UK: The Guardian: "British army veterans denied treatment for brain injuries"

"They have seizures and brain damage but the MoD insists their illnesses are psychological. Now scans could help thousands of soldiers who have been misdiagnosed"

....

"For years, the NHS and the Ministry of Defence have insisted this and other blasts to which Edwards was exposed in a long army career did him no lasting physical harm. They have made the same assertion to many other veterans, claiming their debilitating symptom are psychological, not physical, in origin.


Now an advanced diagnostic technology, magnetoencephalography (MEG), is enabling patients’ brains to be scanned, providing maps and locations of brain injuries with precision. It is set to shake the MoD view to its foundations."

....

"Neil and Becky Edwards say the refusal of the NHS and MoD to accept that his symptoms have a physical origin makes his condition much harder to deal with. Officially, his fits are termed “psychogenic non-epileptic seizures”, a product of his PTSD. “That means psychological therapies are pushed on to Neil that we know don’t work,” says Becky. “He’s constantly asked to relive the experiences that made him a different person. It’s hard to get him to go to an appointment, because to Neil, there’s no point.”

https://www.theguardian.com/society...-veterans-denied-treatment-for-brain-injuries

 

https://www.gov.uk/government/news/professor-awarded-knighthood-for-service-to-military-healthcare

 

"MEG scans have been used to help diagnose TBI in veterans by the US government for more than 10 years. Yet in Britain, an MoD spokesman told the Observer they are seen merely as a “promising technique” that needs further research. He added: “The health and wellbeing of our armed forces is critical. We provide a treatment programme for traumatic brain injuries at the Defence Medical Rehabilitation Centre in Nottinghamshire and are working on a national research programme to advance diagnosis, management and rehabilitation in the area of brain injuries and PTSD.”"

What does that response mean? It doesn't even have the good grace to focus the answer directly on the MEG scan - indeed one could take from that they are saying they are perfectly happy doing what they are doing without them. Thank you.

Also doesn't sound like they are particularly grateful of tech being developed that takes the interpretation out of the hands of neurologists or of them not being able to offer the scans, because that would take too much time/resource of maybe staff that they are short on.

Normally the following sort of thing would be met with an 'this is an exciting development' type reply:

"Until recently, the problem was that analysing the MEG scan data had to be done manually, a process that took many days. The recent breakthrough, made by British medical software company Innovision IP, is the development of a computerised method that cuts the time to produce a report, so greatly reducing cost – a scan plus analysis starts at £5,000 per patient."

 

I checked MEG on PubMed and found a systematic review from the last year. Basically it seems to say that nobody knows whether MEG is useful in this situation. There is no usable evidence (see below). The doctor quoted in the article above works for a private company. It doesn't sound like a story to pin much hope on.

Abstract
Background: The global incidence of traumatic brain injuries is rising, with at least 80% being classified as mild. These mild injuries are not visible on routine clinical imaging. The potential clinical role of a specific imaging biomarker be it diagnostic, prognostic or directing and monitoring progress of personalised treatment and rehabilitation has driven the exploration of several new neuroimaging modalities. This systematic review examined the evidence for magnetoencephalography (MEG) to provide an imaging biomarker in mild traumatic brain injury (mTBI).

Methods: Our review was prospectively registered on PROSPERO: CRD42019151387. We searched EMBASE, MEDLINE, trial registers, PsycINFO, Cochrane Library and conference abstracts and identified 37 papers describing MEG changes in mTBI eligible for inclusion. Since meta-analysis was not possible, based on the heterogeneity of reported outcomes, we provide a narrative synthesis of results.

Results: The two most promising MEG biomarkers are excess resting state low frequency power, and widespread connectivity changes in all frequency bands. These may represent biomarkers with potential for diagnostic application, which reflect time sensitive changes, or may be capable of offering clinically relevant prognostic information. In addition, the rich data that MEG produces are well-suited to new methods of machine learning analysis, which is now being actively explored.

Interpretation: MEG reveals several promising biomarkers, in the absence of structural abnormalities demonstrable with either computerised tomography or magnetic resonance imaging. This review has not identified sufficient evidence to support routine clinical use of MEG in mTBI currently. However, verifying MEG's potential would help meet an urgent clinical need within civilian, sports and military medicine.

 

The pharmaceutical industry is often rightfully blamed for having this model where they're not incentivized to cure diseases, or develop better treatments than marginal ones that keep people as captive customers. But frankly much of health care has the same approach, when lots of people have invested their efforts into some useless thing that they successfully marketed and something comes along to threaten it, they feel the same kind of pressure to keep the failed thing rolling.

In the end it's bad incentives. There just aren't many good incentives, it mostly works on an honor system that assumes good faith and refuses any refutation of that belief. It's hard to miss once you start seeing it. There are people who want to move forward, but most would rather keep doing the thing they're comfortable with, and retraining is such a pain in the ass.

That's mostly true everywhere. It's just that somehow people expect health care to work differently. Somehow.

 

Blast injuries are overly well-reported causes of ABI. The situation is crazy over here. Are there several different beliefs about what Cancer is or is there universal agreement? I'm not sure how the UK is able to differentiate its interpretation of brain injury from the US.

 

Perhaps the problem is the pressure on the NHS. Traumatic Injury medical care is costly. If they head down in the correct direction, the funding pressures would be immense, whereas the system is different in the US.

The new question is should the NHS become privatised if it cannot cope with medical advancements?