Welcome Home - A Podcast for Veterans, About Veterans, By Veterans
Welcome Home is a Willing Warriors and the Warrior Retreat at Bull Run project. The program highlights activities at the Warrior Retreat and issues impacting all Veterans. For questions or feedback, please email us at podcast@willingwarriors.org.
Welcome Home - A Podcast for Veterans, About Veterans, By Veterans
Unlocking Genetic Secrets: Dr. Mark Logue on Dementia Research and the Million Veteran Program
Ever wondered how genetic and environmental factors could influence the risk of Alzheimer's and dementia among veterans? Join us as Dr. Mark Logue, statistician and researcher at the National Center for PTSD at the VA Boston Healthcare System, shares his remarkable journey from serving in Operation Desert Storm to pioneering genetic research. Discover how his work with the Million Veteran Program (MVP) aims to identify at-risk veterans early and develop more effective treatments by uncovering the biological underpinnings of conditions like PTSD, TBI, and cardiovascular disease.
This episode highlights the transformative potential of the MVP, which has already enrolled one million veteran volunteers and seeks to double that number. By integrating genetic data with VA medical records and survey information, this program offers invaluable insights into various health conditions. Dr. Logue explains how veteran participation is crucial, contributing unique data that could shape future healthcare policies and enhance the quality of care for veterans and beyond. Don't miss this enlightening conversation that promises to enrich your understanding of veteran health and genetic research.
Good morning. I'm Larry Zilliox, Director of Culinary Services here at the Warrior Retreat at Bull Run, and this week our guest is Dr Mark Logue. He is a statistician and a researcher with the National Center for PTS at the Boston Healthcare System the VA Boston Healthcare System and I'm really excited to have him on today because he's doing research that involves a lot of the information that's coming from the Million Veteran Program that the VA launched a few years ago. So I wanted to talk to him about that program and see if we can get more veterans involved and where their research is going and what the kind of things that they've found out. So, doc, welcome to the podcast. Great.
Dr. Mark Logue:Larry.
Larry Zilliox:Thanks for having me. So if you would your prior service, if you could tell us a little bit about your service, your Army? I think I read yeah.
Dr. Mark Logue:I was Army Reserves. I signed up for it to help pay for college, like a lot of people, and I got called up for Operation Desert Storm and I spent so. My job in the army was in medical supply and I spent time in Germany trying to increase capacity there for a hospital in Stuttgart.
Larry Zilliox:Wow, that's a big place.
Dr. Mark Logue:Yeah. Yeah, it's a very nice hospital. We weren't sort of the first line for people that were injured coming back, but we were there to handle large scale casualties which thankfully didn't arrive in the way they were worried. Yeah.
Larry Zilliox:So after your time in Germany, you're back here in the States and you're going to school. Where did you go to school at?
Dr. Mark Logue:So I was at the University of Oregon as an undergraduate and then I went to the University of Iowa to do graduate school and do my PhD in statistics.
Larry Zilliox:That's kind of a stretch for schools there I get, were you from Oregon?
Dr. Mark Logue:I was from Oregon originally and then, yeah, I ended up. I had some family members nearby at Iowa, so I was looking for somewhere to go in the Midwest and that's where I ended up. Wow, great, I stuck with the birds. I went from being a duck to a hawk.
Larry Zilliox:Yeah, so now you graduate. And what led you to the VA?
Dr. Mark Logue:Well, it was a bit of a roundabout route actually. So my PhD was in statistics and a lot of math that's what my training was in. But I learned as part of doing my PhD that I really liked applying it to real world problems and real world data and I got involved in genetic studies and at Iowa, there after I graduated, I stuck around Iowa for a while doing the genetics of anxiety disorders, and then, 2007, I ended up moving to Boston and joining a group that was studying the genetics of Alzheimer's disease. Wow, at Boston University, yeah.
Dr. Mark Logue:And while I was doing that, someone from the VA here, mark Miller, who's also at the National Center for PTSD here at Boston VA, approached me and asked if I could help out on his study of the genetics of PTSD. And I'd been and it was a good opportunity. Yeah, yeah, I started working with him and I had more and more projects with him where I was working on PTSD and eventually they started hinting around that you know there's opportunities at the VA and I should be more involved in veteran research. So I got recruited to the VA and I still have my position at Boston University and I still do work there, but I am now full-time VA employee.
Larry Zilliox:Right. When did your work start to involve the Million Veteran Program?
Dr. Mark Logue:Yeah, so Million Veteran Program started, I think, in 2011, about 13 years ago but they didn't really open it up for people to start submitting new projects until more recently, and about five or six years ago I was already working at the VA and I heard that VA researchers were going to be able to get some access to a million veteran program data to start studying things they were interested in. If you could apply for a grant and get funded and I had been doing this PTSD genetics work at the VA and Alzheimer's work at Boston University and I came up with this idea to bring those two worlds together and said that what I wanted to study in the Million Veteran Program was how things like PTSD and other things that affect veterans influence your risk for Alzheimer's. So to look how the genetic risk you get from your parents go together with the things you experience throughout your life and in your service and add up to lose more or less at risk for dementia and Alzheimer's.
Larry Zilliox:Yeah, is that what you're currently working on?
Dr. Mark Logue:That is one of my current projects. Yeah, We've expanded a little and we're more broadly looking at Alzheimer's and dementia and the Million Veteran Program, but that's primarily what I'm interested in the genetics of Alzheimer's disease and how things like PTSD, TBI and we're looking now at things like cardiovascular disease and other things interact with your genetic risk.
Larry Zilliox:And so to the layperson, that would be to try and determine whether or not genetics Alzheimer's is enhanced and maybe early onset Alzheimer's could be a result of a combination of genetics and one's service through PTS, tbi, that kind of thing.
Dr. Mark Logue:Exactly. You inherit things different variants from your parents. You know they may have a higher or lower risk of Alzheimer's and you inherit half your DNA from each parent and end up looking similar to them, and it's not possible to exactly predict who's going to get dementia, but we can tell who's at increased or decreased risk. So we also want to see how that interacts with what goes on and your things, that happen to you throughout your life. Again, as you said, combat exposure and PTSD after the fact and things like head injuries.
Larry Zilliox:What's the goal there? Is it to identify service members who may be at a higher risk and move them into jobs that weren't directly combat related? Or is it on the back end, from a treatment standpoint?
Dr. Mark Logue:It's on the back end from a treatment standpoint. So we're really hoping that you know we can identify people who are at risk for dementia early, and if we can identify people early perhaps it's easier to treat. And also we're hoping we can find the underlying biology of why people are at increased risk so that maybe we can come up with some new and more effective treatments that might be able to work. If you identify someone 10 years ahead of the time they're going to start showing symptoms.
Larry Zilliox:And what's the? What do you hope for as in the near future is sort of a. Will it result in policy changes with the VA or do you think it's going to be mostly treatment focused?
Dr. Mark Logue:I'm hoping for treatment focus and I think it's you know I'm hoping we can help veterans with this. I think anything we find is probably going to help non-veterans as well. I really think you know it's Alzheimer's is, you know, a problem? We've likely all of us have people in our family that have got some kind of dementia or had problems when they get older, and we're looking for ways to prevent that, if we can.
Larry Zilliox:Yeah, do you see?
Dr. Mark Logue:that through medication.
Dr. Mark Logue:I think that's a possibility. There's some medications now that treat symptoms for Alzheimer's, but the goal is a cure at some point, an intervention that substantially slows or stops the disease. That's really, I think, the holy grail we're shooting for. We're not, you know, on the verge of that quite yet, I don't think but there's people that are having some really good ideas. I'm not personally testing drugs or chemicals to try to treat Alzheimer's, but I'm hoping, if I can find the parts of the biology that are going wrong, the things that need to be fixed, and describe those really well in terms of you know what complicated chemicals or genes are involved, that someone can come along and use that information to figure out which drug will work the best.
Larry Zilliox:Yeah, it sounds as though if you can identify people early, then they can get into a treatment protocol, maybe 10 years out. That will stave off this for 10, 20 years.
Dr. Mark Logue:I think that's the hope. You know that that if you, before the damage happens to the brain, if you can, if you can stop in the early phases, before anyone even knows about it, then that that's where your best outcome would lie.
Larry Zilliox:Yeah, the data that you work with comes. Is it primarily from the million veteran program or do you co mingle outside data, or how? How does it work?
Dr. Mark Logue:So I do a lot of work Um in MVP and analyzing the MVP data and the genetic data that all the veterans have provided. But I also try to link that up with data outside of MVP and I feel it's a big National Institute of Aging funded effort to get a lot of people and a lot of data together and really study these genetics and link it to brain scans and blood-based biomarkers and other things you can measure in the blood and really try to make progress on this. And I feel like working in the VA, one of my goals is to make sure all the effort put in by volunteers goes as far as it can and that the VA data is represented outside the VA. So we're not sending any veteran data, any MVP veteran data out, but we're trying to do analyses and generate findings that can be combined with data coming from other places.
Larry Zilliox:What impact did the almost full computerization of medical records have on your research?
Dr. Mark Logue:So that's a place the VA I think was ahead of the game compared to a lot of other places. And in the Million Veteran Program the volunteers you know do surveys but our primary data the things we measured in the blood, with what went on in the VA electronic medical record throughout a veteran's life. So we have all the diagnosis codes and the pharmacy records and we use that to try to figure out, identify who in the data has dementia and then link that with the things we measured in blood and try to see in large groups of people how the people with and without dementia differ.
Larry Zilliox:What shows up for dementia patients as opposed to what's not there for those who don't suffer.
Dr. Mark Logue:Yeah, exactly, or what happens at a higher rate. You know, it's not like you can just spot one thing and that's what caused the dementia. It's not like you can just spot one thing and that's what caused the dementia.
Larry Zilliox:But we can get a sense of the risk factors, the program itself, the Million Veteran Program MVP for short.
Dr. Mark Logue:I thought that was pretty catchy. It's a veteran hazard from having the job that you start using acronyms for everything In the VA. Institutionally that still prevails. It still goes on.
Larry Zilliox:Are there a million veterans involved? Do you know how many are actually in the program?
Dr. Mark Logue:Just a little less than a year ago, the Million Veteran Program hit a million veterans, a million volunteers, wow. So that was a big number. It was sort of named the Million Veteran Program for many years before there were actually a million veteran volunteers, but they finally got there and I think they've shifted the goalposts now and are trying to get two million volunteers, two million veteran volunteers, into MVP. Although I don't think they're going to rename it, as far as I've heard it's going to stay the Million Veteran Program.
Larry Zilliox:Right and if you know, can you tell us what's different about the program as opposed to just getting treatment from the VA and having that treatment information in the system?
Dr. Mark Logue:Right. So a lot of VA research goes on with the VA electronic medical records. If you've got an approved study and you're a VA researcher, you can look for things in the VA medical record and look for the causes of disease. But in MVP, volunteers join up I think there's a website and often they do recruiting at VAs around the country and you sign up and agree to be part of MVP and they do a form consent process and let you know what it involves. But eventually they take a blood sample and you give permission to have your VA electronic medical record linked to that blood sample and they do the genotypes as I mentioned.
Dr. Mark Logue:That's where they measure the DNA or your genetic code at about, I think, 650 or 700,000 spots along the genome and we put those in computers and then we figure out what's going. We try to fill in as much of the genetic code as we can for each person and that's what we can compare across people to do genetic discovery and MVP. So key thing that MVP adds on to the electronic medical record data that we can study is the genetic data and also the survey data we use all the time and it's very valuable. So that has a lot of information about things that may not be immediately available in the VA electronic medical record and things like head injuries for Vietnam veterans. When they served you you wouldn't necessarily see that they didn't necessarily get treatment for that head injury, since it happened many years ago. But on the survey, if someone tells us we had a head injury, we can use that information and learn something about it.
Larry Zilliox:Yeah, the value in this program I see right off the bat is I'm let's say I'm a veteran and I have a 20% rating because I've got a hearing loss and I've got a finger messed up. There's very little data in my medical records that I think would be of much value to researchers. But if I'm a volunteer in the program then I'm getting the surveys and I'm adding all sorts of information that, based on my rating and what I'm being treated for, it's just this information that I'm voluntarily providing through the surveys just never would end up in the record and be of any value to you at all.
Dr. Mark Logue:Well, that's absolutely true. That's a value. But you know, everybody has their own health history and so I think everybody is valuable here, because we need people with high blood pressure and people with low blood pressure, and we need people with Alzheimer's and without Alzheimer's and people who may in the future get Alzheimer's. Even if people think, wow, I don't have a rare disease or something interesting someone would want to study. You know all the assessments they've done and you know what medications they've received and you know what medications they've received and you know even the history of hearing loss. You know that's something over a hundred different MVP projects at this point, studying almost everything you can think of. Yeah, I saw the list, so I'm studying dementia. You know that's my thing. But there are other groups studying. Well, just PTSD by itself, say, or cardiovascular disease, or high blood pressure, and tinnitus is another group, and so all the data From the medical record becomes valuable then for one or more of these studies.
Larry Zilliox:Yeah, and what I was getting at is that it's really important that veterans participate in this program because of the surveys, they're adding information to the database that they wouldn't normally get just by being treated for a 20% service-related illness or injury.
Dr. Mark Logue:Right. The genetics and the surveys really help us out.
Larry Zilliox:Yeah.
Dr. Mark Logue:And that's what we can get just from people getting care at the VA and getting approved to do a study there.
Larry Zilliox:Yeah, it is an amazing program Just looking at it. Like you say, there's over 100 different studies going on and I noticed on the webpage that there's up until March of this year. They listed over 350 articles and just results that they've published. You can download all of those and you can click on the link and read it for yourself If that's something you want to do. I mean, there's some real, real crazy stuff. The autoimmune aliases at the major histocompatibility locus and modify melanoma susceptibility.
Dr. Mark Logue:So if that's the kind of thing that I'll make the word get a little confusing. It's a little heady.
Larry Zilliox:So I'm not sure how much of these things our listeners would be interested in, but the main point there is that this information that you're providing by joining the Million Veteran Program is being used. It's not just going off to sit in some database at the VA so that they can say, oh, we have all this information, we need more funding. They do need more funding. This information that you provide goes into that database and the more veterans that are in that database, the more useful the database is, the better the work product and the end product that the researchers there at the VA and even at universities and places around the country can use to provide treatments hopefully affect policy. All sorts of ways to get more funding and anytime the VA gets more funding, no matter what it's for, whether it's for a research program or whether it's to buy mops for the janitors anytime the VA gets more funding, all the veterans benefit from that. Your current program, your project, how is it funded and for how long is it going to be funded?
Dr. Mark Logue:So currently I have funding from both the VA, from an internal VA merit award mechanism, and we're getting some funding from the National Institute of Aging as well to go in and see if we can improve how we're identifying who has dementia and who doesn't in the VA electronic medical record. I think I agree. I totally agree with your point that this is just a great, influential project. I can say from my perspective as a researcher, it's just very incredible and that sounds like big numbers, to have a million veterans and those are huge numbers and, just to point out, this is one of the largest such databases in the world. There aren't hardly any other projects in this class, you know, on the planet and veterans made that happen. Yeah, it's incredible.
Larry Zilliox:Well, the key here is to keep making it happen. If you're a listener and a veteran and you're not part of the program, I would encourage you to go to the webpage now. That webpage is mvpvagov G-O-V and there see a way to join. It's not hard to join. It took me all of eight minutes to join and order a blood kit so you can draw your own blood and mail it back to them. So if you're in the rural area, you don't have to travel for hours to get to a VA facility to give your blood. They will send you a blood kit and draw your own blood and get that back to the lab and get that information associated with your medical records.
Larry Zilliox:And, as Dr Logue said earlier, you don't have to have a rare disease or even you can be healthy as a horse and you should still join this program, because I'm sure they need markers for healthy people as much as they do for the rest of us. But there's no excuse. Really. It doesn't cost you anything. It's just some time filling out surveys once you get your blood sent in, and it's so valuable for the VA and the researchers to have this information that I really do want everybody to join. Doc, as we wrap this up, I just had one question for you about your research there, the research of your colleagues and that kind of thing, and I'm very curious as to what you and your colleagues think the impact of AI will be on your research.
Dr. Mark Logue:So that's a tricky question. I'm not sure where AI is going to end up in the whole genetics and genomics space. I know it's already being incorporated, for example, into the things people do to read imaging scans and brain scans and other things. We haven't started using it in our genetics and genomics program here. I'm sure people are elsewhere. So I think we still don't know yet what the far-reaching impact for artificial intelligence is going to be in the genomics world. I'm just hoping lots of discoveries and lots of things that advance health for everybody.
Larry Zilliox:Yeah Well, we keep our fingers crossed and say, you know this could be a way to put it to good work, you know, because it may find things that just others were missing. You know this could be a way to put it to good work, you know, because it may find things that just others were missing. You know just patterns and all sorts of things. So we can only hope. I really appreciate you taking the time to talk to us today about the program and your work and I just really appreciate it.
Dr. Mark Logue:Oh no, just thank you for having me on the show and for letting me know about it, and I appreciate the sentiment and all the wishes for everyone to participate in research.
Larry Zilliox:Yeah, well, hopefully we'll get a few more people signed up, For those are regular listeners. If you have any questions or suggestions, you can reach us at podcast at willingwarriorsorg. Until then, we'll have another episode next Monday at 0500. And thank you for listening.
