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NRC on Research on “War on Terror” Detainees: “A Contemporary Problem”?

10:13 pm in Military, Torture by Jeff Kaye

A National Research Council (NRC) 2008 report on a conference on Emerging Cognitive Neuroscience and Related Technologies examined briefly what it characterized as a “contemporary problem,” the possibility of doing research on “war on terror” detainees, removed by the U.S. government from Geneva protections against experiments done on prisoners of war.

In a section of the report that looked at the “Cultural and Ethical Underpinnings of Social Neuroscience,” the report’s authors examined the “Ethical Implications” of these new technologies. The section explored the birth of the new field of bioethics, in response to the scandalous revelations of the Tuskegee experiments. The report noted that “On the whole, however, the system of protections for human research subjects is not well designed to capture instances of intentional wrongdoing,” providing “rather… guidance for well-motivated investigators who wish to be in compliance with regulatory requirements and practice standards.”

The report further described the history surrounding the importance of the rules that constitute the need for informed consent of research participants, and how the Nazi-era experiments led to the Nuremberg principle that “The voluntary consent of the human subject is absolutely essential.” While claiming the current “formal procedures in place for the use of military personnel in medical experiments” are “stringent,” that doesn’t imply “that no abuses can occur, nor that convenient alternative frameworks (such as field testing) cannot be used to circumvent the research rules, but only that the official policies and procedures in the military are rigorous.”

But even with such supposedly “rigorous” policies, the report’s authors see a problem. They ominously ask whether “classified research can ever be ethically sound inasmuch as it lacks transparency, such as in the form of public accountability. For example, if a member of an ethics review board disagrees with a majority decision involving a classified human experiment, that member would be unable to engage in a public protest of that decision.”

At this point in the discussion, another interesting, and even more ominous question rises up before the NSC panel (emphasis added):

A contemporary problem is the status of detainees at military installations who are suspects in the war on terrorism. Presumably, the ethical standards that apply to all human research subjects should apply to them as well. But if they are not protected by the provisions of the Geneva protocols for prisoners of war, the question would be whether as potential research subjects they are nonetheless protected by other international conventions, such as the Universal Declaration of Human Rights (United Nations, 1948). Those technical questions of international law are beyond the scope of this report.

Why should the question of research on detainees arise in this discussion at all?

Evidence of Military Research and Experimentation on Detainees

Jason Leopold and I have been investigating the possibility of research being conducted upon detainees at Guantanamo and other “war on terror” prisoners held by the Defense Department and the CIA. Back in September 2009, I published articles at Firedoglake, The Public Record, and Truthout that noted the research on “uncontrollable stress” conducted upon SERE survival school students subjected to mock torture predated the institution of the so-called “enhanced interrogation program of the CIA. The research was conducted by, among others, a CIA-linked psychiatrist, Dr. Charles A. Morgan III, who is affiliated with Yale University and the National Center for Post-traumatic Stress Disorder.

Morgan has denied his CIA affiliation, but for documentary evidence, see this list of participants at this 2004 DoJ/FBI conference.

This research used methods that were similar to those later instituted under a plan developed by James Mitchell and Bruce Jessen, formerly employed by the military’s Joint Personnel Recovery Agency (JPRA), parent organization to the SERE program, to use coercive forms of interrogation on the new “war on terror” detainees, who the White House and their attorneys at the Office of Legal Counsel  removed from the protection of Geneva Convention protocols. In a report on CIA experiments on torture, Physicians for Human Rights (PHR) noted in an appendix the existence of the Morgan research, but failed to make public the CIA connections, even though they certainly were aware of them.

Originally, the PHR report was going to include a footnote on the existence of a new protocol on human experimentation protections in the military signed by Paul Wolfowitz in early 2002. While they chose not to follow up on this, Leopold and I conducted a seven-month long investigation into the March 2002 issuance of Department of Defense Directive 3216.02, “Protection of Human Subjects and Adherence to Ethical Standards in DoD-Supported Research.” We noted that “the Wolfowitz directive weakened protections that had been in place for decades by limiting the safeguards to ‘prisoners of war’.” Even more, it allowed for waivers of informed consent if the head of a DoD department thought it necessary. There had never been such loose rules on informed consent ever explicitly allowed in the history of military research, although no prominent ethicist had discussed this until we published our article. Prominent ethicist Alexander Capron was quoted in our story for calling these changes “controversial both because it involves a waiver of the normal requirements and because the grounds for that waiver are so open-ended.”

While retaining the blanket prohibition against experimenting on prisoners of war, Wolfowitz softened the language for other types of prisoners, using a version of rules about “vulnerable” classes of individuals taken from regulations meant for civilian research by the Department of Health and Human Services (DHHS).

By removing the detainees from Geneva protections, and taking away “prisoner of war” protections, Bush and the White House lawyers, among them Jay Bybee, John Yoo and Alberto Gonzales, opened up the captured prisoners, many of them sold to the Americans for bounty reward, to possible experimentation.

DoD and HHS Acting Together on Experiments?

Buried in the Wolfowitz directive was a provision (4.4.1) that “actions authorizing or requiring any action by an official of the Department of Health and Human Services (HHS) with respect to any requirements” of research on “vulnerable populations” like prisoners “shall be under the authority of the Director, Defense Research and Engineering.” The reason for HHS involvement was because research “supported or conducted by the Department of Defense that affects vulnerable classes of subjects” had to meet the protections of HHS’s Common Rule language that covers protection of human subjects.

When queried whether there had ever been any DoD research on any kind of prisoner, or the use of HHS personnel to monitor such research, a spokesperson for Defense Research and Engineering indicated that they had no comment.

In 2002, there was another assault on prisoner protections for research, when Bush’s Secretary of HHS asked for and received a year later a blanket waiver for all informed consent on prisoner experimentation for “epidemiological” reasons, including the taking of biological samples. In a future article, I will explore the repercussions of this new policy — also never discussed by any ethical panel, and certainly not by the NRC — on research upon prisoners, and more specifically the possibility of experiments done on the detainees at Guantanamo.

This further investigation may throw light upon the Guantanamo SOP wherein all detainees were subjected to a never-before-attempted use of mass administration of treatment doses of the controversial anti-malaria drug mefloquine (Lariam), as also reported in a special investigation by Jason Leopold and myself last December. The scandal was also the subject of an independent investigatory report published at the same time by Seton Hall University Law School’s Center for Policy and Research.

In a 2002 report on mefloquine adverse events, “Unexpected frequency, duration and spectrum of adverse events after therapeutic dose of mefloquine in healthy adults,” published in top medical journal Acta Tropica, it was noted that 73% of the participants suffered “severe (grade 3) vertigo…” which “required bed rest and specific medication for 1 to 4 days.” Nevertheless, DoD maintains that the use of mefloquine was for public health purposes, to prevent malaria from spreading in Cuba. But as our investigation showed, talking with military medical experts, and examining other military responses to malaria threat, including in Cuba, no such use of such mass treatment doses, with its attendant dangers, was ever used or even proposed. Nor did DoD medical officers at Guantanamo demand the same protocols be used on foreign workers from malarial areas brought into the camp at this same time to work on building Camp Delta and other facilities at the naval base. The workers were employed by Kellogg Brown and Root, a subsidiary of Halliburton.

Was the mefloquine use part of an experimental protocol on the adverse side effects of the drug, a subject of much controversy within DoD at the time? Was it a method of softening up prisoners for interrogation? While calls for greater transparency go unheeded, further investigation by the press may bring answers to these explosive questions.

Guantanamo Medical Chief Was “Advised Not to Talk About” Drug Decision

5:54 pm in Military, Torture by Jeff Kaye

A new story at Truthout, which I co-authored with Jason Leopold, takes up the investigation of the story into the mass drugging of Guantanamo detainees with the controversial drug mefloquine, aka Lariam, which we originally reported earlier this month. When I wrote about the issue here at Firedoglake, I noted that DoD had scrubbed one the key documents we used. I thought it had resurfaced, but looking today, it’s gone again.

The issue of documents is not so key for this latest look into DoD actions at Guantanamo, as we interviewed or had email exchanges with key individuals involved. The most important was Captain Albert Shimkus, Jr. (ret.), who from 2002 to summer 2003 was former commanding officer and chief surgeon for both the Naval Hospital at Guantanamo Bay and Joint Task Force 160, which administered health care to the detainees. A copy of a January 23, 2002 SOP obtained by Truthout showed that it was Shimkus who signed off on the mefloquine policy.

As the article at Truthout explains:

Capt. Albert J. Shimkus… defended the unprecedented practice, first reported by Truthout earlier this month, to administer 1250 mg of the drug mefloquine to all “war on terror” prisoners transferred to Guantanamo within the first 24 hours after their arrival, regardless of whether they had malaria or not. The 1250 mg dosage is what is used to treat individuals who have malaria and is five times higher than the prophylactic dose given to individuals to prevent the disease. One tropical disease expert said there is no “medical justification” for the practice….

Although there were two media reports in 2002 that quoted Shimkus saying “war on terror” detainees were given antimalarial medication, neither he nor any other military or Pentagon official ever disclosed to lawmakers or military personnel who raised questions about the efficacy of mefloquine, that mass presumptive treatment was the policy in place at Guantanamo.

“There were certain issues we were advised not to talk about,” Shimkus told Truthout in an interview, explaining the reason the policy was never publicly disclosed.

In the interview with Truthout, Shimkus goes on to describe what agencies and personnel he relied on to make the decision, as he readily admitted that he was no public health or malaria expert himself. Nevertheless, he persistently defended the mass administration of mefloquine, even if it did possibly lead to serious side effects in some of the detainees. He maintained the “benefits outweighed the risks.”

The Truthout article explains how unusual this kind of antimalaria approach is. In fact, in regards to the use of mefloquine, or of any population transfer from Central or South Asia to a non-malarial endemic area, the procedure was unprecedented, and if you believe the many links provided from the CDC, and elsewhere, was dangerous.

With the original Truthout investigation drawing upon a parallel study by Seton Hall University School of Law’s Center for Policy and Research, and suppositions by both investigations that mefloquine, whose drug family was linked to studies done by the CIA’s MKULTRA (see section on quinolines), was used experimentally to soften up the detainees, Captain Shimkus specifically denied any knowledge of any experiment done on the detainees in regards to mefloquine, or anything else. “I don’t remember in my 18 months [at Guantanamo] a word spoken in regards to research.”

But there was some reason he had been told not to talk about the procedure, and other matters. If the medical treatment at Guantanamo was so world-class, why are they hiding information about what was done there? Why can’t redacted medical records be released? Why do even detainee’s attorneys find it next to impossible to obtain these records? Why is a DoD Inspector General report on drugs and detainees kept totally classified?

The only way such thing can be kept secret is because the American people are not clamoring for the truth to be revealed. That is a sad and sombre reflection upon the state of this society as it goes into the second decade of the 21st century.

Jason and I have brought the country the first clear indication of what kind of drugging shenanigans were happening at Guantanamo. I’ll be honest, I’m unhappy with the response from the human rights community and key political bloggers, not to mention the mainstream press. Has the decision of the Obama administration to leave Guantanamo open, and to follow Bush in the policy of indefinite detention and abusive interrogation (Appendix M), so paralyzed the country that very serious charges of drugging of prisoners can pass by unremarked?

I thank Firedoglake and Truthout for supporting the work that furthers these kinds of investigations. But much more needs to be done. The blowback from non-accountability over torture is creeping into the society at an ever-expanding rate. We see this in the seeming acceptability in which accused prisoners, like Bradley Manning, are kept in onerous conditions akin to a Supermax prison… or Camp Echo at Guantanamo.

For readers, the question of what next lies before you with a moral imperative this holiday season. We bring you the news. You can hide your heads, or you can choose to act, raise your voice, make known the unacceptability of such treatment by the state on prisoners held without charge, without trial, victims of a “war on terror”, itself the blowback from a decades-long policy of supporting dictators and torturers abroad.

Unreported Detainee Deaths at Guantanamo in Jan-Feb 2002?

4:57 pm in Military, Torture, Uncategorized 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 first detainee death at Guantanamo Bay was in June 2006. The [June 16] press
release is below:

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 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.