16. Medical and Biomedical Science and Technology
Military medical and biomedical research is concerned with preserving and optimizing combatants health and capabilities despite extraordinary battle, nonbattle, and disease threats. Individual service men and women are the most important and the most vulnerable components of military systems and mission capabilities. Disease and nonbattle injury typically far outweigh battlerelated injuries as the greatest cause of military casualties. The current force structure is confronted with an expanded potential for largescale regional conflicts, proliferation of WMD, and ready availability of advanced conventional weapons. These dangerous challenges are coupled with enduring threats of disease, harsh climates, and operational stress, often in thirdworld nations lacking any medical infrastructure.
There are five subareas of technology: infectious diseases, medical biological defense, medical chemical defense, Army operational medicine, and combat casualty care. Table E19 and the following paragraphs summarize foreign capabilities and opportunities for each technical subarea.
For humanitarian reasons, much of the research and technology related to this area are shared widely. No one country has a commanding lead. However, virtually all developed countries (including U.K., France, and Germany) will have significant national research programs capable of contributing to U.S. Army requirements. The spread of AIDS and other virulent diseases such as Ebola and other filoviruses, and the emergence of a variety of antibioticresistant bacterial strains have spurred worldwide medical and biomedical research efforts. Many countries involved in medical and biomedical research are not specifically interested in military applications or biomedical defense per se, however, any breakthroughs in prevention and treatment of the more virulent diseases would be of great interest. Here opportunities for cooperation are driven by a variety of factors, including the geographical location of the occurrence of certain diseases (e.g., Kenya, Thailand), or COEs in specific research areas (e.g., virology in France).
Table E19. International Research CapabilitiesMedical and Biomedical Science and Technology
|Infectious Diseases of Military Importance||Infectious diseases||Infectious diseases||Infectious diseases||Singapore, China
Kenya, Thailand, Switzerland, Sweden, Italy, Netherlands
|Medical Biological Defense/Medical Chemical Defense||CBD||CBD||CBD||Many countries involved in applicable biomedical defense research||Canada, Austria
Israel, Sweden, Switzerland, Netherlands, Brazil, Poland, Australia
|Army Operational Medicine||Broad cooperation sought in all aspects of military medicine & casualty care||Medical imaging||Broad cooperation sought in all aspects of military medicine & casualty care|
|Combat Casualty Care||Medical imaging|
|Note: See Annex E, Section A.6 for explanation of key numerals.|
In addition to work directly on medical and biomedical areas, the growth and dissemination of basic biotechnology tools has led to rapid advances in capabilities in a number of foreign countries. These are discussed elsewhere in this annex.
Another area of medicine that is growing rapidly worldwide is the use of internetworking and high quality video to create geographically dispersed medical teams for diagnosis and treatment (including surgery). The underlying technologies are discussed elsewhere in this annex.
a. Infectious Diseases of Military Importance
This technology area seeks to protect soldiers from incapacitating infectious diseases by the development of vaccines and disease preventing drugs, and to return soldiers to duty by the discovery of effective drug treatments. Infectious diseases pose a significant threat to operational effectiveness and most Americans lack natural immunity to diseases that are endemic abroad.
Many diseases that were feared killers only a few years ago have been subdued largely through vaccination and public health advances. The focus of marketdriven pharmaceutical development has been primarily on diseases important in the industrial world. Unfortunately, infections prominent in many strategically significant areas of the world do not receive attention comparable to the extent of the populations affected. This puts our soldiers at greater risk.
Technical challenges of current interest include:
Develop rodent blood and tissue systems for growth of human malaria parasites
These and a number of other technical challenges in medical and biomedical science require the commitment of major research resources from around the world. This is a natural area in which to encourage international cooperation. In addition to the obvious cooperative work with our European allies, the infectious disease research program has international agreements for cooperative research to develop vaccines for the prevention of dysentery, malaria, and dengue fever.
Dysentery is caused by Shigella and leads to severe diarrhea. During Operation Desert Shield/Storm, diarrheal disease became a major threat to U.S. forces57 percent of troops had at least one episode and 20 percent reported they were temporarily incapacitated. The leading cause of lost duty time during Operation Rescue Hope was acute diarrhea.
Malaria has long been a serious problem for military forces, especially during combat. Malaria is the worlds most common insectborne parasitic disease. During Operation Desert Shield/Storm, troops in Southern Iraq became infected with vivax malaria. More recently, troops were infected with vivax or falciparum malaria while serving in Somalia for Operation Restore Hope. Treatment of this deadly disease is complicated by the increasing incidence of drugresistant strains.
Dengue fever is the worlds most common mosquitoborne viral disease. It was encountered during the Vietnam War, and more recently in Somalia. It poses a serious problem whenever military forces are deployed to the tropics.
Countries having significant capabilities and offering special opportunities to address infectious diseases not commonly found in the industrialized world include Israel, Kenya, Thailand, Singapore, and China.
b. Medical Biological Defense
The primary goal of medical biological defense is to ensure the sustained effectiveness of U.S. armed forces operating in a BW environment. Specifically, to prevent casualties by the use of medical countermeasures, to diagnose exposure to BW agents, to use chemotherapeutics and immunotherapeutics to prevent lethality, and maximize return to duty.
Major technical challenges relate to better understanding of the pathogenic mechanisms of a disease in hopes of developing new vaccines. Much of the testing must be done in model systems. Animal models do not currently exist for many of the BW agents. Specific technical challenges include:
Developing appropriate animal models to test safety and efficacy
The Medical Biological Defense Research program includes an international agreement for cooperative research for the development of an improved vaccine for the prevention of botulinum poisoning and for the development of effective treatment drugs. Botulinum toxin, a recognized biological threat agent, is one of the deadliest neurotoxins known to man. The toxin prevents the release of acetylcholine and produces nerve cell dysfunction. The cause of death is usually respiratory paralysis, due to the blockage of transmitter release from the phrenic nerve to the diaphragm muscles. The Imperial College of Science and Technology, United Kingdom, is an international leader in the area of functional and structural analysis of botulinum toxin binding to cholinergic nerves.
c. Medical Chemical Defense
The mission of this program is to preserve combat effectiveness by timely provision of medical countermeasures in response to joint service chemical warfare (CW) defense requirements. The challenges are to maintain technological capability to meet present requirements and counter future threats, to provide individual level prevention and protection, and to provide medical management of chemical casualties.
A major technical challenge is developing pretreatment, protectant, or antidote that is both effective against CW agents and safe for human use. Specific challenges relate to developing models of efficacy and effects, developing pretreatment/antidotes with special characteristics (e.g., quick acting, long acting), generating immune response to small molecules, and developing various reactive/catalytic decontaminant and protectant compounds.
The Medical Chemical Defense Research Program involves cooperative efforts between the United Kingdom, Canada, Israel, Germany, and other nations in developing methods to protect the soldier from CW agents. These nations are using the latest medical information and techniques for these developments. Current efforts include research into pretreatments, antidotes, and medical therapies. Xray crystallographic analytical techniques have been employed to elucidate the structure of acetylcholinesterase. This achievement supports mechanistic studies in understanding the actions of nerve agents as well as development of molecular approaches to a countermeasure. In addition, molecular biochemical techniques are being used to mutate genes to produce variants of human acetylcholinesterase and butylcholinesterase. This will improve understanding of nerve agent mechanisms of action and identification of prophylaxes for nerve agents.
d. Army Operational Medicine
The goals of this effort are to protect soldiers from environmental injury and materiel/system hazards, shape medically sound safety and design criteria for military systems, sustain individual and unit health under operational stress, especially sustained and continuous operations, and to quantify performance criteria and soldier effectiveness.
Technical challenges cover a wide range of effects and issues. These include sleep management, display design criteria, physical and psychological training strategies, tyrosine and caffeine interactions for increased alertness, and a variety of related phenomena.
This is an area in which broad cooperation is sought in all aspects of military medicine. The only technology specifically identified for potential cooperative efforts involves Japans strong capability in medical imaging.
e. Combat Casualty Care
This program aims at saving lives farforward in the combat arena. Major areas where improvement is needed include delivery of farforward resuscitation, minimizing lost duty time from minor injuries, reducing unnecessary evacuations, and decreasing resupply requirements of all forward echelons of care.
Technical challenges include understanding and overcoming the toxicity of oxygencarrying hemoglobin solutions, development of battery power and computing capability to allow computeraided diagnostics, overcoming the problem of applying local hemostatic agents to the wet surfaces of a hemorrhaging wound, and miniaturizing all equipment necessary to induce suspended animation farforward.
As indicated in the table, this also is an area in which broad cooperation is sought in all aspects of combat casualty care. The only technology specifically identified for potential cooperative efforts involves Japans strong capability in medical imaging.
AMC POC: Dr. Rodney Smith
Army Materiel Command
5001 Eisenhower Blvd.
Alexandria, VA 223330001
email: [email protected]
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