Dr. Timothy O’Leary, the Chief Research and Development Officer (CRADO) for the Veterans Health Administration (VHA), U.S. Department of Veterans Affairs (VA), oversees a research program that’s conducted at more than 100 VA medical centers around the nation, and which addresses a full range of health concerns affecting America’s veterans. The research program dates to 1925 and includes biomedical, clinical, rehabilitation, and health services research. Its investigators have earned three Nobel prizes, seven Lasker Awards, and numerous other national and international honors.
Dr. O’Leary’s career began during his undergraduate studies at Purdue University, where he majored in chemistry. He went on to earn a doctorate in physical chemistry from Stanford University and a medical degree from the University of Michigan. He conducted research for the National Institutes of Health (NIH) and the Food and Drug Administration (FDA) before joining the faculty at the Armed Forces Institute of Pathology (AFIP), where he chaired the department of cellular pathology for more than 15 years.
Dr. O’Leary joined the VA in 2004, initially as director of Biomedical Laboratory Research and Development (BLR&D), then director of BLR&D and Clinical Services Research and Development (CSR&D). In June 2014, he was named CRADO for VHA. His research interests include genomics, proteomics, and ultrasensitive detection of biological toxins. He is certified in anatomic pathology by the American Board of Pathology and in molecular genetic pathology by the American Board of Pathology and the American Board of Medical Genetics.
From 1979 to 2010, while he lived and worked in the Washington, D.C., area, Dr. O’Leary served as a reserve member of the Public Health Service Commissioned Corps, serving two tours on active duty.
He has served on numerous federal panels and advisory committees, including the Health and Human Services Clinical Laboratory Improvement Advisory Committee and the Food and Drug Administration Hematology and Devices Panel. The holder of four patents, Dr. O’Leary has authored or co-authored more than 175 journal articles and numerous book chapters and technical reports. He is a past president of the Association for Molecular Pathology, and serves as editor-in-chief for its Journal of Molecular Diagnostics.
The Year in Veterans Affairs and Military Medicine: The theme of this year’s VA Research Week, May 18-22, 2015, was “Celebrating 90 years of Research Excellence.” When you compare today’s program to that of 1925 or, say, the first few decades, what are some differences that illustrate important things about how VA research, and its interactions with other programs, have evolved?
Dr. Timothy O’Leary: One of the differences that’s pretty clear is that in the early years, a much larger fraction of VA research was observational studies. These were very, very important observational studies – for example, the studies done in the cardiovascular research unit at the Washington, D.C. VA that looked at the early evolution of plaques in the arteries of veterans – younger veterans, in many cases. And then as the years went by, you saw an increasing focus on interventions to effectively treat. I’m thinking of things like the Freis study,1 which looked at the treatment of mild to moderate hypertension and showed that treating this was really good for reducing strokes and heart attack.
… Since 2000, we’ve recognized that you can look at genetic changes in cancer, and perhaps in other diseases, and target therapies to those specific changes – and get more effective treatment at lower cost. So it’s really an amazing evolution in medicine as a whole. And in many cases, VA has been at the leading edge of this transformation in medical research over the last 90 years.
And now, while these types of studies go on, increasingly we’re seeing studies in which we’re comparing multiple ways of treating disease, where two or three different approaches have arisen, and we’re trying to see which is best. An example – again, in cardiovascular disease – would be the COURAGE trial2 that was completed in the 2000s, in which coronary angioplasty plus optimal medical therapy was compared with optimal medical therapy alone for cardiovascular outcomes. And so we’ve got this evolution – which really goes along with the evolution of medical understanding in general, and of the way medical research is done – toward not only understanding interventions, but now that we do have effective interventions for many diseases, comparing them to see what’s best.
Another evolution that’s occurred over time has been the introduction, in the last two decades, of research in health care delivery systems. The entire area of health services research was something that was very foreign to VA and to the health care community in general at the time that the VA research program got going 90 years ago. Starting in the latter part of the 20th century, VA was a pioneer in introducing health services research: Figuring out the best ways for the health system to deliver well validated medical therapies and to improve adoption of good medical therapies, as well as assessment of things like the cost effectiveness of medical therapy.