Panel, Conference Presentation
Advancing Critical Health Issues for Veterans
Milken InstituteJonathan Simons, Prudence Fisher, Isla Garraway, Deborah Lafer Scher, Earle Mack, Peter O'Rourke, Arock Bolanos, Christopher Seeley, Gary, Debra, Major Kent
- Panel Purpose & Focus: The panel, hosted by Dr. Jonathan Simons of the Prostate Cancer Foundation (PCF), advocates for public-private partnerships to advance veterans' healthcare, specifically targeting PTSD and prostate cancer, with the aim of creating national models for civilian populations.
- Veterans Health Statistics:
- PTSD is one of two primary focus areas, with 30% of returning veterans diagnosed with some form of the disorder.
- The veteran suicide rate stands at approximately 22 suicides per day.
- Prostate cancer is the most common cancer treated within the Veterans Health Administration (VA).
- Equine Therapy for PTSD:
- Mechanism: The therapy functions as a "biofeedback" loop; horses are hyper-vigilant prey animals that mirror the veteran's emotional state, forcing the veteran to regulate their own anxiety and breathing to calm the animal.
- Program Structure: The Columbia University study utilizes a standardized, non-riding, 8-week manualized protocol (90-minute sessions once weekly) involving group therapy, grooming, and leading exercises.
- Data Collection: The trial includes pre- and post-treatment MRIs of the amygdala to scientifically validate neurological changes and reduce the dropout rates common in traditional talk therapy.
- Scale-Up Plan: The team aims to publish a peer-reviewed manual to professionalize ad hoc programs and eventually seek NIH funding for larger randomized clinical trials.
- Prostate Cancer & Precision Medicine:
- Case Study: Patient Christopher Seeley, a Navy veteran with metastatic resistant prostate cancer, achieved a complete radiographic response (PSA dropped from >200 to 1) after receiving DNA-damaging chemotherapy targeted at a specific BRCA2 mutation.
- Partnership Goal: A $50 million commitment over five years aims to establish a national network of "Centers of Excellence" (targeting 15 centers, currently 6 active) where every veteran with prostate cancer undergoes tumor genome sequencing.
- West LA VA Model: This site serves as the prototype, utilizing multidisciplinary teams to offer precision oncology (reading the tumor code to match drugs to mutations) to all eligible patients.
- Data Utility: Tumor samples collected from veterans in these trials contribute to a database that accelerates the development of new anti-cancer medicines for both veterans and the general public.
- Strategic Infrastructure & Leadership:
- Office of Strategic Partnerships: Established under the Chief of Staff, this office acts as a central hub for corporations and philanthropists to collaborate with the VA, streamlining the approval of initiatives that were previously impossible due to bureaucratic constraints.
- Million Veterans Program: A government initiative profiling the genomes of 630,000 veterans to create the world's largest genetic database for disease research.
- Leverage Multiplier: A 1999 McKinsey study cited indicates that every $1 of public grant can leverage $10 to $15 in private funding; the PCF-VA partnership is cited as proof that these models can scale rapidly across administrations.
- Telehealth Leadership: The VA leads the nation in telemedicine, facilitating over 800,000 visits in the last year, though discussions are ongoing with providers like Comcast to extend connectivity to rural, low-income veterans.
- Operational Challenges & Solutions:
- Research Bottleneck: A primary obstacle is the lack of "unsexy" infrastructure (data managers, specialized nurses, office space) required for clinical trials, which the PCF has filled with grants.
- Patient Access: Urologists identify the biggest remaining hurdle as identifying eligible patients within busy clinics; the proposed solution involves dedicated staff to review charts and invite eligible veterans to trials.
- Role of Advanced Practice: There is a identified need for "Chief Petty Officer" level nurses—veterans with advanced training—to bridge the gap between big data analysis and patient communication.
- Reserve Gaps: A specific need exists for improved resources and peer-support networks for National Guard and Reserve members who cycle through multiple deployments without a consistent home-base support system.
- Forward-Looking Statements:
- The VA seeks to apply the precision oncology model to other disease areas (breast, lung cancer) using the existing telehealth network.
- The Equine Therapy manual aims to be licensed globally, potentially extending benefits to at-risk youth and civilian populations.
- The partnership model is designed to leapfrog government constraints by utilizing private capital and expertise to drive "leading-edge" clinical trials.