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A new study about post-traumatic stress disorder (PTSD) among Vietnam veterans once again spotlights the need to separate the process of establishing veterans’ benefits from scientific research.
Researchers reported in Science (Aug. 18) that among 260 Vietnam vets studied, 18.7 percent had developed war-related PTSD during their lifetimes and 9.1 percent were currently suffering from PTSD.
This is obviously a very small study (approximately 2.6 million soldiers served within the borders of South Vietnam during the war) but its results differ significantly with earlier research.
The Centers for Disease Control and Prevention (CDC) reported in 1988 that 14.7 percent of male veterans developed PTSD after serving in Vietnam but only 2.2 percent still suffered at that time from the condition. The study results spawned newspaper reports such as “Vietnam Veterans’ Health: No Worse Than Others” (New York Times, May 13, 1988) and editorials such as “Misplaced Pity for Vietnam Vets” (Washington Post, June 12, 1988).
The CDC study also spawned politically powerful criticism. The American Legion, for example, responded with its own survey of Vietnam vets and reported that those exposed to heavy combat suffered more post-war emotional problems than those who weren’t.
This political pressure forced Congress to authorize the National Vietnam Veterans’ Readjustment Study (NVVRS), which reported results more acceptable to Vietnam veterans groups, including that 30.9 percent of Vietnam veterans developed PTSD, another 22.5 percent developed partial PTSD, and 15.2 still suffered from the condition in 1990 – a rate seven times higher than that reported by the CDC.
As pointed out in an editorial accompanying this week’s study, “[In 1990] Congress had been poised to phase-out counseling and other services for Vietnam veterans, but the NVVRS triggered an abrupt about-face. The government poured funds into clinical services and research designed to cope with an apparent epidemic of chronic PTSD among Vietnam veterans.”
But the NVVRS had its critics, too, who pointed out many problems in the study, including that while only about 15 percent of Vietnam vets were assigned to combat units, more than 53 percent of the vets had developed full- or partial-PTSD; the PTSD diagnostic criteria used in the NVVRS did not require symptoms that produced functional impairment; and the pattern of PTSD among Vietnam vets differed significantly from the “shell shock” and “combat fatigue” cases of World War I and World War II, respectively.
As is not uncommon in the field of “political” science, this week’s study, which re-assessed 260 vets from the NVVRS study, came up with “Goldilocks” results – reporting much more PTSD than reported by the CDC in 1988 but much less than reported by the NVVRS in 1990.
What are we to make of all these differing results? Should we just accept the new results because they split the difference between the results from CDC and NVVRS? What are the public policy implications of relying on such Goldilocks-type science?
It appears pointless -- all these years after the war -- to debate the statistics of PTSD among Vietnam vets. We’ll never know the precise numbers simply because data collection has been incomplete and their analyses are fraught with insurmountable methodological problems and biases. Certainly many vets experienced war-related PTSD. Some are, no doubt, still affected by it.
That’s about all one can reasonably conclude based on the available data. So what are the implications for veterans’ benefits?
In a rational world devoid of politics, Congress might reasonably restrict benefits to the small minority of veterans whose PTSD claims can be verified against their combat experiences. But in our very different -- sometimes surreal -- world, powerful veterans’ lobbies pressure Congress to increase benefits with few if any restrictions, regardless of the relevant facts and science. Not many politicians are willing to be seen as saying “no” to veterans.
This has happened before in the cases of Vietnam, Cold War-era and Gulf War vets making scientifically questionable claims of health effects caused by Agent Orange, nuclear weapons testing, and depleted uranium weapons, respectively. In those cases, the process of science was misused and abused in order to justify broad health care benefits.
One possible solution is simply for Congress to provide that certain types of military service -- such as any service in theaters of combat, not just actual combat experience, and other forms of hazardous duty -- automatically qualify veterans for lifetime health benefits.
That way, scientific research involving combat veterans will be less politicized and results will be less likely to have been pre-determined and/or skewed by the hidden and not-so-hidden agendas of researchers and their funders.
In the end, unbiased science stands a greater chance of providing policymakers with useful information and -- more importantly -- helping those who have sacrificed and suffered for their country.