The battle for healthy soldiers

The IDF Medical Corps teams up with a new Jerusalem military medical studies track for research advances on the battlefield and off.

By JUDY SIEGEL-ITZKOVICH
shmuel shapira 311 (photo credit: Judy Siegel-Itzkovich)
shmuel shapira 311
(photo credit: Judy Siegel-Itzkovich)
In the bad old days, soldiers were sometimes regarded by the Israel Defense Forces as a potential reservoir of subjects for medical experiments in fields related to the military – without being told if those experiments were risky. The IDF argued that such research findings could save lives. Formally, they had to “volunteer” for clinical trials of experimental antidotes to anthrax, nerve gas and other toxic substances, but many were actually pressured to agree if they wanted to get into elite fighting units or gain certain privileges, such as being exempt from guard duty. The Health Ministry did not supervise these studies, and no approval from independent Helsinki committees on human medical experimentation was required.
Fortunately, thanks to lawsuits against the IDF and lobbying by activist organizations such as the Israel Medical Association and Physicians for Human Rights-Israel, that era of “human guinea pigs” is past. Human medical experimentation may no longer be conducted in the IDF without ministry supervision, Helsinki committees and “informed consent” similar to that required by clinical experimenters in the civilian population.
THE SITUATION improved in the 1990s, as soldiers became more aware of their rights and the IDF realized it had to conform with civilian procedures.
A plea to the High Court of Justice in 2008, followed by a government bill that established strict rules for the IDF Medical Corps, created a system similar to what exists in Israeli hospitals and other research institutions. The Medical Corps opened a special office for accepting health complaints from participants in medical experiments, informing them exactly what substances were tested on them and receiving requests for disability payments.
The establishment of Jerusalem’s IDF/Hebrew University-Hadassah Medical School’s military medicine track – known by the Hebrew acronym Tzameret (“the Acme”) – is promoting joint military medicine research by the two “parent” institutions. The growing shortage of career physicians in the military, and the special type of doctors needed in the IDF were the impetus behind the move. Jerusalem was chosen for the special school after beating Beersheba’s Ben-Gurion University of the Negev in the tender.
Although the IDF has an Atuda (academic officers’) medical program, few 18-year-old highschool graduates have been attracted to it, and only Ben-Gurion University has been able to persuade even a small number to join every year. After graduates complete their IDF service, most will work in public hospitals and clinics. Tzameret students, who commit themselves to serve in the IDF for a number of years after graduation, study all the subjects on the regular HU-Hadassah Medical School curriculum, in addition to taking additional courses relevant to the military, including military physiology and ethics, crisis management, emergency medicine and leadership development.
They are also exposed to other areas of study, such as law, business administration and public health.
THE FIRST class had 50 students, while the current one has 62, according to its head, Prof. Shmuel Shapira, who was addressing a recent clinical conference on military medicine in the auditorium of Hadassah-University Medical Center in Ein Kerem. A specialist in conventional trauma, terror medicine and non-conventional weapon threats who advises the IDF about prevention of and response to potential biological, chemical and nuclear attacks, Shapira was previously head of the Hebrew University-Hadassah Braun School of Public Health and Community Medicine.
He noted in his presentation that most of military medicine involves treatment of wounded “but not only.” In addition, there is a focus on climate injuries, ballistics, stress fractures, effects of blast, situations of extreme stress and responses to unconventional chemical, biological and radiological arms, he said.
Shapira noted that the students are taught about battlefield medicine, exposure to dangerous substances, terror attacks, mental illness, ethical problems and much more. “There are already many specialized medical journals [in English] devoted to military medicine. Now Tzameret has helped establish the Hebrew-language Journal of Israel Military Medicine.
The beginning of military medicine followed the 16th-century invention of gunpowder. “It was a revolution,” Shapira told the audience of senior Hadassah medical center staffers, IDF Chief Medical Officer Aluf-Mishne Nahman Ash and others.
“From then on, hell was the limit,” so that today, armies and home fronts face the threat of anthrax powder in the mail, phospho-organic weapons and even nuclear bombs and fallout, Shapira said.
Sgan-Aluf Dr. Yossi Mendel, who heads the IDF Medical Corps’ research and external relations unit, said the research subjects in the military are varied, and include how best to treat soldiers in the field; preventing illness and suicide; coping with high G forces during flight, pilot exhaustion, post-traumatic stress disorder and other mental-health issues.
The unit receives “dozens of research proposals annually, but can fund only some of them,” said Mendel. “We have separate institutes for naval and air force medicine, and one for military physiology.
We put stress on studies the results of which can easily be applied rather than on basic research. We don’t have the budget to go all the way from animal research in the lab to approval by the US Food and Drug Administration, but when there is a product possibility, we encourage other research institutes to run with it.”
Among actual products that have been developed are a small, mobile oxygen generator that can be used in field situations to keep soldiers alive; this work was done by MAFAT, the Defense Ministry’s R&D department. Another welcome IDF technology under development is the freezing and drying of soldiers’ blood, which can then be stored for several years; if they need a transfusion, the powder – carried by medics – could be mixed with water like freeze-dried coffee, filtered to prevent harm to the kidneys, and then given to those who are bleeding. Mendel noted that the US military has already shown an interest in this technology.
Other works in progress involve biosensors, neuroprotection, magnetic spectroscopes to assess metabolites that might predict a wounded soldier’s chances for survival, and the measurement of stress symptoms with imaging systems.
ESTHER SHAHIMI of the pharmacology department of Hebrew University’s School of Pharmacy noted that trauma to the brain is the leading cause of death in young people aged 15 to 35. “Nothing has succeeded in curing brain trauma; there is supportive treatment, but no cure for it. Trauma sets off a chain of events that can take, minutes, hours or longer. It involves an imbalance of ions due to the flow of calcium ions and glutamate into nerve cells. The next step is inflammation, and an inadequate amount of oxygen can result in minutes. Each part of this process could be the focus for developing drugs.”
Shahimi noted that various companies tried to find treatments in the 1990s, but all failed.
“They had success with lab animals, but not with humans. If a drug that worked with lab animals is given to soldiers or other trauma patients only hours later, when they reach hospital, it will be too late to have an effect.”
Her team worked on a mouse model using dcycloserine (that is already being tested clinically for schizophrenia) and a cognitive enhancer for Alzheimer’s patients. This seems to be effective as much as 24 hours after a trauma instead of only immediately afterwards, she said. “It improves motor and cognitive functions. We also found that it produces benefits after being given only once.
We will start clinical trials soon with the IDF.”
Hadassah senior orthopedist Prof. Charles Millgrom described a study he led that compared IDF trainees with haredi yeshiva students who did not serve.
When bone density was tested, no difference was found between the soldiers, who exerted themselves physically, and the yeshiva students, who spent most of their time in chairs or standing.
But the trainees were found to have stronger bones, apparently due to the higher amounts of calcium in their diets. Yeshiva students consumed less calcium than recommended. Trainees also burned more calories, largely due to the exercise they did daily; the yeshiva students got almost no exercise. Another major difference is that yeshiva students had larger waists (representing more fat) than soldiers, who were in better cardiovascular condition, but displayed more spinal atrophy than the sedentary yeshiva students.
Soldiers benefit from medical research, said Sgan- Aluf Dr. Yuval Heled of the physiology department of the IDF Medical Corps. “A soldier’s exposed to a great deal of physical and mental stress; he needs the proper food, drink and sleep. He often carries heavy burdens on his back, and may have to function in very hot or cold environments.
Physical stress can even kill in hot weather.
“It’s more difficult for some people to cope with physical exertion in the heat. For some it is congenital, and in others it is acquired. We have the only institute in the world that conducts tests in a climate-controlled room to determine how soldiers deal with exertion in a hot environment,” said Heled.
“We look for the gene coded for an enzyme that affects how an individual reacts to exertion in high temperatures. The phenomenon is not yet fully understood, but we may be able to find markers for those unable to cope with the heat.”
“We have looked at only the tip of the iceberg of military medical research,” concluded Shapira.
“With the establishment of our new military medicine track on the Hadassah campus, we hope to do research from the stage involving rodents in the lab and bring the benefits onto the battlefield. It’s a win-win situation.”