Published online 17 December 2010 | Nature | doi:10.1038/news.2010.684

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From battlefield to bedside

Medical research in the British military soldiers on despite defence cuts.

Medical research carried out on the battlefield is likely to have benefits for civilian medicine.Marco Di Lauro/Getty Images

Over the past ten years, British military forces have been engaged in two major conflicts, in Iraq and Afghanistan. Where the military has gone, its medical staff have gone too, and taken research with them into the field.

A meeting this week at the Royal Society of Medicine in London and a raft of papers in a special issue of a Royal Society journal now highlight the importance and benefits of this research.

The UK Strategic Defence and Security Review, released by the government in October, will lead to thousands of job losses in Britain's armed forces. However, an extra £20 million (US$31 million) per year has been earmarked for the provision of health care to men and women in the services. Some £1 million of this money will make its way to research, said Alasdair Walker, surgeon commodore in the Royal Navy and medical director of the Joint Medical Command. At the London meeting, he described the funding boost as a "quite significant enhancement".

Walker points out that war and the needs of the military have always been a huge driver of medicine. Historical examples include the nineteenth-century anaesthetics pioneer Thomas Spencer Wells, who served in the army, and naval surgeon James Lind — widely regarded as having conducted the first clinical trial with his tests of citrus fruits for the treatment of scurvy in the eighteenth century.

"It's in our blood. It's part of us," says Walker. "Military medicine has always been at the forefront of research."

Front-line research

Military medicine spans everything from disease prevention to rehabilitation. Mark Midwinter, a surgeon captain in the Royal Navy, outlined some of the research studies being carried out in war zones. For example, Midwinter is working a randomized trial for the use of nanoparticles of silver on wound dressings. Although there has been much enthusiasm for bandages containing silver — which is thought to have an antibacterial effect — solid evidence is lacking, but initial data look promising.

Modern warfare has also led to a profound change in the types of injury sustained. As detailed in several papers in the January issue of the Philosophical Transactions of the Royal Society B, the rise of the 'improvised explosive device' in Iraq and Afghanistan has led to a significant increase in blast injuries and severe damage to limbs.

Much attention is focused on trauma care, but many soldiers with serious injuries are now requiring long-term rehabilitation of a kind that that did not exist in the past — a key issue for military medical researchers.

Civilian survival

But will the research done in military medicine prove valuable in the civilian field too? Geraint Evans and Louis Lillywhite of the Royal Centre for Defence Medicine in Birmingham argue that it will. In their introduction to a special edition of the Philosophical Transactions of the Royal Society B on military medicine, they note that trauma outcomes in the UK National Health Service have been "sub-optimal" for some time. Military successes in driving up survival rates through developments such as dressings that stop severe bleeding, or changes in the way that medical teams are organized, could help improve things.

Despite the difficulties of doing controlled clinical trials in a military setting, Evans and Lillywhite argue that important work can and is being done. They cite the Prussian military philosopher Karl von Clausewitz, who wrote during the Napoleonic Wars that, on the battlefield, "The light of reason is refracted in a manner quite different from what is normal in academic speculation."

However, they point out, "scientific reasoning can be applied in combat casualty care, to the immediate benefit of the wounded, and in the longer term to the benefit of all mankind". 

  • References

    1. Evans, G. and Lillywhite, L. Phil. Trans. R. Soc. B 366, 124-126 (2011). | Article

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  • #60767

    GB is one of the few nations on the planet that I would be standing up for if they got attacked. That nation has been with us through quite a bit over the last 100 years.

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