An Interesting Followup to Military PTSD Fraud

Uncle Sam says: I want YOU on disability!

Last week the International Congress of Schizophrenia Research was held in San Diego. Since our lab is local, we hosted a number of visiting scientists, each of whom came by to check the place out and give a talk. It was nice; there was a lot of free food. 

Anyway, one of the visitors was a member of a relatively well known east coast institution that has one of the best brain banks out there. 

I'll tell you something about brain banks - their contents might as well be gold, especially for banks that focus on psychiatric and neurological diseases. To understand why, imagine that you've been tasked with curing Alzheimer's disease or schizophrenia and you have absolutely no idea what causes the disease you're in charge of fighting. Apart from genetic interrogation studies, looking at the actual scene of the crime (the brain in question, as it were) is the best way to figure out what's really going on.  

Getting back to the point, our visitor was mentioning that they had a large collection of postmortem brains from patients suffering from a variety of diseases, including schizophrenia, bipolar disorder... and post traumatic stress disorder. The PTSD brains were being built as part of a contract with the federal government via the VA hospital. PTSD claims on the rise, and an increasingly broad segment of resources is being brought to bear as pharma companies see an ever-growing patient population. 

Thinking back to my previous post on PTSD fraud, I interrupted the speaker to ask how they selected PTSD brains for inclusion in their collection. It was kind of obvious he was a little confused why I would ask (PTSD wasn't his area), but he seemed to understand when I elaborated my concerns. Put simply, there are a massive number of false cases of PTSD reported by veterans for the purposes of obtaining disability benefits. This, in turn, flags a large number of individuals as having PTSD who are, if not completely healthy, than at least free from PTSD.

When an organization wishes to build a brain bank of PTSD patients, they use the same databases to obtain potential donors. I'd make a rough guess that three-quarters or more of the PTSD claims are baseless. Even with extreme vetting, I'd wager that a fair number of "normal" brains find their way into the pool of PTSD brains. 

This is a massive problem for several reasons. Biologically, a small number of contaminating samples can be disastrous for human studies. Humans have a massive range of biological heterogeneity compared to inbred rodent strains, which is further complicated by the differences instigated by lifestyle differences (age, sex, weight, smoking, drugs taken for other conditions, just to name a few). These factors require sophisticated statistical normalization to parse, which is aided by increasing the size of the examined cohort. Human tissue is already expensive to obtain and maintain in collection; increasing sample size enough to overcome these side factors makes many investigations (particularly hypothesis-driven studies, which are all-or-nothing affairs most times) prohibitively expensive. When you add a significant numbers of normal brains to the PTSD population, it draws the values of the "diseased" group towards the control population, potentially masking or reducing real effects that could be the basis for further study or drug intervention targets. By admitting fakers to this pool, we are putting chicken shit in the chicken salad.

Unfortunately, there aren't good biomarkers for PTSD to identify the fakers. We have to take psychologists' word for it. In the case of the institute I mentioned, the speaker said that they had two psychologists examine each PTSD case. From what I could tell, neither of them interviewed the corpses, so I tend to doubt that this strategy was completely effective in weeding out the massive number of fraudulent PTSD cases. 

It's a real shame that this fraud will almost certainly delay meaningful treatments for PTSD. I don't doubt for a second that this disease exists. My father treated several individuals with the condition, and it's a disease that leaves you physically indistinguishable but psychologically (possibly neurologically) scarred in ways we don't yet understand. Were I in charge of PTSD research efforts at a center with significant resources, I would throw my money into identifying physiological or biochemical alterations that accompany PTSD, allowing us to create a black-or-white test to identify real patients from those who just want the government dole.

As an ancillary point, it's worth noting that the leading causes of disability in the US are now musculoskeletal problems (read: back pain) and mental disabilities, reflecting a significant increases from fifty years ago (interesting to see musculoskleletal problems on the rise, considering work is far less manual these days). While some of this is due to increased diagnostic and detection standards, it's worth pointing out that these are problems with few true diagnostic measures other than the patient's own claim that they're suffering. So yeah, the numbers of lying assholes seem to be on the rise everywhere.