Most Americans probably aren’t aware that the Department of Veterans Affairs (VA) healthcare system, along with the National Institutes of Health (NIH), is the best and biggest medical research powerhouse in the United States. Millions of veterans have benefited from VA research breakthroughs, including pioneering treatments for PTSD, Agent Orange, and prosthetics.
But it’s not just veterans who benefit. All Americans have profited from VA advances, such as the shingles vaccine, the implantable cardiac pacemaker, and the nicotine patch. The VA is on the frontlines of investigations on the risks of long COVID and studying why prostate cancer is so lethal for Black men.
Quite distressingly, this peerless research system is now under threat. In a November hearing before the Senate Veterans Affairs Committee, the VA’s Under Secretary for Health, Shereef Elnahal, warned of catastrophic consequences should the Senate fail to follow the lead of the House and pass the VA Infrastructure Powers Exceptional Research (VIPER) Act. This legislation reverses a misguided Department of Justice (DOJ) ruling prohibiting VA employees from being paid by academic affiliates for joint research initiatives. Elnahal explained that without VIPER, “major clinical trials answering key questions across all of American medicine” will be at risk.
For decades, the VA has partnered with 90 percent of the nation’s academic medical centers like Boston University, Dartmouth, Yale, and many others. Through these partnerships, VA researchers who devoted up to 40 hours a week doing research, teaching students, and caring for veterans, could secure supplemental funds to investigate everything from the impacts of burn pits to potential cures for Alzheimer’s disease. Although the VA has its own stream of research funding, these academic partners are the conduits for researchers to receive money from non-VA sources like the Department of Defense (DOD), the Centers for Disease Control and Prevention (CDC), the NIH, as well as numerous private foundations like the Prostate Cancer Foundation. These partnerships are critical because federal law prohibits the VA from administering such funds. The funding also supplements VA salaries which are not competitive with those in the private sector. It enables the VA to attract and retain top scientists who devote their careers to the care of the nation’s veterans.
The DOJ ruling that caused the current predicament was issued in 2021. It reinterpreted federal law governing the payment of federal employees conducting research at the VA in partnership with the private sector medical centers. This applies to many of the VA’s key academic partners, such as Columbia, Baylor, Stanford, and Harvard, among many others. For 75 years, VA researchers were permitted – even encouraged – to receive part of their funding from private-sector academic medical centers. Suddenly, the DOJ decided those supplemental payments were illegal. A peculiar double standard was applied to partnerships with public universities like the University of California at San Francisco, which were deemed permissible.
Some researchers could lose a third of their income and face criminal prosecution. After attending a recent meeting of VA trauma researchers, a former VA official said that many clinicians are “heading for the hills.”
The VIPER Act will keep them from fleeing, and that’s why it passed the House with overwhelming bipartisan support. But time is the enemy in the slower-moving Senate as the last days of this congress tick away.
Critical research hangs in the balance. As the VA’s 2024 budget request states unequivocally, the VA’s most important studies and initiatives involve “large multi-center clinical trials and epidemiological studies,” which depend on collaboration between private and public academic medical centers.
Consider, for example, the VA COVID-19 Observational Research Collaboratory (CORC) – a multi-site project that includes public and private universities. The collaborative has a database of 250,000 veterans infected with COVID-19. VA researchers recently released two studies detailing the severe consequences of long COVID.
Another area that could be impacted is prostate cancer research. In 2016, the Prostate Cancer Research Foundation gave the VA a $50 million grant hailed as a “unique public-private biomedical research partnership.” Why? Because the VA, over time, has millions of patients who have prostate cancer, and their data goes back decades. As the CEO and president of the foundation said at the time, the VA can help clarify “why, of 287 different kinds of cancer, even with identical care, prostate cancer is more aggressive and lethal in African-American men.” [MC4] Since 2016, VA has worked with researchers at various public and private universities to answer other critical questions about prostate cancer.
If not immediately reversed, the DOJ rule will also have catastrophic effects on brain research that depends on the VA’s Biorepository Brain Bank. This partnership with Boston University has the world’s most extensive brain tissue collection. The seven-component VA-BU brain banks focus on ailments including PTSD, CTE, and ALS. In 2018, Time magazine named its director, Ann McKee, one of the 50 most influential people in health care. Her research on the brains of veterans and football players has helped establish a link between multiple concussions and the development of CTE. McKee and her colleagues may have to curtail their vital work if the DOJ action is not reversed. PTSD research being conducted by the VA’s National Centers for PTSD in collaboration with Boston University and Dartmouth will also be impacted.
Again, these VA researchers’ knowledge and innovations don’t just help veterans. They’ve helped first responders suffering from PTSD following the 9/11 attacks and many other emergencies. To get to the president’s desk before the end of the year, Senators must attach VIPER to must-pass legislation such as the National Defense Authorization Act or the Omnibus Appropriations bill. If VIPER passes this year, the VA’s pivotal role in the American research enterprise will survive intact. If not, a letter supporting VIPER addressed this week to the Senate by the American Psychological Association and the Association of American Medical Colleges and signed by more than 86 primary medical schools, veterans service organizations, and medical foundations and associations warned “thousands of research projects focused on improving veterans’ health led by VA scientists” will be disrupted.