Psyche, Science, and Society

Torture and the American Psyche forum audio

Thanks to Dori Smith of Talk Nation Radio, our May 3 forum — Torture and the American Psyche: Blurring the Boundaries Between Healers and Interrogators — was audio-recorded. Dori has edited the material for two hald hour shows on Talk Nation Radio. That material is now available. [NOTE: The forum was also video recorded. These videos should be available soon, on YouTube or a similar site. Stay tuned.]

For those who don’t read this blof regularly, here’s the description of the speakers:

SPEAKERS:

Eric Fair currently a divinity student at Princeton will speak from his experience as a civilian contract interrogator in Baghdad, Fallujah, and Abu Ghraib in early 2004. He will lend his first person account to our conversation.

Leonard Rubenstein, J.D. President of Physicians for Human Rights, a Nobel Prize winning organization, is an attorney and veteran of many human rights struggles. He will speak of the role of torture in our contemporary political culture.

David Sloan-Rossiter, Ph.D. will bring his long standing interest in using a psych oana¬lytic perspective to aid communities to the role of moderator of the program. He is co-chair of the Curriculum Committee at Boston Institute for Psychotherapy and Massachusetts Institute for Psychoanalysis.

Stephen Soldz, Ph.D. a local psychoanalyst, social activist and Professor at the Boston Graduate School of Psychoanalysis, is one of the nation’s leaders in opposing psycholo¬gist participation in torture and abuse. He will speak to the history of that struggle in the context of the broader struggle for human rights.

Talk Nation Radio

TNR Show I contains material from the Introduction by David Sloan-Rossiter and an interspersing of material from the talks by Leonard Rubenstein (President of Physicians for Human Rights) and myself. [See Dori's description here and download mp3 here.]

TNR Show II contains the conclusion from my talk, the talk by former Iraq interrogator Eric Fair, and some discussion, including comments by Stephen Behnke, the Ethics Director of the American Psychological Association. [See Dori's description here and download mp3 here.]

Complete Talks, unedited

The Talk Nation Radio versions are selected and cleaned up. For those who would like to listen to the complete talks, Dori has kindly made available the raw recordings.

David Sloan-Rossiter Introduction and Stephen Soldz talk here.

Leonard Rubenstein talk here.

Eric Fair talk here.

The Question & Answer session is available here.

1 comment June 2nd, 2008

Secret clinical trials research puts patients at risk for no benefit

[UPDATED with link to article] An article in the Canadian Press raises serious new questions about the dangers posed to research participants by our corporate-dominated drug development system. Patients were enrolled in clinical trials of a type of blood replacement product despite previous research indicating that these products posed serious risks. The Canadian Press reports that new article in the Journal of the American Medical Association [Available here. Also see accompanying editorial.] pooled data from 13 published studies and three unpublished ones. Their review “showed people who got blood substitutes were 30 per cent more likely to die than those who did not.” These researchers were unable to obtain data from other unpublished studies conducted by companies.

There appear to be several major ethics issue here.

Participants in these studies, who supposedly give informed consent, were not told that prior research suggested these products were harmful. Nor, apparently, were the ethics committees [IRBs] that approved these studies and the informed consent procedures told about the dangers.

The results of several clinical trials were never published, presumably because they produced results indicating the products were harmful. Thus, important information was withheld from the public, putting patients recruited for additional clinical trials at risk.

Lead author Dean Fergusson, a clinical trials expert, said the withholding of the negative results meant ethics boards and trial participants could not accurately weigh the risks and benefits of the research.

“How can patients or their decision makers make truly involved consent without all this information? I think that’s a huge message,” said Fergusson….

The lack of disclosure suggests company stock prices were placed at a higher priority than the safety of people being asked to go into clinical trials, experts suggest.

An additional concern is whether ir is ethical to recruit people for clinical trials, placing the participants at potential risk — which is always the case in drug trials — and then not publish the results. A critical consideration in obtaining approval for research from IRBs is supposed to be a balancing of risks and benefits. Often, the benefits are not to individuals, but to society. If the results are not published, these benefits are not realized. So people are put at risk for no benefit, which is supposedly unethical. It would seem that a commitment to publish the results should be required of any study where there is a serious risk to participants. Otherwise these studies should not be allowed. Note that this argument is different than the argument, with which I also agree, that these studies should be published for the good of the public and that corporate profit should not be allowed to trump public good.

Finally, there is a question of whether these trials should have been undertaken in the first place, given the bad track record of this type of blood replacement products in prior research. The JAMA authors apparently believe the answer is “no”:

The authors were critical of the FDA for not requiring the companies to publish their findings, and for allowing additional trials to be conducted after the risk should have been apparent.

“At some point, somebody should have realized that we’ve tried it in trauma patients, we’ve tried it in surgical patients, we’ve tried it in stroke patients, we’ve tried many different formulations and we keep finding the same result,” said Dr. Charles Natanson, lead author of the meta-analysis, a technique in which data from a number of trials are combined and re-analyzed.

“At some point, and we sort of argue in the paper that may have been the year 2000 . . . it was time to put a halt” to additional trials, Natanson said.

This information raises profound questions about our entire drug development system. The corporate dominance of drug development creates inherent conflicts of interest that put both clinical study participants and the public at risk. Either we need to find ways of overcoming those conflicts of interest or we need to develop a new system for drug development. How many scandals will it take till the health professions, policy-makers, and the public are fed up?

Add comment April 30th, 2008

Almerindo Ojeda: Guantánamo healthcare providers serve interrogators

Last week the Washington Post reported that Guantánamo and CIA detainees alleged that they were given strange psychoactive drugs by force. Jeff Stein of CQ had reported a similar things a few weeks ago. I wrote about this in my piece Involuntary Drugging of US Detainees. In response to the Post article, Almerindo Ojeda wrote a letter to the Post detailing additional evidence that the provision of health services and interrogations at Guantánamo have been intimately linked, with health providers serving the abusive interrogation regime.

Almerindo is the Director of the Center for the Study of Human Rights in the Americas at the University of California at Davis, where they have a wonderful archive, the Guantánamo Testimonials Project with testimony from many sources on the conditions at the prison. The Project — by typing out many handwritten documents, transforming them into searchable text ,and carefully organizing them– is one of the premier sources for such materials as detaneee or FBI accounts of abuses there. My colleagues and I use it all the time.

In any case, the Post did not print Almerindo’s letter. He has thus revised it slightly and given me permission to post it here:

A recent article in the Washington Post (Detainees Allege Being Drugged, Questioned, 04/22/08), quotes Pentagon spokesman Cmdr. J.D. Gordon as saying that interrogations at Guantanamo do not affect or influence medical treatment of the detainees held there. Unfortunately, the evidence suggests otherwise.

Attached to a recent motion on behalf of Guantanamo prisoner Salim Ahmed Hamdan are medical records stating that, on 8/28/02, an ointment was applied to Mr. Hamdan’s lower back and then covered with moleskin–a treatment which the attending medic described as a “special request for medical attention per FBI“. In addition, a medical record for the same detainee dated 2/19/04 carries the annotation “no rec time per Intel“–or “no recreation time per Intelligence” (I understand that exercise is an important component treatment of sciatica, which Mr. Hamdan suffered from then).
Moreover, one of the “counterresistance techniques” approved on December 2, 2002 by then Secretary Rumsfeld against Guantanamo detainees was the use of isolation facilities for up to thirty days. Here, and for selected detainees, “the OIC [or Officer in Charge], Interrogation Section, will approve all contacts with the detainee, to include medical visits of a non-emergent nature.” Although blanket permission to use this and other techniques was rescinded by then Secretary Rumsfeld a month later, their use was still allowed on a case-by-case basis and with approval of the Secretary of Defense (see memos 16-23 in The Torture Papers, by Greenberg and Dratel).

Similarly, section 30-6-d of the 2004 Camp Delta Standard Operating Procedures posted recently by Wikileaks reads as follows:

Detainees who are on self-harm precautions [i.e. those at high risk for suicide or other self-injury] that are scheduled for interrogation will have their clinical status and risk assessment verified by the licensed Behavioral Health staff prior to leaving the block. Detainees on self-harm precautions are generally not clinically stable enough to leave the block.

So the needs of interrogation may trump the reasons for placing a GTMO prisoner in a mental health ward. And this as a matter of standard operating procedure.

Almerindo Ojeda, Director
Center for the Study of Human Rights in the Americas
University of California at Davis
http://humanrights.ucdavis.edu

Add comment April 28th, 2008

California legislative resolution targets health providers aiding torture

One of the most exciting new developments in the fight against psychologist and other health provider collusion in torture are bills in several state legislatures on the issue. In California, Senate Joint Resolution 19 is scheduled to come to a vote any day. [See my earlier coverage here, here, and here.] The Sacramento Bee recently covered the issue. [Note: the vote has been delayed several times since this article on April 5.]:

State senator targets torture
By Aurelio Rojas - arojas@sacbee.com

The California Senate is preparing to weigh in on the hot-button topic of torture, with a twist that combines elements of the Hippocratic oath and the military oath.

Under a resolution that state Sen. Mark Ridley-Thomas plans to put to a vote Thursday, California regulators would notify physicians and other health professionals that they could lose their license and be prosecuted by the state if they are involved in the torture of suspected terrorists.

The Los Angeles Democrat chairs the Senate Committee on Business, Professions and Economic Development, which oversees boards that license health professionals in the state.

During a committee hearing in January, Ridley-Thomas said there is evidence that physicians, psychologists and nurses licensed by the state “have participated in torture or its coverup against detainees in U.S. custody.”

He cited “confirmed reports from the International Red Cross, New England Journal of Medicine, military records and first-person accounts.”

“California has the obligation, I believe, to notify its licensees of laws pertaining to torture that may result in prosecution,” Ridley-Thomas said.

The senator said physicians have reportedly advised interrogators whether prisoners were fit enough to survive “physical maltreatment, informed interrogators about prisoners’ phobias and other psychological vulnerabilities that could be exploited.”

Invoking the Hippocratic oath that physicians traditionally take, he said the state can “withdraw its consent to torture by demanding that its health professionals remember their oath to first do no harm.”

Dr. Vito Imbascini, state surgeon of the California National Guard, said “a few Californians were among the practitioners in the healing arts involved in torture” at U.S. military facilities at Abu Ghraib prison in Iraq and Guantánamo Bay, Cuba.

“But given the tiny number of renegade offenders, we think a more effective approach (than the resolution) would be to target those offenders,” said Imbascini, who represented the 35,000-physician California Medical Association at the hearing.

Neither Senate Republican leader Dick Ackerman nor incoming GOP leader Dave Cogdill was available for comment Friday. But Senate Joint Resolution 19 is likely to provoke spirited debate between Democrats and Republicans in the state Senate, similar to that seen in Congress since 2004 when accounts of abuse, torture, sexual exploitation and homicide at Abu Ghraib came to public attention.

President Bush – with an emphatic “We do not torture” – has defended U.S. interrogation practices and called the treatment of suspected terrorists lawful, despite similar reports of torture at U.S. facilities at Guantánamo and Bagram Air Base in Afghanistan.

Bush has repeatedly noted the world has changed dramatically since the Sept. 11, 2001, terrorist attacks on New York and Washington and says the United States must defend itself with “enhanced interrogation techniques,” which critics contend is a euphemism for torture.

Over the years, the Legislature has weighed in on complicated national issues over which it has no jurisdiction, such as wars and international treaties. But in this instance, it does appear to have some legal standing.

Dr. Richard Fantozzi, president of the California Medical Board, which licenses physicians, cited a 2005 legal opinion by the state attorney general’s office that concluded the state has jurisdiction over licensees serving in the military or practicing in federal facilities.

Fantozzi said the state Supreme Court has also ruled that a state licensing agency may discipline a licensee for conduct occurring outside the state.

But Fantozzi cautioned the committee that under the doctrine of sovereign immunity, if the military does not cooperate, the state “would be prevented from conducting an effective and thorough investigation.”

Barbara Olshansky, a New York attorney, told the committee “all our military laws and regulations, from the field manual to the manuals on interrogation, prohibit torture.”

She said the U.S. Supreme Court also has affirmed that courts have the responsibility to stop torture.

But Olshansky, who filed the groundbreaking suit in which the Supreme Court ruled that U.S. courts have jurisdiction over claims brought by Guantánamo detainees, said there is ample evidence of torture at U.S. facilities.

“We can prove that medical personnel reviewed detainee medical treatment for serious conditions or allowed treatment only on the condition that they cooperate with interrogators,” said Olshansky, who has assembled a network of 750 attorneys representing Guantánamo detainees.

She alleged American medical personnel have also assisted in drugging detainees during interrogations.

But Imbascini, a colonel in the U.S. Medical Corps, said that during two decades of service he has been responsible for hundreds of detainees and has never witnessed “a single act that could construed as abuse.”

“In fact, I can say quite proudly that the care that I and other Californians rendered to detainees and POWs was identical to that provided our own sick and wounded soldiers,” Imbascini told the committee.

Add comment April 14th, 2008

PBS series on health disparities: Unatural Causes

Apropos the New York Times article I posted earlier today o increasing health disparities between rich and poor in the US, a friend has just sent this notice of a related upcoming PBS series, Unnatural Causes, which asks “is inequality making us sick?” that starts this week. Here is the series summary that she sent:

UNNATURAL CAUSES sheds light on mounting evidence that demonstrates how work, wealth, neighborhood conditions and lack of access to power and resources can actually get under the skin and disrupt human biology as surely as germs and viruses. But it’s not just the poor who are sick—so are the middle classes. At each descending rung of the socio-economic ladder, people tend to be sicker and die sooner. What’s more, at every level, many communities of color are worse off than their white counterparts. Compelling personal stories—spanning the country—demonstrate how social conditions are as vital to our health as diet, smoking and exercise.  As Harvard epidemiologist David Williams points out, investing in our schools, improving housing, integrating neighborhoods, better jobs and wages, giving people more control over their work, these are as much health strategies as smoking diet and exercise. And these are the stories that UNNATURAL CAUSES tells.

HOUR ONE: In Sickness and In Wealth (56 mins) What are the connections between healthy bodies and healthy bank accounts? In Louisville, Kentucky, the issues faced by a CEO, a lab supervisor, a janitor, and a welfare mother bring into sharp relief how socio-economic status shapes opportunities to lead healthy lives.  People of color face an additional burden. Solutions, public health officials believe, lie not in more pills but in better social policies.

HOUR TWO: When the Bough Breaks (28 mins) and Becoming American (28 min)
Why do African American infant mortality rates remain more than twice as high as white Americans? Researchers are circling in on a provocative hypothesis:  the chronic stress of racism can become embedded in African American mothers’ bodies and take a toll on their children even before they leave the womb.

In contrast, recent Mexican immigrants, though often poorer, tend to be healthier than the average American. But the longer they live here, the worse their relative health becomes. What’s protective about new immigrant communities that we can all learn from? And what erodes this shield over time?

HOUR THREE: Bad Sugar (28 min) and Place Matters (28 min) The O’odham Indians of Arizona suffer one of the highest rates of Type 2 diabetes in the world. But is this due to their genes, or is it part of the body’s response to decades of poverty, oppression and historical trauma? A new approach rooted in the community re-gaining control over its destiny offers hope where medical-only interventions have failed.

Why is your street address such a good predictor of your health? How can your surrounding built and social environment get inside your body like smog and toxic waste? As recent immigrants move into long-neglected African American urban neighborhoods, their health is beginning to deteriorate too. What can be done to create healthy communities?

HOUR FOUR:  Collateral Damage (28 min) and Not Just a Paycheck (28 min)

Globalization and the U.S. military have disrupted the lives of Marshall Islanders. Many have ended up in the unlikely place of Springdale, Arkansas where a legacy of poverty and powerlessness continues to take a toll on their bodies.

In western Michigan, a factory closure undermines the lives and health of a white, working class community. But the same company shut down their Swedish plant with hardly a ripple thanks to very different social policies.

http://www.unnaturalcauses.org/

Add comment March 23rd, 2008

May 3: Torture and the American Psyche

For those in the Boston area, here’s an announcement of a forum that I am both helping to organize and speaking at. A flyer, suitable for printing and posting, is available here:

Torture and the American Psyche:
Blurring the Boundaries Between Healers and Interrogators
Saturday, May 3, 2008,
9:30 am – 12:30 pm

First Parish Unitarian Church,
382 Walnut Street,
Brookline, MA
http://www.firstparishinbrookline.org

admission is free

DESCRIPTION:

Every day the news brings further details about our country’s recent use of torture and other detainee abuse in national security, and of the debates among our leaders and citizens of practical, legal, and ethical implications of this use. We invite concerned citizens and members of the mental health professions to join together in an open discussion of the far reaching human and moral implications of our nation’s use of torture.

We will discuss the emotional and ethical consequences of being members of a society that sanctions torture and that uses psychologists to make sure abuse is medically and “ethically” conducted. We will have three speakers, followed by a discussion among the panelists and with the members of the audience on the diverse aspects of this topic. Our aim is to facilitate a discussion which will include the emotional, ethical and spiritual dimensions of this topic and allow room for all to participate.

We understand that the topic will give pause to all who consider attending and care will be taken to ensure that the discussion will not devolve into a political diatribe or an immersion into a graphic depiction of torture. We hope that some perspective on feasible actions may emerge from the discussion.

SPEAKERS:

Eric Fair currently a divinity student at Princeton will speak from his experience as a civilian contract interrogator in Baghdad, Fallujah, and Abu Ghraib in early 2004. He will lend his first person account to our conversation.

Leonard Rubenstein, J.D. President of Physicians for Human Rights, a Nobel Prize winning organization, is an attorney and veteran of many human rights struggles. He will speak of the role of torture in our contemporary political culture.

David Sloan-Rossiter, Ph.D. will bring his long standing interest in using a psych oana¬lytic perspective to aid communities to the role of moderator of the program. He is co-chair of the Curriculum Committee at Boston Institute for Psychotherapy and Massachusetts Institute for Psychoanalysis.

Stephen Soldz, Ph.D. a local psychoanalyst, social activist and Professor at the Boston Graduate School of Psychoanalysis, is one of the nation’s leaders in opposing psycholo¬gist participation in torture and abuse. He will speak to the history of that struggle in the context of the broader struggle for human rights.

SPONSORS:

Boston Graduate School of Psychoanalysis, Institute for the Study of Violence
Boston Institute for Psychotherapy
Boston Psychoanalytic Society and Institute
Brookline PeaceWorks
Coalition for an Ethical Psychology
First Parish of Brookline
Massachusetts Association for Psychoanalytic Psychology
Massachusetts Institute for Psychoanalysis
Physicians for Human Rights
Psychoanalytic Institute of New England
Psychologists for Social Responsibility–End Torture Action Committee

Registration is not required but would help us anticipate attendance. If you are interested in attending this program, please email MLoug23@aol.com by Monday, April 28, 2008.

Download flyer here.

CONTINUING EDUCATION

The Massachusetts Institute for Psychoanalysis (MIP) offers Continu¬ing Education for psychologists and social workers. MIP is approved by the American Psychological Association to sponsor continuing education for psychologists. MIP maintains responsibility for this program and its content.
For further information, please contact Mary Loughlin at (978) 692-4790.

Learning Objectives
1. Participants will gain a greater understanding of the way that torture affects all members of a society not just the tortured.
2. Participants will have deeper appreciation of how psychologists’ presence at Guantanamo endorses the United States government stance that torture is morally acceptable.
3 Participants will appreciate the importance of engaging political issues from multiple perspectives including ethical, emotional, spiritual and psychological.

Suggested Readings:
Fair, E. (2007, February 9). An Iraq Interrogator’s Nightmare.
Horton, S., & Rejali, D. (2008, February 13). Six Questions for Darius Rejali, Author of ‘Torture and Democracy’.
Physicians for Human Rights, & Human Rights First. (2007, August). Leave No Marks: Enhanced Interrogation Techniques and the Risk of Criminality.
Soldz, S. (2007, April 13). Aid and Comfort for Torturers: Psychology and Coercive Interrogations in Historical Perspective.

5 comments March 23rd, 2008

Guardian article contrasts IRB protections with APA moral vacuousness on torture

A column in today’s Guardian Comment is Free by Ben Goldacre relates the federal Office for Human Research Protections [OHRP] ridiculous actions interfering with life saving I’d blogged about on New Years Day to the complete lack of any ethical concern by the America Psychological Association for the ethical lapses of psychologists designing Bush’s torture regime. Goldacre points out that OHRP stopped a study in a New York Intensive Care Unit which was using a simple checklist to remind people to follow simple safety protocols. Seems, if it’s research you can’t check the boxes without time-consuming Institutional Review Board [IRB] approval. Of course, if they don’t call it “research,” hospitals can do almost anything they want. The only difference is that in the “research” case, they are actually collecting data to find out if the checklist works. The basic idea, is you can do anything you want without onerous review, as long as you don’t bother to try and find out if it’s helpful.

Goldacre contraststs this silliness, leading potentially to many dead patients, with the ethical blindness that has guided the American Psychological Association [APA] for years when faced with the horrifying roles played by psychologists in the U.S. regime of abusive interrogations. The APAhad its ridiculous silliness as well. They were so concerned about unethical interrogations that they appointed a task force composed mainly of those psychologists most likely involved in unethical interrogations to formulate ethics policy for the association. Makes sese that one would appoint those accused of abuses to formulate your ethics policy, doesn’t it? After all, it wasn’t “research,” so stringent protections weren’t needed.

Here is Goldacre’s article (taken from his Bad Science blog rather than the Guardian because the blog version has many links, including several to this site). Make sure to read the last three paragraphs which discuss the APA madness:

Where’s your ethics committee now, science boy?

by Ben Goldacre

The Guardian,

Saturday February 23 2008

People have done some terrible things, over the years, with science, and with their science skills. I’m talking about Zyklon B, electrocuting gay people straight, torturing people in concentration camps, leaving syphillis untreated in large numbers of black men for an experiment (without telling them, in the US, until the 1970s), and more. Stuff where it’s hard to find any humour.

This is why we have research ethics committees, codes of practise, professional bodies, and regulators like the The US Office for Human Research Protections. Sometimes these organisations can cock up quite badly. Let me tell you about two stories which have been unfolding over the past few months.

In New York, a fiendishly clever trial in ITU departments has looked at one of the simplest interventions imaginable: a ticklist for giving IV lines, a helpful little reminder to wash your hands, wear gloves, and so on. Can something as simple as “using a ticklist”, to check if people are doing the right thing, reduce infections and save lives?

This is the bread and butter of medical academic research, which is usually not about pills, or placeboes, or molecules, but about looking pragmatically at whether one thing works better than another. You will remember that homeopaths and various other quacks are philosophically opposed to this process.

The results were spectacular: in 3 months, the incidence of blood infections from these IV lines fell by two-thirds, and over 18 months, the program saved 1,500 lives and an estimated $200 million. Then someone complained to the OHRP, because this was a research study, and they did not have ethics committee clearance. The project was shut down. This week, the OHRP grandly lifted their ban, explaining that now – since it turns out the research bit is over, and the hospitals are just putting the ticklist into practise – they may tick away unhindered.

This is what we might call the “ethical paradox”. You can do something as part of a treatment program, entirely on a whim, and nobody will interfere, as long as it’s not potty (and even then you’ll probably be alright). But the moment you do the exact same thing as part of a research program, trying to see if it actually works or not, adding to the sum total of human knowledge, and helping to save the lives of people you’ll never meet, suddenly a whole bunch of people want to stuck their beaks in.

Hilary Hearnshaw did an elegant study where she pretended to apply to do a medical research project in the Israel, the UK, and 11 other countries in Europe. She said she wanted to do a trial on a leaflet – contain your excitement - which was designed to help older patients get more engaged with their GP.

Only three countries required the project to go through a process of ethical approval, and in the UK, this was more arduous than in any other country. Getting ethical clearance took ten weeks, required two submissions (because they demanded changes), and five full days of administration, during which the proposal had to be reviewed by full committees, some of which required multiple copies of the application paperwork.

This is just the tip of the iceberg (and I would always welcome more examples by email). For one multicentre clinical trial, each of 125 local research ethics committees required between 1 and 21 copies of a protocol. Ethics approval for another trial, involving 51 centres, required over 25 000 pieces of paper, 62 hours of photocopying, and an average of 3.3 hours of investigator time for each centre. You feel like you’re dying when administrators drag their heels. In the case of medical research, when you delay research findings, and deter researchers from even bothering, people really are dying. This wider harm seems to be a blindspot for the ethics committees, captivated by their own mission creep.

But it’s not the only ethical blindspot. These regulations have their roots in the Nuremburg Code. But while the world of clinicians and academics splits ethical hairs, with our eye off the ball, an elephant has walked into the room.

February has seen another string of prominent psychologists resigning from their membership of the American Psychological Association, in disgust at its failure to take a stand on “abusive interrogation techniques”, cruel, inhuman and degrading treatment, and other activities which you might consider to be torture.

Psychologists are key to these interrogations and other activities, both in designing and enacting what I would rather not call “protocols”, out of compassion for the people on whom they are grimly enacted, in places cameras do not go.

APA members, trained, clinical professionals on their register, who have signed up to their codes of practise, now participate in these activities. The APA’s response has been to specifically bend the codes of conduct to permit their actions, and to obfuscate. Where’s your ethics committee now, science boy?

Bits:

Ken Pope, prominent member of the American Psychological Association (and a former chair of its Ethics Committee), resigned his membership on February 6. He’s the latest of a growing number of professional psychologists who have quit APA in protest of its position on the use of psychologists in government interrogations in the “War on Terror.”

Lots more on the APA and torture at Mindhacks.

Add comment February 24th, 2008

Physicians for Human Rights on California health provider interrogations bill

Physicians for Human Rights President Leonard Rubenstein has written a letter supporting the California bill that would try and get California licensed health providers out of any direct role aiding national security interrogations. [Available as pdf here.]:

January 11, 2007

Senator Mark Ridley-Thomas
State Capitol, Room 4061
Sacramento, CA 95814

Re: Support for Resolution on Health Professional Involvement in Torture

Dear Senator Ridley-Thomas:

I am writing on behalf of Physicians for Human Rights (PHR), an organization that for 20 years has been engaged in mobilizing the health professions to advance human rights. We strongly support the resolution you have offered. It is a critical step toward restoring the integrity of the health professions in the context of national security policy and renewing public confidence in these professions.

For its entire history, PHR has been engaged in documenting torture throughout the world and ending medical complicity in it. We also led the process of establishing international standards for medical documentation of torture (the Istanbul Protocol), which were endorsed by the UN General Assembly. In 1997 Physicians for Human Rights shared in the Nobel Peace Prize as a member of the Steering Committee of the International Campaign to Ban Landmines.

In recent years, we have been actively engaged in stopping torture by the United States and any medical participation in it. We issued a seminal report on the use of psychological torture, Break Them Down, and a medico-legal analysis of “enhanced” interrogation techniques, Leave No Marks (available on our web site, www.physiciansforhumanrights.org.) PHR has been particularly concerned about the role of health professionals as designers, implementers, and supervisors of systematic torture and cruel, inhuman, and degrading treatment of detainees. This role is in direct contravention of the foundational tenets of medical ethics and domestic and international human rights law and significantly undermines the health professional’s role as healer. We and our advisers have written analyses of the problem for the Journal of the American Medical Association and other scientific and legal journals, provided op-ed articles for major newspapers including the Los Angeles Times, and provided testimony to the U.S. Congress. We have also played an active role in providing guidance and advice to professional associations, including the American Medical Association, the American Psychiatric Association, and the American Psychological Association, in setting out the ethical standards applicable to the health profession in the context of interrogation.

It is this background that leads us to support the resolution you are offering. It states clearly that all health professionals should not participate in torture or cruel, inhuman and degrading treatment. Moreover, it follows the approach the American Medical Association and the American Psychiatric Association took after careful study, which holds that to be true to ethical commitments, physicians should not participate in the interrogation of individual detainees at all – even an interrogation that doesn’t involve torture or cruel treatment. These organizations adopted this stance in recognition that the traditional standard – no participation in torture and cruel treatment – is inadequate. I would like to review the reasons for this stance.

First, it is indisputable that even the most benign interrogation is designed to induce distress and anxiety. Interrogations conducted by the United States in the context of detention of terrorist suspects, significantly exacerbate this distress, and the potential for long-term harm, because they take place in a closed environment where human rights violations, including no due process and indefinite confinement, can easily occur. Engaging in any interrogation support in these circumstances, even where the interrogation is legal, is inconsistent with core ethical value of all the health professions in avoiding harm. This stance is similar to the ethical prohibition on physicians from participation in executions even in states where, as in California, capital punishment is legal.

Second, while it is often claimed that health professionals can play the role of a “safety officer” in interrogations, the investigations we and others have conducted have shown that the opposite is the case: in this role, health professionals in Behavioral Science Consultation Teams become the decision-makers in the calibration of the degree of pain and distress to be inflicted. This is shown in a forthright report issued by the Army Surgeon General in 2005, which on the one hand affirmed that health professionals act to assure that interrogations are safe, but expected them to advise interrogators when it was permissible to increase the distress and pain inflicted on a detainee.

Third, it is often argued that health professionals, particularly behavioral scientists, by sharing information and insights about individual detainees, can help establish rapport with a detainee and otherwise support non-coercive interrogations. But this role provides an invitation – which is embodied in current military rules – to share medical records and results of examinations with interrogators. The AMA and American Psychiatric Association have therefore come to the view that their members may train interrogators generally about human behavior and interrogation but not participate in individual interrogations.

Finally, there is a terrible slippery slope in engaging in interrogations that fall short of torture or cruel treatment. As we know, the interpretations of what amounts to torture and cruel treatment by the Justice Department, CIA and Department of Defense are ever-changing, and health professionals ought not to be in the position of being told that a certain interrogation method is acceptable because the lawyers have said so. They are not in a position, either from the point of view of legal knowledge of authority, to contest such determinations, and the prudent approach is to remove them from the situation where such choices must be made. The record of interrogations by the United States has indeed shown that psychologists and physicians have been reassured that the conduct involved does not involve torture and cruel treatment, when in fact it does. Whether serving as supposed “safety officers,” members of Behavioral Consultative Science Teams (BSCTs), or as advisors and implementers to interrogations, health professionals, especially psychologists and physicians, have had their medical expertise and prestige twisted to legitimate criminal treatment of suspected terrorists. The untenable position in which they have been placed can only be avoided by banning participation altogether.

We are aware that some health professionals and the American Psychological Association wish to continue a role for health professionals in interrogations, and thus urge adherence to the pre-9/11 standard, which only prohibits participation in torture or cruel, inhuman or degrading treatment. But the experience of the past six years shows why that standard is unworkable and ineffective, and why both internationally – through the World Medical Association – and domestically, the majority approach since 9/11 has been to end the participation of members of health professions obligated to “do no harm” in interrogation altogether.

Because your resolution does precisely this approach we support it. It can help provide health professionals serving in national security environments the ethical and legal guidance they so desperately require to operate in US detention facilities in a manner that comports with their professional ethics and values. By passing this resolution, California will also send a strong message to national security agencies that there is no circumstance where a health professional should be allowed to participate in the willful infliction of harm, and that California will hold health professionals who engage in these activities accountable for their violation of their solemn duty to “do no harm”.

Sincerely,

Leonard S. Rubenstein
President

3 comments January 13th, 2008

Action Opportunity for California Residents: Get health professionals out of interrogations!

This is an urgent opportunity for action for residents of California who are concerned about the role of psychologists and other health professionals in torture and abuse of U.S. detainees.

A broad coalition of health, human rights, and legal organizations in California are working to encourage the State of California to:

Notify all state-licensed health professionals of their legal and professional obligations not to participate in torture.

Notify them that participants in torture may be subject to prosecution.

Request that the U.S. Department of Defense and the CIA remove all California-licensed health professionals, including psychologists, from participating in prisoner interrogations.

If you would like to know more about this initiative, or sign a related online petition, go to the following web page, posted by the American Friends Service Committee:

http://www.afsc-pswro.org/crm/licensingpetition.php?

The California State Senate will be holding a hearing on Monday afternoon, Jan. 14th, on a proposed resolution on this matter. Contact the California State Senate Committee on Business, Professions and Economic Development, at 916-651-4104, for more information about that resolution and hearing.

Daily Kos blogger Valtin has more information on this. Go read his post. From it I reproduce the actual bill:

AUTHORS COPY
10/15/07 08:1OAM
58048 RN 07 29989 PAGE 1
LEGISLATIVE COUNSEL’S DIGEST
as introduced, Ridley-Thomas.

General Subject: Health professionals: torture.

This measure would request all relevant California agencies to notify
California-licensed health professionals about their professional obligations under international law relating to torture and the treatment of detainees, as specified, and to also notify those professionals that those who participate in torture, among other forms of treatment, may be subject to prosecution. In addition, the measure would request the United States Department of Defense and the Central Intelligence Agency to remove all California-licensed health professionals from participating in prisoner and detainee interrogations

Fiscal committee: yes.

WHEREAS, Health professionals licensed in California, including, but not limited to, physicians, osteopaths, psychologists, psychiatric workers, and nurses, have and continue to serve nobly and honorably in the armed services of the United States; and

WHEREAS, United States Army regulations and the War Crimes Act and, relative to the treatment of prisoners of war, Common Article III of the Geneva Conventions and the Convention against Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment (CAT) require that all military personnel report and not engage in acts of abuse or torture; and

WHEREAS, CAT defines the term “torture” as “any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity”; and

WHEREAS, In 2002, the United States Department of Justice reinterpreted national and international law related to the treatment of prisoners of war in a manner that purported to justify long-prohibited interrogation methods and treatment of detainees; and

WHEREAS, Physicians and other medical personnel and psychologists serving in noncombat roles are bound by international law and professional ethics to care for enemy prisoners and to report any evidence of coercion, or abuse of detainees; and

WHEREAS, The World Medical Association (WMA) issued guidelines stating that physicians shall not use nor allow to be used their medical knowledge or skills, or health information specific to individuals, to facilitate or otherwise aid any interrogation, legal or illegal; and

WHEREAS, The guidelines issued by the WMA also state that physicians shall not participate in or facilitate torture or other forms of cruel, inhuman, or degrading procedures of prisoners or detainees in any situations; and

WHEREAS, The American Medical Association’s (AMA) ethical policy prohibits physicians from conducting or directly participating in an interrogation and from monitoring interrogations with the intention of intervening; and

WHEREAS, AMA policy also states that “(t)orture refers to the deliberate, systematic or wanton administration of cruel, inhumane > and degrading treatments or punishments during imprisonment or detainment. Physicians must oppose and must not participate in torture for any reason … Physicians should help provide support for victims of torture and, whenever possible, strive to change the situation in which torture is practiced or the potential for torture is great”; and

WHEREAS, In May 2006, the American Psychiatric Association stated that psychiatrists should not “participate directly in the interrogation of persons held in custody by military or civilian investigative or law enforcement authorities, whether in the United States or elsewhere,” and that “psychiatrists should not participate in, or otherwise assist or facilitate, the commission of torture of any person. Psychiatrists who become aware that torture has occurred, is occurring, or has been planned must report it promptly to a person or persons in a position to take corrective action”; and

WHEREAS, In August 2006, the American Psychological Association stated ___ that “psychologists shall not knowingly participate in any procedure in which torture ___ or other forms of cruel, inhuman, or degrading treatment or cruel, inhuman, or degrading punishment is used or threatened” and that “should torture or other cruel, inhuman, or degrading treatment or cruel, inhuman, or degrading punishment evolve during a procedure where a psychologist is present, the psychologist shall attempt to intervene to stop such behavior, and failing that exit the procedure”; and

WHEREAS, In June 2005, the House of Delegates of the American Nurses Association issued a resolution stating all of the following: “prisoners and detainees have the right to health care and humane treatment”; “registered nurses shall not voluntarily participate in any deliberate infliction of physical or mental suffering”; “registered nurses who have knowledge of ill- treatment of any individuals including detainees and prisoners must take appropriate action to safeguard the rights of that individual”; “the American Nurses Association shall condemn interrogation procedures that are harmful to mental and physical health”; “the American Nurses Association shall advocate for nondiscriminatory access to health care for wounded military and paramilitary personnel and prisoners of war”; and “the American Nurses Association shall counsel and support nurses who speak out about acts of torture and abuse”; and

WHEREAS, In March 2005, the California Medical Association stated that it “condemns any participation in, cooperation with, or failure to report by physicians and other health professionals the mental or physical abuse, sexual degradation, or torture of prisoners or detainees”; and

WHEREAS, In November 2004, the American Public Health Association stated that it “condemns any participation in, cooperation with, or failure to report by health professionals the mental or physical abuse, sexual degradation, or torture of prisoners or detainees:’ that it “urges health professionals to report abuse or torture of prisoners and detainees;’ and that it “supports the rights of health workers to be protected from retribution for refusing to participate or cooperate in abuse or torture in military settings”; and

WHEREAS, The United States military medical system in Guantanamo Bay, Afghanistan, Iraq, and other United States operated foreign military prisons failed to protect detainees’ rights to medical treatment, failed to prevent disclosure of confidential medical information to interrogators and others, failed to promptly report injuries or deaths caused by beatings, failed to report acts of psychological and sexual degradation, and sometimes collaborated with abusive interrogators and guards; and

WHEREAS, Current United States Department of Defense guidelines authorize the participation of certain military health personnel, especially psychologists, in the interrogation of detainees as members of “Behavioral Science Consulting Teams” in violation of professional ethics. These guidelines also permit the use of confidential clinical information from medical records to aid in interrogations and

WHEREAS, Evidence in the public record indicates that military psychologists participated in the design and implementation of psychologically abusive interrogation methods used at Guantanamo Bay, in Iraq, and elsewhere, including sleep deprivation, long-term isolation, sexual and cultural humiliation, forced nudity, induced hypothermia and other temperature extremes, stress positions, sensory bombardment, manipulation of phobias, force-feeding hunger strikers, and more; and

WHEREAS, Published reports indicate that the so-called “enhanced interrogation methods” of the Central Intelligence Agency reportedly include similar abusive methods and that agency psychologists may have assisted in their development; and

WHEREAS, Medical and psychological studies and clinical experience show that these abuses can cause severe or serious mental pain and suffering in their victims, and therefore may violate the “torture” and “cruel and inhuman treatment” provisions of CAT and the United States War Crimes Act, as amended by the Military Commissions Act of 2006; and

WHEREAS, The United States Department of Defense has failed to oversee the ethical conduct of California-licensed health professionals related to torture; now, therefore, be it

Resolved by the Senate and the Assembly of the State of California, jointly, That the Legislature hereby requests all relevant California agencies, including, but not limited to, the Board of Behavioral Sciences, the Dental Board of California, the Medical Board of California, the Osteopathic Medical Board of California, the California State Board of Pharmacy, the Physician Assistant Committee of the Medical Board of California, the California Board of Pediatric Medicine, the Board of vocational Nursing and Psychiatric Technicians, the Board of Psychology, and the Board of Registered Nursing, to notify California-licensed health professionals via newsletter, email, and Web site about their professional obligations under international law, specifically Common Article HI of the Geneva Conventions, the Convention against Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment, and the amended War Crimes Act, which prohibit the torture of and the cruel, inhuman, and degrading treatment or punishment of detainees in United States custody; and be it further __

Resolved, That the Legislature hereby requests all relevant California agencies ___ to notify health professionals licensed in California that those who participate in torture and other forms of cruel, inhuman, or degrading treatment or punishment may one day be subject to prosecution; and be it further

Resolved. That the Legislature hereby requests the United States Department of Defense and the Central Intelligence Agency to remove all California-licensed health professionals, including, but not limited to, physicians and psychologists, from participating in any way in prisoner and detainee interrogations, in view of their respective ethical obligations, the record of abusive interrogation practices, and the Legislature’s interest in protecting California health professionals from the risk of criminal liability; and be it further

Resolved, That the Secretary of the Senate transmit copies of this resolution to the United States Department of Defense, the Central Intelligence Agency, and all relevant California agencies, including, but not limited to, the Board of Behavioral Sciences, the Dental Board of California. the Medical Board of California, the Osteopathic Medical Board of California, the California State Board of Pharmacy, the Physician Assistant Committee of the Medical Board of California, the California Board of Pediatric Medicine, the Board of Vocational Nursing and Psychiatric Technicians, the Board of Psychology, and the Board of Registered Nursing.

The American Psychological Association is working to weaken this bill to meaninglessness. It is up to concerned health providers in California to organize to see that doesn’t happen.

3 comments January 10th, 2008

Bush admin bureacrats foster hhospital infections

Revere at Effect Measure on the bureaucrats at the federal Office for Human Research Protections working to shut down a simple checklist that reduced a type of hospital-induced infections by 2/3. Another Bush administration nightmare of incompetence:

Who will protect us from our protectors?

I guess there are a lot of things in the newspapers that leave you shaking your head, but a recent Op Ed by surgeon Atul Gawande left both Mrs. R. and me shaking our heads simultaneously, accompanied by jaws headed south and and eyes bulging. Quite a visual, I admit. But consider the source. I’ll let Gawande describe it:

“In Bethesda, Md., in a squat building off a suburban parkway, sits a small federal agency called the Office for Human Research Protections. Its aim is to protect people. But lately you have to wonder. Consider this recent case.A year ago, researchers at Johns Hopkins University published the results of a program that instituted in nearly every intensive care unit in Michigan a simple five-step checklist designed to prevent certain hospital infections. It reminds doctors to make sure, for example, that before putting large intravenous lines into patients, they actually wash their hands and don a sterile gown and gloves.

The results were stunning. Within three months, the rate of bloodstream infections from these I.V. lines fell by two-thirds. The average I.C.U. cut its infection rate from 4 percent to zero. Over 18 months, the program saved more than 1,500 lives and nearly $200 million.

Yet this past month, the Office for Human Research Protections shut the program down. The agency issued notice to the researchers and the Michigan Health and Hospital Association that, by introducing a checklist and tracking the results without written, informed consent from each patient and health-care provider, they had violated scientific ethics regulations. Johns Hopkins had to halt not only the program in Michigan but also its plans to extend it to hospitals in New Jersey and Rhode Island.” (New York Times; hat tip GH)

Two thoughts about this occur to me. Well, maybe three. Thought number one. These guys are the counterpart to “Corporate Legal.” Interpret everything in the most conservative possible manner. In this case, that the checklist is an alteration in the usual standard of medical care and collecting information on it is research, research that might put doctors at risk by showing they weren’t doing the right thing. the second thought is that they saw themselves as protecting doctors against predatory trial lawyers. The third is probably closest to the truth: another example of colossally incompetent bozos at the wheel of a Bush federal agency, driving it off the road and killing by-standers.

I’m not a lawyer basher or a federal agency basher. We need lawyers. They preserve our legal rights and represent us in an extremely complicated system. We need federal agencies, too. Research subjects need to be protected. But we also need to be protected from lawyers and agencies with no common sense or worse, no intention of using their abilities and authority for the public good.

Concerning the main point, damage done specifically by a complex and chaotic medical care system is increasing as pressure on everyone in it increases. Much of this damage is avoidable, caused by inappropriate human actions if not error. Human error is hard to prevent completely, but you can minimize it by training and by routinizing critical tasks. Checklists are an important tool for accomplishing this. Evaluating a checklist’s efficacy should be encouraged, not punished. If they had just put up a checklist without evaluating it, presumably this wouldn’t have been a problem.

So I’ve got a checklist item to pin to the wall of everyone who works at the Office for Human Research Protections:

Step One: Remove head from up your ass.

Feel free to evaluate it at your leisure. Which I hope you’ll have a lot of when the nightmare of this administration is finally over (385 days, 23 hours, 21 minutes and 43 seconds at the instant of finishing writing this post).

1 comment January 1st, 2008