They’re not just ‘headaches.’ Traumatic brain injuries are real. And serious.

cdctbi-300x213The nation’s commander-in-chief did a big disservice to recently injured service personnel and others who have suffered traumatic brain injuries by dismissing what happened as “not very serious” and just “headaches” of little consequence.

Pentagon officials sought to deflect attention from President Trump’s comments at a global economic forum in Davos, Switzerland — off-the-cuff remarks assailed by veteran groups.

Trump, asked about the rising number of service personnel who have been sent for advanced diagnosis and treatment at facilities outside the Mideast, where they were subjected to an Iranian missile attack, made this counter factual comment:

“I heard they had headaches. No, I don’t consider them very serious injuries, relative to other injuries that I’ve seen.”

The president sought to contrast the Jan. 8 injuries suffered by U.S. forces in Iraq with service personnel wounded in the region by roadside bombs, the Associated Press reported, with him saying: “I’ve seen people with no legs and with no arms. I’ve seen people that were horribly, horribly injured in that area, that war.” Of potential traumatic brain harms, he said, “No, I do not consider that to be bad injuries, no.”

The AP reported key background on the Trump statements, criticized by veterans:

“Trump has repeatedly claimed that no Americans were harmed in the Iranian missile strikes on Jan. 8, which came in retaliation for a U.S. drone strike that killed Qassem Soleimani, Iran’s top general. And Trump had said that outcome drove his decision not to retaliate further and risk a broader war with Iran. But in the days following the Iranian attack, medical screening determined that some of the U.S. troops who took cover during the strikes were suffering from concussion-like symptoms.”

The Pentagon has defended its disclosures about the personnel injuries, which have grown steadily from the president’s claim of zero to 11 who were flown out of Iraq on Jan. 10 and Jan. 15 for further examination.

The Washington Post reported that 34 service personnel now have been diagnosed with varying degrees of brain trauma:

“Eight service members who were removed from Iraq for additional treatment at Landstuhl Regional Medical Center in Germany have returned to the United States for more medical care, while nine others remain in Germany, Hoffman said. The remaining 17 who were diagnosed with concussions … have been returned to duty, he said. All of those still receiving care are doing so with outpatient status …. Some will be sent to Walter Reed National Military Medical Center outside Washington, while others will return to their home bases.”

With the rising casualty report, the Veterans of Foreign War became the largest such group to publicly criticize the president’s remarks, the Washington Post reported. “The VFW expects an apology from the president to our servicemen and women for his misguided remarks,” VFW National Commander-in-Chief William “Doc” Schmitz said in a statement.

Earlier, Paul Rieckhoff, founder of Iraq and Afghanistan Veterans of America, condemned Trump’s remarks on the service personnel injuries, saying they were “really counterproductive because we’ve worked for the last decade and a half to highlight and educate people about the invisible injuries of war. He really displayed remarkable ignorance about what could be the signature injury of our generation.”

Randy Reese, executive director at the Washington, D.C., headquarters of the Disabled American Veterans, told the Wall Street Journal: “It just appears the commander-in-chief is somewhat out of touch regarding the seriousness of this injury. There is no mild TBI that doesn’t have consequences.”

The newspaper also reported this:

“Retired Gen. Pete Chiarelli, who led efforts to recognize and treat brain injuries before retiring in 2012, said brain injuries can be more difficult to treat than injuries to arms and legs. ‘The fact is we know so little about the brain that long after we sought to treat the loss of a limb, we are faced with an inability to offer the same kind of relief from the resulting traumatic brain injury,’ he said.”

The president’s remarks stunned military personnel, not just for their disrespect of the injured but also because the armed forces have focused so much on brain trauma and its sustained damage to fighting personnel, the AP reported:

“Traumatic brain injury, or TBI, has been an increasing cause of concern in the military since the conflicts in Iraq and Afghanistan began, with the Department of Defense reporting more than 375,000 incidents between 2000 and 2018, according to a National Academy of Sciences report released last year. The Centers for Disease Control and Prevention reports that the effects of a TBI can vary significantly depending on the severity — ranging from short-term symptoms to life-long debilitating impacts on cognitive and motor function and behavior, including significant changes in thinking and behavior, depression, anxiety and aggression. In 2014 alone, TBIs resulted in approximately 288,000 hospitalizations and were related to nearly 57,000 deaths. ‘Each year, TBI causes a substantial number of deaths and leads to life-long disability for many Americans. In fact, TBIs contribute to about 30% of all injury deaths in the United States,’ the CDC reported. It added that, ‘The consequences of severe TBI can affect all aspects of an individual’s life, including relationships with family and friends, the ability to progress at school or work, doing household tasks, driving, or participating in other daily activities.’”

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be wreaked on them by spinal cord and brain injuries, notably the traumatic type associated with sharp or repeated blows to the head.

In recent years, as fewer politicians have records of military service, presidents, especially, have walked a careful line about matters affecting the armed forces, particularly the grave responsibility of putting American lives in harm’s way. Trump, who avoided military service in Vietnam due to a dubious claim of bone spurs in his heels, has shown little reluctance to excoriate the nation’s military leaders and assert his superior knowledge. He has mocked the disabled, tangled with grieving families who have lost kin in combat, and has built a record of waging war on science or medical evidence in his behavior and policies as president.

This is unhelpful, as the veteran groups have noted, and it contrasts to the growing evidence and public disapproval of situations where individuals may suffer serious and sustained damage due to brain trauma, notably through concussions. This has become a major concern of student and professional athletes, parents, colleges and universities, and sports leagues — amateur and pro. The National Football League, as of January 2020, has paid out almost three-quarters of a billion dollars to resolve with players claims about concussion damages. This did not occur, of course, before the NFL, National Hockey League, and other groups resisted the medical evidence of brain harms tied to their sports. It has taken tough campaigns by researchers, players, and their families to overcome counter factual campaigns about TBI and to safeguard the vulnerable from avoidable injury.

Sure, the Republicans in Congress and the president have pumped billions of dollars more into military budgets, enriching already wealthy corporations that make the arms and supplies our forces require. But voters in the upcoming elections may want to remember and to look closely at the character of a leader who, in the posh confines of a conclave of some of the wealthiest people on the planet, shows little regard for fighters in the field and the different ways they may be harmed, including when a barrage of rockets explode on top of them.

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