Conference Presentation, Panel, Fireside Chat
Bringing 21st Century Medicine to America's Veterans
- Strategic initiatives aim to modernize care for veterans and the public through collaborative, multidisciplinary approaches involving clinicians, scientists, and geneticists to advance precision medicine and integrate diverse "omics" data.
- The VA is positioning itself to navigate a $169 billion budget and Congressional constraints by partnering rather than relying solely on funding, seeking to "de-risk" clinical investments for biotech and pharma sectors.
- Specific research targets include addressing the PTSD and TBI crisis, with over 22 daily veteran suicides, by shifting focus from behavioral syndromes to underlying molecular biology and pathways.
- A major longitudinal study involving 4,000 West Point cadets and 4,000 Air Force Academy cadets is underway in conjunction with the NCAA to investigate brain trauma and resolve Chronic Traumatic Encephalopathy (CTE) issues using biomarkers prior to death.
- The Los Angeles VA has established precision medical oncology as standard practice, utilizing internal molecular pathology labs for validated genetic tests on lung cancer and melanoma, with patients accessed within no more than four weeks.
- Prostate cancer, which constitutes almost a third of all cancers in the veteran population, is being used as a model system to study racial disparities between Caucasians and African Americans, with data showing outpaced private sector application of validated biomarkers.
- Clinical success stories include an "extreme responder" in prostate cancer who dropped a PSA level from 120 to single digits and resolved severe anemia within three months using a drug approved for melanoma, surviving far beyond a typical life expectancy of weeks to months.
- Biotech leaders perceive the VA as having a "treasure trove of data" yet view the organization as insular and disconnected, necessitating an "Uberized" model to allow small biotechs efficient access to networks and patients.
- Proposals include a "Cooperative Alliance Model" where a foundation acts as an independent third party to orchestrate a common roadmap, avoiding top-down management and addressing legal IP data sharing challenges.
- Operational improvements seek to create a "super streamlined IRB process" with one contract and standardized IP transfers to enable small companies to conduct end-of-one clinical trials instantly.
- The VA plans to act as a convener for medical technology, sports innovators, and clinical experts to develop solutions for prevention, diagnosis, treatment, and reintegration regarding head trauma.
- A partnership with the Elks organization provided four million dollars over four years specifically to address homelessness, supporting a shift from a passive stance to a proactive approach in fulfilling needs.
- Challenges to growth include negative media inertia from past issues like Phoenix, a small public affairs team, and the perception that half of pharmaceutical drugs fail to work, requiring better communication of value propositions to industry leaders.
- Future success depends on establishing a central "point person" for precision oncology programs, as current efforts remain decentralized despite existing connections at UCSF and the Durham VA.
- The VA intends to share data with the entire community to engage computational modelers and engineers, while internal cultural change is supported by legal cover for employees engaging in partnerships.
- External collaborations have demonstrated significant media potential, such as a Google virtual reality video garnering over 20 million hits, to build momentum and showcase "easy victories" regarding clinical trials and state-of-the-art capabilities.