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Medical Journal Cites Truthout, Raises Questions About Medical Abuse at Guantanamo

Tuesday, 28 August 2012 10:10 By Jeffrey Kaye, Truthout | Report

Mefloquine, a controversial antimalaria drug used on all detainees sent to the detention center at Guantanamo.Mefloquine, a controversial antimalaria drug used on all detainees sent to the detention center at Guantanamo. (Photo: David Davies)A new medical journal article seriously questions the US government's rationale for use of the controversial antimalaria drug mefloquine on all detainees sent to the detention center at Cuba's Guantanamo Bay US Naval Base.

The article cites a series of investigative reports published by Truthout, which first broke the news about the mass administration of mefloquine at Guantanamo in December 2010.
 
Mefloquine has been connected to a number of serious side effects, including damage to the vestibular system, depression, anxiety, panic attacks, hallucinations, bizarre dreams, nausea, vomiting, sores and homicidal and suicidal thoughts and behaviors. The drug was previously sold under the brand name Lariam.

According to the author of the medical journal article, Army public health physician Remington Nevin, "analysis suggests the troubling possibility that the use of mefloquine at Guantánamo may have been motivated in part by knowledge of the drug's adverse effects and points to a critical need for further investigation to resolve unanswered questions regarding the drug's potentially inappropriate use."

Nevin was quoted in Truthout's December 1, 2010, report as saying the high dosage of mefloquine Guantanamo detainees were forced to take upon arriving at the prison facility was akin to "pharmacologic waterboarding."

Nevin's journal article, "Mass administration of the antimalarial drug mefloquine to Guantánamo detainees: a critical analysis," was published in the August issue of the peer-reviewed medical journal, Tropical Medicine and International Health (TMIH). In addition to Truthout's work, Nevin also cited a separate investigation conducted by Seton Hall School of Law's Center for Policy and Research as well as
Guantanamo Medical Standard Operating Procedures (SOPs) released under the Freedom of Information Act (FOIA) in 2007.

Nevin is a military doctor at the Department of Preventive Medicine, Bayne-Jones Army Community Hospital, Ft. Polk, Louisiana, and has published on the mefloquine issue before and testified before Congress about mefloquine's dangers earlier this year.

The Department of Defense (DoD) has maintained since the use of mefloquine was uncovered that the decision to presumptively administer full treatment doses of mefloquine to all incoming detainees was intended "to prevent the possibility" of malaria "spread[ing] from an infected individual to uninfected individuals in the Guantanamo population, the guard force, the population at the Naval base or the broader Cuban population."

But as Nevin pointed out in his journal article, citing a March 2011 Truthout story by this reporter and Truthout's lead investigative reporter, Jason Leopold, "not all individuals arriving at Guantanamo received treatment consistent with MDA ["mass administration of mefloquine"]. Indeed, hundreds of workers hired by Halliburton affiliate KBR, sent to build the new prison facility at Guantanamo, were not subjected to the DoD's mefloquine protocol, even though many if not most of them came from malaria-endemic countries. US service personnel were also not given presumptive doses of mefloquine at Guantanamo.

Nevin also seriously questioned the rationale for presumptive treatment, noting that usually such treatment without diagnosis is reserved for refugees or immigrant groups, who, for instance, might arrive in the United States and "face barriers to accessing medical care after their arrival and that US clinicians may have limited clinical experience with malaria, thus contributing to delays in diagnosis."

But Nevin explained that this rationale was inapplicable at Guantanamo "where ample and timely medical care was presumably available, provided by military healthcare providers familiar with the clinical and laboratory diagnosis and management of the disease." Indeed, other government documents show that blood tests for malaria were administered to detainees.

Advised Not to Talk About "Certain Issues"

In a more technical portion of the article, Nevin also examined the medical rationale for even assuming mefloquine would be a proper drug for presumptive treatment of malaria. Additionally, he noted reporting by Leopold and Kaye, which described internal discussions in February 2002 at the Armed Forces Epidemiological Board (AFEB), where questions about malaria control at Guantanamo were raised. This AFEB meeting never mentioned the use of mefloquine, which policy had begun just the month before, although other malaria control measures and drugs were discussed.

Not mentioned in the TMIH article, but reported by Truthout in December 2010, the AFEB also met in May 2003 to discuss mefloquine's severe neuropsychiatric side effects, as the drug was often prescribed in prophylactic doses to US military personnel. No mention was made of the Guantanamo protocol at that meeting either.

Yet, evaluation of a presumptive treatment protocol was definitely on the mind of medical personnel at Guantanamo at the same time the mefloquine SOP was instituted. We know this because another drug was presumptively given to all the detainees at the same time. This drug was Albendazole, a drug that kills intestinal parasites.

According to a March 2003 Guantanamo Detainee Hospital SOP, "Medical Interventions for Helminthic Infections," stool samples were taken from all detainees upon arrival. But the samples were "not to collect clinical data on the specific detainee," but were "intended to provide epidemiological validation of the treatment protocol."

It is not known if clinical data were collected to "provide epidemiological validation" of the mefloquine treatment protocol. FOIA requests for more information on the use of mefloquine at Guantanamo are ongoing and some are under appeal.

The Nevin article also doesn't mention that Capt. Albert J. Shimkus, the former chief surgeon for Task Force 160 at Guantanamo, which administered health care to detainees, told Truthout in December 2010 that he and other military officers at Guantanamo were told not to discuss the mefloquine decision.

Shimkus, who was also commanding officer at the Guantanamo Naval Hospital until summer 2003, was the medical official who signed the policy directive to presumptively treat all Guantanamo detainees with a high dosage of mefloquine.

"There were certain issues we were advised not to talk about," Shimkus said. Shimkus has repeatedly said the mefloquine was used for clinical and public health purposes and not for any other reason.

Drugs' "Function Is to Cause Capitulation"

Nevin's TMIH article was published only a month after a DoD inspector general (IG) report on the use of "mind-altering" drugs on detainees was released. The IG found that drugs were not used to "facilitate interrogation," but nevertheless, some detainees were drugged for psychiatric reasons and also for "chemical restraints."

The report did not reference the use of mefloquine on detainees.

The IG also indicated that the drugs used by DoD, including powerful antipsychotic medications like Haldol, "could impair an individual's ability to provide accurate information." Moreover, at least one detainee, supposed "dirty bomb" suspect Jose Padilla, was led to believe he was given a "truth drug" during interrogation.

The placebo use of "truth drugs" to trick suspects into talking was discussed at some length in a 1962 CIA interrogation manual, declassified in 1997. The use of a placebo drug, while telling a prisoner he is being given a truth drug, is meant to give the prisoner a psychological rationalization for giving information or cooperating.

But the CIA manual, known widely as the KUBARK manual, did not eschew the use of drugs themselves, though there was an issue around the accuracy of information so derived. However, according to the CIA manual, information was not always the primary goal of use of drugs.

As the CIA described the situation (bold emphases added), "Like other coercive media, drugs may affect the content of what an interrogatee divulges. Gottschalk notes that certain drugs 'may give rise to psychotic manifestations such as hallucinations, illusions, delusions, or disorientation', so that 'the verbal material obtained cannot always be considered valid'.... For this reason drugs (and the other aids discussed in this section) should not be used persistently to facilitate the interrogative debriefing that follows capitulation. Their function is to cause capitulation, to aid in the shift from resistance to cooperation. Once this shift has been accomplished, coercive techniques should be abandoned both for moral reasons and because they are unnecessary and even counter-productive."

The publication of the TMIH article also follows new revelations published at Truthout last June that, until the mid-1970s, the antimalaria drug cinchonine was illegally stockpiled by the CIA as an "incapacitating agent."

Other drugs used by the DoD on detainees are the subject of an ongoing investigation by Truthout.

Nevin's article concludes, "formal investigation may yet reveal the precise rationale and motivation for the use of mefloquine among Guantanamo detainees." However, no such investigations are known to be even in the planning stages.

Copyright, Truthout. May not be reprinted without permission.

Jeffrey Kaye

Jeffrey Kaye, a psychologist living in Northern California, writes regularly on torture and other subjects for  Truthout, The Public Record and Firedoglake. He also maintains a personal blog, Invictus. His email address is sfpsych at gmail dot com.


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Medical Journal Cites Truthout, Raises Questions About Medical Abuse at Guantanamo

Tuesday, 28 August 2012 10:10 By Jeffrey Kaye, Truthout | Report

Mefloquine, a controversial antimalaria drug used on all detainees sent to the detention center at Guantanamo.Mefloquine, a controversial antimalaria drug used on all detainees sent to the detention center at Guantanamo. (Photo: David Davies)A new medical journal article seriously questions the US government's rationale for use of the controversial antimalaria drug mefloquine on all detainees sent to the detention center at Cuba's Guantanamo Bay US Naval Base.

The article cites a series of investigative reports published by Truthout, which first broke the news about the mass administration of mefloquine at Guantanamo in December 2010.
 
Mefloquine has been connected to a number of serious side effects, including damage to the vestibular system, depression, anxiety, panic attacks, hallucinations, bizarre dreams, nausea, vomiting, sores and homicidal and suicidal thoughts and behaviors. The drug was previously sold under the brand name Lariam.

According to the author of the medical journal article, Army public health physician Remington Nevin, "analysis suggests the troubling possibility that the use of mefloquine at Guantánamo may have been motivated in part by knowledge of the drug's adverse effects and points to a critical need for further investigation to resolve unanswered questions regarding the drug's potentially inappropriate use."

Nevin was quoted in Truthout's December 1, 2010, report as saying the high dosage of mefloquine Guantanamo detainees were forced to take upon arriving at the prison facility was akin to "pharmacologic waterboarding."

Nevin's journal article, "Mass administration of the antimalarial drug mefloquine to Guantánamo detainees: a critical analysis," was published in the August issue of the peer-reviewed medical journal, Tropical Medicine and International Health (TMIH). In addition to Truthout's work, Nevin also cited a separate investigation conducted by Seton Hall School of Law's Center for Policy and Research as well as
Guantanamo Medical Standard Operating Procedures (SOPs) released under the Freedom of Information Act (FOIA) in 2007.

Nevin is a military doctor at the Department of Preventive Medicine, Bayne-Jones Army Community Hospital, Ft. Polk, Louisiana, and has published on the mefloquine issue before and testified before Congress about mefloquine's dangers earlier this year.

The Department of Defense (DoD) has maintained since the use of mefloquine was uncovered that the decision to presumptively administer full treatment doses of mefloquine to all incoming detainees was intended "to prevent the possibility" of malaria "spread[ing] from an infected individual to uninfected individuals in the Guantanamo population, the guard force, the population at the Naval base or the broader Cuban population."

But as Nevin pointed out in his journal article, citing a March 2011 Truthout story by this reporter and Truthout's lead investigative reporter, Jason Leopold, "not all individuals arriving at Guantanamo received treatment consistent with MDA ["mass administration of mefloquine"]. Indeed, hundreds of workers hired by Halliburton affiliate KBR, sent to build the new prison facility at Guantanamo, were not subjected to the DoD's mefloquine protocol, even though many if not most of them came from malaria-endemic countries. US service personnel were also not given presumptive doses of mefloquine at Guantanamo.

Nevin also seriously questioned the rationale for presumptive treatment, noting that usually such treatment without diagnosis is reserved for refugees or immigrant groups, who, for instance, might arrive in the United States and "face barriers to accessing medical care after their arrival and that US clinicians may have limited clinical experience with malaria, thus contributing to delays in diagnosis."

But Nevin explained that this rationale was inapplicable at Guantanamo "where ample and timely medical care was presumably available, provided by military healthcare providers familiar with the clinical and laboratory diagnosis and management of the disease." Indeed, other government documents show that blood tests for malaria were administered to detainees.

Advised Not to Talk About "Certain Issues"

In a more technical portion of the article, Nevin also examined the medical rationale for even assuming mefloquine would be a proper drug for presumptive treatment of malaria. Additionally, he noted reporting by Leopold and Kaye, which described internal discussions in February 2002 at the Armed Forces Epidemiological Board (AFEB), where questions about malaria control at Guantanamo were raised. This AFEB meeting never mentioned the use of mefloquine, which policy had begun just the month before, although other malaria control measures and drugs were discussed.

Not mentioned in the TMIH article, but reported by Truthout in December 2010, the AFEB also met in May 2003 to discuss mefloquine's severe neuropsychiatric side effects, as the drug was often prescribed in prophylactic doses to US military personnel. No mention was made of the Guantanamo protocol at that meeting either.

Yet, evaluation of a presumptive treatment protocol was definitely on the mind of medical personnel at Guantanamo at the same time the mefloquine SOP was instituted. We know this because another drug was presumptively given to all the detainees at the same time. This drug was Albendazole, a drug that kills intestinal parasites.

According to a March 2003 Guantanamo Detainee Hospital SOP, "Medical Interventions for Helminthic Infections," stool samples were taken from all detainees upon arrival. But the samples were "not to collect clinical data on the specific detainee," but were "intended to provide epidemiological validation of the treatment protocol."

It is not known if clinical data were collected to "provide epidemiological validation" of the mefloquine treatment protocol. FOIA requests for more information on the use of mefloquine at Guantanamo are ongoing and some are under appeal.

The Nevin article also doesn't mention that Capt. Albert J. Shimkus, the former chief surgeon for Task Force 160 at Guantanamo, which administered health care to detainees, told Truthout in December 2010 that he and other military officers at Guantanamo were told not to discuss the mefloquine decision.

Shimkus, who was also commanding officer at the Guantanamo Naval Hospital until summer 2003, was the medical official who signed the policy directive to presumptively treat all Guantanamo detainees with a high dosage of mefloquine.

"There were certain issues we were advised not to talk about," Shimkus said. Shimkus has repeatedly said the mefloquine was used for clinical and public health purposes and not for any other reason.

Drugs' "Function Is to Cause Capitulation"

Nevin's TMIH article was published only a month after a DoD inspector general (IG) report on the use of "mind-altering" drugs on detainees was released. The IG found that drugs were not used to "facilitate interrogation," but nevertheless, some detainees were drugged for psychiatric reasons and also for "chemical restraints."

The report did not reference the use of mefloquine on detainees.

The IG also indicated that the drugs used by DoD, including powerful antipsychotic medications like Haldol, "could impair an individual's ability to provide accurate information." Moreover, at least one detainee, supposed "dirty bomb" suspect Jose Padilla, was led to believe he was given a "truth drug" during interrogation.

The placebo use of "truth drugs" to trick suspects into talking was discussed at some length in a 1962 CIA interrogation manual, declassified in 1997. The use of a placebo drug, while telling a prisoner he is being given a truth drug, is meant to give the prisoner a psychological rationalization for giving information or cooperating.

But the CIA manual, known widely as the KUBARK manual, did not eschew the use of drugs themselves, though there was an issue around the accuracy of information so derived. However, according to the CIA manual, information was not always the primary goal of use of drugs.

As the CIA described the situation (bold emphases added), "Like other coercive media, drugs may affect the content of what an interrogatee divulges. Gottschalk notes that certain drugs 'may give rise to psychotic manifestations such as hallucinations, illusions, delusions, or disorientation', so that 'the verbal material obtained cannot always be considered valid'.... For this reason drugs (and the other aids discussed in this section) should not be used persistently to facilitate the interrogative debriefing that follows capitulation. Their function is to cause capitulation, to aid in the shift from resistance to cooperation. Once this shift has been accomplished, coercive techniques should be abandoned both for moral reasons and because they are unnecessary and even counter-productive."

The publication of the TMIH article also follows new revelations published at Truthout last June that, until the mid-1970s, the antimalaria drug cinchonine was illegally stockpiled by the CIA as an "incapacitating agent."

Other drugs used by the DoD on detainees are the subject of an ongoing investigation by Truthout.

Nevin's article concludes, "formal investigation may yet reveal the precise rationale and motivation for the use of mefloquine among Guantanamo detainees." However, no such investigations are known to be even in the planning stages.

Copyright, Truthout. May not be reprinted without permission.

Jeffrey Kaye

Jeffrey Kaye, a psychologist living in Northern California, writes regularly on torture and other subjects for  Truthout, The Public Record and Firedoglake. He also maintains a personal blog, Invictus. His email address is sfpsych at gmail dot com.


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