Addressing Brain Injury: A Costly Crisis

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March brings with it National Brain Injury Awareness Month, a time when we reflect on those who have experienced brain injury as well as the care givers who treat these patients and protect others from future harm. Every year around 1.5 million Americans experience a traumatic brain injury (TBI), and about 50,000 of these cases end up being fatal. Estimates vary, but studies find that our nation spends tens of billions every year to care for people with TBI. The costs go far beyond the phase of acute medical treatment. It involves long-term support and therapy for the chronic medical and psychological problems that often accompany TBI. Indeed, the long-term changes in personality, cognition and behavior represent the most disabling and costly aspects of damage to a human brain.

But first, some history.

One of the first modern, detailed reports of the psychological problems that follow TBI involved Phineas Gage, a railroad construction worker who, in 1848, survived after an iron tamping rod was projected through his skull, seriously damaging the frontal lobe of his brain. His physician, Dr. John Harlow, would later describe personality changes by Gage. Before that fateful day at work on the railroad, Gage had been responsible and socially well adapted. But after the iron rod damaged his brain, he became irreverent, profane, and unable to take responsibility. As Dr. Harlow noted, “he was no longer Gage.”

The first systematic study of the behavioral consequences of TBI began early in the 20th century, by Adolf Meyer. He published several comprehensive case reports about patients who had behavior disturbances after head injuries. He later proposed a set of disorders to describe these changes, which he called “traumatic insanities.”

Today, most incidents of brain damage happen with young people, but there is a second peak among the elderly. The elderly and children are most at risk from falls. Traffic accidents and violence are more common among young adults.

Current news reports about TBI have focused on service members hurt by explosive devices while serving overseas, or on concussions suffered by football players in the NFL. About 19.5 percent of service members have experienced a probable TBI during overseas deployment, and a study of the NFL found that for every two games played, at least one person has a concussion.

These injuries lead to high rates of behavioral disorders and mental illness, including depression and post-traumatic stress disorder. These conditions, which for decades were studied principally at the behavioral level, are now the subject of detailed molecular research in human brain, thanks to the donations of hundreds of brains from the next of kin of individuals who die with these conditions. With the availability of large amounts of human brain tissues, we are building a massive public resource of molecular and genetic information related to how these conditions influence the function of the brain. In particular, we are exploring how difference in DNA, RNA, and proteins characterize the brains of these individuals. We anticipate that new insights with potential therapeutic implications will emerge from this effort. By making the data available to the general scientific public, the possibilities of scientific discovery will be dramatically expanded.

With such enormous emotional and economic costs to our sports heroes and the men and women serving in the military, one would think that our country would be electrified into action. Sadly, this is not the case.

Four decades ago, President Nixon declared a war on cancer, and focused federal resources on fighting a disease that kills millions of Americans every year. Today, depending on the type of cancer you might get, the diagnosis is no longer a death sentence and the National Cancer Institute now spends $5 billion annually to save lives.

In comparison, the National Institutes of Health spends approximately $90 million a year on TBI — much of that focused on basic research, with a tiny fraction of those meager dollars used to design new treatments. With threats by President Trump to cut the NIH budget by 18%, it is uncertain what effect this might have for those suffering from TBI. We must do better for our people, and act in fiscally prudent ways to avert tens of billions in medical costs and lost productivity incurred annually.

Originally published at on March 21, 2017.