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Radio podcast. We post something new every week
and you're going to find it informative. We want
to welcome to Veterans Radio today from the National
Association of Veterans Research and Education
Foundation, its CEO, Rashi Romanov. Rashi, welcome
to Veterans Radio. Thank you so much. I'm excited
to be here. Well, this is a great opportunity
to talk about a hidden gem, if you will, inside
the VA. But let me set this up a little bit.
You hold a bachelor's degree in biology and public
policy and a master's degree in health care policy
and management. You've been a Fulbright scholar,
a presidential management fellow. You've worked
for the VA. You've been a Director of Operations
for the VA Center for Strategic Partnerships
in the Office of the Secretary. When you left
there in 2017, you went to work for American
Health Insurance Plans. You were the Executive
Vice President of the Elizabeth Dole Foundation,
which so many veterans know what good work they
do. You've had a career focused on health care
and veterans affairs, so this is sort of being
CEO of Navref is sort of the perfect job, but
I suspect nobody knows what Navref is, so let's
start there. I would agree. absolutely, you know,
it's in so many ways, it's a perfect job. And
I love what we do. So, NAVREP is what I often
say is one of the best kept secrets of the VA.
We are a membership association and we represent
the congressionally authorized nonprofit infrastructure
that the VA uses to advance veterans research.
So essentially the easiest way to explain it
is anytime you hear of an NIH trial happening
at the VA, of a Pfizer or Merck trial happening
at the VA, chances are all of that funding and
all of that work is being coordinated. by one
of these VA affiliated nonprofits. It's an infrastructure
that's been around for more than 30 years. It
was, you know, Congress and VA came together
and in the late 80s really innovated this whole
design of how the VA could work more effectively
with the private sector because essentially if
tomorrow one of these pharmaceutical companies
creates a cure for cancer, we want to make sure
that veterans can be first in line to access
that. without these nonprofits and this infrastructure,
there would really not be a way for veterans
to be able to access these lifesaving drugs.
So we love representing this space. I think this
public private partnership space and ways to
connect, cutting edge, emerging healthcare innovations,
therapeutics, new drugs, being able to connect
all that to the VA and the federal government
is a really, really exciting place, especially
right now. NAVREF sort of sits right in between
that ecosystem and tries to make all this easier.
Well, it is important right now in particular
because VA just celebrated its 100 years of medical
research that's really focused on veteran -related
issues. That's kind of a milestone not many people
can point to, is it? Absolutely. And it's not
uncommon. Sometimes when we talk to people, there's
a little bit of, wait, VA does research? And
you're like, yes. Not only does it do research,
but it has this rich tradition and rich history
of doing research that's not only benefited veterans,
but has really advanced American public health
for all Americans and all citizens of the world.
The VA research program, as you rightly noted,
it turned 100 years old. My joke that I often
say is it doesn't look a year past 97, but it
turned 100 years old this year. And so we spent
a lot of time really raising and celebrating
all of the amazing achievements that the VA has
celebrated in this last century. So things like
the pacemaker, the nicotine patch, they did the
first successful liver transplant. So many examples
of how the VA has really been on the precipice
and cutting edge of research and new drugs and
new therapeutics. But you know, more recently,
these aren't all just things from like the 60s
and 70s. More recently, you know, things like
psychedelics research, which is in the news a
lot. VA is pioneering the work that's happening
there. Recently, there was a really great news
article about VA researchers actually doing the
early work to isolate GLP -1s that are used in
things like Ozempic and Wigovia. So when you
think about, you know, know, all of the achievements
that the VA has done over the last hundred years,
and then you start to contextualize that in terms
of what the next hundred years could look like,
especially when you think of how much data the
VA has and the future of healthcare is really
going to be around how we're using data effectively
to empower. local physicians and local decision
making and really be able to better predict disease.
And I cannot think of a system that is better
poised to lead on this than the VA, which is
the largest integrated healthcare system. It's
that piece of it in particular is particularly
fascinating in that you have this huge population
that the VA has got data on. Now it's mostly
men, but that's changing over time. But the million
veteran push, hey, we want all this data so we
can ultimately more personalized treatment by
segmenting it more clearly than just male, female,
old, young. I mean, it really has a unique data
set as computers get better, AI gets better,
researchers get better. It's got to be a treasure
trove for researchers. Absolutely. You know,
it's over 9 million enrollees in the VA healthcare
system. You mentioned the Million Veteran Program,
which is the world's largest and most diverse
genetic biobank, again, in the entire world.
And to say nothing of the fact that, you know,
one thing that I think makes the VA so unique
the ability to do longitudinal studies at the
VA. Now, wait, wait, explain what longitudinal
studies for those of us who did not get a Fulbright
scholarship. Well, longitudinal studies is essentially
just these long -term multi -year, multi -generational
even in some instances studies. When we think
about things like traumatic brain injury or a
toxic exposure or cancer or Alzheimer's, dementia,
things that progress and change over time. You
know, the VA holds on to patients for years,
if not decades. Now people's interactions and
sort of level of engagement with the VA might
change over time, right? When they're working,
they might only go to the VA for certain kinds
of appointments, and maybe they go to a civilian
or their, you know, employer insurance provider
for different things. But in a lot of instances,
the VA is having engagement with their patients
for years, if not decades. So the ability to
be able to study, well, what does toxic exposures
and the progression of this look like over a
lifetime is really unparalleled. And traumatic
brain injuries in the news all the time, and
it changes over time. If you have a TBI in your
20s or 30s, how that manifests and changes in
your 40s, 50s, and 60s looks very, very different.
And there's no other system in the country, if
not the world, that's really able to monitor
this progress and study disease progression like
you can at the VA. And just to put some more
context in this, I have an article in front of
me from Task and Purpose. It says in physical
year 2024, Congress appropriated 984 million
to the VA for 102 research sites nationwide and
nearly 7 ,300 active projects. Those numbers
are astounding. Unless I read them here, I would
never have somebody to ask me, how many do you
think? Talk about the scope of all that and where
NAVREV sits in on that. Yeah, so it's a great
question. And what I would say is, You know,
that $984 million that you cited, that actually
doesn't even include extramural funding, which
is what NAVREF really supports. So on top of
that $984 million, our members facilitate annually
upwards of $300 million a year. on clinical research.
So the way that I say it just to make it easy
is about one in every three dollars that the
VA is spending on research is actually coming
from an external partner, right? It's a place
like the NIH. DOD is increasingly investing in
the VA for research as it relates to service
member health. the pharmaceutical industry, biotech
sector is increasingly coming to us saying, hey,
we really want to leverage data, we really want
to work with you, state and local governments,
philanthropy. So places like the prostate cancer
foundation made a historic $50 million investment
into VA research over the last few years. And
so, you know, it's, you're right. I think it's
when people often say like, so tell me what's
going on in VA research. I say it's my most favorite
and hardest question to get because it's It's
almost easier to say what's not happening in
VA research, right? There's just so many opportunities
and fields of study. Now, what I will say, what
the VA has done, I think, over the last five
to 10 years is really making sure that they're
focused in on those issues that are most impacting
veteran populations. And so VA's Office of Research
and Development has really taken on an enterprise
optimization plan where they're really ensuring
that those resources are going to the areas where
we know veterans are really struggling, right?
Areas like mental health, behavioral health,
suicide prevention, traumatic brain injury, PTSD.
cancer, aging, dementia. So it's really, really
fascinating to be able to take a step back and
look at what's possible. And then I think, you
know, from the perspective of NAVRA, because
we sort of sit in this bridge with the public
and private sector, where does it make sense
for the private sector to really leverage the
VA for the testing of new drugs? So like cancer
is perhaps the oncology program is perhaps the
biggest area of interest right because we know
that veterans have a higher incidence and prevalence
of cancer um either as a result of their military
service or as a result of other factors um so
places you know it's a great place to come and
study things like lung cancer prostate cancer
we have such higher rates of that unfortunately
within the veteran population and so oftentimes
you have a lot of interest from the manufacturers
and the drug developers of those cures and of
those life -saving interventions to really want
to come to the VA and figure out how can we design
these interventions to really best serve the
veteran community. For those of us in the veterans
world and are familiar with terms like presumptive
conditions, Parkinson's, ALS, And we've had the
chance on Veterans Radio to talk to the leaders
of the Parkinson's Foundation and the ALS Foundation
about how they help veterans. But part of this
is sort of, it's that swinging door between civilian
population and veteran population. Do you see
the push being pushing out from VA or pulling
in from VA on those kind of issues? Yeah, and
I think that tends to be one of the biggest questions
right now, really, is it really comes down to
where people are accessing their care and how
they're able to connect back to some of these
benefits that they really only get at the VA.
I think it's, you know, one of the things that
I think is really interesting about all of this
is, you know, the bedrock of VA research is really
rooted in partnerships. And that partnership
is really between leading academic medical centers
and the VA. You know, as is often quoted, the
VA trains more than 70 % of the nation's doctors,
right. And so the benefit of this system not
only do you have veterans, I think, moving in
and out of the system, we also have providers
moving in and out of the system, right? Chances
are if you're at the VA in Durham, you're doing
some sort of appointment or seeing patients at
Duke as well. And so it's allowed not only, so
I think not only as patients are moving in and
out of the system, you also have this movement
of providers, which has allowed the VA to bring
in the best and brightest of academic medicine
to treat veterans. I think as veterans are seeking
out care in the community, I'll be honest, I
don't think that's going anywhere. I think when
you sort of see what's happening with the budget
and in the news, I think community care is an
element that's gonna be here for a bit. So what
I think we're really focused on is how are we
working with those community care providers and
those systems so that. when a veteran goes out
into the community to seek care and maybe, you
know, something happens on a lung cancer screening
or something happens with the breast cancer screen,
how are they connected back to the VA so that
they can still be enrolled and connected with
all these research opportunities that they're
really only going to get at the VA? Yeah, there
are some things VA does much better than the
civilian population because it's its cohort of
patients have a higher incident of that. thing,
and therefore they are more experienced, more
trained, more focused on recognizing it. We're
talking to Rashi Romanov, CEO of National Association
of Veterans Research and Education Foundation,
better known as NAVREF, N -A -V -R -E -F. Put
a dot org on that and you can find the website.
How did a nice Pittsburgh girl like you end up
so focused on a veteran healthcare and research
issues? Yeah, great question. If you would have
told me 20 years ago that this is what I'd be
doing, actually, I don't know. I don't know that
I would totally believe it. But I think going
through grad school, going through all the formal
training, I knew I wanted to do something around
impacting healthcare. Honestly thought I might
end up at a place doing more global health care,
global women's health, things like that. And
when I was a presidential management fellow,
just going through a job fair, if you can believe
it, in DC, met someone at the VA, and they said,
hey, so what are you interested in? And I said,
I really want to work in health care, but I want
the work to make a difference. I want to be able
to feel the impact. And they said, well, have
you ever thought about working at the VA? And
I'll be honest, like many Americans, I was like,
I didn't really know that much about the VA.
I did not come from a military family, so it
was a bit of a black box to me, which I think
is helpful now at this job when you think about
explaining this to other partners. And so when
I started to think about it, you know... largest
integrated healthcare system in the world, the
ability, and it's a national leader. If you figure
something out in the VA, it is going to become
a national if not global standard. And the ability
to transform healthcare policy and the delivery
of healthcare at that level for a population
that has so earned the highest quality of healthcare.
I can't think of another patient population in
the country that deserves the highest quality
of healthcare than our service members and veterans.
It just sort of checked all the boxes, and I
think the ability, and I think there's also,
I'll just say this, I think particularly in this
environment that we're living in in Washington,
I often say this feels like the last bastion
of an issue that has wide bipartisan support.
One of the things I used to say at the VA, which
still stands true about working in this space,
I love that you don't really know the political
affiliation of anyone you're working with in
these circles because, everyone is so hyper focused
on serving veterans and serving their families.
And I can't think of a better North Star when
you're going to work every day. And so it's really
honestly reassuring to work in a space where
not only you feel like you can have an impact,
but there's such wide support around doing the
right thing and wanting to get this right and
knowing that getting it right is of critical
importance that it makes partnership so much
easier. Well, let's transition from there. It's
a good jumping off point because Research is
a long game and we've just talked about VA has
been at it for a hundred years as Never have
looks into the future for research. There are
certainly economic concerns But talk about why
this is so important in the in the long game
aspect of it Absolutely. So I love that research
is a long game. I think I'm probably going to
steal it. It is a long game, and it's a team
sport. That's our other line that we say. You
need a lot of different entities supporting and
rowing in the right direction for biomedical
research to really be successful. When you talk
about, I'll give you one example of something
that shows that research is a long game at the
VA. Back in the 80s, and the New York Times recently
published on this, so I'll give credit to them.
But back in the 80s, there was a VA researcher
at the Bronx who was doing all this work on lizards
and lizard venom, right? And it was this really
interesting story of, okay, why are they doing
lizard? And they were saying, essentially the
premise being, you don't really see a lot of
overweight lizards. I wonder what's going on
here. I wonder what's happening in sort of their
biology and in their systems to allow all this
to happen. They did all this work. They got lizard
venom. They isolated all these compounds. Fast
forward, this VA researcher at the Bronx isolated
the GLP -1 compound via lizard venom. Can I stop
you there because it would be so easy to look
at lizard research and call it fraud, waste,
and abuse. Absolutely. Absolutely. You have to
keep the long game in mind in research. It's
a long game. And the reporting is really great.
And it was interesting because there's a line
in there. Now, I will say wearing my VA hat,
there's a line in there where the researcher
actually brought it to the VA and said, hey,
I think there's something here. And there's one
line in the article that said the VA was like,
oh, I'm not sure that there's a benefit here
to veterans. And then fast forward, the GLP -1
is Ozempic, Wigoby, like all these. different
medications around diabetes and weight loss,
and is really transforming how we're thinking
about chronic care management in the United States.
And so an example of something that started as
maybe an isolated project in the 90s, now 20,
30 years later, having this huge impact in how
we think about diabetes is fascinating. So it
is a long game. One of the interesting things
too about VA health care and VA research is the
world of clinical trials. And I don't think the
general public, most veterans understand kind
of what clinical trials are about and why that's
so important as a segment of VA managed care.
Can you talk from NAVRAF standpoint about clinical
trials and the value? Yeah, absolutely. And I
think, you know, if there's one thing, I think
the beginning of 2025 is really showed us, and
this is, I think, beyond just the VA veteran
space, is that I think the world of research
has to do a better job of explaining what it
is they do. I think there's a lot of things that
people don't understand about how all of this
is organized. And so I will say, for the purposes
of clinical trials in the VA, access to clinical
trials and clinical research is a fundamental
component of high quality care. There has been
research that's been published that says institutes
and research centers that are doing research
have higher quality of care output, right? A
big part of it. So, you know, what I often say
to civilian populations is if, God forbid, somebody
gets really sick and they say, okay, where do
you want to go? People might say, oh, I want
to try to get to the Mayo Clinic. I want to try
to get to the Cleveland Clinic. St. Jude's is
a really good example in the pediatric space.
When you dig into that and you say, well, why
those places and it's usually oh well they have
doctors there that will get me into some trial
or some life -saving medication right and that
is exactly how we should be thinking about the
VA. So not only clinical trials are the opportunities
for veterans and patients to be able to access
new emerging treatments, new emerging therapeutics.
Some of these new drugs, when you think about
things like radiation oncology, may allow you
to defer things like surgery or painful chemotherapy.
There's newer therapies that are available that
might suit the veteran and the patient and their
family more adequately. Drugs that have a higher
efficacy rate, higher likelihood of being successful.
So there's a lot there in terms of the benefits
to the patient. What I'll also say, and this
is a bit more of a systems thinking, but research
is also one of the most compelling things we
have to offer. providers and young physicians
that are looking for places to come. Oftentimes,
when it comes to recruitment, being able to say,
you know, not only can you come here and be,
you know, a clinician and see patients or an
oncologist, but you will also be able to access
all of this data and do cutting edge research
and publish papers and transform care. That's
why a lot of physicians and clinician scientists
get into this field, right? They want to find
cures to these diseases. And so not addressing
sort of the connection of all this stuff to,
you know, research isn't a nice to have. It's
a critical component of high quality care. But
from a systems angle, without research, being
able to recruit physicians and nurses and all
these, it's going to become much, much more challenging
for the VA. Well, and you, if a doctor or a scientist
in that realm wants to have the opportunity to
be challenged and use their scientific creativity
to something useful. That's why it's a great
recruiting tool. When we've talked to researchers
and doctors at the VA, oftentimes they're saying,
well, okay, let me give you the phone number
or the email address where you can link up and
see if you qualify for the clinical trial. One
of the things VA Scope does, it's really a national
scope, so we do these, and somebody from California
can get in, or Maine, or Florida, or Alaska,
which you may not get in a more localized healthcare
practice. So I always found that kind of interesting
that, hmm, there's a pretty big reach on this,
isn't there? Absolutely. And you know, I often
say VA made investments into things like telehealth
back in the 90s when it was not the sexy thing
to be thinking about. They invented things like
the electronic medical record when it was not
the trend hot item to think about. And so The
result is that now, 20, 30 years later, there's
such a robust technological infrastructure. So
things like VA's tele -oncology programs here,
they're sort of headquartered in Durham, but
the physicians working on that are seeing patients
all over the country via telehealth. In what
other system is that possible for you to be able
to get the best and brightest of, you know, cancer
leadership and cancer expertise in a small town
potentially in, you know, North Dakota via telehealth?
It's just, it's amazing. Well, we really appreciate
the time you've given us today, Rashi Romanoff,
CEO of Navref. If people want to know more, and
maybe we're going to get a couple of VA researchers
say, yeah, maybe I should join up, or corporate
partners, where do they go to get some more information?
Absolutely. So we always direct everyone, come
to our website. www .NAVREF .org, N -A -V -R
-E -F. Reach out there, email our team if you
want to get connected about ways to learn about
how you can get involved in VA research. We have
a number of resources available on our website
around things for PIs and researchers who are
trying to learn more about extramural research
ways to get involved. Just reach out to us. If
you're a veteran who's interested in learning
more about research, also let us know. Things
like the Million Veteran Program are always looking
for people to get involved. And if you're really
passionate about research or want to learn more,
we're happy to connect you locally to some advocates
that can really help get you connected into these
trials. Well, NAVRF's doing very important work
supporting the work that VA is doing in research,
which is very important work. Sureshya, thank
you for the time that you've given to Veterans
Radio today. Thank you so much, Jim. It was great
to be here. And I want to thank everybody for
listening to Veterans Radio today. I am Jim Fossone.
It's been a pleasure to be your host. I'm a Veterans
disability lawyer at Legal Help for Veterans
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