Drug used to curb smoking amongst vets seen as killer?

Secretary James Peak of the Veterans Affairs Administration briefed reporters today on the issue of smoking cessation. Specifically, Peak mentioned the Pfizer drug Chantix which is supposed to help patients quit smoking. According to the non profit organization the Institute for Safe Medicine Practices nearly 3,000 serious health effects including suicides, heart trouble and aggression, the study said.

Currently the military is using the medication to help treat soldiers who have Post Traumatic Stress Disorder (PTSD). The Department of Veterans Affairs has been conducting studies on the possible adverse health effects which have been noted in the research provided by the Institute for Safe Medicine Practices. The study has focused on 945 patients who are using differing medications to curb their smoking habits. Out of those 945 patients 143 have also taken the drug with therapy.

According to Peak the veteran population that has been using Chantix to stop smoking is about 33,000 but Peak stressed that if the rates of high injury and suicide were to continue, the department would not hesitate to take it off the shelf. “We know how to do recalls; given our electronic records we are at a better position than most to do that on a large scale across the this entire department.”

Democrats though criticized the Veterans Administration for what they viewed as playing with people’s lives. "Nearly 40 suicides and more than 400 incidents of suicidal behavior have been linked to Chantix, yet the VA has chosen to continue the study and administer Chantix to veterans with PTSD," said Congressman Bob Filner (D-CA).

The Veterans Affairs Department will continue conducting its study but Peak stressed that the department would continue to do whatever necessary to keep veterans healthy. “We understand this population very well, we’re a department of veterans,” Peak added “our veterans mean absolutely everything to us.”

Afghan Journal: Psychology in the field

Talk Radio News Service Embedded Correspondent Richard Miller interviews Captain Shanda Smith, a staff psychiatrist with the Combat Stress Unit out of Bagram Air Force Base, about the psychological stress sustained in combat and post traumatic stress disorder. (15:04)

Changes to security clearance questions exclude combat stress counseling

Speaking form the Restoration and Reliance Center at Ft. Bliss Texas, Secretary of Defense Robert Gates announced changes to the questionnaire that military personnel are required to fill out in order to obtain their security clearance. Question No. 21 on the form asks about the applicant's mental health history and whether the applicant has sought mental health treatment.

Gates spoke about a review by the Army inspector general which found that soldiers were not seeking help with mental health issues because military member feared that by doing so they put their security clearance and therefore their jobs at risk. Gates said that after he learned about this, the Department of Defense undertook to change the wording of the question to exclude counseling for combat related stress disorders.

After an eight month process to change the government wide form, the questionnaire now makes clear that seeking treatment for mental health problems related to combat stress is not a disqualification for receiving or renewing security clearance.

"There are two aspects it seems to me when dealing with Post Traumatic Stress Disorder," said Gates. "First developing the care and the treatment of these soldiers...the second and in some ways perhaps equally challenging is to remove the stigma that is associated with PTSD to encourage soldiers, sailors, Marines and airman who encounter these problems to seek help."

New study examines costs of PTSD

The RAND Corporation held a congressional briefing today on “Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery” in which senior social research analyst Terri Tanielian discussed the findings of RAND’s recent study on Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) amongst U.S. military troops who have been deployed to Iraq and Afghanistan.

Tanielian said the RAND study explored the dynamics of PSTD, major depression, and TBI. It examined prevalence, societal costs (including decreased productivity and loss to suicide), and gaps in care for these conditions. Tanielian said that approximately 300,000 veterans currently suffer from PTSD, and that two-year post-deployment costs vary with severity but average about $26,000 per case. She also said that members of the Army or the Marines are at higher risk for these conditions than those enlisted in the Air Force or Navy, and that Hispanics and women are also at higher risk. However, she said the most determining risk factor was combat exposure and experience. Tanielian explained that while effective treatments do exist, not enough veterans are accessing them for reasons that range from scarce availability to fears pertaining to potential career implications and confidentiality risks. Increasing the number of people who receive care, she emphasized, can not only benefit veterans but can also offset the cost of treatment per case.

Senate Committee review on Veteran's Disability Compensation

At the United States Senate Committee on Veterans' Affairs review of Veteran's Disability Compensation: Expert Work on PTSD and Other Issues, the purpose of the hearing was to hear recommendations on how the VA Disability system can be improved, since the current system is outdated, burdensome, and fails to address many issues.

Ranking Member Senator Richard Burr (R-NC) said that under his bill, the Veterans Mental Health Treatment First Act, there would be a wellness stipend while the veterans were waiting for treatment, and all the veteran would have to do is hold off on the rating claims. This emphasizes wellness as opposed to claiming disability. The current system, he said, does not keep pace with society and understanding disabilities. The rating schedules have not been updated in six decades, and promoting rehabilitation is a main goal, since there are young men and women returning from war that cannot return to work. Returning to the workforce, Burr said, should be the main goal of the VA, and this may require a large upfront cost.

Dr. Joyce McMahon, PhD, Managing Director, Center for Health Research and Policy, said survey results suggest that the relationship between compensation and medical treatment for PTSD (Post Traumatic Stress Disorder) showed through a series of indirect questions virtually no evidence for veterans to avoid treatment from fear of losing their benefits. In respect to evaluating the quality of life for veterans, they also did surveys of veterans and found that the degree of disability was in decline. With primary mental disabilities, they found there to be low physical quality of life as well.

Dr. Dean G. Kilpatrick, PhD, Director, National Crime Victims Research and Treatment Center, Medical University of South Carolina, said testimony showed that doctors were limited in their ability to take a lengthy exam of persons diagnosed with PTSD, and therefore were not able to have a thorough evaluation. Currently, Kilpatrick said, the same sets of criteria are used to evaluate all sorts of mental disorders, and that means that the criteria are crude and outdated. The DSM (Diagnostic and Statistical Manual of Mental Disorders) used by mental health professionals needs to be utilized.

The research team concluded that it is not appropriate to have an "across the board" evaluation of veterans with PTSD but should be done on a case by case basis. The evaluations should be timely, and there is no justification to single out and stigmatize veterans with PTSD by reevaluating them every two to three years. One of the disadvantages to reevaluation is cost, and if it was decided to do regular reevaluations, it should not be done until the resources are available to do a more thorough evaluation.

In response to a question, Kilpatrick said there is lore out there that veterans that get compensation have no incentive to seek treatment because there is no reason to get better. Research showed, he said, that some veterans may seek treatment because at a higher level of disability, they get better options for treatment.