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In high school I was a mediocre student at best, at risk of not graduating on time. (I eventually earned my GED and then my BS from New York Institute of Technology.) As part of an extracurricular program, I was working as an intern at a commodities trading company in the World Trade Center. On 9/11 I could see the smoke from the Twin Towers from my home. My immediate response was to decide to enlist.

Serving in the military gave me internal standards to live up to, as well as the means to achieve them. I served in the Marines from 2002–2006 and went straight into emergency medical services in 2006. So I didn’t go through a period of wondering what to do with myself once I no longer had a military purpose. Not only is my work fulfilling, I actually enjoy it. It’s one of my favorite things to do!

Serving in the Marines trained me to deal well with emergencies. I don’t freak out, and I don’t take things personally. An important part of my role as a paramedic is being relaxed and comforting—staying calm and helping others to stay calm. We have a saying in the Marines: “Smooth is fast and fast is smooth.”

A big part of maintaining calm—which I definitely acquired in the service—is never to anticipate. You may think you know what’s going to happen, but then it turns out you had it all wrong. So one way not to be sidelined is always to keep in mind that anything can happen. I’m ready to work at whatever comes my way.

A huge percentage of veterans I served with in the invasion of Iraq developed PTSD—I’d go so far as to say more than 90 percent, whether they acknowledged it or not. In fact, I think those who denied it often tended to spiral out of control the fastest.

I myself experienced PTSD. On my road trip home from leaving the military, I slept with a knife in my hand while napping in the car, even in the hotel room. I was lucky in that my EMS work gave me a sense of purpose and helped keep me stable. In both the military and EMS work, one has to deal with high-stress situations. In a way, the skills I have that can save someone’s life replaced the skills I had that could take someone’s life.

People now are much more aware of PTSD and TBI than they were in 2006, when I left the Marines. Now, as a paramedic, if I found out that my patient had been standing next to a bomb when it detonated, I would suspect TBI and take him to a hospital.

In November 2017, a former Navy corpsman and fellow paramedic, David Guzman, and I cofounded the Black 6 Project. The Black 6 Project organizes medical and disaster missions that we fund through the Black 6 Coffee Roasting Co., which sources and roasts coffee. The name comes from my second deployment to Iraq. “Black 6” was the radio handle of the command element of the headquarters platoon.

We had a coffee shop in the East Village, but had to shut it down during Covid. Right now, we’re only doing online sales. But we’re looking at the possibility of opening another coffee shop, in Brooklyn. We’re also considering opening a roastery on Long Island. Not only would we distribute coffee from the roastery, we would train roasters.

When Covid shut down the cafe, I looked around for a useful way to channel my “entrepreneur energy.” Since I work as a paramedic at NYU Langone Health, I had access to the NYU Veterans Future Labs, as well as a network of people there. The emphasis at the lab is to develop new ways to help people.

Students from NYU’s School of Engineering created 3D printing devices for us to make masks, which my Black 6 colleagues then assembled. As a paramedic, I already knew administrators from different hospitals, so I asked them what they needed. Everyone needed stuff. In addition to the masks, we delivered other PPE. I was also able to call on the network of restaurants I knew from distributing coffee, to support Food for Impact, which delivered free and low-cost meals to frontline workers in hospitals, EMS stations, police precincts, and fire stations.

My wife Jane is a designer, craftsperson, and photographer. She’s done a lot of the graphics for the Black 6 Project, including our logo.

We have two sons, a six-year-old and a one-year old. I’ve taken the older one with me on humanitarian missions that are safe for children, including to Guatemala and the Philippines. I want him to be thankful for what he has and to realize that not everyone is as lucky as he is. I also like him to meet some of the people I served with. Now other Veterans have started bringing their kids on missions, too.

I hope that research can advance our early recognition of TBI and point the way toward successful treatment and recovery, so its effects are minimal. Also, we can use the data obtained from Veterans to better understand its long-term effects and help us provide better care.

I was working as a physician when the Army recruited me in 1987 to help modernize its medical research infrastructure. I thought it would be for a couple of years—it turned out to be 28 years.

In 2001 the Army sent me to Kuwait to serve as Command Surgeon. I arrived the day before 9-11. Suddenly, I was part of the leadership of a huge medical support team. While there, I saw trauma like I had never seen before. Despite all the severe wounds, we managed to save a lot of lives. The stress on the troops was tremendous, and we starting having suicides.

These were typically one-year rotations. I returned to the U.S., to Walter Reed Hospital, where I was Chief, Preventive Medicine Service, and treated returning troops. Basically, I was doing clinical work while serving in a leadership role in management.

During this period, we started to see more traumatic brain injury (TBI) and suicides and to talk about the invisible wounds suffered by active military and veterans. Of course, people in general—and veterans in particular—have always had mental health problems. But it wasn’t talked about. Especially if you were in the military, you were expected to just “toughen up.”

In 2004, I was deployed as the MNFI Command Surgeon in Iraq, where I was responsible for reforming detainee health care, restoring civilian health care, and overseeing coalition care, as well as serving as the acting health attaché. For much of my deployment, we had no armored vehicles or security escorts, so moving between bases was particularly risky. When I returned in 2005, it took me a good six months to recover my equilibrium. My wife noticed that I drove as if in a war zone. I also found out that my replacement in Iraq had been killed.

From 2008 to 2014, I was assigned responsibility for managing the DoD Trauma Research Program; I focused on new techniques and products to save the lives and reduce morbidity of troops injured in the line of duty. A major responsibility of mine was a portfolio of more than 600 projects focused on TBI.

The turning point in public attitudes toward trauma, which came in 2007, was due to media attention. In particular, the New York Times published an influential article on concussion among football players, and the Washington Post published a series on military troops who had been overwhelmed by stress. The military came under even more public scrutiny than the NFL, and everyone started talking about the “invisible wounds of war.” Then Congress got involved and increased research funding.

In 2012, President Obama issued an executive order to improve access to mental health services for veterans, service members, and military families. This was a good start, but the plans for dealing with psychological and brain injury needed to evolve.

Within a month of my retirement in 2015, I became involved with Cohen Veterans Bioscience. It seemed the best way for me to direct my passion for developing objective diagnostics for PTSD and TBI. Though the federal government provides money for research, nonprofits play a special role in developing strategy. The power of a nonprofit like CVB lies in its ability to bring people together. This is a result, in part, of its nonprofit status. Unlike an industrial company, it doesn’t have to vie for profits, so it has more leeway to act as a catalyst for new collaborations and discoveries.

As a member of CVB’s Strategic Advisory Council, I’ve worked extensively on development of the Brain Trauma Blueprint, guiding efforts to define its direction. The Blueprint, which sets out a path for improving TBI research and clinical care, is now in its final stages. The first round has six domains, which is a good start. We are starting to think about what domains to address next.

We’ve now published a number of peer-reviewed articles on TBI in the Journal of Neurotrauma that will help address current research gaps and recommend paths forward. The Blueprint is meant to be a living document. We’ll soon be opening this TBI blueprint up for comments from the community, both professionals and patients.

We’ve also been leading a blueprint specific to diagnosing PTSD and how we can improve research, to progress toward the development of objective diagnostics. We expect to publish this in 2022.

I would say, to maximize its ability to bring researchers together to accomplish things they couldn’t accomplish alone. A great example is CVB’s work on genetic markers for predicting risk for PTSD. Various groups had been working on the problem for years, but it wasn’t until CVB was able to bring all the data together that we were able to discover that there is a genetic component to PTSD risk.

One lesson I’ve learned from my long, multi-faceted trajectory is that out of bad can come good. The problems veterans experience have helped to focus attention on PTSD and TBI. The benefits then extend beyond the veteran community, to the mental health field as a whole.

By passionately engaging in a multitude of research efforts and bringing them under one tent with industry-experienced scientific leadership, Cohen Veteran Bioscience will enable current and future research toward new therapeutics to accelerate at a rate never seen before.  

Although cognitive behavioral therapy can be effective, access to a therapist can be challenging, and the wait times to see a therapist can be months. Some Veterans may live in an underserved area which requires them to travel far to a VA or care center to receive treatment.

In addition, many Veterans need access to sustainable and rewarding employment opportunities coupled with effective social support groups similar to what the VFW and Foreign Legion provided after World War II.  Fortunately, certain forms of Social Media will be able to bring Veterans and support networks together to make a meaningful impact.  

Finding sustainable jobs and strong social support by Veteran’s employers, families and the community.

The incredible passion and commitment of each and every participant.  Over 200 participants that are dedicating their careers and every day life to making a difference.

Cohen Veterans Bioscience is providing scientific thought leadership toward PTSD research similar to what the Michael J. Fox Foundation is doing for Parkinson’s.  In five years, PTSD research and understanding could advance more than it has since 9/11, or the last 15 years.

“I’d like to preface this by saying that the military experience is diverse and can be vastly different from individual to individual. We so often look at the difficulties and issues Veterans face as if all of them face the same issues; this just isn’t the case. My thoughts and opinions are shaped both from my personal experience in the military, my journey after getting out, and hearing the stories of the many Veterans I’ve interviewed over the last two years as a filmmaker and journalist.

One thing I’ve learned is that society can’t bear all the responsibility of re-integration; actually most of the responsibility has to fall on the Veteran. We have to take control of our lives and our future hopes to the best of our ability in order to move forward. I think this primarily comes from finding new purpose.”   

In short and general terms I think the greatest challenge for Veterans is the difficulty, and sometimes stubborn refusal, to transition from one identity into the next phase of life. It’s uncomfortable and scary to deactivate the ‘warrior’ or ‘soldier’ mentality.  But it’s necessary. Society’s responsibility in this is to take the Veteran out of the box and know that every Vet’s experience is different.

Many are thriving after smooth transitions; we just don’t hear about them. For the ones who are struggling, their difficulties can range from physical, mental or emotional to something far more practical and simple like setting up healthcare, starting a business or applying for a job.

We often use the term “re-integration” as if the Veteran is coming back to something they were a part of at one point. For many Veterans, their late teen and early adult years were shaped by the culture and structure of the military, including a decade and a half of war. Upon returning to a complex and often divided society, many are simply “integrating.”

I think identity is a big part of it; at least it was for me. At some point I had to start looking into the future and letting go of some of the past that was defining me. A time spent in the military can be whatever you want it to be no matter the experience. It can be what defines you forever, but it doesn’t have to be. Your best years are not behind you and if you live as if they are, you’re missing out on so much. Do you want to be the 40-year-old high school sports star wearing your letterman jacket still talking about knockin’ heads and throwing touchdowns, or do you want to move forward into the life that’s waiting for you?

The ‘Veteran experience’ has changed a fair deal in the last 15 years but mostly in the areas of mental and physical healthcare. I think the real question might be how has the Veteran experience changed over the last 40 years. And why?

Post-Vietnam was a time for the government to rekindle society’s love and trust in the American Military, and we did a really really good job of this – primarily through movies and the narrative of the ‘American Hero’. This idea has accelerated in the last 15 years to the point where society has become obsessed with war heroes.

In some ways this shift in sentiment is good because it allows space for an easier transition than those of the Vietnam era. However, in my opinion, viewing every Veteran as a war-wearied soldier returning from the battlefield and ‘valorizing’ everyone who serves has created social incentives for Veterans to be traumatized by war, which then becomes something that starts to define them; regardless of their experience. In some ways this slows the process for developing effective mental health treatments and having a real discussion about what it means for a country to be at war.

The majority of Veterans never see combat and often are supporting war efforts from miles and sometimes hundreds of miles away. That’s not to say the experience of deployment, the constant unknown in a place where people want to hurt you with the threat of death in the back of your mind doesn’t have an effect on someone. It’s just a far different experience than the minority of soldiers whose daily lives consist of operations outside the wire, directly witnessing the devastating effects of conflict.

Cohen Veterans Bioscience and Cohen Veterans Network have set up an innovative model that has the potential to disrupt the current care model in two significant ways that I can see.

First, Cohen Veterans Network is dedicated to providing comprehensive mental health care to Veterans and their family or support network. In addition, they are extending services to anyone who has ever enlisted, regardless of discharge. This is something you don’t see even in many boutique Veteran service organizations. This is huge because many Veterans fall through the cracks and are denied benefits due to minor infractions in the military, or are enlisted and discharged because they just couldn’t adjust to military life.

Second, Cohen Veterans Bioscience is bringing together some of the greatest minds in the world to tackle the issues of PTSD and TBI. And while they are using some of the most innovative research and technologies available, they haven’t lost sight of the fact that so much of this issue has to do with heart. That is to say that treating PTSD is just as much emotional as it is physiological or psychological. And I think this organization truly recognizes that.

I think the two most urgent needs are to establish the most effective treatment protocols that are tailored to the individual’s situation – the existing and most urgent problem, and to determine the most effective ways to prevent traumatic brain injury and post-traumatic stress and preserve long term resiliency and brain health. These priorities span the continuum of optimizing health; mitigating risks in order to sustain long term resiliency, and effective treatment of impacts.

Cohen Veterans Bioscience is not limited by small thinking. CVB is effectively working to establish a collaborative environment across government, industry and academia specific to Veterans’ brain heath concerns, and across the continuum of interrelated factors and dynamics that comprise post-traumatic stress manifestations.

I am most excited about the efforts represented in the Translational Toolbox. I have high expectations that the focused efforts and synergies in the areas of biomarkers, data standards and knowledge engineering, biorepositories, preclinical modeling, and computational disease models will enable the entire community of interest to move forward in ways not possible before, and will yield incredible insights into better understanding, prevention, and treatment.

Through active engagement and its fundamental collaborative and scientific framework, Cohen Veterans Bioscience has been increasing awareness and support across the community of interest for a more coherent approach to brain health – one that will produce meaningful results and impacts.

I am very excited about the establishment of the Veterans Advisory Council. We have designated Frank Larkin to be the Chairman of the Council and he has distinguished himself in a lifetime of service as a Navy SEAL, in law enforcement, the Secret Service, as the Director of the Joint Improvised Explosive Device Defeat Organization, and as the Sergeant at Arms for the U.S. Senate. The Council is a diverse cohort of senior leaders from across industry, academia and government with interest, access and experience in Veterans’ concerns related to TBI and PTS. The Veterans Advisory Council will represent, advocate and support Veterans’ interests in advancing CVB’s mission, relationships with partners, and a broader community engaged in the research, prevention, and treatment of TBI and PTS.

More about Brian Losey, Rear Admiral, U.S. Navy (Retired)

Brian Losey, Rear Admiral, U.S. Navy (Retired), was Commander of Naval Special Warfare Command in Coronado, California. He previously served as commander under the US Africa Command, Combined Joint Task Force Horn of Africa, and as commander, Special Operations Command Africa. His operational assignments have included a full range of duties in Sea, Air, Land (SEAL) Teams, SEAL Delivery Vehicle (SDV) Teams, and Special Boat Teams, and deployments to named and contingency operations around the world. He commanded SDV Team One and served as deputy commander and commander of the Naval Special Warfare Development Group. He has worked extensively with interagency and international partners in enhancing security cooperation relationships, capabilities, and capacities. Other assignments include duty as deputy commander, Naval Special Warfare Task Group, US 6th Fleet; Maritime Operations officer and deputy chief of Current Operations in the Joint Special Operations Command; and US 7th Fleet special warfare officer in USS Blue Ridge (LCC 19). He served in the executive office of the President as a director on the National Security Council Staff bridging two administrations. Brian holds a master’s degree in National Security Strategy from the National War College. He is a graduate of the Defense Language Institute, the Armed Forces Staff College, and Air Command and Staff College.

Since 1914, more than 100 years following the introduction of high explosives on the modern battlefield, we are still handicapped in our ability to diagnose the consequence of battle and exposure to blast. The recent discovery of a new pattern of microscopic level of brain injury, related to military blast exposure is calling into question our past approach for treating the poly-trauma effects of PTS, TBI, moral injury and use disorders. Presently, this pattern of microscopic blast TBI can only be qualified in post-mortem examination.

There is an urgent need to develop reliable diagnostic imaging and blood markers for TBI in a living person. Early identification of this injury manifestation and disease evolution is necessary to effectively treat the underlying brain injury that may be complicating the treatment of other combat related conditions, such as TBI, moral injury, use disorders and the nexus to suicides. The historic course of action for treating these abnormal presentations has defaulted toward psychiatric or behavioral health focused disorders and treatments that have largely incorporated the use of mood stabilizing medications. We urgently need to confirm or deny the presence of TBI in order to accurately characterize the variables challenging the veterans we are seeking to help.

Cohen Veterans Bioscience is focused on leveraging strict scientific peer reviewed processes to further knowledge of the diseases and injuries that challenge our veteran community. The national emphasis on caring for our wounded warriors has seen the emergence of many support programs and therapies. Few of these veteran directed solutions have had any serious level of scientific rigor applied to them to qualify or validate whether they are effective in their claims. As a stand alone non-profit entity, CVB is on a neutral platform to provide an unbiased assessment of these programs. Many of these programs have compelling anecdotal examples of success in helping both active duty and veterans in need.

The veteran in serious need of assistance is challenged either by a lack of visibility or knowledge about programs that have been either proven effective or ineffective. More often that not, a recommendation from a buddy or teammate guides many veterans to these program referrals. Struggling veterans and their families are emotionally vulnerable as they seek solutions. CVB’s effort to identify and confirm scientifically validated treatment and support programs reduces the risk that one of these active duty warriors or veterans goes down the wrong path. Veterans in desperate need cannot afford to trade off valuable time to effective care, not to mention being able to afford the high expense associated with many of these programs.

CVB’s attention to high scientific standards and evaluation methodologies can offer many of these promising programs the formal validation that will reach the high bar of trust and confidence for our veterans. Public and private organizations, along with government agencies would be able to leverage metrics for program or treatment validation. It would lead to more appropriate referrals for our veterans and further enhance collaboration for data collection and analysis.

The effort that Cohen Veterans Bioscience has underway pursuant to the recent DoD grant to study pharmaceuticals that have clinical efficacy for treating PTSD is significant. So many of our active duty warriors and veterans diagnosed with PTSD, TBI, moral injury, pain and use disorders have been prescribed a long list of drugs predominantly prescribed to treat symptoms, not the root cause of their problem. It would be irresponsible to state that all pharmaceutical therapies are bad. Truth be told, providers not completely qualified to evaluate therapeutic effectiveness or consequence, have prescribed many drugs without any sense of application. Pharmaceuticals have provided life stabilizing and life saving options for many challenged by disease and abnormal physiological or psychological conditions. Very few drugs since 2001 have been scientifically validated for the treatment of PTSD. To date, many practitioners have followed a course of “plug and play” for effect. This reflection is often voiced by veterans who have been prescribed dozens of medications in their pursuit to feel normal again, a life free of pain and fear.

CVB’s efforts to develop an accelerated and adaptive clinical trial, leveraging precision medical approaches for treatment and evaluation could very well change our path forward for treating PTSD. CVB’s design and validation of new and current pharmaceutical options will significantly illuminate what actually works on diagnosing, managing, extinguishing, and preventing PTSD. Considering the large numbers of active duty and veterans currently diagnosed with PTSD, this challenge has significant implications both within the military enterprise and in the civilian sector where PTSD also challenges many worldwide.

Cohen Veterans Bioscience’s effort to bring knowledge to government leaders and policymakers continues to have impact in advancing new agency authorizations, tasking provisions and targeted funding intended to fuel new research collaboration, information sharing, innovation and discovery.  There are so many variables that make up the complex rubric allied to veterans brain health.

The second and third order effects related to a veteran’s health and stability touch family, friends, teammates and community. These brave men and women voluntarily stepped up on the line to serve this great nation with the goal of protecting our freedoms and ensuring our security.  Many have gone into harm’s way at personal expense and sacrifice.  We cannot leave any more of them behind. It is our national obligation to support those that have come home with both visible and invisible wounds. Our effort to deal with the consequences of their honorable service cannot be at the expense of a veteran’s dignity or sense of self worth. Unfortunately, 20 veteran suicides a day has become a horribly painful metric for this nation, we have a long challenging march ahead.

 

I am confident that if Cohen Veterans Bioscience can influence the development of new diagnostic imaging technology, blood marker indicators, and neuro-cognitive assessment for TBI in a living person, it will be a game changer for how we address combat related poly-trauma. We desperately need to define blast related TBI and its disease progression in our warrior population. This developmental effort, coupled with knowledge gained from companion longitudinal research on TBI, will undoubtedly lead to early diagnosis and targeted treatment for blast related brain injuries. It will clearly inform appropriate therapies, rehabilitative support and injury prevention that has a nexus to both training and combat operations.

I am very excited about energizing a large movement to vacuum data into the BRAIN Commons that I expect will illuminate connections that have not been visible to date. This cross cutting data integration and analytical effort will lead to the development of information leading to knowledge and decision support, that will further guide action and future direction. The BRAIN Commons will fuel collaboration and more research evolution that will elevate the opportunity to innovate and discover new solutions. I predict that in three to five years, we will have advanced brain health science beyond our expectations. As a result, we will be improving a meaningful post-service life experience for our veterans, reducing suicides and finding ways to prevent these destabilizing poly-trauma conditions.

Invisible Wounds: the Personal Crisis

Hear his story firsthand as Frank Larkin presents at the 2017 Cohen Veterans Care Summit: Igniting the Spark

Watch Video

More about Frank Larkin

Frank Larkin served as the United States Senate Sergeant at Arms (SAA). As chief law enforcement and executive officer of the Senate, the SAA enforces rules of the Senate; provides a range of technical and administrative services to Senators in their Washington, DC, and state offices; and maintains security in the Capitol and Senate office buildings.

Frank was a member of the Senior Executive Service, recently serving as both the Acting Director and the Vice Director of the Joint Improvised Explosive Device Defeat Organization (JIEDDO) within the Department of Defense. He previously served as JIEDDO’s Director for the Counter IED Operations-Intelligence Integration Center. JIEDDO’s mission was to focus all Department of Defense actions in support of the combatant commanders’ efforts to defeat improvised explosive devices (IEDs) as weapons of strategic influence. Frank’s focus was in support of our deployed warfighters and special operations forces around the globe and the integration of a “whole of government” disruption effort targeting extremist networks that employ IEDs.

Frank served for more than two decades in the United States Secret Service (USSS), beginning in 1984 as a Special Agent assigned to the Philadelphia and Washington Field Offices, before assignment to the Presidential Protective Division. He was assigned to the Office of Congressional Affairs for a two-year fellowship on Capitol Hill, serving a year each with the Senate and House Appropriations Committees. Frank entered the USSS supervisory ranks as Assistant to the Special Agent in Charge of the New York Field Office, where he led financial, electronic, and organized crimes investigations. Following the events of 9/11, he returned to Washington, DC, as the Assistant Special Agent in Charge of the Presidential Protective Division, supervising White House security operations. As Assistant Special Agent in Charge of the Technical Security Division, Frank was responsible for tactical countermeasures programs. In 2004, he was promoted to the Senior Executive Service, assuming the position of Deputy Assistant Director for Protective Research and Chief Technology Officer.

Following his USSS career, Frank was Director, Program Management & Leadership, for the Raytheon Company, and more recently, worked at Lockheed Martin’s Defense & Intelligence Solutions, responsible for providing operations and intelligence analysis support to the intelligence community.

A veteran of the US Navy, Frank has a significant military and law enforcement special operations background, serving as a special warfare operator in the Navy SEALs. After his Navy service, he was a uniformed patrol officer with the Norristown (PA) Police Department, a homicide detective with the Montgomery County (PA) District Attorney’s Office, and a Maryland State Trooper-Flight Paramedic.

Frank holds a BA degree in criminal justice and an MS degree in public administration from Villanova University. He is the recipient of numerous awards, including the US Secret Service award for valor, the Department of the Army’s Exceptional Civilian Service award, and the Superior Civilian Service award.

Cohen Veterans Bioscience is a non-profit 501(c)(3) biomedical research and technology organization dedicated to advancing brain health by fast-tracking precision diagnostics and tailored therapeutics.

Cohen Veterans Bioscience is a non-profit 501(c)(3) biomedical research and technology organization dedicated to advancing brain health by fast-tracking precision diagnostics and tailored therapeutics.

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