We owe so much to the servicemen and servicewomen who have died defending our country. One of our many debts of gratitude to them — and to all of those who have served in the Armed Forces — is their contributions to major advances in the biomedical sciences, many of which were forged in the awful crucible of war.
Emergency medicine and modern surgery were honed and improved by what physicians and medics encountered on the battlefield. Technological breakthroughs such as portable ultrasound and penicillin trace their early development to war settings. Therapies for tuberculosis following World War II, the invention of the implantable cardiac pacemaker, and innovations in prosthetics have all resulted from research funded by the Department of Veterans Affairs.
Medical and scientific researchers must continue learning from our veterans beyond the battlefield. In so doing, we rightfully honor those who serve our country. We learn to provide better care for veterans, and can disseminate this new knowledge to benefit all Americans.
As the Trump administration begins the important and challenging work of continuing to transform the VA into an organization that provides exemplary health care to veterans, it should take this opportunity to rethink the VA’s role in biomedical research.
Advancing the field of medicine requires linking scientific research and clinical care. Think of it as a roundtrip from bedside to lab bench and back again. Such an approach — having what’s observed in the clinic inform basic research, and then translating discoveries from the lab into therapies for patients — is a simple enough concept. Putting it into practice is considerably more difficult to achieve.
The tremendous gains in our ability to save lives on the battlefield have led to new challenges of managing conditions that veterans may have to contend with for decades — chronic pain, traumatic brain injury, post-traumatic stress disorder, and chronic fatigue, among others. While these may be prominent in veterans, they aren’t unique to them. Carefully focusing research to develop therapies for veterans suffering from these war-related conditions can lead to breakthroughs that will also improve the lives of millions of other Americans afflicted by similar conditions.
We propose three potentially transformational steps that the VA could undertake to better capitalize on its unique position to catalyze discovery in the biomedical sciences.
Seamlessly integrate clinical care and research. The VA could — and should — become the national example for science at the bedside and clinical medicine in the laboratory. No other organization can potentially link these two components on as large a scale as the VA. It is the largest integrated health care system in the US, funds a research program with an annual budget of more than $600 million, maintains affiliations with more than 90 percent of medical schools across the nation, and is the largest provider of medical training nationwide.
The opportunity to develop a fully integrated health research system with continuous feedback between discovery and implementation can offer profound benefits to our veterans and to the country’s approach to health care in general.
To realize this vision, the VA must recognize research as an integral element of its health care mission. Clinician-scientists should have their research efforts adequately encouraged and incentivized, not just permitted. Research should not take priority over clinical care, but it can’t be an afterthought, either.
Maximize data as a resource. Data have become a highly valuable resource in health research. The VA has access to unparalleled amounts of data pertaining to veterans’ health. It has employed electronic health record systems for more than 30 years. It maintains other databases and repositories that contain health information and biospecimens collected from veterans during and after their military service. Collecting patient-generated data from wearable devices such as activity trackers and sensors from other personal devices will be the next frontier. Carefully analyzing this wealth of data will yield new insights into understanding disease and delivering care.
Data alone does not confer insight, though. That requires committing to personnel, analytic tools, and a strategy for extracting knowledge. This will require enhancing the VA’s infrastructure and expanding its capabilities to include data scientists, artificial intelligence, and other resources needed to remain a leader in health care and research. Until then, valuable insights may be hidden away in incomprehensible mountains of data.
Breakdown barriers that silo VA research. Unlike the National Institutes of Health and the Department of Defense, which both fund a mix of internal and external projects, the VA funds only internal research. The logic behind this structure is sound: It serves the goal of improving care for veterans by making careers at the VA more attractive to outstanding clinician-investigators and ensures that veterans have research dedicated to their interests. But not offering funding to scientists outside the system leads to many missed opportunities.
Today, successful biomedical research often requires working across agencies and institutions. The VA has struggled to do this well. Better coordination within the VA and closer collaboration with outside partners, including industry and other institutions, can streamline efforts and expedite progress. At a minimum, the VA needs to implement policy changes that will make it a more amenable partner. Daunting institutional barriers, such as those related to data sharing, currently stymie collaboration with outside partners, putting the VA at risk of being left out and left behind.
We anticipate that there will be much discussion in the coming months about the types of relationships that VA-provided health care should have with private sector health care providers. What likely won’t get as much attention, and runs the risk of being overlooked, is how the direction taken by the new administration will affect the VA’s biomedical research. Clinical care should not be thought of as separate from research; both need to be considered together. The goal should be for even closer integration between the two.
Veterans are a unique group, not just in the valor they have demonstrated or the debt that we owe them, but also in the role they play to advance biomedical science. This often invisible service can lead to advances that make them more whole while also improving the well-being of their fellow citizens. The administration can honor that service by thinking beyond just modernizing the VA and instead aiming to transform the agency into the model health-research system that ushers in the future of medical care and scientific discovery.
Stephen L. Hauser, MD, is the director of the Weill Institute for Neurosciences and chair of neurology at the University of California, San Francisco; has advised the secretary of Veterans Affairs, including in his current role as chair of the Research Advisory Committee on Gulf War Veterans’ Illnesses at the US Department of Veterans Affairs; and previously chaired reports from the Institute of Medicine (now the National Academy of Medicine) on veterans’ health issues. Jon-Eric VanLeeuwen, PhD, is a faculty member in the neurology department at the University of California, San Francisco, and serves as the managing director for the Research Advisory Committee on Gulf War Veterans’ Illnesses.
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