RESEARCH PROPONENT: Directing Medical Research and Forging New Methods for Better Results
Interview with
Major General George W. Weightman
Command General
U.S. Army Medical Research
and Materiel Command and Ft. Detrick
by Jeff McKaughan, MMT Editor
Major General George W. Weightman took command of the United States Army Medical Research and Materiel Command in November 2007. A native of Eden Mills, Vt., he received his Bachelor of Science Degree from the United States Military Academy at West Point, N.Y., in 1973. He was commissioned as a lieutenant of infantry and stationed at Schofield Barracks, Hawaii, where he served in the 1st Battalion, 35th Infantry, 25th Infantry Division. He was awarded a Doctorate of Medicine degree from the University of Vermont in 1982 and completed his family practice residency training at Eisenhower Medical Center, Fort Gordon, Ga. He was then assigned to Keller Army Community Hospital at West Point, where he served as chief, Department of Primary Care and Community Medicine. In 1989, he became the 82nd Airborne division surgeon and served with the All Americans during Operations Just Cause and Desert Shield/ Storm. Subsequently, he served as family practice residency director at Womack Army Medical Center before commanding the medical element, Joint Task Force Bravo, Soto Cano, Honduras. He then commanded the McDonald Army Community Hospital, Fort Eustis, Va., and the 30th Medical Brigade in Heidelberg, Germany.
In July 1999, he became the Chief of the Medical Corps Branch at the United States Army Personnel Command, Alexandria, VA. From May 2002 to October 2002, Weightman served as assistant surgeon general for force projection and then became the commanding general, 3rd Medical Command (Forward), and Coalition Forces Land Component command surgeon for Operation Iraqi Freedom. He later served as commanding general, 44th Medical Command/Corps Surgeon, XVIII Airborne Corps at Fort Bragg, N.C. He was then selected to command the U.S. Army Medical Department Center and School and Fort Sam Houston, San Antonio, Texas, from August 2004 until July 2006. After commanding the North Atlantic Regional Medical Command and Walter Reed Army Medical Center from August 2006 to March 2007, Weightman was assigned to the Office of the Surgeon General until November 2007.
Additional military schools include the Infantry Officer Advanced Course, the Army Medical Department Officer Basic and Advanced Courses, Airborne and Jumpmaster Schools, the United States Army Command and General Staff College, and the United States Army War College.
Weightman is board certified by the American Board of Family Practice and is a Fellow in the American Academy of Family Physicians.
Weightman’s awards include the Distinguished Service Medal, Legion of Merit (three Oak Leaf Clusters), Bronze Star Medal (one Oak Leaf Cluster), Meritorious Service Medal (two Oak Leaf Clusters), Joint Service Commendation Medal, Army Commendation Medal (three Oak Leaf Clusters), Armed Forces Expeditionary Medal (with Bronze Arrowhead device), Southwest Asia Service Medal, NATO Medal, Expert Infantry Badge, Expert Field Medical Badge, Senior Parachutist Badge with combat star, Honduran Parachutist Badge, Meritorious Unit Commendation, and Army Superior Unit Award. He is also a member of the Order of Military Medical Merit.
Major General Weightman was interviewed by MMT Editor Jeff McKaughan
Q: Could we start with an overview of MRMC? How does the MRMC of today look different from the MRMC of a few years ago? How will the next few years impact the organization’s structure and mission?
A: One of the significant attributes of MRMC is that it is not just a research and development command. It performs medical materiel “life cycle management” which means we are involved in the entire product development process from “bright idea” to basic science research, advanced development, to prototype down selection, to acquisition fielding and follow-on support to units with our products. This gives us tremendous advantages and streamlines the entire complex development process because we are involved in every single step. This has not always been the case, and we are unique amongst the services in this approach to medical research and resourcing. For medical chemical and biological defense products, the life cycle program is managed by the Department of Defense and MRMC provides the lead research and development laboratories.
Another big difference I have observed over the last several years is our extensive use of partnerships with not only the other services, but civilian academic institutions, other federal agencies and private industry, including big pharmaceutical companies. Because of these new relationships I believe that we have leveraged science and technology that would not have been available if we had decided to do everything in house. It also keeps us current in this very dynamic scientific environment and gives us a lot more agility to leverage new technology as we continuously try to meet the requirements of the warfighter.
In recent years we have increased our focus on combat casualty care. We have dedicated a tremendous amount of resources into this area, which has resulted in significant improvements in the survival rates of our warfighters on the battlefield. Examples of some of our products include new resuscitative surgical techniques; improved gear for our medics, to include the combat application tourniquet and hemostatic dressings; and improved critical care availability while rapidly evacuating our patients from the battlefield back to the United States.
We are also committing significant resources into the areas of psychological health and traumatic brain injury. Our focus is on predeployment screening, in-theater monitoring, mitigation strategies, and post deployment screening and intervention.
Q: What does FY09 funding—and beyond—look like for U.S. Army medical research? How does Army medical research fair in comparison to the other services’ research funding?
A: Our funding levels are adequate at the present time. We have received significant support from Congress, DoD, the Army, and the Military Healthcare System. I believe that the country recognizes the significance and relevance of our work and, in their continuing efforts to support the warfighter, they recognize the direct impact that our work has on readiness, survivability and performance. The Army presently performs about 70 percent of all of the medical RDT&E within the DoD and we benefit greatly with our significant partnerships with the other services in many areas.
Q: Can you describe the research labs within MRMC? Is there a reason there are six, and what do they each do?
A: Each of our labs has significant and unique capabilities and, between them, they help us cover a wide spectrum of research activities.
The United States Army Research Institute of Infectious Diseases [USAMRIID, Fort Detrick, Md.] specializes in the development of diagnostics, vaccines and mitigation treatments for those select agents that we feel could be used by enemies of the United States. Under BRAC 2005, this laboratory will become the centerpiece of the new Medical Biological Defense Research Center of Excellence. The Walter Reed Army Institute of Research [WRAIR, Forest Glen, Md.] focuses on those infectious agents that our warfighters could be exposed to in their worldwide deployments. These include such well-known agents as malaria, dengue, other tropical diseases, influenza and HIV. The WRAIR also has subordinate laboratories that focus on dental health and trauma research and the effects of lasers on military personnel. Under BRAC 2005, the WRAIR laboratory will become the centerpiece of the new Medical Infectious Disease Research Center of Excellence.
The United States Army Research Institute of Chemical Defense [USAMRICD, Aberdeen Proving Ground, Md.] specializes in research to protect our forces from chemical weapons and includes methods for the prevention, treatment, and diagnosis of those chemical agents that could be used against our forces. Under BRAC 2005, this laboratory will become the centerpiece for the medical chemical defense research aspect of the new Chemical Biological Defense Research, Development, and Acquisition Center of Excellence. The United States Army Institute of Surgical Research [USAISR, Ft. Sam Houston, Texas] focuses on research related to battlefield trauma and burn care. They have a dual mission of research and direct patient care at Brook Army Medical Center. Under BRAC 2005, the mission will increase and the laboratory will be the centerpiece for the new Battlefield Health and Trauma Center of Excellence. United States Army Aeromedical Research Lab [USAARL, Fort Rucker, Ala.] conducts research on medical issues encountered during rotary wing flight. They test medical equipment for airworthiness and are active in research that determines the medical stresses on crew and patients due to flight. They also have significant research on both acoustic challenges on the battlefield and in aircraft, as well as helmet design.
United States Army Institute of Environmental Medicine [USARIEM, Natick, Mass.] focuses on impacts of the environment on the warfighter’s performance. This includes how to minimize the impact of heat, cold and altitude. They also conduct research on improving performance through better rations and nutritional supplements and are also working on technologies to remotely assess a soldier’s physiologic condition.
Even though these labs each have a specific and unique focus, there is considerable exchange of information so we avoid duplication of effort. Having them located at the various locations around the country has been an added benefit because they are generally associated with other organizations within the Army and federal government that are doing related work. For example, the USAARL is collocated with the Army Aviation Center at Ft. Rucker, the USAISR is collocated with the Burn Center at Brook Army Medical Center, USAMRICD is collocated with the Chemical Command at APG, WRAIR is very close to the National Institutes of Health [NIH] in Bethesda, USARIEM is collocated with the Solider System Command at Natick, and USAMRIID will be the cornerstone of the new National Interagency Biodefense Campus [NIBC] at Detrick.
Q: With regards to BRAC, what impact will that have on Fort Detrick itself and more specifically MRMC?
A: BRAC really didn’t influence Fort Detrick a whole lot. We have over a billion dollars worth of new construction going on currently, however, a lot of that was Congressionally directed and unrelated to BRAC.
One example is the National Interagency Biodefense Campus, which was directed by Congress back in about 2001. The campus, which includes us here at MRMC and USAMRIID [U.S. Army Medical Research Institute of Infectious Diseases] along with the Department of Homeland Security which will build the National Biodefense Analysis and Countermeasures Center. This DHS lab will focus on forensics, meaning that if an agent was used somewhere in the country, it would be brought here for analysis to determine where it came from, who made it and what it was.
Additionally, the National Institute of Allergy and Infectious Diseases, a subagency of the National Institute of Health, will build a lab that will concentrate on vaccine research as well as imaging capabilities. With this they will be able to take select agents that there are no known cures for and do various imaging scans to further the search for a cure.
The combination of these various agencies and labs into one campus here at Fort Detrick will help centralize research efforts. So, while not BRAC related it certainly is Congressionally related. The one small piece that is BRAC related is that the biodefense research work that the Navy does will move to Fort Detrick. They will be moving out of WRAIR [Walter Reed Army Institute of Research] and be part of this campus. This is a relatively small portion of all of the new construction that is currently ongoing. If you look around at all of MRMC, probably the place that was affected the most by BRAC was Aberdeen Proving Ground. We have our lab for chemical defense up there. There was a time when people thought that Aberdeen might go away as a part of the process, but it has worked out the other way. A number of different organizations are going to APG which is helping us in that there are other Army systems—chemical systems and Chemical Command, for example, so our lab will have better partnership opportunities. We have also received funding unrelated to BRAC to recapitalize that facility, which will hopefully take place over the next six years.
Q: What about down in San Antonio?
A: On the medical side, other than with Walter Reed and Bethesda coming together, San Antonio has seen the biggest changes.
Basically Wilford Hall, the Air Force’s biggest hospital is joining forces with Brooke Army Medical Center at Fort Sam Houston. All of the inpatient care will move over to Brooke, which is in the process of building a new patient tower—and more research facilities as well. Some of the outpatient facilities will go over to Wilford Hall at Lackland Air Force Base. As part of this, they have formed a new center of excellence for battlefield and trauma medicine. This has entailed quite a bit of construction right where the Institute of Surgical Research and the Burn Center are. In essence, this is more than doubling the space available there with the co-location of various smaller labs.
Q: Is this actual growth in numbers or a realignment of existing facilities and staff?
A: Primarily it is just a consolidation of resources. It is growth in dimensional size and scope by bringing labs and people—both from within and outside the Army—together.
For instance, we have a small dental research unit up in Great Lakes that will, along with the dental research units from the other services, be moving down there to a central location.
Q: Over the years there have been rumblings of centralizing medical services and functions between the services. Any thoughts on the pros and cons of having a single military medical research organization? Would MRMC be in a good position to be the nucleus of such an organization?
A: I think it makes a lot of sense to have a joint military research command. We already collaborate in many ways with the other services and I feel there could be additional benefits by maximizing this collaboration. We have several officers from the other services on staff at MRMC; this has benefited us tremendously because they bring new and fresh perspectives to what we do. However, as we create a new command, it has to be made perfectly clear that each service will still have unique requirements and the new structure must be able to protect these service equities.
I believe MRMC is in position to lead this effort, not only because of the volume of research that we do today, but also because we also execute about 70 percent of the medical research, development, test and evaluation [RDT&E] dollars for DoD. Additionally, as I mentioned previously, I feel very strongly that there are tremendous advantages in life cycle management structure and this would offer the other services some significant advantages that they do not presently enjoy.
What is keeping us from doing this today? I believe it is the usual issues of governance, money and protection of service equities. These can and will be addressed in the future and I am very hopeful that within the next several years a joint MRMC will be born.
Q: Following that, with each of the services performing medical research in various forms, what do you do to ensure that there is no duplication of efforts and resources in programs in development?
A: We do presently have other services working on our staff and in our labs. We also have them represented on our Integrating Integration Process Teams, which meet regularly to decide where our capability gaps are and how best to meet them with our existing resources. At Forest Glen, WRAIR is collocated with the Naval Medical Research Center and within the next three years the Navy will be moving their biological defense program to the NIBC at Fort Detrick. Our overseas labs in Kenya and Thailand routinely collaborate with Navy labs in Indonesia, Peru and Egypt. The Armed Services Biomedical Research Evaluation and Management [ASBREM] committee is one of our governing bodies; it meets regularly with multi-service participation to help us set multi-service research priorities and provide a forum for sharing our research strategies.
Q: Other than events like vendor days, how do companies go about doing business with MRMC and letting you know about technologies they have that might fill capabilities needs?
A: We announce all of our research needs as broad agency announcements on the Web so that there is maximum visibility to all vendors and potential researchers. We also have a very active small business recruitment office where businesses can go and tell us of their products so that we can better match them up with our needs. We are also participants in all the major medical symposiums. We actively work our networks with academic and industrial forums to both articulate our needs and to scope out what is on the horizon that could be leveraged. Such opportunities as the Biotechnology Industry Organization and the Advanced Medical Technology Association give us international recognition and exposure.
The MRMC also has direct links to companies in joint development through cooperative research and development agreements.
Q: What are some of the real success stories that reflect what MRMC achieving?
A: There are a number that come to mind quickly:
In July 1999, he became the Chief of the Medical Corps Branch at the United States Army Personnel Command, Alexandria, VA. From May 2002 to October 2002, Weightman served as assistant surgeon general for force projection and then became the commanding general, 3rd Medical Command (Forward), and Coalition Forces Land Component command surgeon for Operation Iraqi Freedom. He later served as commanding general, 44th Medical Command/Corps Surgeon, XVIII Airborne Corps at Fort Bragg, N.C. He was then selected to command the U.S. Army Medical Department Center and School and Fort Sam Houston, San Antonio, Texas, from August 2004 until July 2006. After commanding the North Atlantic Regional Medical Command and Walter Reed Army Medical Center from August 2006 to March 2007, Weightman was assigned to the Office of the Surgeon General until November 2007.
Additional military schools include the Infantry Officer Advanced Course, the Army Medical Department Officer Basic and Advanced Courses, Airborne and Jumpmaster Schools, the United States Army Command and General Staff College, and the United States Army War College.
Weightman is board certified by the American Board of Family Practice and is a Fellow in the American Academy of Family Physicians.
Weightman’s awards include the Distinguished Service Medal, Legion of Merit (three Oak Leaf Clusters), Bronze Star Medal (one Oak Leaf Cluster), Meritorious Service Medal (two Oak Leaf Clusters), Joint Service Commendation Medal, Army Commendation Medal (three Oak Leaf Clusters), Armed Forces Expeditionary Medal (with Bronze Arrowhead device), Southwest Asia Service Medal, NATO Medal, Expert Infantry Badge, Expert Field Medical Badge, Senior Parachutist Badge with combat star, Honduran Parachutist Badge, Meritorious Unit Commendation, and Army Superior Unit Award. He is also a member of the Order of Military Medical Merit.
Major General Weightman was interviewed by MMT Editor Jeff McKaughan
Q: Could we start with an overview of MRMC? How does the MRMC of today look different from the MRMC of a few years ago? How will the next few years impact the organization’s structure and mission?
A: One of the significant attributes of MRMC is that it is not just a research and development command. It performs medical materiel “life cycle management” which means we are involved in the entire product development process from “bright idea” to basic science research, advanced development, to prototype down selection, to acquisition fielding and follow-on support to units with our products. This gives us tremendous advantages and streamlines the entire complex development process because we are involved in every single step. This has not always been the case, and we are unique amongst the services in this approach to medical research and resourcing. For medical chemical and biological defense products, the life cycle program is managed by the Department of Defense and MRMC provides the lead research and development laboratories.
Another big difference I have observed over the last several years is our extensive use of partnerships with not only the other services, but civilian academic institutions, other federal agencies and private industry, including big pharmaceutical companies. Because of these new relationships I believe that we have leveraged science and technology that would not have been available if we had decided to do everything in house. It also keeps us current in this very dynamic scientific environment and gives us a lot more agility to leverage new technology as we continuously try to meet the requirements of the warfighter.
In recent years we have increased our focus on combat casualty care. We have dedicated a tremendous amount of resources into this area, which has resulted in significant improvements in the survival rates of our warfighters on the battlefield. Examples of some of our products include new resuscitative surgical techniques; improved gear for our medics, to include the combat application tourniquet and hemostatic dressings; and improved critical care availability while rapidly evacuating our patients from the battlefield back to the United States.
We are also committing significant resources into the areas of psychological health and traumatic brain injury. Our focus is on predeployment screening, in-theater monitoring, mitigation strategies, and post deployment screening and intervention.
Q: What does FY09 funding—and beyond—look like for U.S. Army medical research? How does Army medical research fair in comparison to the other services’ research funding?
A: Our funding levels are adequate at the present time. We have received significant support from Congress, DoD, the Army, and the Military Healthcare System. I believe that the country recognizes the significance and relevance of our work and, in their continuing efforts to support the warfighter, they recognize the direct impact that our work has on readiness, survivability and performance. The Army presently performs about 70 percent of all of the medical RDT&E within the DoD and we benefit greatly with our significant partnerships with the other services in many areas.
Q: Can you describe the research labs within MRMC? Is there a reason there are six, and what do they each do?
A: Each of our labs has significant and unique capabilities and, between them, they help us cover a wide spectrum of research activities.
The United States Army Research Institute of Infectious Diseases [USAMRIID, Fort Detrick, Md.] specializes in the development of diagnostics, vaccines and mitigation treatments for those select agents that we feel could be used by enemies of the United States. Under BRAC 2005, this laboratory will become the centerpiece of the new Medical Biological Defense Research Center of Excellence. The Walter Reed Army Institute of Research [WRAIR, Forest Glen, Md.] focuses on those infectious agents that our warfighters could be exposed to in their worldwide deployments. These include such well-known agents as malaria, dengue, other tropical diseases, influenza and HIV. The WRAIR also has subordinate laboratories that focus on dental health and trauma research and the effects of lasers on military personnel. Under BRAC 2005, the WRAIR laboratory will become the centerpiece of the new Medical Infectious Disease Research Center of Excellence.
The United States Army Research Institute of Chemical Defense [USAMRICD, Aberdeen Proving Ground, Md.] specializes in research to protect our forces from chemical weapons and includes methods for the prevention, treatment, and diagnosis of those chemical agents that could be used against our forces. Under BRAC 2005, this laboratory will become the centerpiece for the medical chemical defense research aspect of the new Chemical Biological Defense Research, Development, and Acquisition Center of Excellence. The United States Army Institute of Surgical Research [USAISR, Ft. Sam Houston, Texas] focuses on research related to battlefield trauma and burn care. They have a dual mission of research and direct patient care at Brook Army Medical Center. Under BRAC 2005, the mission will increase and the laboratory will be the centerpiece for the new Battlefield Health and Trauma Center of Excellence. United States Army Aeromedical Research Lab [USAARL, Fort Rucker, Ala.] conducts research on medical issues encountered during rotary wing flight. They test medical equipment for airworthiness and are active in research that determines the medical stresses on crew and patients due to flight. They also have significant research on both acoustic challenges on the battlefield and in aircraft, as well as helmet design.
United States Army Institute of Environmental Medicine [USARIEM, Natick, Mass.] focuses on impacts of the environment on the warfighter’s performance. This includes how to minimize the impact of heat, cold and altitude. They also conduct research on improving performance through better rations and nutritional supplements and are also working on technologies to remotely assess a soldier’s physiologic condition.
Even though these labs each have a specific and unique focus, there is considerable exchange of information so we avoid duplication of effort. Having them located at the various locations around the country has been an added benefit because they are generally associated with other organizations within the Army and federal government that are doing related work. For example, the USAARL is collocated with the Army Aviation Center at Ft. Rucker, the USAISR is collocated with the Burn Center at Brook Army Medical Center, USAMRICD is collocated with the Chemical Command at APG, WRAIR is very close to the National Institutes of Health [NIH] in Bethesda, USARIEM is collocated with the Solider System Command at Natick, and USAMRIID will be the cornerstone of the new National Interagency Biodefense Campus [NIBC] at Detrick.
Q: With regards to BRAC, what impact will that have on Fort Detrick itself and more specifically MRMC?
A: BRAC really didn’t influence Fort Detrick a whole lot. We have over a billion dollars worth of new construction going on currently, however, a lot of that was Congressionally directed and unrelated to BRAC.
One example is the National Interagency Biodefense Campus, which was directed by Congress back in about 2001. The campus, which includes us here at MRMC and USAMRIID [U.S. Army Medical Research Institute of Infectious Diseases] along with the Department of Homeland Security which will build the National Biodefense Analysis and Countermeasures Center. This DHS lab will focus on forensics, meaning that if an agent was used somewhere in the country, it would be brought here for analysis to determine where it came from, who made it and what it was.
Additionally, the National Institute of Allergy and Infectious Diseases, a subagency of the National Institute of Health, will build a lab that will concentrate on vaccine research as well as imaging capabilities. With this they will be able to take select agents that there are no known cures for and do various imaging scans to further the search for a cure.
The combination of these various agencies and labs into one campus here at Fort Detrick will help centralize research efforts. So, while not BRAC related it certainly is Congressionally related. The one small piece that is BRAC related is that the biodefense research work that the Navy does will move to Fort Detrick. They will be moving out of WRAIR [Walter Reed Army Institute of Research] and be part of this campus. This is a relatively small portion of all of the new construction that is currently ongoing. If you look around at all of MRMC, probably the place that was affected the most by BRAC was Aberdeen Proving Ground. We have our lab for chemical defense up there. There was a time when people thought that Aberdeen might go away as a part of the process, but it has worked out the other way. A number of different organizations are going to APG which is helping us in that there are other Army systems—chemical systems and Chemical Command, for example, so our lab will have better partnership opportunities. We have also received funding unrelated to BRAC to recapitalize that facility, which will hopefully take place over the next six years.
Q: What about down in San Antonio?
A: On the medical side, other than with Walter Reed and Bethesda coming together, San Antonio has seen the biggest changes.
Basically Wilford Hall, the Air Force’s biggest hospital is joining forces with Brooke Army Medical Center at Fort Sam Houston. All of the inpatient care will move over to Brooke, which is in the process of building a new patient tower—and more research facilities as well. Some of the outpatient facilities will go over to Wilford Hall at Lackland Air Force Base. As part of this, they have formed a new center of excellence for battlefield and trauma medicine. This has entailed quite a bit of construction right where the Institute of Surgical Research and the Burn Center are. In essence, this is more than doubling the space available there with the co-location of various smaller labs.
Q: Is this actual growth in numbers or a realignment of existing facilities and staff?
A: Primarily it is just a consolidation of resources. It is growth in dimensional size and scope by bringing labs and people—both from within and outside the Army—together.
For instance, we have a small dental research unit up in Great Lakes that will, along with the dental research units from the other services, be moving down there to a central location.
Q: Over the years there have been rumblings of centralizing medical services and functions between the services. Any thoughts on the pros and cons of having a single military medical research organization? Would MRMC be in a good position to be the nucleus of such an organization?
A: I think it makes a lot of sense to have a joint military research command. We already collaborate in many ways with the other services and I feel there could be additional benefits by maximizing this collaboration. We have several officers from the other services on staff at MRMC; this has benefited us tremendously because they bring new and fresh perspectives to what we do. However, as we create a new command, it has to be made perfectly clear that each service will still have unique requirements and the new structure must be able to protect these service equities.
I believe MRMC is in position to lead this effort, not only because of the volume of research that we do today, but also because we also execute about 70 percent of the medical research, development, test and evaluation [RDT&E] dollars for DoD. Additionally, as I mentioned previously, I feel very strongly that there are tremendous advantages in life cycle management structure and this would offer the other services some significant advantages that they do not presently enjoy.
What is keeping us from doing this today? I believe it is the usual issues of governance, money and protection of service equities. These can and will be addressed in the future and I am very hopeful that within the next several years a joint MRMC will be born.
Q: Following that, with each of the services performing medical research in various forms, what do you do to ensure that there is no duplication of efforts and resources in programs in development?
A: We do presently have other services working on our staff and in our labs. We also have them represented on our Integrating Integration Process Teams, which meet regularly to decide where our capability gaps are and how best to meet them with our existing resources. At Forest Glen, WRAIR is collocated with the Naval Medical Research Center and within the next three years the Navy will be moving their biological defense program to the NIBC at Fort Detrick. Our overseas labs in Kenya and Thailand routinely collaborate with Navy labs in Indonesia, Peru and Egypt. The Armed Services Biomedical Research Evaluation and Management [ASBREM] committee is one of our governing bodies; it meets regularly with multi-service participation to help us set multi-service research priorities and provide a forum for sharing our research strategies.
Q: Other than events like vendor days, how do companies go about doing business with MRMC and letting you know about technologies they have that might fill capabilities needs?
A: We announce all of our research needs as broad agency announcements on the Web so that there is maximum visibility to all vendors and potential researchers. We also have a very active small business recruitment office where businesses can go and tell us of their products so that we can better match them up with our needs. We are also participants in all the major medical symposiums. We actively work our networks with academic and industrial forums to both articulate our needs and to scope out what is on the horizon that could be leveraged. Such opportunities as the Biotechnology Industry Organization and the Advanced Medical Technology Association give us international recognition and exposure.
The MRMC also has direct links to companies in joint development through cooperative research and development agreements.
Q: What are some of the real success stories that reflect what MRMC achieving?
A: There are a number that come to mind quickly:
- Joint Theater Trauma Registry
- Joint Trauma Analysis and Prevention of Injury in Combat
- Resuscitative medicine
- Tourniquet use
- Increased survivability on the battlefield
- Adenovirus vaccine
- Dengue vaccine
- Bioscavengers
- Telemedicine
- Pre- and Post-deployment mental health screening
- Ebola virus vaccine
- Sound-reducing stethoscope
- Leishmania topical antibiotic
- Nutritionally balanced ration
- Battlemind training
Q: Are there any new programs expected to start in the coming year? What is the trigger that initiatives new programs and what process do suggestions go through to decide on whether to fund new programs or not?
A: We’re very excited about two new areas that are just getting started.
The first is the Defense Center of Excellence for Psychological Health and Traumatic Brain Injury. The center will focus on these two very relevant and complex health issues and will be looking at all aspects of them from diagnostics, to treatment modalities, and to mitigation strategies.
The second area is that of regenerative medicine. We are helping to establish the Armed Forces Institute of Regenerative Medicine in collaboration with several partners, to include NIH, the U.S. Department of Veterans Affairs, and two major clinical consortiums headed up by Wake Forest University and Rutgers University. The goal of this new effort is to produce five new products for our wounded warriors over the next five years. Examples of the products include growing new digits, facial reconstruction, and burn healing without scarring. Pretty exciting stuff.
The process for identifying new programs is multifaceted. We are a requirements-driven organization. Warfighter medical needs are translated through the Army Medical Department Center and School to formal requirements that become the basis for new or expanded budget requests. Increased funding is then put to use filling technology gaps that ultimately put products into the hands of the warfighter that meet their medical needs. The DoD and the Department of the Army have processes for determining medical research requirements that lead to new programs. Within our overall budget there are some discretionary funds that I can direct to specific research areas as new requirements are identified. If funds are not immediately available for new technology or requirements, I can also go the Medical Command, the Defense Healthcare Program, or the assistant secretary of the Army for Acquisition, Logistics and Technology to ask for assistance in different funding programs. As I mentioned previously, we have Integrating Integration Process Teams that meet several times a year to identify and prioritize our research goals and, based upon their recommendations, we allocate our existing research budget or program for future years’ research dollars. Additionally, Congress appropriates annual funds that are directed for specific scientific areas.
Q: Is there a priority or heavier emphasis on research projects that deliver prevention of illnesses or wounds, or more towards treatments and cures?
A: It is without a doubt a balanced effort. Much of what we do is driven by science—what’s doable. We are a very product-oriented command. I can’t spend 15 to 20 years doing basic science and never delivering anything to servicemembers.
We certainly do some of the basic research in order to get to the next step. And that goes for whether its prevention, detection or mitigation—it’s all the same in that you have to go where the science will let you go. This will vary from disease to disease as to which path we choose in each case.
Obviously, we would like to prevent things before that happens, but quite honestly, as an R&D community—not just here at MRMC—we haven’t done a good job of selling what we do. It’s difficult to say that we have kept 20 percent of the force from getting sick—how do you quantify that because they didn’t get sick. It’s difficult to come up with statistics that support some of our efforts where as it is easier to quantify how people are saved once they become wounded or detect with this assay or piece of equipment a disease in significantly less time than ever before.
We are working all three—prevention, detection and mitigation— equally and at the same time.
Q: Previously, I have heard you talk about systems biology and what it can mean to MRMC and medical research. Tell me what that is and where the benefits come from.
A: Systems biology is not something that is just within medical R&D but is really a new way of approaching how problems are attacked. Instead of just having a biologist look at malaria for example, you may want to have a chemist, a physicist, a public health representative all look at that disease from a systems point of view. Looking at the disease and how it affects one person differently from another requires different specialties to see why someone is more susceptible than another. What is in an individual’s genes that determines this and how can it be quantified.
This technique, systems biology crosses traditional stove-piped scientific specialties to look at the whole system—not just the bug but the environment, the host and the victim, and how they all interact. It goes from learning more about the genes and beyond to the proteins and what they do and other interactions they can cause.
I am very excited about this within the command. We are starting to look at issues in this systems biology approach instead of the more traditional methodology. This is all relatively new and extremely exciting and we are starting to change our business and scientific practices to position ourselves for the future and take advantage of this cross-fertilization and work together. It is a matter of changing culture and how things have been done for quite awhile.
We are setting up training and education mechanisms to help people understand and transition to this horizontal integration of scientists and researchers.
There is also a funding issue dealing with how we alter funding paths to reflect this cross-over of efforts. So much of the money that MRMC receives is already earmarked for specific areas. I do have some flexibility in moving that between programs but we might also need to educate those that allocate the funding at the top end so they understand what the benefits are.
Q: I understand that William Howell, SES, principal assistant for acquisition, is leaving MRMC later this year. How would you characterize his contributions to the medical acquisition process at MRMC?
A: Mr. Bill Howell is a godsend and has single handedly had the greatest impact on MRMC of anyone that has ever worked here. He will be retiring this fall and we will miss him tremendously. Bill is a master of the acquisition process; however, his true value is in making a seamless transition from our advanced development concepts to acquiring real products that we can provide to the warfighter. His exceptional knowledge of the Food and Drug Administration procedures and extensive work with the pharmaceutical industry helped us rapidly move drugs and vaccines from the lab to production. He understands the language of medical researchers and has been a master at articulating the acquisition requirements to them, and vice versa. He has such great credibility and trust within both the medical and acquisition communities that when he talks, everyone listens. When I talked earlier about medical materiel “life cycle management” and its benefits for MRMC, Bill was the major force in making that concept so effective.
Q: What role does MRMC play in either finding prevention techniques, determining detection methods or finding treatments for post traumatic stress disorder [PTSD]?
A: This is certainly a very relevant topic. I actually am not a fan of talking about PTSD unless we are talking about a specific person or disorder because, quite frankly, I think psychological health is a better term to use to put the whole thing in the right context.
Many of the people that we are talking about within the services have been exposed to some extraordinary circumstances in combat. So, how do you react to very traumatic events—close combat, battlefield wounds to those in your unit or even to yourself, for example. Individually, we all have to react to that and there is normal process for doing so. Some people have more difficulty than others and these are the ones that probably have PTSD. But we all have post traumatic stress it’s just a matter of how each individual addresses it.
That’s why I approach the subject in this manner and like to make that distinction because we are still learning about this whole process of how to deal with traumatic events. We are looking at this from a variety of different angles. We are looking at genetics—some individuals may be better equipped to handle stress than others. Another consideration is how does a person’s environment or past—family life or training for example—either aids in handling stress or makes one more vulnerable to stress related issues.
We are working to identify those factors—genetic, neurochemical, as well as the environmental issues that influence how each of us deals with stress. We are also looking at what goes wrong, and once we can identify and quantify what the difficulties were in handling stress conditions, then we can look at how to mitigate those issues. This is the spectrum of psychological health and hopefully just a small portion of those people on the far end actually cannot make it through the process and come out psychologically healthy.
Additionally, our Military Operational Medicine Research Area Directorate has been very aggressive in developing multiple “Battlemind” training regimens to increase the resiliency of our warriors to traumatic stress. This training has been expanded to predeployment, during deployment, and postdeployment modules, as well as other programs oriented towards commands and family members.
Scientifically, we are at the very front-end of looking at this and trying to quantify it. We are now able to quantify much more than we have in the past because of the tremendous advances in the overall scientific community in the last five to 10 years in neuroscience and specific neurotransmitters that are responsible for pain, pleasure, depression and so on. Couple that with genomics to help figure out individual traits and tendencies.
MRMC’s doing some of the basic science research but our big role is that we have been asked by the Department of Defense to be the integrator. There is actually a center of excellence standing up right now directed by Brigadier General Loree Sutton. She has been given the task and funding to be the lead in looking at traumatic brain injury and psychological health. Her center has been stood up to first educate the public and second, to coordinate the research efforts around the country by determining what is being done and identify gaps in the research, and where more effort is needed. Her center is also to act as the central point of contact—be a central clearing house—as we get new clinical practice guidelines on how to standardize treatments.
We are working with them, primarily on the research and development phase to help them identify those gaps in research and who the subject matter experts in academia, pharmaceutical and industry are to facilitate progress.
Knowing what is being done, where and how, is crucial to progress so resources are put to best use and not duplicated. In some ways, however, duplication of effort is not necessarily a bad thing and in certain cases you want some duplication. It works to validate those efforts, and you also find in many cases that while two efforts may start out at the same point different branches and sequels of their research take them towards different solutions. Basically a little redundancy is probably desirable—a lot of redundancy is not. Congress also funded the Department of Veterans Affairs with a significant amount for research in this area and we are coordinating with them to make sure that we are doing collaborative research. There is a lot of money involved addressing this issue and we are making sure it is used efficiently for the best end results.
Q: Any final thoughts?
A: This command is a true national treasure and the intellectual capital that it represents cannot be overstated. We are focused on delivering products to our nation’s armed forces and to the country as a whole—we have a tremendous track record of achievement of which we should all be proud. As a result of our research, we are literally changing the way America treats trauma patients around the country. Eight of the 12 most common vaccines used today in America have a military research legacy. We have helped our warfighters achieve the highest survivability after battle injury and the lowest disease and non-battle injury rates in the history of the world. I am confident this command will continue to provide every possible advantage to medically support our warfighter, no matter where in the world he or she is deployed. •