question: What if you could change that? What if you could make the adrenaline go away?\u003c/p>\n\u003cp>\u003cstrong>An old drug finds a new role\u003c/strong>\u003c/p>\n\u003cp>Murray Raskind directs Mental Health Services for the Department of Veterans Affairs Puget Sound Health Care System. About a decade ago, he became interested in a drug called Prazosin, which was traditionally used to treat high blood pressure.\u003c/p>\n\u003cp>Prazosin can be bought generically for about ten cents a pill. It can have the side effect of making people dizzy. For the most part, it's been supplanted by other, more recent hypertension drugs, whose effects last longer. But Prazosin turned out to have another use: It makes the PTSD brain less receptive to adrenaline.\u003c/p>\n\u003cp>As a result, as Raskind discovered, prazosin can change the way those patients dream.\u003c/p>\n\u003cp>Raskind tells the story of one of the first vets he ever treated with prazosin, a veteran Raskind calls Charles, who spent 13 months in a combat infantry unit in Vietnam.\u003c/p>\n\u003cp>What haunted Charles was one specific event from his service: Under an ambush by Vietcong forces, Charles and a fellow soldier, his closest friend, found themselves trapped in a landing zone in the jungle. Charles watched as his friend was killed by a mortar round. Fragments of the round pierced Charles' right knee, leaving him unable to run. Charles was saved at the last minute by troops in a Huey helicopter, just as Vietcong forces climbed through the wire to reach him.\u003c/p>\n\u003cp>\"This near-death experience,\" says Raskind, \"and even more distressing, the death of his best friend, whose death he felt he was unable to prevent, haunted him most nights, every week, year in and year out.\"\u003c/p>\n\u003cp>After a few weeks of Prazosin, Charles came in for a follow-up appointment. He told Raskind that he didn't think the drug was working. He was still dreaming, just about something else.\u003c/p>\n\u003cp>According to Raskind, the dream went like this: \"I'm in my fifth-grade classroom. And there’s a test, and if I don’t pass the test, I’m not gonna be promoted to the next grade. And I never even got the assignment!”\u003c/p>\n\u003cp>It was the stress dream, says Raskind, of a healthy brain, trying to work things out. \"I said 'Charles, that’s MY nightmare!'\" Raskind recalls.\u003c/p>\n\u003cp>So far the studies on prazosin have been small (abstracts can be found online, \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed?term=Thompson%20CE%2C%20Taylor%20FB%2C%20McFall%20ME%2C%20Barnes%20RF%2C%20Raskind%20MA\">here\u003c/a> and \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/20473055\">here\u003c/a> and \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/20726290\">here\u003c/a> – as well as of a 2008 round-up of data, \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/18387899\">here\u003c/a>) but promising in decreasing nightmares and helping people sleep longer.\u003c/p>\n\u003cp>Other small studies involving non-combat PTSD – people who had been victims of \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2350188/?tool=pubmed\">crime and sexual assault\u003c/a>, as well as \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/19934720\">refugees\u003c/a> – found an improvement in the quality of their dreams, and overall sleep, as well.\u003c/p>\n\u003cp>The Department of Veterans Affairs is undergoing \u003ca href=\"http://www.research.va.gov/programs/csp/csp563.cfm\">its own study \u003c/a>on prazosin in PTSD, which is taking part in 13 medical centers across the country. But is already prescribing the drug to about 15 percent of its PTSD patients -- about 70,000 people.\u003c/p>\n\u003cp>Murray Raskind, for one, would like to see that number rise.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"For us,\" he says, \"it's a simple thing that works.\"\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/quest/28257/can-ptsd-nightmares-be-cured","authors":["210"],"categories":["quest_12"],"tags":["quest_252","quest_22","quest_10537","quest_10536","quest_13203","quest_10532","quest_10533","quest_2328","quest_13202","quest_10538","quest_10535","quest_2655","quest_10534","quest_10531"],"label":"quest"},"quest_26829":{"type":"posts","id":"quest_26829","meta":{"index":"posts_1591205157","site":"quest","id":"26829","score":null,"sort":[1320436852000]},"guestAuthors":[],"slug":"from-swords-to-test-tubes-the-million-veteran-program","title":"From Swords to Test Tubes: The Million Veteran Program","publishDate":1320436852,"format":"audio","headTitle":"QUEST | KQED Science","labelTerm":{"site":"quest"},"content":"\u003cp>http://www.kqed.org/.stream/anon/radio/quest/2011/11/2011-11-07-quest.mp3\u003c/p>\n\u003cfigure id=\"attachment_26844\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2011/11/schuler_2.jpg\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2011/11/schuler_2.jpg\" alt=\"\" title=\"schuler_2\" width=\"640\" height=\"360\" class=\"size-full wp-image-26844\" srcset=\"https://ww2.kqed.org/app/uploads/sites/39/2011/11/schuler_2.jpg 640w, https://ww2.kqed.org/app/uploads/sites/39/2011/11/schuler_2-400x225.jpg 400w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Carl Schuler is one of 10,000 vets to have donated blood samples to the Million Veteran Program.\u003c/figcaption>\u003c/figure>\n\u003cp>Every year, on Veterans Day, we hear stories about bravery on the battlefield, or the challenges returning veterans face.\u003c/p>\n\u003cp>This story is about a different type of military service: It’s \u003ca href=\"http://www.research.va.gov/mvp/\">a project\u003c/a> where veterans help scientists learn more about conditions like cancer and post-traumatic stress disorder.\u003c/p>\n\u003cp>It's what brought Carl Schuler to the VA Medical Center in Palo Alto one sunny October morning. \u003c/p>\n\u003cp>Schuler served in the military for ten years, completing two tours in Iraq. The second tour was in Fallujah, where he oversaw a batallion of 18 soldiers. \u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>What haunts him about his time in Iraq is the fact that he came home largely unscathed. That was not the case for his best friend, who was badly injured by an IED. \u003c/p>\n\u003cp>\"You start thinking, well, how fair is that?\" says Schuler. \"Here's my friend, 88 percent burned, two people in his battalion killed. And here I am in a similar situation and we're all OK. It's a tough thing to deal with.\"\u003c/p>\n\u003cp>Back in the States, Schuler struggled with problems that will sound familiar to a lot of returning vets. He's had to tame his road rage. And sometimes, he can be a bit withdrawn.\u003c/p>\n\u003cp>What's gotten him through this is helping other returning soldiers. He is now a fellow for a group called \u003ca href=\"http://www.missioncontinues.org/\">The Mission Continues\u003c/a>. His placement is with a group called \u003ca href=\"https://app01.usatogether.org/\">USA Together\u003c/a>, counseling Bay Area vets who are having financial problems.\u003c/p>\n\u003cp>It’s that same impulse -- to help vets – that brought him down to the VA Medical Center in Palo Alto on a recent morning. \u003c/p>\n\u003cp>Schuler came to take part in something called the \u003ca href=\"http://www.research.va.gov/mvp/\">Million Veterans Program\u003c/a>, or MVP. It is a project to build the largest database of medical information in the world, with both medical histories and blood samples from one million US vets. The Medical Center in Palo Alto is one of 33 VA hospitals across the country taking part, with the ultimate goal of making participation available to all veterans enrolled in the VA healthcare system. The recruitment will last between five and seven years. In 2012 alone, the program is projected to cost $19.8 million. \u003c/p>\n\u003cp>What makes this program possible is something that puts the VA well ahead of the curve, when it comes to health care: electronic medical records.\u003c/p>\n\u003cp>At a time when virtually every other sector of the economy has gone online, medicine has lagged behind. Most American doctors still carry paper files when they go into see a patient. Less than a third of hospitals have digitized records.\u003c/p>\n\u003cp>But VA abounds in electronic data, says the VA’s Dr. Jennifer Hoblyn. She says in addition to clinical records of its 8.6 million patients, the VA also has annual assessments that it uses to track patients, including evaluations of depression, PTSD, alcoholic substances, traumatic brain injury, and other conditions. All of the information is digitized and available to VA doctors. \u003c/p>\n\u003cp>\"It's an amazing medical record,\" says Hoblyn, \"and it stretches back 25 years.\" \u003c/p>\n\u003cp>Now, the VA wants to pair that information -- detached from individual names -- with anonymous blood samples from a million vets. It would be the biggest medical database in the world.\u003c/p>\n\u003cp>That's an exciting prospect for people like Robert Hiatt, who chairs the Department of Epidemiology and Biostatisticsis at UCSF.\u003c/p>\n\u003cp>Hiatt says when he started out in his field, researchers would send staff with clipboards from doctor’s office to doctor’s office, pulling folders from shelves and manually tallying up the data.\u003c/p>\n\u003cp>Electronic databases have made this type of research vastly faster and more powerful. A massive database like what the VA is building would allow Hiatt to compare thousands of anonymous medical records with just a few keystrokes. \u003c/p>\n\u003cp>It would help him and other researchers look for genetic explanations to the mystery of why some people get sick with diseases like lung cancer, and others don't. \u003c/p>\n\u003cp>\"We know smoking leads to lung cancer, but not everyone who smokes gets lung cancer,\" says Hiatt. \"And some people who get lung cancer don't smoke. Is that because of some genetic predisposition? Or some large genetic protective effect?\"\u003c/p>\n\u003cp>Those types of questions are common in epidemiology, as well as in drug development, where researchers try and understand why some drugs work for some people, but not others.\u003c/p>\n\u003cp>At the VA, one major focus of research is on PTSD, which is relatively common, but hard to predict. Some soldiers suffer terribly. Others don't. To understand why, you need to look for patterns, across large numbers of vets.\u003c/p>\n\u003cp>Joel Kupersmith, the VA's Chief Research and Development Officer, says the MVP will allow VA researchers to compare the genes of people who have PTSD with others who don't. They’ll also take environmental factors into consideration: Where a vet lives, what other conditions he or she has, what he or she might have been exposed to in the service. \u003c/p>\n\u003cp>\"It gets to be very complicated,\" says Kupersmith, \"and you need large numbers to sort it out.\"\u003c/p>\n\u003cp>It's a bit like an impressionist painting that only comes into focus when you stand far away from it. The more data, says UCSF’s Robert Hiatt, the stronger your conclusions.\u003c/p>\n\u003cp>\"Big numbers are important because effects are small. In order to see effects and have some confidence in them, you need large numbers.\" \u003c/p>\n\u003cp>Recently, the Million Veteran Project signed on its ten thousandth participant. \u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2011/11/Flier.jpg\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2011/11/Flier-300x169.jpg\" alt=\"\" title=\"Flier\" width=\"300\" height=\"169\" class=\"alignleft size-thumbnail wp-image-26846\">\u003c/a>\u003c/p>\n\u003cp>The VA's Kupersmith believes that in 18 months they’ll pass the half-million mark. That would put them well ahead of the other medical databases currently available to researchers, including \u003ca href=\"http://www.dor.kaiser.org/external/DORExternal/rpgeh/index.aspx\">Kaiser Permanete's biobank\u003c/a>, which includes anonymous saliva samples -- containing DNA -- from 170,000 Kaiser patients, and is aiming for 500,000 participants. \u003c/p>\n\u003cp>To reach its goal, VA staff will have to convince hundreds of thousands of veterans to come in and donate blood. They'll also have to reassure them that the information will be kept private.\u003c/p>\n\u003cp>\"The info is totally de-identified,\" says the VA's Jennifer Hoblyn. \"Each sample gets a unique study info number. So actually it won’t be connected with your name whatsoever.\"\u003c/p>\n\u003cp>Schuler says he knows this information isn't likely to improve his own health, or even that of the soldiers he served with. But he considers it an extension of his work to help other vets, \"another piece of the puzzle,\" he says.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>It's a way to continue his service, even now that he's back home.\u003c/p>\n\n","blocks":[],"excerpt":"A massive database like what the VA is building would allow scientists to compare thousands of anonymous medical records with just a few keystrokes, to study conditions such as cancer and PTSD. ","status":"publish","parent":0,"modified":1370996909,"stats":{"hasAudio":true,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":35,"wordCount":1136},"headData":{"title":"From Swords to Test Tubes: The Million Veteran Program | KQED","description":"A massive database like what the VA is building would allow scientists to compare thousands of anonymous medical records with just a few keystrokes, to study conditions such as cancer and PTSD. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"From Swords to Test Tubes: The Million Veteran Program","datePublished":"2011-11-04T20:00:52.000Z","dateModified":"2013-06-12T00:28:29.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"26829 http://science.kqed.org/quest/?post_type=audio_reports&p=26829","disqusUrl":"https://ww2.kqed.org/quest/2011/11/04/from-swords-to-test-tubes-the-million-veteran-program/","disqusTitle":"From Swords to Test Tubes: The Million Veteran Program","path":"/quest/26829/from-swords-to-test-tubes-the-million-veteran-program","audioUrl":"http://www.kqed.org/.stream/anon/radio/quest/2011/11/2011-11-07-quest.mp3","audioDuration":null,"audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>http://www.kqed.org/.stream/anon/radio/quest/2011/11/2011-11-07-quest.mp3\u003c/p>\n\u003cfigure id=\"attachment_26844\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2011/11/schuler_2.jpg\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2011/11/schuler_2.jpg\" alt=\"\" title=\"schuler_2\" width=\"640\" height=\"360\" class=\"size-full wp-image-26844\" srcset=\"https://ww2.kqed.org/app/uploads/sites/39/2011/11/schuler_2.jpg 640w, https://ww2.kqed.org/app/uploads/sites/39/2011/11/schuler_2-400x225.jpg 400w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Carl Schuler is one of 10,000 vets to have donated blood samples to the Million Veteran Program.\u003c/figcaption>\u003c/figure>\n\u003cp>Every year, on Veterans Day, we hear stories about bravery on the battlefield, or the challenges returning veterans face.\u003c/p>\n\u003cp>This story is about a different type of military service: It’s \u003ca href=\"http://www.research.va.gov/mvp/\">a project\u003c/a> where veterans help scientists learn more about conditions like cancer and post-traumatic stress disorder.\u003c/p>\n\u003cp>It's what brought Carl Schuler to the VA Medical Center in Palo Alto one sunny October morning. \u003c/p>\n\u003cp>Schuler served in the military for ten years, completing two tours in Iraq. The second tour was in Fallujah, where he oversaw a batallion of 18 soldiers. \u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>What haunts him about his time in Iraq is the fact that he came home largely unscathed. That was not the case for his best friend, who was badly injured by an IED. \u003c/p>\n\u003cp>\"You start thinking, well, how fair is that?\" says Schuler. \"Here's my friend, 88 percent burned, two people in his battalion killed. And here I am in a similar situation and we're all OK. It's a tough thing to deal with.\"\u003c/p>\n\u003cp>Back in the States, Schuler struggled with problems that will sound familiar to a lot of returning vets. He's had to tame his road rage. And sometimes, he can be a bit withdrawn.\u003c/p>\n\u003cp>What's gotten him through this is helping other returning soldiers. He is now a fellow for a group called \u003ca href=\"http://www.missioncontinues.org/\">The Mission Continues\u003c/a>. His placement is with a group called \u003ca href=\"https://app01.usatogether.org/\">USA Together\u003c/a>, counseling Bay Area vets who are having financial problems.\u003c/p>\n\u003cp>It’s that same impulse -- to help vets – that brought him down to the VA Medical Center in Palo Alto on a recent morning. \u003c/p>\n\u003cp>Schuler came to take part in something called the \u003ca href=\"http://www.research.va.gov/mvp/\">Million Veterans Program\u003c/a>, or MVP. It is a project to build the largest database of medical information in the world, with both medical histories and blood samples from one million US vets. The Medical Center in Palo Alto is one of 33 VA hospitals across the country taking part, with the ultimate goal of making participation available to all veterans enrolled in the VA healthcare system. The recruitment will last between five and seven years. In 2012 alone, the program is projected to cost $19.8 million. \u003c/p>\n\u003cp>What makes this program possible is something that puts the VA well ahead of the curve, when it comes to health care: electronic medical records.\u003c/p>\n\u003cp>At a time when virtually every other sector of the economy has gone online, medicine has lagged behind. Most American doctors still carry paper files when they go into see a patient. Less than a third of hospitals have digitized records.\u003c/p>\n\u003cp>But VA abounds in electronic data, says the VA’s Dr. Jennifer Hoblyn. She says in addition to clinical records of its 8.6 million patients, the VA also has annual assessments that it uses to track patients, including evaluations of depression, PTSD, alcoholic substances, traumatic brain injury, and other conditions. All of the information is digitized and available to VA doctors. \u003c/p>\n\u003cp>\"It's an amazing medical record,\" says Hoblyn, \"and it stretches back 25 years.\" \u003c/p>\n\u003cp>Now, the VA wants to pair that information -- detached from individual names -- with anonymous blood samples from a million vets. It would be the biggest medical database in the world.\u003c/p>\n\u003cp>That's an exciting prospect for people like Robert Hiatt, who chairs the Department of Epidemiology and Biostatisticsis at UCSF.\u003c/p>\n\u003cp>Hiatt says when he started out in his field, researchers would send staff with clipboards from doctor’s office to doctor’s office, pulling folders from shelves and manually tallying up the data.\u003c/p>\n\u003cp>Electronic databases have made this type of research vastly faster and more powerful. A massive database like what the VA is building would allow Hiatt to compare thousands of anonymous medical records with just a few keystrokes. \u003c/p>\n\u003cp>It would help him and other researchers look for genetic explanations to the mystery of why some people get sick with diseases like lung cancer, and others don't. \u003c/p>\n\u003cp>\"We know smoking leads to lung cancer, but not everyone who smokes gets lung cancer,\" says Hiatt. \"And some people who get lung cancer don't smoke. Is that because of some genetic predisposition? Or some large genetic protective effect?\"\u003c/p>\n\u003cp>Those types of questions are common in epidemiology, as well as in drug development, where researchers try and understand why some drugs work for some people, but not others.\u003c/p>\n\u003cp>At the VA, one major focus of research is on PTSD, which is relatively common, but hard to predict. Some soldiers suffer terribly. Others don't. To understand why, you need to look for patterns, across large numbers of vets.\u003c/p>\n\u003cp>Joel Kupersmith, the VA's Chief Research and Development Officer, says the MVP will allow VA researchers to compare the genes of people who have PTSD with others who don't. They’ll also take environmental factors into consideration: Where a vet lives, what other conditions he or she has, what he or she might have been exposed to in the service. \u003c/p>\n\u003cp>\"It gets to be very complicated,\" says Kupersmith, \"and you need large numbers to sort it out.\"\u003c/p>\n\u003cp>It's a bit like an impressionist painting that only comes into focus when you stand far away from it. The more data, says UCSF’s Robert Hiatt, the stronger your conclusions.\u003c/p>\n\u003cp>\"Big numbers are important because effects are small. In order to see effects and have some confidence in them, you need large numbers.\" \u003c/p>\n\u003cp>Recently, the Million Veteran Project signed on its ten thousandth participant. \u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2011/11/Flier.jpg\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2011/11/Flier-300x169.jpg\" alt=\"\" title=\"Flier\" width=\"300\" height=\"169\" class=\"alignleft size-thumbnail wp-image-26846\">\u003c/a>\u003c/p>\n\u003cp>The VA's Kupersmith believes that in 18 months they’ll pass the half-million mark. That would put them well ahead of the other medical databases currently available to researchers, including \u003ca href=\"http://www.dor.kaiser.org/external/DORExternal/rpgeh/index.aspx\">Kaiser Permanete's biobank\u003c/a>, which includes anonymous saliva samples -- containing DNA -- from 170,000 Kaiser patients, and is aiming for 500,000 participants. \u003c/p>\n\u003cp>To reach its goal, VA staff will have to convince hundreds of thousands of veterans to come in and donate blood. They'll also have to reassure them that the information will be kept private.\u003c/p>\n\u003cp>\"The info is totally de-identified,\" says the VA's Jennifer Hoblyn. \"Each sample gets a unique study info number. So actually it won’t be connected with your name whatsoever.\"\u003c/p>\n\u003cp>Schuler says he knows this information isn't likely to improve his own health, or even that of the soldiers he served with. But he considers it an extension of his work to help other vets, \"another piece of the puzzle,\" he says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It's a way to continue his service, even now that he's back home.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/quest/26829/from-swords-to-test-tubes-the-million-veteran-program","authors":["210"],"categories":["quest_4","quest_12"],"tags":["quest_252","quest_10410","quest_10409","quest_13203","quest_2328","quest_13202","quest_3314","quest_3025","quest_10411"],"featImg":"quest_26844","label":"quest"},"quest_11859":{"type":"posts","id":"quest_11859","meta":{"index":"posts_1591205157","site":"quest","id":"11859","score":null,"sort":[1296493206000]},"guestAuthors":[],"slug":"a-better-military-through-genetics","title":"A Better Military Through Genetics","publishDate":1296493206,"format":"standard","headTitle":"QUEST | KQED Science","labelTerm":{"site":"quest"},"content":"\u003cp>\u003cspan class=\"left\">\u003ca href=\"http://www.kqed.org/quest\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2011/01/Soldiers1.jpg\" alt=\"\">\u003c/a>\u003cem>Can genetics help them be all they can be?\u003c/em>\u003c/span>\u003c/p>\n\u003cp>A new \u003ca href=\"http://www.fas.org/irp/agency/dod/jason/hundred.pdf\">report\u003c/a> commissioned by the Department of Defense recommends that everyone in the military eventually get their DNA sequenced. The idea is that scientists can use this treasure trove of information to quickly learn a lot about which bits of DNA lead to which traits or diseases. The military brass would then use this information to better care for soldiers and to make a more effective fighting force.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>For example, maybe they will be able to find people who are more prone to suffer from post traumatic stress disorder. These folks could then be kept away from the front lines.\u003c/p>\n\u003cp>Or maybe they can find soldiers who are more likely to be resistant to certain diseases. These folks would be the ones sent to regions where those diseases are common. And so on.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Of course they will also find out many other things that may be more useful to society (and the soldier’s personal lives) like which bits of DNA predispose someone to diabetes, cancer, heart disease, etc. And which bits make someone more likely to be tall, strong, have dark hair or green eyes or anything else the scientists can measure.\u003c/p>\n\u003cp>This obviously has the potential for good but it still feels a bit creepy to me. Especially if the military misuses or abuses the information it gets.\u003c/p>\n\u003cp>Everyone (including the military) has to be careful not to over interpret the data. Just because a piece of DNA correlates with a lower risk of PTSD, that does not mean it is the only piece of DNA that does. It may just be one of many.\u003c/p>\n\u003cp>So you can imagine people who are at a higher risk for PTSD being moved to the front lines because an incomplete understanding of their DNA made them look like they were at a lower risk. These kinds of mistakes would be bad for the soldier and may eventually cost us a war.\u003c/p>\n\u003cp>There also needs to be some kind of oversight to prevent outright abuse by military officials who do not understand the limitations of our DNA knowledge. We need to make sure they don’t do what a \u003ca href=\"http://www.eeoc.gov/eeoc/newsroom/release/4-18-01.cfm\">railroad company did\u003c/a> a few years ago.\u003c/p>\n\u003cp>Back in 2001 railroad workers brought a suit against BNSF railroad. The suit alleges that the company secretly tested 125 workers for a DNA snippet that increases someone’s risk for developing carpal tunnel syndrome. The story was that BNSF wanted to be able to deny worker’s compensation for any of these workers that developed carpal tunnel syndrome because they had a pre-existing condition.\u003c/p>\n\u003cp>Besides being against the law, this was also just plain stupid on the part of the railroad. They did not understand that the DNA snippet was not really predictive and that it was one of many genetic factors that can lead to an increased risk. They basically tried to figure out what the elephant looked like from just its tail.\u003c/p>\n\u003cp>The military may also use genetics to exclude some people from jobs they’d like to do or from the military entirely. I am not sure we will ever know DNA well enough to justify this sort of thing but at the very least we need to be sure that the generals understand what we can and can’t learn from our DNA. And that we update the military head honchos constantly.\u003c/p>\n\u003cp>Once the cost of reading our DNA drops to $1000 or less, we’ll all eventually be getting our DNA sequenced. And if the military follows the report’s recommendations, then the military will be testing the waters of our genetic pool. We can all learn from the mistakes they make along the way. I just hope the learning process doesn’t endanger any of our soldiers. \u003c/p>\n\u003cp>\u003ca href=\"http://www.livescience.com/history/090429-military-experiment-1.html\">The 10 Most Outrageous Military Experiments\u003c/a>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> 37.7749295 -122.4194155\u003c/p>\n\n","blocks":[],"excerpt":"A new report recommends that all military people have their DNA sequenced to advance science and to create a better military. Can we trust the military to get this right - or anyone?","status":"publish","parent":0,"modified":1309991844,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":18,"wordCount":660},"headData":{"title":"A Better Military Through Genetics | KQED","description":"A new report recommends that all military people have their DNA sequenced to advance science and to create a better military. Can we trust the military to get this right - or anyone?","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"A Better Military Through Genetics","datePublished":"2011-01-31T17:00:06.000Z","dateModified":"2011-07-06T22:37:24.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"11859 http://www.kqed.org/quest/blog/2011/01/31/a-better-military-through-genetics/","disqusUrl":"https://ww2.kqed.org/quest/2011/01/31/a-better-military-through-genetics/","disqusTitle":"A Better Military Through Genetics","path":"/quest/11859/a-better-military-through-genetics","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan class=\"left\">\u003ca href=\"http://www.kqed.org/quest\">\u003cimg src=\"http://ww2.kqed.org/quest/wp-content/uploads/sites/39/2011/01/Soldiers1.jpg\" alt=\"\">\u003c/a>\u003cem>Can genetics help them be all they can be?\u003c/em>\u003c/span>\u003c/p>\n\u003cp>A new \u003ca href=\"http://www.fas.org/irp/agency/dod/jason/hundred.pdf\">report\u003c/a> commissioned by the Department of Defense recommends that everyone in the military eventually get their DNA sequenced. The idea is that scientists can use this treasure trove of information to quickly learn a lot about which bits of DNA lead to which traits or diseases. The military brass would then use this information to better care for soldiers and to make a more effective fighting force.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>For example, maybe they will be able to find people who are more prone to suffer from post traumatic stress disorder. These folks could then be kept away from the front lines.\u003c/p>\n\u003cp>Or maybe they can find soldiers who are more likely to be resistant to certain diseases. These folks would be the ones sent to regions where those diseases are common. And so on.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Of course they will also find out many other things that may be more useful to society (and the soldier’s personal lives) like which bits of DNA predispose someone to diabetes, cancer, heart disease, etc. And which bits make someone more likely to be tall, strong, have dark hair or green eyes or anything else the scientists can measure.\u003c/p>\n\u003cp>This obviously has the potential for good but it still feels a bit creepy to me. Especially if the military misuses or abuses the information it gets.\u003c/p>\n\u003cp>Everyone (including the military) has to be careful not to over interpret the data. Just because a piece of DNA correlates with a lower risk of PTSD, that does not mean it is the only piece of DNA that does. It may just be one of many.\u003c/p>\n\u003cp>So you can imagine people who are at a higher risk for PTSD being moved to the front lines because an incomplete understanding of their DNA made them look like they were at a lower risk. These kinds of mistakes would be bad for the soldier and may eventually cost us a war.\u003c/p>\n\u003cp>There also needs to be some kind of oversight to prevent outright abuse by military officials who do not understand the limitations of our DNA knowledge. We need to make sure they don’t do what a \u003ca href=\"http://www.eeoc.gov/eeoc/newsroom/release/4-18-01.cfm\">railroad company did\u003c/a> a few years ago.\u003c/p>\n\u003cp>Back in 2001 railroad workers brought a suit against BNSF railroad. The suit alleges that the company secretly tested 125 workers for a DNA snippet that increases someone’s risk for developing carpal tunnel syndrome. The story was that BNSF wanted to be able to deny worker’s compensation for any of these workers that developed carpal tunnel syndrome because they had a pre-existing condition.\u003c/p>\n\u003cp>Besides being against the law, this was also just plain stupid on the part of the railroad. They did not understand that the DNA snippet was not really predictive and that it was one of many genetic factors that can lead to an increased risk. They basically tried to figure out what the elephant looked like from just its tail.\u003c/p>\n\u003cp>The military may also use genetics to exclude some people from jobs they’d like to do or from the military entirely. I am not sure we will ever know DNA well enough to justify this sort of thing but at the very least we need to be sure that the generals understand what we can and can’t learn from our DNA. And that we update the military head honchos constantly.\u003c/p>\n\u003cp>Once the cost of reading our DNA drops to $1000 or less, we’ll all eventually be getting our DNA sequenced. And if the military follows the report’s recommendations, then the military will be testing the waters of our genetic pool. We can all learn from the mistakes they make along the way. I just hope the learning process doesn’t endanger any of our soldiers. \u003c/p>\n\u003cp>\u003ca href=\"http://www.livescience.com/history/090429-military-experiment-1.html\">The 10 Most Outrageous Military Experiments\u003c/a>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> 37.7749295 -122.4194155\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/quest/11859/a-better-military-through-genetics","authors":["6177"],"categories":["quest_4"],"tags":["quest_210","quest_227","quest_1192","quest_1194","quest_1200","quest_1213","quest_1824","quest_2162","quest_2266","quest_2328","quest_2724"],"featImg":"quest_19252","label":"quest"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. 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