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The man on a journey to find the Holy Grail to prevent brain injury

By John Grady, ScoutComms Special Correspondent When Gen. Peter Chiarelli became vice chief of staff of the Army in August 2008, he admitted, “I didn’t even know what [Post Traumatic Stress (PTS) and Traumatic Brain Injury (TBI)] were.” Yet during his four-plus years as vice chief, he made it a top priority to find out what they were and why people responded differently to this kind of stress and brain injury, and to understand what was holding soldiers back from seeking help. Though Chiarelli is now retired from the Army and living in Seattle, he continues to pursue answers to those questions as chief executive officer of the not-for-profit One Mind. He is also working to eliminate the stigma associated with seeking mental health treatment. “[PTS] is something that has been part of war since there was war,” he noted. Chiarelli spoke recently at the annual meeting of the Army Historical Foundation in Arlington, Va. on One Mind’s current and future priorities. He followed up with the Scout Report after his presentation to provide more context. One Mind is promoting an “open science” approach to diagnosing, treating and curing brain disease. By “open science,” as he told the foundation, Chiarelli refers to making research, results and data available to everyone. A more detailed definition is available at onemind.org. He said in the interview that the inefficiency of the medical research ecosystem “makes the Pentagon look like a paragon of efficiency.” He also said that PTS and TBI are “not just a problem with soldiers.” According to the Center for Disease Control and Prevention (CDC), 2.5 million people suffered from head trauma last year in the United States. By contrast, Chiarelli told the Foundation, “312,000 in all services suffered head trauma since these wars began.” The research on PTS that One Mind and other organizations are gathering “is showing this could be affected by genetics.” In short, individuals react and recover differently. “We don’t understand the biology of PTS and TBI.” Chiarelli noted that diagnosing what is going on in a person’s brain after a traumatic injury or concussion is far different than treating a broken leg. where there is certainty about what happened and what to do. The basis for diagnosis of PTS comes from 20 questions out of DSM-5, he said. “We’ve got to do better than that.” Unlike civilian society where government and corporate research funding has tailed off, the military has attacked the problem in trying to find solutions. Chiarelli cited Special Operations forces as an example of finding solutions for members who need assistance. In those forces, he said a culture has developed where it’s all right to seek treatment without the stigma being attached to that decision. One Mind’s Gemini program holds promise because it involves two studies that have teamed up, the TRACK-TBI U.S. study and the CENTER-TBI European study. TRACK-TBI involves 11 research universities. It is a longitudinal study, which means that the clinical study tracks individuals over time, and it’s a complete evaluation, going beyond anything that has been done before, according to Chiarelli. The One Mind website says that TRACK-TBI will involve 3,000 patients in the United States. Enrollment began in 2014 for the study. CENTER-TBI is a European observational study that will involve nearly 6,000 patients, and will focus on gathering data from patients admitted to emergency rooms, intensive care units and hospital. “One of the keys to this effort are global public-private partnerships,” noted Chiarelli. “These are large societal problems.” The partnerships he spoke of are with patient communities such as PatientsLikeMe, other non-profits, governmental, corporate, philanthropic, scientific, and academic communities. Chiarelli went on to say that “we are hopeful that the data gathered will be useful in looking for solutions in treating depression, Parkinson’s and ALS [Lou Gehrig’s disease].” The One Mind website also listed addiction and Alzheimer’s as illnesses that will benefit from the open science principles, collaborative structures and technology solutions One Mind is developing in its PTS and TBI programs. “What is the risk factor?” Chiarelli asked, before answering. “Identifying genetic markers associated with brain disease and injury, that’s really where we need to be with this. That would be the Holy Grail.”

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