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
THE SITUATION improved in the 1990s, as soldiers became more
aware of their rights and the IDF realized it had to conform with civilian
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
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
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
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
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
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.
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.”
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.
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.
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.”
noted that various companies tried to find treatments in the 1990s, but all
“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
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
We will start clinical trials soon with the
Hadassah senior orthopedist Prof. Charles Millgrom described a
study he led that compared IDF trainees with haredi yeshiva students who did not
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.
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.
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.”