Moral fiber

A hundred years ago, battlefield soldiers who exhibited neurological symptoms like insomnia, tremors and hypersensitivity to noise without showing visible wounds were often charged with cowardice. Eventually (and reluctantly) the term “shell shock” was coined to describe the injuries that caused disrupted lives decades after the end of the First World War.

As we progressed through a century’s worth of wars, we referred to the condition as battle fatigue and then Post-Traumatic Stress Disorder (PTSD). We’re still somewhat ambivalent about the diagnosis, and treatment is also a bit of a crapshoot, depending upon both enlightened clinicians and funding of resources.

(During World War II, the Royal Air Force actually distinguished “medical casualties” from those classified as Lacking Moral Fibre (LMF). It was a diagnosis intended to prevent shirkers of combat missions turning their experience to profit as private pilots.)

We’re much more adept at sending men and women off to fight than we are at caring for them after they return. If they return.

So I was very heartened by this report out of NPR this week about a medical researcher and combat veteran who answered the unspoken call for help from a comrade, switched specialties and hung on for a decade to hunt down the physiological factors that constitute what we now call Traumatic Brain Injuries (TBIs). We are in the midst of a bumper crop of TBIs, thanks to the use of improvised explosive devices (IEDs) in Iraq and Afghanistan, so Kit Parker and his team are meeting a critical need.

There are several parts to this story that are worth highlighting.

We’re a hundred years on from the Western Front, with incredible advances in both life-ending and life-saving technologies, and we’re still teetering at the edge of the Dark Ages in terms of how we characterize the human costs of warfare. As one of the on-the-ground investigative leaders put it, “If you don’t have blood coming out of your head, if you don’t have a penetrating injury, you’re fine, everything’s OK, have a nice day.”

I love the way that Parker, a Harvard biophysicist specializing in the cellular workings of the heart as a muscle, essentially sat still and listened to what was not being said when his National Guard comrade Chris Moroski called him. He heard what his friend didn’t have the words to ask for, and he took action to ensure that Moroski got proper diagnosis and care for his TBI.

Then he took extraordinary action to ensure that others with TBI would also get proper diagnoses and care. Because he changed his research focus from the heart to the brain to understand how blast waves produced by IEDs physically disrupt brain tissue and function. Until he started his inquiry, no one had investigated this.

There have been some exceptional people working on unravelling this mystery, and I love how they’ve been unremitting in their pursuit of nailing down the cause of these injuries, and laying out preventive and therapeutic measures to protect soldiers. Many of them are combat veterans, but they all have that scientific curiosity that drives them to pursue “ground truth”. I applaud their tenacity and devotion; may their funding never wither away.

I am not at all surprised by the fact that there’s no corresponding research into drug therapies because pharmaceutical companies can’t see profits in the prospect of repairing broken brains, so they don’t see any merit to investing in it—even though TBIs are sustained in a lot of non-combat situations like auto accidents. They haven’t found a way to rake in millions from Alzheimer’s; they’re not going to piss away bench scientists on TBI when they can tweak the formula of Viagra or Lipitor, file new patents and spend that money on advertising direct to the consumer.

(If anyone should be labeled as LMF, it’s Big Pharma.)

So Parker’s team continues to work on gathering the data that will eventually lead to something that might entice some drug company to produce a treatment. NPR’s going to continue reporting on this, and I’m looking forward to following the story. This is why we need basic and applied science, and this is why we need to know about it.