VA treats Veterans Like "Disposable" Lab Rats
by Justice Lover
The following was emailed to me today by :
ALLIANCE FOR HUMAN RESEARCH PROTECTION
Promoting Openness, Full Disclosure, and Accountability
http://www.ahrp.org and http://ahrp.blogspot.com
FYI
The Washington Times reports:
"Currently, the VA and other federal agencies are conducting nearly 300
clinical studies involving veterans with PTSD. Most studies are behavioral,
including one that tests the effects of yoga on PTSD sufferers. Twenty-five,
however, are testing drugs on 4,796 veterans, more than half (2,488) of whom
are just returning from the wars in Iraq and Afghanistan, according to
clinical trials filed with the National Institutes of Health (NIH) and
reviewed by The Times."
Perhaps no other news report involving unethical human experimentation
demonstrates how far along the slippery slope the American government and
the pharmaceutical industry have plunged. The report is about the
exploitation of the vulnerability of disabled U.S. veterans who served in
Afghanistan and Iraq.
The veterans are being enrolled in an unethical drug experiment with the
approval of the Department of Veterans Affairs, an experiment that exposes
them to Pfizer's controversial anti-smoking drug, Chantix, whose documented
serious risks include psychotic episodes, violence and suicide.
The FDA acknowledges that nearly 40 suicides and more than 400 incidents of
suicidal behavior have since been linked to Chantix.
"Just two weeks after Mr. Elliott began taking Chantix in November, the VA
learned from the Food and Drug Administration (FDA) that the drug was linked
to a large number of hallucinations, suicide attempts and psychotic
behavior. But the VA did not alert Mr. Elliott before his own episode in
February. In failing to do so, Mr. Elliott said, the VA treated him like a
"disposable hero." "You're a lab rat for $30 a month," Mr. Elliott said.
In all, nearly 1,000 veterans with PTSD were enrolled in the study to test
different methods of ending smoking, with 143 using Chantix. Twenty-one of
the veterans testing Chantix reported adverse effects from the drug,
including one who suffered suicidal thoughts.
This government supported medical atrocity was uncovered by an investigation
by The Washington Times and ABC News which is airing the report under the
heading "Disposable Heroes"
http://abcnews.go.com/Blotter
Contact: Vera Hassner Sharav
veracare@ahrp.org
212-595-8974
~~~~~~~~~~~~
http://washingtontimes.com
/
THE WASHINGTON TIMES
VA testing drugs on war veterans
Experiments raise ethical questions
Audrey Hudson (Contact)
Tuesday, June 17, 2008
The government is testing drugs with severe side effects like psychosis and
suicidal behavior on hundreds of military veterans, using small cash
payments to attract patients into medical experiments that often target
distressed soldiers returning from Iraq and Afghanistan, a Washington
Times/ABC News investigation has found.
In one such experiment involving the controversial anti-smoking drug
Chantix, the Department of Veterans Affairs (VA) took three months to alert
its patients about severe mental side effects. The warning did not arrive
until after one of the veterans taking the drug had suffered a psychotic
episode that ended in a near lethal confrontation with police.
Veteran James Elliott arrives at the Veterans Affairs Medical Center in
Washington for his scheduled substance-abuse class in April. Mr. Elliott, a
chain smoker, served 15 months in Iraq as an Army sharpshooter and suffers
post-traumatic stress disorder.
Iraq war veteran James Elliott opted for a government clinical trial for a
smoking-cessation drug for $30 a month, starting in November. Two weeks
later, the FDA informed the VA of serious side effects.
Iraq war veteran James Elliott smokes on his porch in Silver Spring as he
talks about his experiences in war and dealing with post-traumatic stress
disorder. Mr. Elliott suffered a psychotic episode while taking the
anti-smoking drug Chantix.
James Elliott, a decorated Army sharpshooter who suffers from post-traumatic
stress disorder (PTSD) after serving 15 months in Iraq, was confused and
psychotic when he was Tasered by police in February as he reached for a
concealed handgun when officers responded to a 911 call at his Maryland
home.
For photos, video of James Elliott, official FDA documents and more, visit
the interactive site for the Disposable Heroes report.
Mr. Elliott, a chain smoker, began taking Chantix last fall as part of a VA
experiment that specifically targeted veterans with PTSD, opting to collect
$30 a month for enrolling in the clinical trial because he needed cash as he
returned to school. He soon began suffering hallucinations and suicidal
thoughts, unaware that the new drug he was taking could have caused them.
Just two weeks after Mr. Elliott began taking Chantix in November, the VA
learned from the Food and Drug Administration (FDA) that the drug was linked
to a large number of hallucinations, suicide attempts and psychotic
behavior. But the VA did not alert Mr. Elliott before his own episode in
February.
In failing to do so, Mr. Elliott said, the VA treated him like a "disposable
hero."
"You're a lab rat for $30 a month," Mr. Elliott said.
One of the nation's premier medical ethicists said the VA's behavior in the
anti-smoking study violated basic protections for humans in medical
experiments.
"When you're taking advantage of a very vulnerable population, people who
have served the country, and the agency that's responsible for their welfare
isn't putting their welfare first, that's a pretty serious breach of
ethics," said Arthur Caplan, director of the Center for Bioethics at the
University of Pennsylvania.
In all, nearly 1,000 veterans with PTSD were enrolled in the study to test
different methods of ending smoking, with 143 using Chantix. Twenty-one
veterans reported adverse effects from the drug, including one who suffered
suicidal thoughts, the three-month investigation by The Times and ABC News
found.
Mr. Caplan, who reviewed the consent and notification forms for the study at
the request of The Times and ABC News, said the VA deserved an "F" and that
it has an obligation to end the study, given the vulnerability of veterans
with PTSD and the known side effects of Chantix. "Continuing it doesn't make
any ethical sense," he said.
The VA continues to test Chantix on veterans, even as reported problems with
the drug increase and have prompted at least one other federal agency to
take action. On May 21, the Federal Aviation Administration banned airline
pilots and air traffic control personnel from taking Chantix, citing the
adverse side effects.
The VA responds
VA officials defend their use of veterans in medical studies, saying that
helping PTSD sufferers to stop smoking would prolong their lives. As for the
three-month delay in notifying its patients about the Chantix problems, the
VA said bureaucracy slowed down their warning because the alert letters had
to be issued through an Institutional Review Board (IRB) that oversees the
experiment at each VA location.
"We don't have the authority to just send directly to patients material that
has not been approved by the IRB sites,"said Miles McFall, director of the
VA's programs for PTSD sufferers. "We did sense urgency. And we respond to
that urgency doing just what we did here, which was, I think, incredibly
quick response for a governmental institution.
"We believe that we took responsible action by informing the clinicians who
are the people most in touch with the patients to be on the lookout for any
potential side effects and to respond appropriately," he said.
While Mr. Elliott blames Chantix for his mental breakdown and confrontation
with police, VA officials said they cannot be sure.
"We don't know that Chantix was the cause of this, first of all. And it's
presumed that that's the case. We don't know that to be a fact," Mr. McFall
said.
Mr. McFall said the veterans with PTSD in the anti-smoking study "are at
high risk to use tobacco" and the goal of the experiment is to determine how
best to deliver treatment - through a mental health counselor or a smoking
clinic. Chantix was one of several options tested on the veterans.
"FDA approved, and that drug is available to help individuals stop smoking
and VA makes that drug available," Mr. McFall said. "It does not deny access
to them."
Asked about adverse reactions now linked to the drug, Mr. McFall said: "We
are certainly aware of FDA warnings and we took all precautions ... so it
can be used safely. All drugs have side effects or potential side effects."
Dark history of medical tests
The government has a controversial history of using military personnel as
human research subjects.
Mustard gas was tested on the military during World War II, radiation during
the early Cold War period, LSD in the 1960s, herbicide in Vietnam and
Panama, and chemical and biological warfare drugs during the Gulf War,
according to Senate testimony given by the Vietnam Veterans of America (VVA)
on July 10, 2002.
In most of those cases, few if any military test subjects were informed of
the potential health consequences of the exposure.
"We have a phrase to describe this phenomenon - the disposable soldier
syndrome," said Richard Weidman, former VVA director of government
relations.
The most infamous government experiment is the Tuskegee Syphilis Study
conducted by the U.S. Public Health Service from 1932 through 1972, which
used 400 poor and uneducated black male sharecroppers who carried the
sexually transmitted disease.
The men were purposely undiagnosed and untreated for a disease that already
had progressed to late stages, and were studied through autopsy.
The government effectively blocked the unwitting participants, who also were
drafted in 1940 to serve in WWII, from receiving medical treatment for
symptoms they were told were caused by "bad blood." Of the participants, 28
men died of the disease, 100 others died from complications brought on by
syphilis, and the disease spread to 40 wives and 19 children.
Ongoing tests with vets
The VA has extensive screening of veterans who enroll in medical experiments
and requires detailed consent forms to ensure patients know about the
potential complications and benefits.
Currently, the VA and other federal agencies are conducting nearly 300
clinical studies involving veterans with PTSD. Most studies are behavioral,
including one that tests the effects of yoga on PTSD sufferers.
Twenty-five, however, are testing drugs on 4,796 veterans, more than half
(2,488) of whom are just returning from the wars in Iraq and Afghanistan,
according to clinical trials filed with the National Institutes of Health
(NIH) and reviewed by The Times.
One study conducted by the National Institute of Mental Health is using
virtual-reality exposure - sights, sounds and smells from the Iraq
battlefield, along with a drug called D-Cycloserine that reduces fear.
Other studies are testing drugs on veterans with PTSD, including the
antidepressants paroxetine, mirtazapine and citalopram - all carry warnings
of suicidal side effects.
"Over 150,000 soldiers are currently deployed in Iraq as part of Operation
Iraqi Freedom (OIF) and 12 percent of returning OIF veterans have PTSD,"
said one study that is using the drug paroxetine on 160 veterans "who have
returned from the Iraq theater within the past six months."
Warnings about taking paroxetine include "suicidal thinking about harming or
killing oneself or planning to trying to do so" among young adults up to 24
years of age, according to NIH.
Another study on the use of mirtazapine for veterans of Iraq and Afghanistan
is testing the efficacy and tolerability of the drug on 100 veterans.
Citalopram is being tested on 300 veterans "exposed to high levels of combat
stress."
The NIH warning for paroxetine also applies to mirtazapine and citalopram.
The VA has not revealed how many veterans are registered in an experiment to
study the effects of divalproex in the treatment of PTSD, but the FDA warned
health care professionals on Jan. 31 it had received reports of suicide and
suicidal thoughts linked to the anticonvulsant drug.
Smoking study's fine print
Mr. Elliott was one of 940 veterans with PTSD who participated in the
Veterans Affairs Cooperative Studies Program (CSP) # 519, "smoking-cessation
treatment for veterans with post traumatic stress disorder" ongoing at 10 VA
clinics.
The CSP studies date back to the 1940s, when 10,000 veterans suffering from
tuberculosis were recruited into VA studies to test different drugs to treat
the disease.
The smoking-cessation study uses nicotine replacement products like gum and
patches as well as Chantix - a drug that is supposed to block certain brain
receptors that make smoking pleasurable. The $11 million taxpayer-funded
study was approved in 2004, two years before the FDA approved Chantix for
prescription use.
The FDA says that nearly 40 suicides and more than 400 incidents of suicidal
behavior have since been linked to Chantix.
Mr. Elliott began taking Chantix on Nov. 6. Two weeks later, on Nov. 20, the
FDA issued its first alert that it had "received reports of suicidal
thoughts and aggressive and erratic behavior in patients who have taken
Chantix," also known as varenicline.
"A preliminary assessment reveals that many of the cases reflect new-onset
of depressed mood, suicidal ideation, and changes in emotion and behavior
within days to weeks of initiating Chantix treatment," the November FDA
alert said.
"The role of Chantix in these cases is not clear because smoking cessation,
with or without treatment, is associated with nicotine withdrawal symptoms
and has also been associated with the exacerbation of underlying psychiatric
illness. However, not all patients described in these cases had pre-existing
psychiatric illness and not all had discontinued smoking," the FDA said.
On Jan. 18, the drug manufacturer Pfizer revised its warning label to state
"patients who are attempting to quit smoking with Chantix should be observed
for serious neuropsychiatric symptoms, including changes in behavior,
agitation, depressed mood, suicidal ideation and suicidal behavior."
On Feb. 1, the FDA held a news conference to announce that new health risks
have been associated with the drug.
VA officials started addressing the FDA alert on Nov. 26 and Dec. 4 with
conference calls among government officials "to inform prescribers about
these potential problems and advise patients accordingly," according to a
timeline agency officials provided The Times.
On Feb. 4, VA officials were told to "formulate and approve an action plan,"
and on Feb. 13, a second consent form and letter was submitted for approval
by VA officials.
The letter received by Mr. Elliott and other veterans was dated Feb. 29,
more than three weeks after he already had suffered his mental breakdown and
confrontation with police.
VA letter watered down?
While the alerts from Pfizer and the FDA clearly mentioned suicide and
suicidal thoughts as possible side effects, the VA's letter to its veterans
used no such language.
"Scientists have recently learned that varenicline can sometimes have
serious side effects in some people," the VA letter said. "These side
effects may include an increase in psychiatric symptoms such as anxiety,
nervousness, tension and depression as well as untoward changes in
behavior."
Asked why the letter omitted the most significant side effect, Mr. McFall
said "the more verbiage you use, the more difficult and lengthy it becomes,
hard to read. It's more likely veterans won't pay attention to it if you
overdo."
However, a secondary research consent form sent with the letter that
participants are now being asked to sign cites "changes in behavior,
anxiety, nervousness, tension, depression, thoughts of suicide, and
attempted and completed suicide."
Mr. McFall said the serious side effects were included in the secondary
consent form, and not the notification letter, because "it's better to have
the letter be brief" so that it is not a "burden for people who sometimes
have problems reading."
"They have eyesight problems," Mr. McFall said. "Many of our veterans are
getting elderly, so we're trying to keep things simple and to the point,
while at the same time pointing them to the most important document, which
is the consent form."
Veterans who are participating in the smoking-cessation program are
carefully screened to ensure they are not suicidal, psychotic or homicidal,
Mr. McFall said.
According to the VA research consent form Mr. Elliott initially signed, he
would be required to fill out questionnaires "about some war zone events
that you may have experienced" and interviews "regarding symptoms of other
psychiatric disorders and your use of drugs and alcohol."
"Has there been a time in the past month when things were so bad that you
were thinking a lot about death or that you would be better off dead?" is
one example question listed on the consent form.
Mr. Elliott filled out monthly checklists on the extent to which he had
nightmares about his military experience or flashbacks, became "super alert"
or on guard, and whether he had a "feeling as if your future will somehow be
cut short."
Chantix debate
New York Magazine writer Derek De Koff detailed the nightmares and suicidal
behavior he suffered while on Chantix in a Feb. 10 article, and said that at
one point he felt like throwing himself in front of a tour bus or crashing
his head into a computer screen.
"All this seemed logical, but also weirdly funny, even at the time: I could
see how crazy these impulses were, I could recognize them as suicidal
cliches. But I couldn't make them go away," Mr. De Koff wrote.
In September, musician Jeffrey Carter Albrecht was shot by a neighbor who
mistook him for a burglar. The guitarist and keyboardist who once played
with Edie Brickell & New Bohemians went on a rant that friends say was
fueled by alcohol and the drug Chantix.
A spokesman for Pfizer could not be reached after three calls seeking
comment. However, in full-page ads published May 29 in several newspapers
including USA Today, Dr. Joseph Feczko, Pfizer chief medical officer, said
the company is "committed to patient safety" and "furthering our knowledge
of Chantix."
The FDA has declined to pull Chantix from the market, citing the health
benefits of smoking cessation.
"This actually is a very important drug," Dr. Celia Winchell, team leader
for the FDA division of anesthesia, analgesia and rheumatology, said during
the February teleconference announcing the new warning.
"Although we are getting these reports, there's also a lot of anecdotal
reports out there where this drug has worked when no other drug would," Dr.
Winchell said.
"Smoking itself has very serious consequences. And so I think it's important
to try to manage the risk associated with the drug, also realizing that it
has a lot of benefits for some folks," Dr. Winchell said.
More than 5,000 people were treated with the drug in preliminary trials
before it was approved for prescription use. However, patients with serious
psychiatric illness such as schizophrenia, bipolar disorder and major
depressive disorder did not participate in those tests.
Ethics of future VA tests
Mr. Caplan, the bioethicist, said that using veterans with PTSD in clinical
trials carries a "high risk" that must be addressed by the VA. "Researchers
have a special obligation to vets with PTSD since they are a vulnerable
population somewhat prone to threats or even violence against themselves or
others," he said. "They need to keep a hawklike eye on subjects involved in
high stress experiments and make sure that families and friends are involved
and on board any research projects to help monitor subjects."
"I am not against research to try and improve the health of those with PTSD
but only if it is done with the highest levels of consent, transparency,
supervision and accountability," he said.
Mr. Caplan recommended several steps the government should adopt before
allowing future testing on vulnerable veterans, including more participation
by families and veterans on committees that review and approve research
proposals.
Future studies that involve veterans with PTSD also should receive special
approval from the VA secretary.
And a clear policy should be established that prohibits drugs reported to
have serious side effects be tested on populations at risk of those side
effects, including veterans with PTSD, he said.
(Emphasis by Justice Lover)
This is absolutely unethical behavior. Giving them a pass on this puts you on the wrong side of this issue. You are telling me these guys are well-organized and smart enough to run big NIH research projects but 'accidentally' fail to disclose these monies?
If there were real ethical standards in psychiatry, they would be fired, no one would believe their research, and practitioners would be really angry at these guys, not making excuses for them."
Your stand on this issue is very telling.