When Johnny Comes Marching Home Again - Then What? The intersection of Science and Public Policy

President Obama's promise to draw down forces in Iraq is in the process of being fulfilled. But only some of America's soldiers, marines, sailors and air force men and women make it home. Others are reassigned, this time to Afghanistan, about which a more opaque vision of troop withdrawal is dangled before us. Our all-volunteer forces continue their exposure to extraordinary stressors which severely try even the most even-tempered, fit and well-balanced men and women.

And then we see stories about, and pictures of, troops on duty, surrounded by their enemies who are sworn to (and do) kill and maim them, suddenly brought to the United States again. And other stories, about their family problems, suicides, drug use, problems with the law, post traumatic stress disorder and our government's promise - once again - to take care of our wounded warriors "better this time" without convincing evidence that the promise will be kept. In the 20th and 21st centuries we have seen budgetary constraints, long-term disability costs, the military need to return its troops to duty rather than acknowledge their need for withdrawal from combat, and an unwillingness to face the truth about the effects of wartime stresses on the men and women who serve America determine our policy about caring for returning military.

As described in my last blog, there is a new scientific tool which might help our government distinguish the men and women who are most at risk of damage from the stress of wartime service, and who are damaged by their experiences. My question is: will our military carefully study and then appropriately utilize existing and developing telomere research as one (of several) screening tools before and after sending people into combat to determine who is at risk and who has been injured by service?

There is a very real risk: that sending people to war in Iraq, Afghanistan and other far-flung posts, will invariably lead to serious stress-related damage to their chromosomes and be associated with destruction of their families, suicides, drug use, problems with the law and post traumatic stress disorder. Who would be willing to volunteer for military duty then? What family would approve of that service? What citizenry would then vote in favor of a war in far-off places?

The Walter Reed Experience Reduplicated

The recent murderous attack by a 3rd Iraq deployment Sergeant prompted me to think back two years to the Walter Reed Hospital scandal, in which brain injured, severely wounded and post-traumatic stress disordered personnel were lodged in horrible facilities and provided with back-ward care (click on title for Soldiers Face Neglect, Frustration At Army's Top Medical Facility by Dana Priest and Anne Hull,
Washington Post Staff Writers, Sunday, February 18, 2007; Page A01). If this was the care that an arrogant neglectful Congress and our politician-led armed forces provided to men and women who were willing to give their lives and limbs on behalf of their country, should we stop a consider whether we should have a universal health system, controlled at the top by our federal government and its bureaucracy?

Unless we have a moral and ethical framework, upon which our proposed federal health reform is built and contained, we will be duplicating and expanding the philosophy and conditions which led to the uncaring and inhumane Walter Reed Hospital experience. If health care is the domain of hospital administrators, insurance company executives, nursing home operatives, pharmaceutical manufacturers and sales people, we will not have a humane, appropriate and ethical health care system.

Mr. Obama, I would rather hear that you were meeting with persons on the front lines of patient care, and ethicists, than with health industry related major political donors. Those who have the daily responsibility for patients' well being, and ethicists, can tell us what we need to do to build a great health system. The industry people will tell us to build a system that will be good for them.