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Wed Nov 7 23:04:55 GMT 2007

I read the article.   In my reading there was ONE MAJOR message  and one that 
we should all endorse.  

Our treatments, be it in the hospital, clinic, emergency room, or war zone  
should be contemporary and based on clear scientific evidence.   It is  
inappropriate to use outdated or urban legends type information, especially when  
there is an opportunity to evaluate our new cutting edge treatments.   

What Dr. Holcomb and the article did NOT say, is that with EVERY military  
campaign back as far back as records have been kept, we have made advances  
because of record keeping, and in comparing methods of  treatment.    And with 
such evidence based medicine, new  advances are available to both civilian and 
military practice.   Some  examples of such progress based on  data analysis 
include:    Rapid transport by ambulance (Larrey), Trauma registries (Florence 
Nightengale),  Blood banking, vascular trauma options, use of air vs ground 
ambulance, MAST  trousers, treatment of colon injuries, missile wounds in and 
around the heart,  damage control, use of tourniquets, choice of resuscitative 
fluids, treatment of  burns, treatment of blast, and on and on and on.      

TO NOT KEEP DATA, COMPARE TREATMENTS AND OUTCOMES, AND TO SCIENTIFICALLY  
ANALYZE THE LARGE AMOUNTS OF DATA WHICH CAN BE ACCUMULATED DURING WARTIME,  
RELATING TO INJURY, FROSTBITE, BURNS, INFECTIONS, MENTAL HEALTH, COMMAND,  
ADMINISTRATION, RESUPPLY, ETC. ETC. WOULD BE IRRESPONSIBLE ON THE PART OF THE  
SCIENTIST SURGEON.    WE HAVE ALWAYS DONE SO, AND ALWAYS MUST. 

Is this human "experimentation?"   Of course not, it is a sign of  
responsible leadership.    It is responding to an opportunity to  keep and closely 
analyze data which has been determined ahead of time to be of  value to either 
continue old treatments, introduce new ones, or make mid course  corrections.      
Some of the US Military  Regulations MANDATE such analysis of data collected 
during wartime, comparing  alternate actions.   Other US Military Regulations 
prohibit such  things as RANDOMIZATION.   As I read them, it seems that the 
dicotomy  is not on the part of the Military Medical Establishements, but in the 
 conflicting writings of the regulations.    I would STRONGLY  support 
responsible leadership continuing to treat wounded soldiers with the  latest known 
knowledge, while using every opportunity to collect NEW KNOWLEDGE  in a 
responsible and evidenced based manner.    

Finally, and this is an invitation to any one at any level who might be  
committed to holding back our military medicine capabilities to be at a level of  
the last war, I would offer the following opportunities.   

IF MILITARY REGULATIONS PROHIBIT THE MILITARY FROM DEVELOPING A  CLINICAL 
EVALUATION AT THE SAME LEVEL AS THOSE AVAILABLE IN CIVILIAN SURGICAL  AND MEDICAL 
PRACTICE, MANY ORGANIZATIONS EXIST, (BOTH PROFESSIONAL ASSOCIATIONS,  AND 
INDIVIDUAL SURGICAL PROGRAMS IN MEDICAL SCHOOLS) WHERE A VERY RESPONSIBLE  IRB 
GIVES PROFESSIONAL OVERSIGHT.    MANY OF US WOULD BE HAPPY TO  DEVELOP AND 
ADMINISTER SUCH REVIEW OF NEW KNOWLEGE, INCLUDING APPROPRIATE AND  SCIENTIFIC 
RANDOMIZATION, FOR ANY BRANCH OF THE MILITARY.    

By this e-mail, I am appealing to the highest levels of the military, up to  
and including the Surgeons General and the Deputy Secretary of Defense for  
Health Affairs and the newly nominated Secretary of Veterans Affairs to join  
with each of us to assure that wounded US soldiers continue to receive the  
highest degree of medical and surgical care, commensurate with contemporary  
trauma centers.    This includes a data registry and  randomization of existing, 
standards of practice and comparisons to emerging  treatments which IRBs would 
approve and monitor.     Should  this very sound surgical principle violate 
some outdated military regulations,  then I would plead to the highest, HIGHEST, 
level of our military leadership, up  to and including the President of the 
United States, to change the regulations  to put the soldier, sailor, marine, 
and governmental official on the same level  as most civilian trauma centers in 
the United States.  

Kenneth L. Mattox, MD
Houston

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