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?

Why Draw Lots For Health Care?

A provocative headline "Drawing Lots for Health Care" in the NY Times (p. A12 03/13/2008) leads the reader into a depressing description of the woes of uninsured Oregonians, whose number and plight have been worsened by our recession. My quick check of Kaiser Foundation's state health statistics site (http://statehealthfacts.org/) showed no great disparity between the demographics and insurance status of Oregonians and other state residents, although historically (going back to the 1980s, there were notable differences, including a rapidly aging population and a lack of industry which retained young insurable individuals in Oregon). The NY Times article noted that Oregon's health insurance lottery ". . . is intended for low-income adults who lack private insurance and do not qualify for Medicaid or Medicare." Oregon's budget cuts have reduced the number of people served from about 100,000 four years ago to about 17,000 now.

Perhaps I am unrealistic, but I consider it unethical to provide insured health care only to the few who are fortunate enough to win a state lottery. Oregon and Oregonians are victims of an economic cycle which was caused by failure of the federal government to responsibly tax and spend. Our government has been radical in its abandonment of sensible economic policies. Oregonians are the canaries in the coal mines: their distress is a clear indicator that it is time for the United States to take responsibility for providing an ethical and moral system of care for all of its residents. Profits of the military-industrial complex must yield to the basic need of Americans for health care.