In a recent critique of the Department of Veterans Affairs policy on conducting research into the effects of medical marijuana on PTSD and/or chronic pain, John Hudak of the Brookings Institute states that “old-fashioned biases, incomplete evaluations of existing literature, and a mischaracterization of policy has, to this point, won the day at VA.”
Hudak’s description of VA’s research program as lacking complete information, its response as an unfortunate combination of false information, and its rationale as incomprehensible logic, all hit the nail on the head.
By law, any research conducted by the VA must be “in connection with the provision of medical care and treatment to veterans” and, more specifically, should focus on “research into injuries and illnesses particularly related to service.”
VA’s current research priorities do not accomplish either of these statutory objectives.
First, with regard to both research into medical marijuana and research on dogs, the VA’s response to its critics has been to rely on misleading information to support its position.
With regard to dog research, VA took credit for medical advancements such as insulin and the recently FDA-approved artificial pancreas. However, the discovery of insulin took place in 1921, a full two years before VA’s research program was created. Medtronic, the company that created the artificial pancreas, recently denied that VA’s dog research had any involvement in the device.
Similarly, with regard to medical marijuana research, VA stated that that side effects associated with its usage , including an increase in suicide, development of psychotic symptoms, and an increase in traffic accidents, outweighed any benefits to the research.
However, upon further review, the VA’s stated reasons are easily refuted, including by a report from the National Academies of Sciences, Engineering and Medicine, which found that “there is conclusive or substantial evidence that cannabis or cannabinoids are effective for the treatment of chronic pain in adults.” Moreover, as also noted by Hudak, if impaired driving were a bar to medical research, the entire pharmaceutical industry would go out of business.
Second, VA’s reliance on support from veterans service organizations and other outside authorities has been inconsistent at best.
To this end, VA has stated that animal models are unreliable in the context of granting presumptive benefits to veterans subject to toxic exposures during service, but defends dog research as “necessary” to save human lives when faced with a possible defund of the program.
Likewise, in defense of its canine research program, VA relied heavily on the support of veterans service organizations, such as the American Legion, as a justification for continuing the research. Nonetheless, despite the support of the same veterans service organizations, again including the American Legion, of medical marijuana research, VA once again chooses only to rely on this support when it corroborates the Department’s pre-determined conclusion. Many veterans groups also happen to oppose the VA’s dog research, a fact VA has conveniently ignored.
Next, in conversations about both medical research and benefits, VA has a tendency to manipulate scientific and legal standards to its own benefit, and not the benefit of veterans.
In the context of cannabis research, VA has stated that, based on its own review on research and literature, entitled Benefits and Harms of Cannabis in Chronic Pain or PTSD, that there was “insufficient evidence to demonstrate benefits of cannabis use for patients with PTSD or chronic pain.” The term “insufficient evidence” is again one that the VA likes to rely on in denying presumptive benefit claims.
However, VA has been reprimanded by the U.S. Court of Appeals for Veterans Claims on numerous occasions for relying on insufficient evidence as substantive negative evidence.
Similarly, VA Secretary David ShulkinDavid Jonathon ShulkinBiden's nominee for VA secretary isn't a veteran — does it matter? The Hill's Morning Report - Presented by Mastercard - Congress slogs toward COVID-19 relief, omnibus deal A crisis that unites veterans MORE’s claim that dog research is “necessary” is based on outdated information that is taken out of context.
Finally, VA’s research program is an example of why rigorous oversight of the agency from Congress and other stakeholders must remain a top priority. As noted above with regard to medical marijuana research, VA stated it conducted its own internal study which proved not to be systemic or thorough, and thus, ultimately misleading.
Similarly, with regard to the canine research program, although VA stated after a scathing report by USA Today that it would review any research on canines more rigorously, to date, VA has failed to release any findings or reports as to what its more rigorous oversight would entail, leading many to believe that it has not actually changed any of its research protocols.
In the conclusion of his analysis, Hudak states that “Shulkin has an obligation to do better.”
Indeed, Shulkin has an obligation to review the priorities of the entire VA research program, and to encourage the Department to refocus its limited funding on medical research that complies with its statutory obligation to treat veterans’ illnesses and injuries related to service, rather than reinforcing the status quo that puts the interest of entrenched researchers over that of veterans.
Rory E. Riley-Topping has dedicated her career to ensuring accountability within the Department of Veterans Affairs (VA) to care for our nation’s veterans. She is the principal at Riley-Topping Consulting and has served in a legal capacity for the U.S. House of Representatives Committee on Veterans’ Affairs, the National Veterans Legal Services Program, the U.S. Court of Appeals for Veterans Claims, and the Department of Veterans Affairs. You can find her on Twitter @RileyTopping.