The Year in Veterans affairs & military medicine
U.S. Department of Veterans Affairs photo
■■ Rich Bartels has blood drawn by LeAnne Pomeroy, a Million Veteran Program ( MVP) research assistant, as part of volunteering to be an MVP participant.
exception of a few large clinical trials that we run every year, most of the research done in VA was done, and is done, in individual research laboratories scattered around the country but not tightly coordinated with each other. MVP is an attempt to bring a more massive collaboration together that enables us to achieve economies of scale, while still harnessing the phenomenal intellects and skill sets of VA researchers around the country. A second change in the way VA research is done is point-of-care research, which is an attempt to take large clinical trials, particularly those that are comparing two well-accepted health care interventions: things that might both be standard of care, but
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may not be quite equal. Point-of-care research allows us to compare these interventions in a prospective, randomized fashion as they are used in the clinic. This will potentially give us the opportunity to run very large clinical trials that are capable of detecting somewhat small differences in reasonable time and at a reasonable cost. Now, why might that be important? Say we’re treating somebody for depression. Well, maybe one antidepressant is 5 percent better than another. A traditional randomized control trial can’t be big enough, at finite cost, to detect that small a difference. But 5 percent is a big deal if you’re one of those 5 percent who gets an immediate response. And it can have a tremendous impact
down the road. So being able to identify things that are just slightly better at a reasonable cost has, in a health care system that takes care of six million people, a tremendous effect. Maybe 10,000 individuals might be effectively treated who weren’t treated effectively before. We’re planning to launch a large point-of-care study over many sites comparing two diuretics used for the treatment of hypertension. One of them, chlorthalidone, has been used in most of the trials looking at the effectiveness of treating hypertension using diuretics. But the other, hydrochlorothiazide, is actually prescribed about 10 to 20 times as often, both inside and outside the 13