Probe: Combat care not effective

Baltimore Sun

BAGHDAD — The U.S. Army has quietly altered or abandoned some experimental medical treatments for troops injured in combat, as advances once hailed as groundbreaking are found ineffective or even dangerous.

Advanced dressings for wounds, a blood-clotting drug, and alternative procedures for emergency blood transfusions all were introduced early in the Iraq war, often with little evidence to support them beyond anecdotes or tests on animals.

But an investigation by The (Baltimore) Sun reveals that military doctors and medics, and some officers have rejected or curtailed use of many new devices and techniques as data from the war zone yield disappointing or troubling results.

Senior Army doctors rushed medical innovations onto the battlefield without the rigorous review common in civilian hospitals, the Sun found, and sometimes changed or disregarded data from their own scientists.

In some instances, wounded soldiers were among the first humans on whom the treatments were used. And though the Army’s published research supports the treatments, some Army studies concluding that they are ineffective or dangerous haven’t been published.

The aggressive push in combat medicine is a point of pride to some Army doctors. Others deride it as reckless, and still others say they felt pressured to defy their own judgments in favor of the military’s favored, but unproven, treatments.

“I worry that some soldiers were hurt by the overzealous use of unproven therapies,” said Dr. Ian H. Black, head of anesthesia at the Army’s main combat hospital in Baghdad in 2006 and 2007 and a former Army researcher. “I look back and I wonder, did I hurt someone?”

The Army’s surgeon general, Lt. Gen. Eric B. Schoomaker, said that changes in combat medical care show that Army medicine is responsive to the lessons learned in warfare.

“We’re not doing experimentation in theater. It’s unethical,” Schoomaker said.

But, he said, the Army will re- examine its treatment protocols to make sure the service is not “out ahead of the headlights” with unsupported treatments.

Among The Sun’s findings:

URoughly 17,000 packages of a blood-clotting substance were shipped to Iraq in 2008 for distribution to Army medics, despite cautions from the service’s own scientists against using it on humans.

UAn $89 bandage given to every combat soldier and honored by the Army as one of its “greatest inventions” was deployed despite two unpublished studies from the service’s research laboratory showing that it was no more effective than gauze.

UA blood-clotting drug, injected copiously into wounded soldiers in 2005 and 2006, became the Army’s “standard operating procedure” more than a year before clinical studies evaluating the drug’s use on trauma patients had been completed. The drug has since proved largely ineffective in three unpublished Army studies and potentially dangerous in at least one.

UTransfusions of fresh whole blood, considered dangerous in civilian medicine, became standard treatment in the war, based on anecdotes and theoretical arguments. It unwittingly exposed 20 or more patients in Iraq and Afghanistan to hepatitis.

There is little data or documentation from either the Army or civilian hospitals to prove that the military’s aborted new treatments were helpful or harmful. But a group of military physicians and researchers, many of whom spoke with The Sun, have complained to Army investigators that senior medical officials manipulated research and “stressed results at the expense of good science.”