Johns Hopkins sees new Military & Veterans Health Institute as national model

War is finite, but for the warriors who take part in the battles, their scars, both physical and psychic, continue long after they've departed the so-called theaters of operations. It falls to the military to take care of their own both on the battlefield and back home, and their leadership, in the form of the Department of Defense, is reaching into the academic medical world for support. The DOD is allocating more than $1 billion annually to join forces with civilian medical research entities, and Johns Hopkins, in the form of its newly established Military & Veterans Health Institute, is vying for a seat at the table.

The marriage of Johns Hopkins Medicine and the military is far from far-fetched. There's something of the stars and bars in Hopkins' DNA: William Welch, founder of the Johns Hopkins School of Public Health, served as preceptor for one Maj. Walter Reed, whose name marks the Army's best-known hospital. More recently, since 1981 Johns Hopkins has provided care for 42,000 veterans and their families under a DOD contract with Johns Hopkins Health Services, based in Glen Burnie, Md.

It was JHHS' director, Mary Cooke, who first conceived the idea of MVHI, several years ago. "I told John Woodson, the assistant secretary of defense for health affairs, that we wanted to be a model for the nation," she says. To that end, Cooke formed a powerhouse steering committee. It brought together faculty from the schools of Public Health (Scott Zeger and Ellen MacKenzie), Medicine (Andy Lee and Kostas Lyketsos), and Engineering (Greg Hager), as well as the Applied Physics Lab (Mike McLoughlin) and Cooke's own JHHS.

Only one vital person was absent: a visionary for the group whom the military would trust. "What we were missing was street cred," says Cooke. "None of us on the steering committee had worn a uniform. We needed someone who came from the military world, and had the leadership knowledge to develop a long-term partnership strategy."

Cooke and the committee found their man in James Gilman, an Army major general who retired in January 2013 after 35 years of service. "We had other applicants with as many stars on their shoulders, but he is a physician who brings the right kind of leadership," Cooke says.

Indeed, Gilman's Army medical career paralleled the clinical, research, and management track familiar to so many Johns Hopkins medical faculty, including stints running Walter Reed, San Antonio's Brooke Army Medical Center, and, in his final command, directing most of DOD's medical research at Fort Detrick.

In a phrase, Gilman speaks DOD, as he made abundantly clear in an MVHI PowerPoint presentation slide he titled What I Can Do for You Now. "I can explain the difference between the game you know (NIH) and the one you don't (DOD)," wrote Gilman.

He elaborated on that point recently in his Glen Burnie office. "Hopkins is the best in the world at getting NIH funding, but DOD is different," he said.

Instead of principal investigators determining their own course of research and submitting a grant proposal to NIH, "I'm trying to get [faculty] to understand that the military determines the research requirements," he says. "The military looks around to see problems they need to solve, like better ways to stop people from bleeding to death on the battlefield or generating bone growth after an IED [improvised explosive device] injury. The military creates a problem statement, then the researcher looks at the problem statement and says, 'I think I can meet that requirement'" and goes after the DOD funding opportunity.

Depending on their background, some faculty say they have no problem letting DOD set their research course.

"A hallmark of engineering is we engineer to meet a need," says MVHI's Whiting School representative, Greg Hager, who also leads that division's initiative for integrating robotics and surgery. Hager envisions the Whiting School filling DOD demands for robotic training, especially for military doctors who deploy and need to refresh their techniques upon returning home. He also sees faculty taking image guidance currently used in controlled hospital settings and re-engineering it for battlefield conditions. There, "you want image guidance that is portable, wireless, and connected," says Hager.

Similarly, the School of Medicine's Kostas Lyketsos, who helped develop the MVHI concept, says that DOD's solution-oriented approach could fast-track certain research. "DOD medicine has a number of important missions, but the most important one is not to produce health care; it's to use health care to have an effective fighting force," Lyketsos says. "So I don't see them [involved] in basic science that could be eventually translated; instead, they want stuff that's ready to go."

It will fall on Jim Gilman to play matchmaker in a field that already has several veteran suitors seeking— and getting—DOD grants. Notably, the Boston-based, multihospital consortium known as CIMIT—the Center for Integration of Medicine and Innovative Technology—has done, according to Gilman, an excellent job lobbying Congress for funding to work on DOD's problems. That became obvious during this past August's annual symposium of DOD medical researchers and grant seekers in St. Petersburg, Fla. While Hopkins had few attendees and a single presenter on the podium, CIMIT had numerous representatives working the rooms, meeting with the Army's research directors.

But instead of being discouraged, Gilman and MVHI's steering committee see opportunity. Provisions for five years of seed money may well provide MVHI with the time to gain a foothold with the DOD, especially given the diversity of intellectual firepower the institute can draw upon. In his role at Fort Detrick, Gilman had a chance to assess academic entities seeking DOD grants. "While others may have a head start, the collective resources here, all operating under the Johns Hopkins umbrella, are far greater than any other group has to offer," he notes.

If Gilman can get DOD to buy into that opinion, Hager sees the beginning of a long, beneficial relationship. "What's different about DOD is that, for larger grants, there needs to be a comfort level, a trust that the institution can actually carry out the work," he says. "That's what I think of as being MVHI's role: being the holder of a trust for the institution. It's a conduit through which DOD and Hopkins can act, and a good match between the two."