Thursday, December 4, 2008

Psychological health and traumatic brain injury research

This year marked a dramatic increase in psychological health and traumatic brain injury research when the Congressionally Directed Medical Research Programs was given $301 million to advance the military’s understanding of how these injuries occur and how they can be treated.

Falling under the auspices of the U.S. Army Medical Research and Materiel Command at Fort Detrick, Md., the CDMRP granted 201 awards with the unprecedented fiscal 2007 funds, according to program director Navy Capt. E. Melissa Kaime.

Mild traumatic brain injuries and psychological health issues, especially post traumatic stress disorder, can have many overlapping symptoms, said Kaime, which is why CDMRP is researching them together.

‘‘We have the money now that we can fund the entire spectrum of research,” said Kaime.

Although CDMRP primarily directs cancer research, the directorate and its staff had the experience and expertise to manage the $301 million handed over, said Kaime. Since it was created in 1992, CDMRP is responsible for directing and supervising $4.7 billion in Congressional appropriations for peer-reviewed research aimed to prevent, control, and cure disease.

‘‘I think Congress has seen what we’ve done over the years and sees the value of the way we do things,” she said.

The scientific selection process started with reaching out to the experts in the field and asking ‘‘Where are the gaps in the science?” After garnering their input, it went to smaller integration panel where senior clinicians and scientists set the investment strategy of the program areas the research was needed to bridge the science that already existed while looking into future possibilities.

‘‘They distilled down in concrete terms where the gaps were in research that we needed to fill,” said Kaime.

The program analyzers then sent the call out to the public at large and got more than 2,000 responses of different types and directions of scientific research requested.

Organizing the proposals into the proper categories so they could be judged on their scientific merit by experts became the next order of business with peer-review panels.

On each panel scientists and medical professionals were paired with family members and actual patients who had suffered a TBI or psychological health illness to give the proposal review process another dimension, said Kaime.

‘‘(These illnesses) can have a profound impact on families,” said Kaime.

Having the laymen involved helped direct the research to the servicemembers and families who could actually benefit from future positive impacts that may come from the research, she added.

‘‘They’re there to ask the bigger questions ... like ‘so how is this going to help us,’” said Kaime.

By receiving a grade from the robust and rigorous review process, the strengths and weakness are hashed out through the months-long transparent process. They then go through an integrity check and get signed off by multiple layers of leadership in the Department of Defense’s medical commands.

‘‘I’m very excited about the ones we selected,” said Kaime. ‘‘We may have only funded 10 percent of the proposals, but it’s the very best science has to offer.”

The contract negotiations for the 201 grants were finished at the end of last September, and CDMRP is currently going through the process again on a smaller scale with the fiscal 2008 funds of $92 million of deployment-related medical research, including additional funding for psychological health and TBI among the requested research topics.

‘‘We couldn’t do this if we didn’t have a strong base at MRMC,” said Kaime. ‘‘It’s not just CDMRP; it takes an entire team.”