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2005 TRICARE Conference
Remarks as Delivered by Deputy Secretary of Defense Paul Wolfowitz, Washington, DC, Wednesday, January 26, 2005

Thanks, Bill [Dr. William Winkenwerder, Assistant Secretary of Defense for Health Affairs].  Ladies and gentlemen, thanks for that warm welcome.

 

            Bill said I'd have a large audience here.  I didn't quite know what he meant.  I guess that normally a person would need some kind of rare medical condition to attract the attention of so many medical people at one time. 

 

I'm happy to say that that's not what brings us together today, at least I don't think so.  Still, it does look like a perfect opportunity to ask for some medical advice. [Laughter]  I'm trying to think of what I should ask about. [Laughter]

 

            President Reagan used to like to tell the story about a famous playwright named Moss Hart, who was also something of a hypochondriac. And whenever he was introduced to a doctor on any social occasion, he'd launch into a description of what his latest medical complaint was.  I don't imagine that's happened to anyone here, has it? [Laughter] 

 

Well, the way President Reagan told the story, one evening at a party, Hart was introduced to a certain Dr. Jones, and true to form he began a long description of his lower-back pain. The host who introduced him was a bit embarrassed and quickly explained that Dr. Jones wasn't a real doctor; he was, like me, a Ph.D. doctor, in this case a doctor of economics.  And without missing a beat, Hart turned back to the doctor and said, "Last week I bought some IBM stock, and I was wondering…." [Laughter]

 

            Of course, the real reason you're here is to talk about the issues you're facing and to set the stage for improving what is already one of the premier health services in the world.  And I'm very grateful for this opportunity to join you. 

 

And I'd like to begin by telling you that I know that President Bush and Secretary Rumsfeld, and in fact the entire Department of Defense, deeply appreciate the fantastic job that you're doing.

 

            Your efforts are important not only for your patients and their families -- and that would be important enough -- but really they're important for our entire country, because you have the responsibility for maintaining the health and the effectiveness of America's defenders. 

 

And of course, that responsibility now rests on your shoulders in a time of war, and it's a global war at that, which means that what you do is helping to ensure the security and freedom of the American people.  And for that we're all deeply grateful.

 

            Everyone in the profession of medicine has a responsibility for the well-being of their patients.  But perhaps only you can say that the safety of the nation hangs on your work as well. 

 

And let me add that this applies not only to those who care for our uniformed personnel; it includes those of you who care for the health of military families.  Yours too is a 24-7 job.  It contributes to the morale and effectiveness of our servicemen and women.  Thanks to you, our men and women serving on the front lines can go about their missions with a confidence that can only come from the knowledge that, while they're deployed, the most dedicated medical team in the world is watching over their loved ones.

 

            I was very struck on a visit to the families of the 1st Infantry Division in October -- one of the divisions deployed in Iraq -- at how hard all the families work together to make sure that their loved ones on the front lines don't worry about them.  And I'm sure it helps their peace of mind that they've got so many great military medical caregivers that do worry about them, a reassurance that directly contributes to the vital missions that our uniformed personnel are engaged in.

 

            You all follow in a long and distinguished tradition of military medicine, a tradition that includes breakthroughs in medical knowledge that have also benefited civilian medicine.  I'm going to run through a list of achievements.   Maybe you're all familiar with them.  There are a couple here I didn't know about, maybe some that are new even to you.  It's worth recalling the history of extraordinary breakthroughs that have benefited the whole world:

 

Yellow fever, notably, was eliminated as a scourge thanks to a particularly distinguished Army doctor.  His name was Walter Reed.  You're all probably more familiar with him because he's the namesake of the Army Medical Center. But he was a great pioneer in medicine himself.

           

The lifesaving miracle of antibiotics was made available to the whole world after it was proven on the battlefields of North Africa in World War II.

 

Also in the Second World War, another Army doctor, Lt. Col. Harry Plotz, found a way to restore the lost potency of typhus vaccines.  This had an immediate benefit for troops in the field.  And it set the stage for the joint military-civilian commission that attacked typhus worldwide.

 

The virus that causes Asian influenza was first isolated by the U.S. military, which set the stage for commercial vaccine development.

 

And today, important advances in medicine continue to be made by institutions like the Navy Medical Research Center.  I first became acquainted with their work when I served as U.S. ambassador to Indonesia almost 20 years ago.  The Naval Medical Research Unit  -- NMRU, we called it -- is one of those overseas centers that's been doing remarkable research on tropical medicine. 

 

NMRC's research program has accounted for important advances in tropical medicine as well as the development of repellants against insects, the invention of heart-lung machines, treatment for shock, methods for lowering the body temperature for patients in heart surgery, the creation of the Navy Tissue Bank and the Armed Forces Radiobiology Research Institute, even advances in the care of frostbite.  That, obviously, wasn't done in Indonesia.

 

            A few weeks ago, though, the Jakarta center deployed medical personnel to the area devastated by the recent tsunami.  They're helping relief efforts by putting their unique abilities to work making medical assessments and surveillance.  And having been there myself just 10 days ago, I can tell you that the need is immense and the help of our research center is much appreciated.

 

            In fact, I'd have to say the help of the U.S. Armed Forces is incredibly appreciated.  And, speaking as a former ambassador to Indonesia, I think all of us were a bit astonished.  Here's a country that normally is very suspicious of any foreign military on their soil, but this time they welcomed the U.S. military like angels of mercy, which in fact we were.  I'm proud to be associated with an organization that has saved tens of thousands of lives, I believe, in the tsunami-ravaged areas.

 

            Another facility that's making a critical contribution these days is USAMRIID, the U.S. Army Medical Research Institute of Infectious Diseases.  Based up at Fort Detrick [Maryland], the institute has a staff of 700 of the top experts in the world on the subject of infectious diseases and biological defense.  They include microbiologists, physicians, veterinarians, pathologists, chemists, molecular biologists, virologists, nurses and regulatory scientists. 

 

They are the lead medical research laboratory for the U.S. Biological Defense Research Program.  And they are expanding their research in partnership with two other Cabinet-level departments, Homeland Security and Health and Human Services.  Together they are building the new National Biodefense Campus at Fort Detrick.  

 

Biodefense, I think, is a subject that many people thought we wouldn't have to worry about with the end of the Cold War.  Unfortunately, we have to worry about it more now than ever.  Since 9/11, and since those anonymous anthrax attacks, I can't think of a more urgent issue than confronting this threat of bioterrorism.  And this unprecedented research effort will benefit not only men and women in uniform, obviously, and not just our country, but the entire world.

 

            These are just a few of the vital contributions that military medicine has made and is making in the ongoing effort to ensure the security of the American people. 

 

You are part of a large and complex health system.  The military health system has over 130,000 employees and an operating budget of almost $30 billion per year.  That system is augmented by the global TRICARE network.  Altogether, it's an enormous undertaking, with a mission like no other in the world.

 

            But when all is said and done, I truly believe -- and I think you would agree with me -- that your greatest contribution is the care you provide directly to our servicemen and women: before they deploy, while they're in the field and in combat, when they're injured -- if they're injured -- and when they come home. 

 

Over the past few years, I've had the privilege of seeing some remarkable examples of that dedication, that professionalism, that effectiveness.  I've seen it in Iraq and in Afghanistan where our medical teams have raised battlefield medicine to a level beyond anything that was even imaginable in previous wars.  And I've seen it in the care that our wounded service men and women are receiving at Landstuhl, at Walter Reed, the Naval Medical Center in Bethesda, and at field hospitals in Baghdad.

 

            Let me tell you about a few of the remarkable people who in my experience represent military medicine at its very best: 

 

One of them is Dr. Marlene DeMaio, a Navy orthopedic surgeon.  I guess in full disclosure I should say she was my surgeon for some relatively insignificant surgery I had to have.  I want to mention her, though, because she was a leader in improving the body armor that our troops have in the field. 

 

Believing -- and I think demonstrating correctly -- that simply designing body armor with computer designs without testing it on cadavers would produce an inadequate design, she stepped forward and pulled together a team of researchers, including physicians and engineers, that cut through the red tape.  In fact, I think that's an understatement.  They really had to confront some major bureaucratic challenges, but secured the approval to conduct needed field tests. 

 

Those studies were the first to examine the biomechanics behind armor trauma.  It was tough work.  Sometimes, in fact, I think a lot of you know, some of the toughest jobs we have are confronting resistant bureaucracy. But Dr. DeMaio and her team were equal to the task. 

 

She is dedicated and determined, and she found a group of people who were equally so. As one of her colleagues put it, she applied her own blood and sweat to make the project work, all the while continuing to see patients in the Pentagon and elsewhere and maintaining a surgical schedule in orthopedics.  In fact, she has a full schedule down in Portsmouth, which is why she couldn't join us today. 

 

But in a period of only 18 months, standards were revised, armor plates were redesigned, and a more effective body armor was employed on the ground, where it has saved countless lives. 

 

And you don't have to take my work for that.  Our soldiers tell that story better than anyone:  Like a sergeant who's been a patient at Walter Reed.  When a mortar pierced the bed of a five-ton truck and landed on his back, it miraculously failed to detonate.  It also failed to penetrate the ceramic plate of the armor the sergeant was wearing.  The armor cracked, but, as he said, "If I hadn't had the body armor, I wouldn't be here."

 

            Another sergeant [Adam Replogle] I have gotten to know was hit in the chest with an RPG during the fighting down in Karbala.  He lost his left arm and the sight in his left eye, but he survived a direct hit thanks to his body armor.  He joined me a few months ago for a visit to Landstuhl. He was a real inspiration for many of the patients that we visited.

 

There was one young man lying in a bed with a cast on his wrist.  When Sergeant Replogle asked him how he was doing, the young man in the bed looked at the sergeant's arm and his eye and said, "Well, I'm doing better than you."   And without missing a beat, the young sergeant said, "Hey!  I'm doing pretty damned good."

 

            Ladies and gentlemen, two members of Dr. DeMaio's extraordinary research team are here today.  Cdr. Steven Parks has a degree in nuclear engineering from the Naval Academy.  And while he is retired from active duty with the Navy, he continues to make a contribution through his research in ballistics, which is critical to an understanding of injury patterns. 

 

And Col. Geoffrey Ling has the distinction of being both a physician and a Ph.D. with a specialty in neurology.  He serves on the faculty of the Uniformed Services University of the Health Sciences Medical School in Bethesda and will soon lead the blast injury program at DARPA. 

 

I'd like to ask them to stand so that we can acknowledge their achievement and that of the entire team that works on body armor.  [Applause]

 

            Thank you and your entire team for all you've done to help protect our men and women in uniform.  It's an enormous public service.

 

            Of course, body armor can't prevent against every injury.  That's when the medics and trauma teams take over.  As Dr. Winkenwerder said earlier, advances in battlefield medicine and in the transportation of the wounded in Iraq and Afghanistan have resulted in the lowest mortality rate ever seen in modern warfare.  In large measure, that outcome is a result of a whole team of dedicated professionals.

 

            We have a few of those heroes with us today.  Dr. Andrew Friedman specializes in plastic and reconstructive surgery.  He's just returned from a year's deployment that included nine months in Iraq and three months in Afghanistan, in one of the most dangerous areas of that country, where he commanded the 933rd Forward Surgical Team.

 

            Dr. Friedman can tell you at length about the courage of our young men and women even when they're injured, about their confidence in our medical teams, about the many Afghans he treated -- who clearly understood and appreciated that we are in their country as friends -- and about the Iraqis -- who are still learning to trust us and are frequently amazed that we will treat them as well as our own wounded.

 

            One of Dr. Friedman's proudest achievements while on deployment involved Spec. John Perenelli, an Army Reservist from New York, who suffered a very serious injury in his side from a bullet that passed between the plates of his body armor.  During surgery, this young soldier needed 12 units of blood, which his teammates gladly donated.  He lost a kidney and part of his colon. But today, in part because of that care he received in the field, he's on convalescent leave with his family.  He's just one of the servicemen and women who benefited from the skill and dedication of Lt. Col. Friedman.

 

            Another doctor from Walter Reed is with us as well.  Dr. Leon Moores is chief of neurosurgery and also a veteran of Operation Iraqi Freedom.  He, too, has been involved in life-saving procedures on wounded soldiers and Marines.

 

            And I should also explain that Dr. Moores brings a special empathy to their care.  He began his own career as a cadet at West Point and served both as an infantry officer and with the 82nd Airborne.  Only then did he enroll in the Uniformed Services medical school.

 

            Back home at Walter Reed, he has continued to work with the wounded who have been evacuated.  One of his patients is here with us today, Army Spec. Hugo Gonzalez, who grew up in Puerto Rico.

 

            I met Hugo last summer shortly after he entered the hospital. He'd been injured in June as the gunner on a humvee in Iraq.  They rode into an ambush.  He was hit with shrapnel from an IED [improvised explosive device] and suffered a life-threatening injury to his head.  He received emergency surgery in Baghdad, including a craniotomy, to relieve the swelling.

 

He was evacuated, first to Germany, then to Washington, where I first met him.  They preserved a piece of his skull inside his body in a procedure that some of you are probably familiar with.  And a few days ago, Dr. Moores reversed the procedure by carrying out a cranioplasty. That operation brings Hugo one step closer to recovery.  And yesterday, I'm happy to say, he was discharged from the hospital.

 

            Hugo is with us this morning, together with his mother, who's visiting from her home in the Dominican Republic.  I'd like to ask all four of them, including Mrs. Gonzalez, to stand and let us recognize their service.  [Prolonged applause]

 

            Thanks to all of you, including Hugo's mother.  I must say, the families of these patients are part of our medical care system, and it makes such a difference when they are there with their loved ones.

 

            Another critical component of every medical team are the nurses and technical specialists who work with the wounded at every step in the recovery process -- in field hospitals, here at home, and everywhere in between.  I'd like to introduce you to one of those very special nurses, Air Force Captain Bill Moore, who provides acute care for injured patients during their evacuation flights from Iraq to Germany.

 

Captain Moore has flown 18 missions during Iraqi Freedom as part of a Critical Care Air Transport Team.  We have seven such teams serving in the Iraq theater.  Their job is to take care of the most seriously injured during that six-hour flight from Iraq to Ramstein Air Force Base, and then again for the short ambulance trip to Landstuhl. 

 

On more than one occasion, Captain Moore was instrumental in keeping badly injured patients alive while they were in the air.  I should also point out that Bill served as a nurse for nine years as an enlisted airman.  He left the Air Force in the 1990s, only to return six years later.  His first day back on the job at Wright-Patterson Air Force Base was September 11th, 2001.  The rest, as they say, is history. 

 

General [John W.] Handy [Commander, U.S. Transportation Command and Commander, U.S. Air Mobility Command] was at a Cabinet Room briefing with the President last night with the combatant commanders, and he reported to the President that we have not lost a single patient on any of those evacuation flights.  That's a remarkable record.

 

            I'm going to ask Captain Moore to stand, and let's thank not only him, but I want to mention that his son is serving on the [U.S.S.] Abraham Lincoln in that lifesaving mission off Indonesia.  Thank you, Captain Moore.  [Extended applause]

 

            And of course, as you all know, care of the wounded does not end in field hospitals or even with their evacuation.  In an important sense, that's just the beginning.  Our goal as much as possible is to restore our wounded heroes to the life they knew before they were injured.  And that calls for surgical teams and nurses and physical and occupational therapists who are extraordinarily committed to this goal and who are tireless in its pursuit.

 

            In my visits to the hospitals, I've gotten to know some of those dedicated professionals and their patients.  One of those patients is a young Army lieutenant, Melissa Stockwell.  Melissa and her husband, Richard, had just graduated from the University of Colorado and were commissioned together.  Last spring they were both deployed to Iraq.

 

            Melissa was a transport officer.  She was riding in a humvee in Baghdad, learning her convoy's route, when a roadside IED exploded. The injuries that Melissa sustained resulted in the loss of her left leg.

 

            Richard was with her from the moment she got to the field hospital.  When I first met them, Melissa had already undergone 11 operations in some six or seven weeks.  In the weeks and months since then, she's been learning to walk with a prosthetic device and the support of an incredibly dedicated and, some might say, relentless support team. 

 

They include Bob Bahr, Melissa's physical therapist and a retired lieutenant colonel; their occupational therapist; Capt.Katie Yancosek, fondly known as "Captain Y"; and the third member of her team, a physician's assistant for physical medicine and rehabilitation, Amanda Turner McGee.

 

            I saw Melissa and Bob Bahr on Inauguration Day, and they seemed to be getting along quite well with each other.  I said, "I thought you're supposed to hate your physical therapist, if they're doing their job right."  She said, "Well, I hate him often enough, but right now I'm feeling good about him."  [Laughter]

 

            With us today are Melissa, her rehabilitation team, and her husband, Richard, who is now serving with the Old Guard at Fort Myer. Let's thank all of them.  [Extended applause]

 

            These are just a few of the countless stories of young men and women who have a chance to build a life thanks to medical personnel who have gone above and beyond the call of duty.

 

            I understand this conference is going to span a range of major issues and activities, from fitness to cost-containment.  I commend your efforts to improve what is already an outstanding system. 

 

Just this week, Dr. Winkenwerder announced plans to expand post-deployment screening so that we can better understand the effects of conflict on the physical and emotional health of our returning service members and their families.  This is a critical step to ensure that we are doing absolutely everything within our power to care for these outstanding young Americans.

 

            In reviewing areas to improve our health system, the focus needs to stay on the great quality of care that you provide, while tackling the serious issue of increased costs.  Your work has to ensure that the TRICARE benefits that people currently enjoy are affordable far into the future.

 

            And at the same time, I'd like to remind you once again of the importance of what you do.  Last week in his Inaugural Address, President Bush reminded us that the best hope for peace in our world is the expansion of freedom in all the world.  In the pursuit of that better world, the President said, a few Americans have accepted the hardest duties. 

 

In my book, you're among them.  The work you do is trying.  It's consuming.  It calls for mental and physical toughness and a heart of gold.  But it's vital work.  You make it possible for our military and their families to do their jobs. 

 

So keep up the good work.  Thank you for inviting me here to speak today and for welcoming the heroes that I brought with me.  Thank you for the great service you provide to the greatest military in the world.  I appreciate it, as does Secretary Rumsfeld, President Bush, and the American people. Thank you.  May God bless you.  And may God bless your great work.  [Applause]