Brenda L. Mooney
Thanks to cutting-edge efforts to use targeted testing and strict guideline-adherence, the care of patients with serious illnesses is arguably better than ever at the VA and military healthcare systems. For cancer, that means the use of both tumor testing for somatic mutations and germ line testing for hereditary mutations to find treatment to improve survival.
Those efforts, combined with universal healthcare offered by both the VA and MHS, mean that important advances benefit all patients, regardless of race, religion or ethnicity – something that is not always the case in private healthcare.
Much of this would have been beyond imagination 60 years ago when U.S. Medicine printed its first issue. While a vigorous research program was being initiated at the VA, most veterans received only inpatient treatment there and were often discharged on their own for chronic illnesses, such as diabetes, that might have created or exacerbated acute illness. (That quickly changed as some of the research paid off, and the realization grew that, despite Vietnam War veterans, the average VA patients was an old man with a range of comorbidities that required management).
Meanwhile, the Vietnam War was a game-changer for military medicine and its ability to save lives on the battlefield because of rapid casualty evacuation, the availability of whole blood and other improvements.
Yet, as advanced as federal medicine has become, it still faces some of the world’s oldest medical foes, many of them more common in servicemembers and veterans than civilians. Those include gout, challenging dermatologic conditions, fast-spreading infectious diseases, cancers caused by toxic exposures and the wide-ranging consequences of battlefield traumatic brain injuries.
The annual Compendium of Federal Medicine seeks to provide new and useful information about the range of conditions faced by federal healthcare providers. Critical to our mission is to keep in mind that veterans and military servicemembers aren’t always typical patients; because of their service, they have faced situations and conditions that can adversely affect their health. Their sacrifices go far beyond the risk of being wounded or killed in battle.
It is especially gratifying when our writers can share information that goes against the conventional wisdom and can contribute to a change in practice to improve care. Among the many examples of that in the 2024 Compendium are:
- the counter-intuitive findings that frail veterans had better survival when treated with more-intensive multiple myeloma therapy;
- while extremely rare, activated phosphoinositide 3-kinase delta (PI3Kδ) syndrome (APDS), might be slightly more common than thought now that genetic testing is available;
- that tackling the emotional systems of “diabetes distress” improves outcomes; and
- that gout really isn’t the “disease of kings”, affecting only the affluent, but plagues all socioeconomic classes, with veterans being especially vulnerable.
Other articles also turn assumptions on their heads. Did you, like most clinicians, assume that patients with serious mental illnesses (SMI) such as schizophrenia or bipolar disorder have cognitive deficits and social avoidance modifications because they are socially isolated? New research now suggests that those are actual symptoms of the SMIs and not caused by living conditions.
Or, did you accept early assumptions that Agent Orange exposure wasn’t linked to the development of polycythemia vera and other myeloproliferative neoplasms (MPNs)? New research suggests otherwise.
Here’s one with far-reaching implications: A new report presented to Congress found that an unknown but considerable number of traumatic brain injury (TBI) cases are received not from explosions in combat but from the blast overpressure yielded by firing large weapons, including those used for in training.
It is our hope that you find the 2024 Compendium of Federal Medicine interesting and informative in the year of U.S. Medicine’s 60th anniversary.