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V.A. Seeks A Million Vets for Research

Researchers from the Department of Veterans Affairs are conducting a study that they hope will include a million veterans from around the country. They’re finding plenty of willing recruits at the Durham VA Medical Center.

By Rose Hoban

Dan Ocheltree has a new nickname: “1,004.”

Ocheltree, an EKG technician at the Durham Veterans Affairs Medical Center, really wanted the nickname “1,000,” but he had a delay getting registered for the Million Veteran Project, a large genetic study being conducted by the VA.

Rose Smith has been adding a bead to a jar for every veteran enrolled in the study. Here, she's adding a sticker to note their 5000th enrollee. Photo credit: Rose Hoban.

Nurse Rose Smith has been adding a bead to a jar for every veteran enrolled in the study. Here, she’s adding a sticker to note their 5000th enrollee. Photo credit: Rose Hoban.

The Million Veteran Project, or MVP as it’s known to staff at the Durham VA, started several years ago with the goal of registering and drawing blood from a million veterans throughout the VA system.

Now, in the halls of the Durham VA, friends greet Ocheltree, a former Army medic by calling out, “Hey, 1,004!”

“It doesn’t really matter whether it’s 1,000, 1,004 or 18,” Ocheltree said, “the most important thing is that the project is helping out veterans in general.”

“We’re collecting blood samples for genetic analysis with the goal of examining health issues and their relation to genes,” said William Yancy, a researcher who is the local site coordinator for the MVP, a nationwide study based in Boston.

Last week, Yancy and his coworkers at the Durham VA registered their 5,000th study participant.

Yancy explained that 50 of the VA’s 152 medical centers and clinics serve as study recruitment sites. Currently, samples are being taken in North Carolina only at the Durham and Salisbury VA Medical Centers.

“We’re really looking for a million participants,” Yancy said. “If you do the math, each site has to recruit 20,000. And we just got to 5,000, over two-and-a-half years.

“We have two or three years more to get the extra 15,000.”

For future use

According to Yancy, the study investigators aren’t totally clear on what they want to study yet, but having a huge databank of a million samples would make any future study easier to do, as well as statistically strong.

One way of advertising the study is a "wrapped" set of elevator doors on the 8th floor of the Durham VA Medical Center. Photo credit: Rose Hoban

One way of advertising the study is a “wrapped” set of elevator doors on the 8th floor of the Durham VA Medical Center. Photo credit: Rose Hoban

The first whole human genome wasn’t mapped until 2000; that sequence was produced at a cost of about $1 million. That cost is already down to between $1,000 and $4,000, and scientific companies are working to get it down to about $100 per sequence.

Meanwhile, veterans all over the country are donating single vials of blood that are given an anonymous identification number and shipped to Boston for cold storage.

Yancy said the genetic sequences on participants in the MVP have not yet been done, as VA researchers are waiting for the price to drop.

But new genetic discoveries are being made daily.
For example, Yancy pointed to recent research showing that some people have a genetic mutation that makes them respond to the blood thinner warfarin (commonly known as Coumadin) differently.

Different people’s blood thins at different rates, Yancy said. Genetic information now allows doctors to predict how long it’ll take to determine what the standing dose should be.

“There are studies that have been done about how long to be on a starting dose, to get their blood thinned, instead of guessing what it’s going to be, which is what we’ve done for years and years,” he said.

Yancy said that’s why the VA is starting to collect blood for future genetic research.

“The technology is rapidly improving and it alleviates the need for 50 independent studies,” he said. “We’re getting economies of scale, which makes it a good investment for the VA.”

Once sequenced, whatever information the genetics yield will then be matched to questionnaires veterans answer about their habits, medical history and any exposures, such as Agent Orange, they may have had in the military.

“I think probably the best examples will be [post traumatic stress disorder] and traumatic brain injury,” Yancy said. “Some people are more susceptible to the consequences of those diseases and there seems to be some genetic predisposition, so we’ll be looking at that.”

Recruitment challenge

The immediate challenge in Durham though is recruiting an additional 15,000 participants.

Nurse Rose Smith and Technician

Vietnam-era veteran Burnice Smith signs his consent form for the Million Veteran Project. Photo credit: Rose Hoban

Vietnam-era veteran Burnice Smith signs his consent form for the Million Veteran Project. Photo credit: Rose Hoban

Nancy Steward, Yancy’s co-workers, spend a lot of their time talking up the project with patients who come into the various VA clinics and among staff members like Ocheltree. They’re also placing ads in veterans’ newsletters and they talk at local VFW halls asking veterans to add a 10-minute visit to the MVP onto their next clinic visit.

“We put stickers on bags in the pharmacy when patients are getting prescriptions filled; we laminated MVP signs and put them on cafeteria tables,” Stewart said.

Stewart and Smith even convinced the Durham VA administration to put informational “wraps” on some elevator doors at the 8th floor primary care clinic.

“We’d put it on all of them if we could,” Yancy said, laughing.

But the best recruiting tool is talking with individual veterans.

“We have veterans who have come in and enrolled who are heads of VFWs in different counties. They say, let me take brochures back,” Smith said. “We actually had a van driver bring up a whole load of veterans in his van, about seven of them.”

Smith and Steward also haunt the clinic waiting rooms talking to veterans who are waiting to be seen for other care.

That’s how they found Burnice Smith, who came in for a clinic visit the other day.

Steward chatted with him in the waiting room, and he quickly agreed.

“When she told me it was a study to help out, I’m all for it” said Smith, a Vietnam-era veteran who was posted on Ft. Bragg for four years during the 1970s.

Steward walked Smith into her office where she explained the study and they went over the consent form and questionnaire together.

She even had a spare pair of reading glasses so he could read the 13-page consent form.

“You really have all your bases covered,” Smith laughed, as he took the glasses.

After he signed the consent form, Steward walked Smith into the next room, where a phlebotomist took a single vial of blood.

“When you’re doing genetic analysis, you don’t need very much,” Yancy said. “Then you sequence the entire DNA with whatever your process is. So then its done, and you can look back at that information in the database.”

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