Testing Program Fails Soldiers, Leaving Brain Injuries Undetected

Testing Program Fails Soldiers, Leaving Brain Injuries Undetected
By Daniel Zwerdling, Joaquin Sapien and T. Christian Miller

In 2007, with roadside bombs exploding across Iraq, Congress moved to improve care for soldiers who had suffered one of the war’s signature wounds, traumatic brain injury.

Lawmakers passed a measure requiring the military to test soldiers’ brain function before they deployed and again when they returned. The test was supposed to ensure that soldiers received proper treatment.

Instead, an investigation by ProPublica and NPR has found, the testing program has failed to deliver on its promise, offering soldiers the appearance of help, but not the reality.

Racing to satisfy Congress’ mandate, the military chose a test that wasn’t actually proven to detect TBI (tramatic brain injury): the Automated Neuropsychological Assessment Metric, or ANAM.

Four years later, more than a million troops have taken the test at a cost of more than $42 million to taxpayers, yet the military still has no reliable way to catch brain injuries. When such injuries are left undetected, it can delay healing and put soldiers at risk for further mental damage.

Based on corporate and government records, confidential documents, scores of interviews and emails obtained under the Freedom of Information Act (FOIA), our investigation found:

The people who invented ANAM and stood to make money from it were involved in the military’s decision to use it, prompting questions about the impartiality of the selection process. No other tests received serious consideration. A report by the Army’s top neuropsychologist circulated last year to key members of Congress labeled the selection process “nepotistic.”
The Pentagon’s civilian leadership has ignored years of warnings, public and private, that there was insufficient scientific evidence the ANAM can screen for or diagnose traumatic brain injury. The military’s highest-ranking medical official said the test was “fraught with problems.” Another high-ranking officer said it could yield misleading results.
Compounding flaws in the ANAM’s design, the military has not administered the test as recommended and has rarely used its results. The Army has so little confidence in the test that its top medical officer issued an explicit order that soldiers whose scores indicated cognitive problems should not be sent for further medical evaluation.
Top Pentagon officials have misrepresented the cost of the test, indicating that because the Army invented the ANAM, the military could use it for free. In fact, because the military licensed its invention to outside contractors, it has paid millions of dollars to use its own technology.
The military has not conducted a long-promised head-to-head study to make sure the ANAM is the best available test, delaying it for years. Instead, a series of committees have given lukewarm approval to continue using the ANAM, largely to avoid losing the data gathered so far.

Several current and former military medical officials criticized the Defense Department’s embrace of a scientifically unproven tool to use on hundreds of thousands of soldiers with TBIs.

“The test was not developed for the purposes of identifying the kinds of problems that we see in concussions,” said Dr. Stephen Xenakis, a retired brigadier general and former adviser on mental health issues to the chairman of the joint chiefs of staff. The test was picked “without asking ourselves the questions: what are we trying to achieve here and what are we going to use the screenings for?”

Army Surgeon General Eric Schoomaker acknowledged there have been problems with the testing program and called it a “first step.”

“The Army recognized all along that it was not an optimal test,” Schoomaker said in a written statement to ProPublica and NPR. He added that the Army has tried to improve the ANAM test and is comparing it to alternatives.

Many experts in the field say Congress’ mandate for testing went beyond what science can provide. There is no computerized test that, on its own, allows doctors to diagnose TBI.

Yet studies have indicated the ANAM shows promise when used immediately after a blast, helping doctors determine if soldiers are sharp enough to return to duty. Other studies, as yet unpublished, show the test may also be able to detect certain cognitive problems months after a brain injury.

Those most familiar with the ANAM program insist that testing can be of significant value if used properly — and that this is where the military has gone wrong.

“We have failed soldiers,” says retired Col. Mary Lopez, who used to manage the Army’s testing program. “It is incredibly frustrating because I can see first-hand the soldiers that we’ve missed, the soldiers that have not been treated, not been identified, [or] misdiagnosed. And then they struggle.”  (Read Full Article)

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