The Paradox of War
Pamela B. Davis, MD, PhD
"The irony of war means that where destruction is intended and attained, reconstruction is inevitably the result. ... The more ingenious the methods of destruction, the more salutary the restoring alternatives."1
I write as the world marvels at the first photographs of Gabrielle Giffords released publicly since a gunman shot her at point-blank range in January. The Arizona Congresswoman is smiling, her hair much shorter and darker, but her face offering no hint of the trauma suffered in an assassination attempt that left six people dead and another 13 wounded.
Giffords survived in part because of a series of fortunate coincidences. Her caregivers on scene made sure she was able to breathe. She was near a Level 1 trauma hospital. And the doctors on hand that day had deep experience in combat medicine and neurosurgery.
These physicians knew the crucial lessons medicine has learned from treating soldiers in Iraq and Afghanistan.
For one thing, it is better to remove large portions of the skull than risk pressure on the brain. For another, it's safer to leave shards of bone and bullet fragments within the brain than poke around to remove every one for fear of infection. Both steps initially appear counterintuitive, but have spread widely in civilian medicine as military practice has proven their worth.
As our cover story explains, these conflicts regularly contribute to other advances that help patients. More soldiers than ever before are surviving battlefield wounds (the fatality rate from injuries is about half that of Vietnam). This means that we must find more and better ways to help veterans once they come home. Biomedical engineering researchers, for example, work constantly to create more responsive prosthetic limbs. Today they are exploring the newest frontier in this realm: neural interface technology. In one example of this model, an artificial finger sends electronic signals that the brain interprets as actually feeling what is touched.
Meanwhile, other Case Western Reserve faculty explore how to help soldiers who have suffered brain injuries. As many insights as neuroscience and imaging advances have provided, this organ remains all too mysterious. What combinations of cognitive, psychological and motor interventions offer the best chances for progress? And how might these treatments for veterans also assist victims of stroke or other neurological difficulties?
Every war accelerates medical progress. The Civil War introduced the concept of emergency medicine, including the value of rapid treatment. Triage became even more commonplace during World War I. World War II, meanwhile, catalyzed rapid production of antibiotics like penicillin. Each one of these gains helped transform stateside medicine and assisted thousands more traditional patients.
Today professor Erin Lavik works on synthetic platelets designed to stop internal bleeding in soldiers far from medical treatment. Professor Jonathan Stamler, meanwhile, reports that he is close to developing drugs that can provide nitric oxide for fighting forces operating at high altitudes in mountainous regions. Wartime creates a critical sense of urgency. Our challenge is to respond with innovations that help our troops—which, in turn, benefit us all.
1. J. van der Meulen, quoted in Ton., N. The Tumultuous Life of Johannes Esser: Father of Plastic Surgery, 2002.