Posts filed under 'Medicine'
As one of very few health professionals who has viewed Guantanamo detainee health files as a consultant to defense and habeas attorneys, I was not at all surprised by the findings of a new paper in PLOS Medicine by Vincent Iacopino and Stephen N. Xenakis: Neglect of Medical Evidence of Torture in Guantánamo Bay: A Case Series. Iacopino and Xenakis report on their examination of the medical records and reports by independent medical and psychological consultants on nine Guantanamo prisoners. They find that, despite strong evidence that the prisoners were subjected to torture, the health professionals examining and treating them made no attempt to determine if the prisoners had been abused and failed in their ethical (and military) duty to document and report torture and ill treatment.
The findings of this study demonstrate that allegations by these nine detainees of torture were corroborated by forensic evaluations by non-governmental medical experts and that DoD medical and mental health providers at GTMO failed to document physical and/or psychological evidence of intentional harm.
In each case we reviewed, detainees alleged forms of abuse that are highly consistent with torture as defined by the UN Convention Against Torture as well as the more restrictive US definition of torture that was operational at the time . In one case, unclassified interrogation plans and interrogation summaries provided precise corroboration of the methods of torture and ill treatment that the detainee alleged.
The medical evaluations in this case series revealed evidence of severe physical and severe and prolonged psychological pain as stipulated in the Bybee definition of torture. But, according to the Bybee definition of torture, even if the requisite pain thresholds had been exceeded, the infliction of such pain had to be the interrogator’s “precise objective” to constitute torture.
The medical doctors and mental health personnel who treated the detainees at GTMO failed to inquire and/or document causes of the physical injuries and psychological symptoms they observed. Psychological symptoms were commonly attributed to “personality disorders” and “routine stressors of confinement.” Temporary psychotic symptoms and hallucinations did not prompt consideration of abusive treatment.
The documentation of torture and ill treatment in medicolegal evaluations conducted by non-governmental medical experts indicates that each of the detainees continues to experience severe, long-term and debilitating psychological symptoms that are likely to persist for many years, and possibly a lifetime.
The Defense Department has issued a response to Iacopino and Xenakis which, in its failure to even mention their main charges can be taken as an official confirmation that Guantanamo health professionals do no investigate or document the terrible abuses suffered by many prisoners there:
DoD personnel working in detention facilities operate under a high level of scrutiny and consistently provide the most humane and safe care and custody of individuals under their control. The Joint Medical Group is committed to providing unconditional appropriate comprehensive medical care to all detainees regardless of their disciplinary status, cooperation, or participation in a hunger strike. The healthcare provided to the detainees being held at Guantanamo Bay rivals that provided in any community in the United States. Detainees receive timely, compassionate, quality healthcare and have regular access to primary care and specialist physicians. The care provided to detainees is comparable to that afforded our active duty service members. All medical procedures performed are justified and meet accepted standards of care. A detainee is provided medical care and treatment based solely on his need for such care and the level and type of treatment is dependent on the accepted medical standard of care for the condition being treated. Diagnosis of such conditions and medical care and treatment for them are not affected in any way by a detainee’s cooperation, or lack thereof, during an interrogation session. Similarly, medical care is not provided or withheld based on a detainee’s compliance or noncompliance with detention camp rules or on his refusal to end a hunger strike. Medical decisions and treatment are not withheld as a form of punishment. Additionally, the medical staff has no involvement in discipline decisions made by detention personnel.
This DoD reesponse also neatly elides the Iacopino and Xenakis claims in another way in that it is written in the present tense and thus only applies to current practices. Yet Iacopino and Xenakis, by their methodology of examining medical records, are talking about past practices. The DoD “response” makes no claims whatsoever recording the appropriateness of past practices. It thus seems likely that some of those practices were indefensible, even by Defense Department spokespeople not usually noted for their truthfulness.
The Iacopino and Xenakis findings are entirely consistent with my experience reading medical files on one Guantanamo prisoner on whom I consulted. Despite claims that he had been subjected to abuse, and mental health symptoms consistent with abuse, there was no indication in the hundreds of pages I read that any health professional had made any attempt to find out if he had been abused or to document possible abuse. Rather, the mental heath staff seemed only interested in whether the prisoner might make a suicide attempt. Beyond that, his obvious anguish appeared to be of no interest to the psychologists and other mental health staff.
Further, the Guantanamo medical unit and the Obama Justice Department fought tooth and nail to prevent any independent examination of these records, much less of the prisoner himself. The prisoner’s attorneys requested, and the habeas judge ordered, that the records be made available for examination by an independent psychologist, me, to determine if there was a possibility that mental health issues might interfere with the prisoner’s ability to cooperate with his attorneys. The Guantanamo medical staff filed a declaration denying any need for independent evaluation. And the Justice Department appealed every step. First they opposed any access to records as too burdensome. Then they appealed access to more than the past few month’s records. They appeared to objected to any scrutiny on principle, which in itself in a sign of inadequate transparency at Guantanamo and is the exact opposite of what should occur in an institution run by a democratic government. We cannot take the word of officials at an institution absent meaningful independent scrutiny that abuses and ethical lapses were, or are, absent.
The Iacopino and Xenakis paper contributes to existing evidence, including the questionable use of anti-malarial drugs, that Guantanamo healthcare was often problematic and deserves independent scrutiny. While the Bush and Obama administrations have made every effort to keep those records secret, health professionals should challenge that secrecy. We should demand that Guantanamo medical records be opened, with prisoner consent, to independent inspection. Further, all detainees desiring it should be able to receive independent medical evaluations.
Additionally, independent of the issues of possible abuse, the complete medical records of released prisoners should be made available to those prisoners and/or their current health providers. To suppress medical records for years of a person’s life is unethical as it interferes with released individuals’ ability to obtain required care in the present and the future. Health professionals from all disciplines should make clear that denial of access to their records by released prisoners is in simply unacceptable.
May 1st, 2011
A story I missed from last month demonstrating the lengths to which the government went to keep Guantanamo prisoners out of the US:
WikiLeaks cable casts doubt on Guantanamo medical care
By Carol Rosenberg | McClatchy Newspapers
WASHINGTON — The Bush administration was so intent on keeping Guantanamo detainees off U.S. soil and away from U.S. courts that it secretly tried to negotiate deals with Latin American countries to provide “life-saving” medical procedures rather than fly ill terrorist suspects to the U.S. for treatment, a recently released State Department cable shows.
The U.S. offered to transport, guard and pay for medical procedures for any captive the Pentagon couldn’t treat at the U.S. Navy base in southeast Cuba, according to the cable, which was made public by the WikiLeaks website. One by one, Costa Rica, the Dominican Republic, Panama and Mexico declined.
The secret effort is spelled out in a Sept. 17, 2007, cable from then assistant secretary of state Thomas Shannon to the U.S. embassies in those four countries. Shannon is now the U.S. ambassador in Brazil.
At the time, the Defense Department was holding about 330 captives at Guantanamo, not quite twice the number that are there today. They included alleged 9/11 mastermind Khalid Sheik Mohammed and two other men whom the CIA waterboarded at its secret prison sites.
The cable, which was posted on the WikiLeaks website March 14, draws back the curtain on contingency planning at Guantanamo, but also contradicts something the prison camp’s hospital staff has been telling visitors for years — that the U.S. can dispatch any specialist necessary to make sure the captives in Cuba get first-class treatment.
“Detainees receive state-of-the-art medical care at Guantanamo for routine, and many non-routine, medical problems. There are, however, limits to the care that DOD can provide at Guantanamo,” Shannon said in the cable, referring to the Department of Defense.
The cable didn’t give examples of those limits. But it sought partner countries to commit to a “standby arrangement” to provide “life-saving procedures” on a “humanitarian basis.”
It’s unclear what prompted the effort. The cable said then Deputy Secretary of State John Negroponte had approved making the request at the behest of then Deputy Defense Secretary Gordon England, who at the time oversaw Guantanamo operations.
Negroponte said Wednesday that he had “no recollection” of the request but that it would have been unrealistic to expect the Latin American nations to agree to it, “because anything to do with Guantanamo was always so politically controversial for any of these countries.” England didn’t respond to a request for comment.
Earlier that year, a captive had managed to commit suicide, according to the military, inside a maximum-security lockup. Two medical emergencies also tested Guantanamo’s medical services in 2006: Two captives overdosed on other prisoners’ drugs they’d secretly hoarded, and then three men were found hanged in their common cellblock before dawn one Saturday.
In 2007, lawyers for Guantanamo’s eldest detainee, former U.S. resident Saifullah Paracha, who Pentagon officials said was a key al Qaida insider, also challenged the military’s plans to conduct a heart catheterization procedure at the base.
Paracha, now 63 and still suffering from a chronic heart condition, wanted to be taken to the U.S. or his native Pakistan for the catheterization. He refused to undergo the procedure at the base, even after the Pentagon airlifted a surgical suite and special equipment to the base to undertake the procedure.
The U.S. Supreme Court refused to consider Paracha’s request that he be brought to a U.S. hospital rather than have the experts brought to him.
“Where do they treat soldiers with heart problems?” said Zachary Katznelson, who at the time was part of Paracha’s pro-bono legal team. “They get them out of Guantanamo as soon as possible. They take them to a real cardiac care unit. It’s already risky enough.”
The WikiLeaks cable “clearly indicates that everything we were telling the courts, everything that Saifullah was telling us, was true,” Katznelson said. “Guantanamo did not have the facilities to adequately treat Saifullah on the island.”
The cable also makes clear that the driving force behind seeking the arrangements was the fear that detainees would use a medical emergency to exercise their legal rights.
The cable said that emergency medical treatment on American soil presented “serious risks” to the U.S. government, or USG.
“Admitting particular detainees might lead litigants to argue that U.S. courts should order the USG to admit other, more dangerous, detainees,” the cable said. “These concerns are unique to the United States and are not something that third countries face.”
A State Department official said the U.S. was never able to arrange for emergency medical treatment elsewhere. But a Pentagon spokeswoman argued such a deal wasn’t really necessary.
U.S. captives in Cuba “receive the highest quality medical care, the same caliber as that received by our own service members,” Army Lt. Col. Tanya Bradsher said.
“Medical emergencies are handled on a case-by-case basis to identify the most effective means of providing appropriate medical treatment to the detainee at Guantanamo,” she said. “This may include bringing in outside medical capabilities should the need arise.”
Those outside specialists have included cardiologists and a spinal surgeon. Colonoscopies are done more or less routinely.
Today, there’s an added complication: Congress forbids the Defense Department to use taxpayer money to transport Guantanamo captives to the U.S.
(Rosenberg reports for the Miami Herald.)
April 27th, 2011
Paul Krugman recently raised the question of where the capitalist term “consumer” started being used for medical patients and discussed the pernicious effects this usage has on healthcare:
Here’s my question: How did it become normal, or for that matter even acceptable, to refer to medical patients as “consumers”? The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car — and their only complaint is that it isn’t commercial enough.
What has gone wrong with us?
On his blog today he answers the origins question:
Rashi Fein directs me to a paper he published in 1982, which begins
A new language is infecting the culture of American medicine. It is the language of the marketplace, of the tradesman, and of the cost accountant. It is a language that depersonalizes both patients and physicians and describes medical care as just another commodity. It is a language that is dangerous.
Alas, I can’t find a publicly available copy of the Fein paper.
April 24th, 2011
Jeff Kaye, in Firedoglake, calls attention to a strange report of multiple deaths at Guantanamo in early 2002, deaths which are now denied by all sources. These inconsistencies highlight the need for a full, independent investigation of the treatment of detainees, with an emphasis on health issues and the multiple roles of health professionals.
Unreported Detainee Deaths at Guantanamo in Jan-Feb 2002?
By Jeff Kaye
According to the transcript (PDF) of a February 19, 2002 meeting of the Armed Forces Epidemiological Board (AFEB), “[a] number of the detainees have died of the wounds that they arrived with” at Guantanamo. This statement came from Captain Alan “Jeff” Yund, a preventive medicine doctor and the Navy’s liaison officer to the AFEB, as he discussed “mortuary affairs” at Guantanamo, part of a larger discussion on health issues at the new prison facility.
During the meeting, Captain Yund identified himself as working directly with Admiral Steven Hart, the Director of Navy Medicine Research and Development, as well as “a number of other admirals.”
Yund’s full quote is as follows, on pg. 108 of the transcript (bold added):
Mortuary affairs is an important but hopefully small aspect of the activities of the [Guantanamo] hospital. A number of the detainees have died of the wounds that they arrived with. So there’s attention being paid to doing the things with the body that would be appropriate for their culture.
In a December 7 email interview with Captain Yund, who is now retired, Yund stated he does “not recall that I was ever very directly involved in detainee health issues” at Guantanamo. Accordingly, he said the following in regards to his statement about detainee deaths:
“I did not make that statement from personal or direct knowledge. It may have come from CAPT Shimkus’ presentation, or possibly from conversations or meetings with other Navy Preventive Medicine personnel colleagues. It is not the type of statement I would have made without having learned it from a source I considered reliable.”
The reference to “CAPT Shimkus” is to Captain Albert J. Shimkus, commanding officer of the U.S. Naval Hospital at Guantanamo at the time, and JTF 160 chief surgeon. Captain Lund explained that he remembered hearing a “a detailed and fascinating account” of “events and issues” at Guantanamo, though he couldn’t remember the date or place. This is the “presentation” to which Captain Yund refers in his explanation above.
In a telephone interview on December 13 with Captain Shimkus, who now is an Associate Professor in National Security Decision Making at the U.S. Naval War College, Shimkus expressed shock over the claims there were any deaths at Guantanamo while he was there. (Captain Shimkus left Guantanamo in August 2003.) He said that “no deaths occurred” while he was there, but that he did speak at the time of the task force preparing for possible deaths. He could not offer any explanation for what Captain Yund reported.
In the AFEB transcript itself, there is no surprise or other comment or correction made on on Yund’s announcement concerning detainee deaths. The meeting was also attended by other military medical staff, civilian medical advisers, and upper-levels of the DoD bureaucracy, including Admiral Hart, and Assistant Secretary of Defense for Force Health Protection and Readiness, Dr. William Winkenwerder, and his deputy, Ellen Embrey. The meeting, held at the Island Club, North Island Naval Air Station, San Diego, was chaired by Dr. Steven Ostroff from the Centers for Disease Control.
By all accounts, in the initial days of prisoner transfer to Guantanamo, a number of detainees arrived with serious battle wounds. Notes from a doctor working at the facility, dated February 22, 2002, which I reviewed, discuss the previous day’s cardio-thoracic and neurosurgeries. A thoracotomy (excision of a portion of a lung) was said to have been performed on detainee “205.” The same day’s notes also describe an incident in which a detainee was handcuffed via a broken arm.
In response to my initial inquiry on 2002 detainee deaths at Guantanamo, Major Bradsher replied fully as follows:
The press release refers to the “three detainees who died of apparent suicides on June 10, 2006,” and is a summary of the disposition of the remains.
After receiving this first communication from DoD’s press operations office, I asked for further clarification, and in particular “as to why a Captain at an Armed Forces Epidemiological Board meeting in Feb. 2002 would refer to earlier deaths at Guantanamo, ostensibly from battlefield wounds.”
Major Bradsher responded, “I can’t speak for Captain Yund. As I have stated before, the first detainee fatality in Guantanamo was in June 2006.”
At this point, what we have is a mystery. There are no other reports regarding early battlefield deaths among the prisoners rendered to Guantanamo. We know that some of them arrived on litters, and needed immediate medical attention. We know that officials there even expected some deaths. But DoD maintains that no deaths prior to June 2006 occurred, and the principal reporter to the AFEB meeting on this subject, Captain Yund, does not remember the statement, though he notes “it is not the type of statement I would have made without having learned it from a source I considered reliable.”
Dr. Steven Miles, author of Oath Betrayed: Torture, Medical Complicity, and the War on Terror, shared his reaction to news of the possible deaths reported here:
This is an enormously important event. I have tried, without success to have the DoD or the media, clarify the huge inconsistencies in prisoner death reporting to no avail. My article on this remains unpublished by the medical media and by Slate etc.
The uncertainty over what really occurred in the early days at Guantanamo was accentuated by recent revelations by Truthout.org and Seton Hall University of Law’s Center for Policy and Research on the mass administration of the drug mefloquine to detainees who arrived at Guantanamo. Ostensibly described as an antimalarial measure, there are numerous reasons to question its use, not least because of its well-known high rates of neuro-psychiatric side effects, and also because such mass empiric treatment of mefloquine has never occurred and experts found such use potentially harmful and without medical justification.
Truthout has promised further investigation into the mefloquine scandal, including interviews with some of the principles involved, in a report to be published in the coming week.
There is a tremendous need for Congressional and/or independent investigations that have full mandate and subpoena power to ferret out the truth about what has occurred at Guantanamo and other U.S. “war on terror” prisons. The biggest obstacle to this, besides the Pentagon and the GOP, is the Democratic Party leadership itself, which refuses to undertake or fund such investigations, and whose leader in the White House, President Barack Obama, opposes — against treaty obligations described in Article 12 of the Convention Against Torture — such investigations.
December 19th, 2010
Last week, Jason Leopold and Jeff Kaye at Truthout, and Mark Denbeaux and students from Seton Hall Law School both published reports of the use of a potent anti-malarial drug, mefloquine, with all detainees when they arrived at Guantanamo. The drug was used administered at a high treatment dose (as opposed to a lower prophylactic dose).
Mefloquine is associated with serious neuropsychiatric symptoms in a significant fraction of those receiving it at that dose. . The neuropsychiatric side effects, such as increased anxiety, depression, suicidal ideation, may have been exacerbated by the Standard Operating Procedures in place at Guantánamo which required that all detainees be placed in a minimum of four weeks isolation upon arrival, an SOP in effect for at least two years.
The question arises as to why this drug was routinely administered. The authors raise possibilities ranging from malpractice, through experimentation, to deliberate torture. At present, there is no evidence of the latter two possibilities, though there are some disturbing aspects which raise questions.
Bioethicist Steven Miles sent me the following statement:
I have prescribed and taken mefloquine. This strikes me as mass public health malpractice rather than torture. It is more akin to the mandatory, unconsented, unmonitored and nonvalidated use of pyridostigmine and various vaccines to our troops going to Iraq than the abuse of psychotropic drugs against Soviet dissidents with “sluggish schizophrenia.”
Several other physicians involved in anti-torture efforts that I have communicated with have expressed the same position, that this was most likely malpractice rather than deliberate infliction of suffering for interrogation or other purposes.
In any case, the routine use of this drug on a captive population without informed consent raises disturbing questions regarding the medical care at Guantanamo. It emphasizes the importance of opening up the records, including the medical records of detainees, for independent examination. Only with transparency and external independent review can disturbing questions be answered.
Here is the Seton Hall press release on the report:
SETON HALL LAW REPORT SHOWS U.S. MILITARY ROUTINELY ADMINISTERED CONTROVERSIAL DRUGS TO DETAINEES IN GUANTÁNAMO BAY
Findings suggest detainees were unnecessarily dosed with a medication known to induce hallucinations, paranoia and psychosis
Seton Hall University School of Law’s Center for Policy and Research has issued a report, Drug Abuse: An Exploration of the Government Use of Mefloquine at Guantánamo documenting the medically inappropriate use of a dangerous pharmacological treatment on Guantánamo Bay detainees.
According to the report, the U.S. military routinely administered mefloquine, a controversial malaria treatment, at five times the standard prophylactic dose. Mefloquine, even at the standard dose, is known to cause adverse side effects such as paranoia, hallucinations, aggression, psychotic behavior, memory impairment, convulsions, suicidal ideation and possibly suicide.
The prophylactic dose of mefloquine is 250 mg. On arrival at Guantánamo, as a matter of standard operating procedure, detainees received 1250 mg of mefloquine. The larger dose of mefloquine was administered without taking a patient history of any kind.
Dr. G. Richard Olds, tropical disease specialist and founding Dean of the Medical School of the University of California at Riverside, commented on the long-lasting effects of the drug: “Mefloquine is fat soluble, and as a result, it does build up in the body and has a very long half-life. This is important since a massive dose of this drug is not easily corrected and the ‘side effects’ of the medication could last for weeks or months.”
The Centers for Disease Control and Prevention reports, and the U.S. military concedes, that malaria is not a threat in Guantánamo. For that reason, U.S. military personnel and contractors are not prescribed any prophylactic anti-malarial medication.
“Mefloquine was administered to detainees contrary to medical protocol or purpose,” commented Professor Mark P. Denbeaux, Director of the Seton Hall Law Center for Policy and Research. “The record reveals no medical justification for mefloquine in this manner or at these doses. On this record there appears to be only three possible reasons for drugging these men: gross malpractice, human experimentation or ‘enhanced interrogation.’ At best it represents monumental incompetence. At worst, it’s torture.”
Dean Olds concluded, “In my professional opinion there is no medical justification for giving a massive dose of mefloquine to an asymptomatic individual. I also do not see the medical benefit of treating a person in Cuba with a prophylactic dose of mefloquine.”
Professor Stephen Soldz, Director of the Center for Research, Evaluation, and Program Development, Boston Graduate School of Psychoanalysis and President of Psychologists for Social Responsibility, added, “For years there has been an almost complete lack of transparency regarding medical practices and procedures at Guantánamo. The military has failed to provide credible explanations for its procedures. Detainees and their attorneys have been denied access to their own medical records, an egregious ethical violation. All health providers should join the call for Guantánamo to respect fundamental rules regulating medical ethics everywhere.”
The report, Drug Abuse: An Exploration of the Government Use of Mefloquine at Guantánamo, may be found at http://law.shu.edu/ProgramsCenters/PublicIntGovServ/policyresearch/upload/drug-abuse-exploration-government-use-mefloquine-gunatanamo.pdf.
TruthOut.org published an article independent of the Seton Hall Law report. Read it here: http://www.truth-out.org/controversial-drug-given-all-guantanamo-detainees-amounted-pharmacologic-waterboarding6558
December 8th, 2010
Noted bioethicist Steven Miles has sent this comment on recent reports that President Bush received medical assurances that waterboarding didn’t cause long-lasting harm before authorizing waterboarding. He notes the passivity of the American Medical Association [AA] in face of overwhelming evidence of organized medical complicity with torture and the AMA’s failure to call for investigation or accountability for those involved:
Former President Bush filled in the last link showing that medical complicity with torture was integral to the program.
Previous documents had shown that physician design and monitoring of coercive, abusive and torture interrogations was approved by Secretary of Defense Rumsfeld and the Office of Medical Services of the CIA.
As President Bust put it in an interview posted on CNN yesterday, “Another technique was waterboarding, a process of simulated drowning. No doubt the procedure was tough, but medical experts assured the CIA that it did no lasting harm.” [added emphasis] In other words, the medical oversight and go-ahead for torture was incorporated into the very highest presidential authorization of torture.
It need not be reiterated that waterboarding has been prosecuted as torture by the United States and that President Bush’s statement on its efficacy has been repudiated by the government itself.
Previously, the policy foundation for medical complicity with torture has been traced as high as Secretary of Defense Rumsfeld and to the CIA administrative structure. Now it goes all the way past the President’s lawyers to the President himself.
The AMA [American Medical Association] stands on the bad apple theory. It renounces medical complicity with torture in principle while not standing for independent truth commissions or censuring the physicians responsible. As the AMA’s chief ethics spokesperson puts it.
“AMA Institute for Ethics Director Matthew Wynia, MD, noted that, while the recent Fay Report on intelligence activities at Abu Ghraib calls for further investigation into the role of medical professionals and states that at least two prison medics failed to report abuse, there are also several “instances of doctors doing the right thing under adverse circumstances.”
The silence of AMA and IOM [Institute of Medicine] with regard to serious moral accountability for crimes against international law and for degradation of international standards of medical ethics becomes even more glaring.
In holding to standards against clinicians who participate in torture that are not backed up with accountability; in a silence that implies that the structural participation in torture is a “political” matter rather than the destruction of medical professionalism; in continuing to seek shelter in the discredited idea that US torture was made possible by a few medical bad apples, US medicine had separated itself from physicians who are fighting torture in Turkey and Egypt and is utterly unable to speak on behalf of their cause or protection.
November 7th, 2010
Alan Gilbert, at Democratic Individuality, discusses the Guatemalan research abuses and places them in the context of decades of horrific research conducted against unwitting prisoners, depressed housewives, and other “undesireables.” He concludes by relating it to the recent CIA research:
Experimentation on prisoners in America has abated, though, according to Reverby’s interview today, it is still being debated. Nonetheless, psychologists, anthropologists and other professionals have participated in “medicalizing” torture. As opposed to the American Medical and Psychiatric Associations which stood against war crimes, the leadership of the American Psychological Association has participated in certifying “walling” – so that a torturer who throws a prisoner against a wall without maiming her is just doing “kind and usual punishment” – and the like. The CIA has long corrupted medical research, working on sensory deprivation – covering the body in an orange suit, wearing goggles, distorting the senses, getting the prisoner in a diaper on the way to be tortured on Jeppeson airlines in Egypt or Uzbekistan or Guantanamo – to break down the person’s psyche (see Albert W. McCoy, A Question of Torture). Charles Graner, who went to jail for Abu Ghraib, “taking the fall” for the crimes of Bush, Cheney, Rumsfeld and Rice inter alia, was a prison guard in America. He learned to put women’s underwear on the heads of naked men long before he got to Abu Ghraib.
Still, the medical experimentation practiced by government-instigated or sponsored physicians on prisoners in the US and Guatemala, and developed largely on a racist and sexist basis, has been stopped or, to some extent, abated. Now, however, similar procedures are engaged in by officials and doctor/psychologists torturing Arab and Muslim captives. The seemingly consolidated gains of one era have been undercut, in a sharply authoritarian direction, by the Bush-Cheney administation. They have been limited by Obama (as in the case of Hilary Clinton’s apology to the Guatemalan government), but the criminals have also been protected by the Obama administration. Jessica Mitford once quipped, “You may not be able to change the world, but at least you can embarrass the guilty.” But sometimes, real victories can be won after long and difficult struggle. They are always, however, in danger of erosion. This is perhaps the most devastating argument against “reformism.” At the least, the will to fight must be constantly renewed. The American doctors knew they were “not Nazis”; in the absence of movements from below against racism, however, they distinguished – and today distinguish – themselves in the annals of crime.
The whole article, while long, is well worth reading. For long-time activists it will bring back many memories of struggles long past that are, alas, still all too contemporary.
October 5th, 2010
Physicians for Human Rights has just released the following statement on the relationship between research abuses in Guatemala and recent CIA torture research. [Here are my thoughts on this.]:
October 4, 2010
For Immediate Release
Nathaniel Raymond, Director of Campaign Against Torture
Stephen Greene, Strategic Communications Consultant
Physicians for Human Rights Decries Obama Administration’s Double Standard on Illegal Human Experimentation; 1946 Guatemala Case and Alleged CIA Experimentation on Black Site Detainees Both Deserve Equal Justice
Cambridge, MA–In the wake of revelations about America’s experimentation on unwilling human subjects in Guatemala in 1946, Physicians for Human Rights (PHR) calls on President Obama to equally investigate credible evidence of illegal human subject research on detainees in CIA custody during the Bush administration.
“What was done to 700 Guatemalans 64 years ago without their consent is appalling,” said Physicians for Human Rights CEO Frank Donaghue. “But President Obama’s apologies for the Guatemala case ring hollow when the White House refuses to investigate similar crimes that allegedly occurred in the past decade. The credible evidence of illegal human experiments by the CIA on black site detainees deserves equal attention and justice.”
PHR’s June 2010 report, Experiments in Torture: Human Subject Research and Evidence of Experimentation in the ‘Enhanced’ Interrogation Program, was the first peer-reviewed analysis of evidence indicating that the Bush administration allegedly conducted illegal human research and experimentation on prisoners in US custody. The research was apparently used to insulate interrogators from potential prosecution and to standardize the use of torture.
“The conduct of health professionals in both cases—Guatemala and the CIA black sites—makes a mockery of bedrock principles of medical ethics and the law,” stated Scott Allen, MD, lead medical author of the PHR report. “Human subject research protections mean nothing if they don’t apply to all people all of the time—regardless of politics.”
CIA physicians and psychologists collected and analyzed data on the physical and psychological impact of the “enhanced” interrogation tactics, analysis which became the basis of Department of Justice memos justifying the torture program. This alleged program of illegal human subject experimentation violates medical ethics, federal law, and international research standards, including the Nuremberg Code and the Common Rule. These practices could, in some cases, constitute war crimes and crimes against humanity.
“While the proposed federal commission on the abuses in Guatemala is welcome, the American people must also learn the truth about what was done in our name over the past decade to detainees in CIA custody,” said Nathaniel Raymond, Director of PHR’s Campaign Against Torture and lead author of the PHR report. “The Departments of Justice and Health and Human Services must investigate these credible allegations of human experimentation on detainees by the CIA with the same mandate as the Guatemala case.”
PHR calls on President Obama, working with Congress, to appoint a federal commission to investigate what American physicians and psychologists did to people subjected to torture in US custody. John Durham, the Department of Justice prosecutor tasked with investigating the destruction of CIA interrogation videotapes as well as interrogations that went beyond what was authorized by the Department of Justice memos, should also be given a clear mandate to probe allegations of illegal research at the black sites, Guantanamo and elsewhere.
October 4th, 2010
According to top US officials, abusing people in the name of research without their permission is awful, truly awful. In fact, it is so awful that it takes two Cabinet officials to apologize. That is, if the abuses were committed a long time ago, by researchers who are not around to be held accountable and if there is a friendly foreign government likely to be outraged about the abuse. However, US officials have so far been totally silent about horrific, unethical research conducted by US government researchers within the last decade.
Recently, Secretary of State Hillary Clinton and Secretary of Health and Human Services Kathleen Sebelius profusely apologized for a study conducted by the US Public Health Service in which nearly 700 incarcerated people and soldiers in Guatemala were, without their knowledge, deliberately infected with syphilis and other sexually transmitted diseases in order to test if penicillin could prevent infection. In a statement the two Cabinet secretaries expressed their outrage at “such reprehensible research.” In fact, so disturbed is the US government at this research that President Obama reportedly will call the Guatemalan president to apologize again.
This research violated the basic ethical principles that were supposed to guide research done on people — “human subjects research” in the professional lingo — since World War II. These principles were codified in the Nuremberg Code internationally and in the Common Rule guiding most research on people conducted or funded by US government agencies, including the Department of Health and Human Services of which the Public Health Service is a part as well as the Defense Department and the CIA. Fundamental to these and all other recent codes of research ethics are two basic principles: informed consent and minimization of harm. Thus, the Nuremberg Code, containing principles developed for the trials of German doctors who conducted horrific experiments in the Nazi concentration camps, begins with the principle of informed consent:
“The voluntary consent of the human subject is absolutely essential. This means that the person involved should have legal capacity to give consent; should be so situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, over-reaching, or other ulterior form of constraint or coercion; and should have sufficient knowledge and comprehension of the elements of the subject matter involved as to enable him to make an understanding and enlightened decision. This latter element requires that before the acceptance of an affirmative decision by the experimental subject there should be made known to him the nature, duration, and purpose of the experiment; the method and means by which it is to be conducted; all inconveniences and hazards reasonable to be expected; and the effects upon his health or person which may possibly come from his participation in the experiment.”
A little later the Nuremberg Code states the obligation of medical researchers to minimize harm resulting from experimental procedures:
“The experiment should be so conducted as to avoid all unnecessary physical and mental suffering and injury.
“No experiment should be conducted where there is an a priori reason to believe that death or disabling injury will occur; except, perhaps, in those experiments where the experimental physicians also serve as subjects.”
The Guatemalan study egregiously violated both these principles and deserves opprobrium. Rather than informed consent, the purpose of the study was deliberately hidden from those infected. These individuals were infected with dangerous, often deadly, illnesses. This research was awful, reprehensible, even horrific, and should never have been contemplated, let alone, conducted. I am glad that it only took a short time since historian Susan M. Reverby of Wellesley College revealed the abuses in a soon-to-be-published paper — available in preprint form on Reverby’s website — until US government officials vociferously condemned it.
But the US government does not need to look back nearly 65 years to find horrific research conducted by US government researchers. In June 2010, Physicians for Human Rights (PHR) issued a report, Experiments in Torture: Human Subject Research and Experimentation in the “Enhanced” Interrogation Program, that documented research and experimentation conducted in this century by CIA physicians and psychologists related to the abusive techniques used as part of the CIA’s “enhanced interrogation” torture program.
These researchers observed the torture of CIA prisoners in the so-called “black sites” and recorded the tortured prisoners’ responses. They paid special attention to the possibility that the torture would kill the prisoners. At times they recommended changes in torture techniques, such as the addition of salt to the water used for the partial drowning techniques that have come to be known as “waterboarding” so as to prevent possible death from induced electrolyte imbalance. This change in procedure allowed the prisoners to be waterboarded many dozens of times while preventing their escape into death. As PHR argued, the main reason for this apparent safety-related research was not the protection of prisoners, but to provide legal cover for the torturers and torture policy-makers by allowing them to claim that medical professionals were assuring the prisoners’ safety.
These abuses were reported by PHR in its peer-review report back in June. (I am one of the authors of that report.) Secretary of Health and Human Services Secretary Kathleen Sebelius was notified by letter of these abuses, abuses that violate the same research ethics principles — informed consent and minimization of harm — that were violated by the Guatemalan STD research. But, rather than express her outrage at this “reprehensible research,” Secretary Sebelius maintained her silence, as did every government official, other than a CIA press spokesman who denied our claims without presenting the slightest bit of evidence. Secretary Sebelius’ department referred an official complaint regarding unethical CIA research to the very same CIA that had already publicly denied the charges. So far, no government agency has committed to investigating these CIA abuses, which occurred far more recently than the Guatemalan horrors.
In response to the over 60 year old Guatemalan abuses, the Secretaries of HHS and State announced the creation of a commission that will undertake to assure that all human subjects research conducted by US researchers meets the highest ethical standards. As NBC News reported:
“In addition to the apology, the U.S. is setting up commissions to ensure that human medical research conducted around the globe meets ‘rigorous ethical standards.’ U.S. officials are also launching investigations to uncover exactly what happened during the experiments.”
If the purpose of the commission is really “to ensure that human medical research conducted around the globe meets ‘rigorous ethical standards,’” there cannot be a double standard. The same rules must apply to all researchers, everywhere, and to all research subjects, whoever they are. Ethics are there to protect the despised and powerless, not just those deemed deserving. Those researchers aiding CIA or other classified activities cannot get a free pass. We are at an important juncture, either unethical CIA research is investigated and those responsible are held accountable or the whole regime preventing unethical research that has been developed since the world became aware of Nazi horrors will collapse in hypocrisy. We cannot afford to let that happen.
October 3rd, 2010
Amalia Rosenblum in Haaretz reports that the open source concept is emerging in biomedical research, leading to a major new development in Alzheimer’s disease diagnosis for an unusually small investment of monetary resources. Furthermore, the results are being shared with little regard for traditional “intellectual property” rights which impede rapid dissemination and utilization of newly-generated knowledge:
A daring initiative for the good of humanity
Business must follow science in democratizing knowledge in the Internet age.
By Amalia Rosenblum
The ability to diagnose Alzheimer’s disease based on a spinal fluid test has made significant progress, media outlets around the world reported last week. This progress joins breakthrough studies after decades in which Alzheimer’s research hardly advanced and the disease could only be diagnosed conclusively by an autopsy.
Progress has been made possible by collaboration among scientists, universities, the U.S. administration and large pharmaceutical companies. They aim to disseminate the findings and discoveries immediately, free of charge, waiving scientists’ intellectual property rights. The project, incorporated under the name Alzheimer’s Disease Neuroimaging Initiative, was launched in 2003 and has cost some $100,000. In American terms, the price of one day of war has produced a generational leap in researching one of the most agonizing diseases known to mankind.
Such a low cost underlines the absurd way the race for money and prestige limits the development of critical tests and medicines. A number of factors combine to create a reality almost contradictory to the Hippocratic oath. The main ones are the U.S. administration’s restricted funding for university research and the Bayh-Dole Act, which since the 1980s has let drug companies finance university studies in exchange for exclusive control of the patents and influence over research objectives.
In view of this, the ethos of the Alzheimer’s Disease Neuroimaging Initiative is inspiring. Instead of having small study groups keeping their knowledge secret until publication for fear of losing funds or prestige, scientists now dare to unite resources and information. The idea is seen as innovative in especially competitive areas of medical research. A similar study focusing on Parkinson’s disease was launched recently with $40 million in funding. Similar initiatives are underway in scleroderma (an autoimmune disease ), Huntington’s disease, asthma and heart failure among young women.
But in a wider cultural perspective, this may be seen not as an academic upheaval but an expansion of the new paradigm of know-how based on the Internet revolution – the Wiki or open-source concept. This concept is based on collaboration, transparency and availability of research and development. Entire computer systems are based, at least partially, on open-source software. This philosophy holds that private ownership of content does not serve humanity. Take it from the millions of people who turn to Wikipedia as their first step in seeking information – this idea is contagious.
The problem, of course, is that a similar trend has not yet occurred in the economy. In other words, no sound business model has been designed to accompany the democratization of knowledge or the immediacy and joy of spreading content on the Web.
Scientists, like pilots, teachers, artists and bus drivers, must make a living, of course. And drug companies cannot be expected to risk billions of dollars on experiments and research without making appropriate profits. But as the Alzheimer researchers’ initiative shows, the Internet revolution will spare no Old World monopoly – because nobody can write a patent on the human aspiration for knowledge and answers.
August 19th, 2010