Dr Hart, Dr Whyte and I are all back into our work routines after having spent a week at back-to-back meetings in Washington, DC, both focused on traumatic brain injury care.
One meeting was for the Traumatic Brain Injury Model Systems of Care program (more on that later). The other meeting was the Third Federal Interagency Conference, which was attended by many of the leading researchers in TBI diagnosis and treatment from around the world. Talks ranged from sharing ways to learn about damage to the brain caused by different types of injuries (such as blast injuries being sustained by soldiers in Iraq and Afghanistan, motor vehicle crashes and sports concussions), to new technologies to identify areas of the brain that have been injured, and new approaches for treating the injury and its consequences.
This meeting brought together researchers who are treating and studying many different groups of people, including soldiers, civilians and athletes, who may face different types of challenges. There were several interesting topics addressing problems that many survivors face, such as sleep and fatigue, headaches, depression and cognitive issues. We will share information about some of these in future posts. You can also visit: http://tbi-interagency-conference.org for specific information on the content and speakers.
At this conference, which Dr. Hart helped organize, Dr. Whyte and I participated in a discussion about the challenges in doing research to determine whether certain medications might improve outcomes after TBI. Some of you may have heard about how some drugs can help with problems such as irritability, memory, attention, alertness and other complications of TBI. However, you may not be aware of how difficult it is to actually "prove" that a medication improves recovery. One challenge is that most people improve to some degree after their injury via natural recovery, so if a medication is added early on, it's hard to determine whether the person would have gotten better whether or not he/she received the medication. Also, remember that every brain injury is different, and every injured person is different.
From a scientific standpoint, the best way to do a study about medications and brain injury is a large study where some people get the medication and some don't, in what is called "a controlled trial." The two groups can be compared to see if the people in the group who got the study drug recovered faster or more completely than the group that didn't receive it. It's even better if the participants and those rating recovery don't know who is getting the study medication and who is receiving the placebo (a pill that looks like, but does not contain, the study drug). Large studies like these are more expensive and take longer to complete than smaller studies. However, small uncontrolled, studies may be more likely to lead to erroneous conclusions, so in our presentation we encouraged efforts to do larger, controlled studies.
Another challenge with doing studies where only some of the participants get the study treatment is that some people are reluctant to participate in a study where there is a chance that they will be in the placebo (or non-treatment) group. Even though we did highlight some of the difficulties encountered with this type of research, because there is some evidence that medications may help at least some people with recovery after TBI, we remain committed to pursuing studies that help clarify what medications may be useful and for whom. In future posts we will look at the evidence supporting the use of some of these medications. We welcome your comments and feedback as to what types of studies you would like to see us review.