VA treatment should be based on evidence, not political pressure

Last week, lawmakers introduced legislation that would require the VA to make hyperbaric oxygen therapy (HBOT) available to any veteran with post-traumatic stress disorder (PTSD) and extend its use among veterans with traumatic brain injuries (TBI). This builds upon a previous expansion of its off-label use at VA for veterans who have not shown clinical improvement, similar legislation passed by multiple states, and attention from VA’s COVER Commission.

All this is happening without evidence that HBOT actually works to treat either PTSD or mild TBI.

Study after study after study after study after study has failed to show any evidence that HBOT improves symptoms of PTSD or mild TBI more than sham treatments. It does have legitimate medical uses, such as treating decompression sickness among divers, but for-profit treatment centers make unsupported claims that it can treat multiple other diseases.

This doesn’t mean no veterans showed any improvement over a course of HBOT sessions — which should not be surprising. Clinical trials compare the effectiveness of real drugs to fake ones to tease out how much of any improvements (or side effects) are caused by the medication itself compared to the placebo effect. The passage of time alone can also ease some symptoms: 85 percent of those who experience a mild TBI, also known as a concussion, fully recover within a matter of months; for many, symptoms of PTSD can fluctuate in response to external stimuli. So it’s inevitable that there are compelling anecdotes out there from folks who saw improvements after trying HBOT — but that isn’t the same as proof.

One of the representatives who introduced the bill touted it as an “additional choice” for veterans. While I understand the lure of assuming more choices is inherently better, the evidence does not support that belief. Importantly, older individuals and those with lower cognitive ability have more challenges navigating choice-heavy health care landscapes.

I understand, deeply and viscerally, why people are so desperate for new treatments for these complicated and often devastating conditions. My husband sustained a penetrating TBI in Iraq and subsequently developed PTSD. We’ve lived with the challenges those conditions have brought for nearly 14 years, and I closely follow any potential advancements in available treatments. I’ve enthusiastically encouraged him to try alternative approaches, too — when they have no potential risks. That is not true of HBOT, which has medical risks and possible side effects including damage to the ears, seizures, and more.

And just because my husband and I are open to seeing whether other types of interventions may work does not mean that I believe taxpayers should be paying for them. I absolutely back the necessity for medical research and support federal funding for that research. The government should also continue moving to overcome remaining barriers to testing medical marijuana and other potential treatments.

However, HBOT has already been thoroughly studied by VA, the Department of Defense, and outside researchers. It is not effective for PTSD or mild TBI.

Politicians should not dictate what treatments are available to veterans, the evidence should.

Don’t be lured by the siren calls of anecdotes, especially by those out to make a profit, lest VA be legislated to pay for jade eggs or coffee enemas next.

Kayla Williams is a Senior Fellow and Director of the Military, Veterans, and Society Program at the Center for a New American Security. She previously served two years as Director of the Center for Women Veterans at the Department of Veterans Affairs, serving as primary advisor to the Secretary on policies, programs and legislation affecting women veterans. Prior to that, she worked at the RAND Corporation, where she did research related to veteran health needs and benefits, international security and intelligence policy. She is the author of “Love My Rifle More Than You: Young and Female in the U.S. Army,” a memoir of her deployment to Iraq.