More Evidence of Medical Experimentation at Guantánamo

22.12.10

In an investigative report for Truthout, my colleagues Jason Leopold and the psychologist and blogger Jeffrey Kaye have followed up on an important story they published three weeks ago, “Controversial Drug Given to All Guantánamo Detainees Akin to ‘Pharmacologic Waterboarding’” (which I cross-posted here, with commentary). In that article, they revealed how, in the months following the opening of Guantánamo on January 11, 2002, every single prisoner was forced to “take a high dosage of a controversial antimalarial drug, mefloquine, an act that an Army public health physician called ‘pharmacologic waterboarding.’”

In my introduction to that article, I noted how Jason and Jeff contributed significantly to a growing body of work demonstrating that the detention program in Guantánamo, and in the “high-value detainee” program in the CIA’s secret prisons, involved human experimentation, of which medical experiments like the antimalarial project were just a part. Much more remains to be uncovered, but their article was part of a number of reports this year which have begun to shed light on this disturbing aspect of the detainee program. Human experimentation first came to light prominently in “Experiments in Torture: Human Subject Research and Evidence of Experimentation in the ‘Enhanced’ Interrogation Program,” a report published by Physicians for Human Rights in June, and another important part of the story emerged in October, when Jason and Jeff (who has spent many years placing the “War on Terror” detention and interrogation policies in the wider context of CIA experimentation since the 1950s) published an article on Truthout entitled, “Wolfowitz Directive Gave Legal Cover to Detainee Experimentation Program,” revealing how the program had been given the green light by Cheney’s deputy in March 2002.

In this latest article, cross-posted below, Jason and Jeff focus on the role played by Capt. Albert J. Shimkus, “the former commanding officer and chief surgeon for both the Naval Hospital at Guantánamo Bay and Joint Task Force 160, which administered health care to detainees,” in approving the “mass presumptive treatment” policy, which reveals some dubious claims about Cuban fears of an malaria epidemic and the prevailing rate of malarial infection in Afghanistan at the time Guantánamo opened, and also reveals many examples of how US government concerns about the anti-malarial drug never made it to Guantánamo — or were, perhaps, deliberately ignored.

Key to this article is the discovery of a January 23, 2002, “Infection Control” Standard Operating Procedure (SOP) which “called for the mass presumptive treatment of malaria using mefloquine.” As Jason and Jeff explain:

The “Infection Control” SOP, which was signed by Shimkus and has not been previously released, says, “detainees are native to a region plagued by a number of infectious diseases. It is estimated that a number of these detainees will carry one or more of these illnesses upon arrival … Empiric therapies will include … mefloquine 1250 mg.”

Medical literature usually describes “empiric therapy,” or presumptive treatment for malaria, as the administration or self-administration of antimalarial drugs for symptomatic individuals, or occasionally groups of at-risk patients, who do not have access to laboratories or medical facilities and in whom malaria cannot be formally diagnosed.

At Guantánamo, however, all detainees, whether they had symptoms or not, were given laboratory tests to determine if they had malaria, and doctors were accessible “24/7″ in the event symptoms started to surface, Shimkus said, calling into question the rationale for mass presumptive treatment.

Ex-Guantánamo Official Was Told Not to Discuss Policy Surrounding Antimalarial Drug Used on Detainees
By Jason Leopold and Jeffrey Kaye, Truthout, December 20, 2010

Military officials were instructed not to publicly discuss a decision made in January 2002 to presumptively treat all Guantánamo detainees with a high dosage of a controversial antimalarial drug that has been directly linked to suicide, hallucinations, seizures and other severe neuropsychological side effects, according to a retired Navy captain who signed the policy directive.

Capt. Albert J. Shimkus, the former commanding officer and chief surgeon for both the Naval Hospital at Guantánamo Bay and Joint Task Force 160, which administered health care to detainees, defended the unprecedented practice, first reported by Truthout earlier this month, to administer 1250 mg of the drug mefloquine to all “war on terror” detainees transferred to the prison facility 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 has said there is absolutely no “medical justification” to support the military’s decision to presumptively treat all Guantánamo detainees for malaria with high doses of mefloquine.

Mefloquine is also known by its brand name Lariam. It was researched by the US Army in the 1970s during the Vietnam War and licensed by the Food and Drug Administration (FDA) in 1989. Since its introduction, it has been directly linked to serious adverse effects, including depression, anxiety, panic attacks, confusion, bizarre dreams, nausea, vomiting, sores, hallucinations and homicidal and suicidal thoughts.

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 Guantánamo.

“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. He could not recall who told him not to discuss the issue.

Shimkus, who is now an associate professor of national security studies at the Naval War College in Newport, Rhode Island, said officials from the Centers for Disease Control (CDC), the Navy Environmental Health Center (NEHC) and the Armed Forces Medical Intelligence Center at Fort Detrick, Maryland, which is part of the Defense Intelligence Agency, were all involved in the discussions that resulted in the issuance of a January 23, 2002, “Infection Control” Standard Operating Procedure (SOP) that called for the mass presumptive treatment of malaria using mefloquine.

Detainees started arriving at Guantánamo two weeks earlier and were held in a detention center known as Camp X-Ray.

The “Infection Control” SOP, which was signed by Shimkus and has not been previously released, says, “detainees are native to a region plagued by a number of infectious diseases. It is estimated that a number of these detainees will carry one or more of these illnesses upon arrival … Empiric therapies will include … mefloquine 1250 mg.”

Medical literature usually describes “empiric therapy,” or presumptive treatment for malaria, as the administration or self-administration of antimalarial drugs for symptomatic individuals, or occasionally groups of at-risk patients, who do not have access to laboratories or medical facilities and in whom malaria cannot be formally diagnosed.

At Guantánamo, however, all detainees, whether they had symptoms or not, were given laboratory tests to determine if they had malaria, and doctors were accessible “24/7″ in the event symptoms started to surface, Shimkus said, calling into question the rationale for mass presumptive treatment.

Shimkus said the NEHC bore the primary responsibility for recommending that mefloquine be administered to all detainees in treatment doses, but there was consensus among the various government agencies about using the drug in this way.

“There was no one that said, ‘Captain, this is not the way to go,’” Shimkus said. “I did not do anything in isolation. Any policy would have been approved by a higher authority” up the medical chain of command.

Shimkus could not recall the names of the officials from the various government agencies who agreed with and signed off on the policy. Nor could he identify his immediate medical supervisor, a colonel at United States Southern Command (SOUTHCOM), which is responsible for contingency planning and operations in Cuba, who Shimkus said would have also been involved in the decision.

Cuban Government Concerns

Shimkus said one of the reasons that factored into the decision to presumptively treat war on terror detainees with mefloquine was concerns raised by the Cuban government.

In an interview with Miami Herald reporter Carol Rosenberg in February 2002, Shimkus said he and other medical officers stationed at Guantanamo met with Cuban doctors and government officials on February 8, 2002, to “reassure the government that suspected terrorist prisoners are not introducing malaria into” Cuba, “which has been free of the mosquito-borne disease for 50 years.”

Rosenberg reported on February 22, 2002, that steps taken to prevent the spread of malaria at Guantánamo included “impregnating the uniforms of both prisoners and troops who handle prisoners with mefloquin [sic] and other agents to kill the parasite.” The Herald‘s February 22, 2002, report was the first and only time mefloquine use at Guantánamo has ever been mentioned. But Rosenberg’s report did not state that Shimkus had already signed a policy directive authorizing mass presumptive treatment.

Shimkus told Truthout he could not recall specific details of his discussions with the Cubans. He did not respond to follow-up questions about Rosenberg’s characterization regarding the use of mefloquine.

Just three days prior to the publication of the Herald‘s report, Navy Capt. Alan “Jeff” Yund appeared before the Armed Forces Epidemiological Board (AFEB) and was queried about malaria at Guantánamo.

But Yund, the Navy’s liaison officer to AFEB, did not disclose that mefloquine was being administered to detainees. He said he believed detainees who were infected with the disease would be treated on a case-by-case basis with a different antimalarial drug known as primaquine, and that other steps would be taken to protect against mosquitoes.

Yund told Truthout via email that he did not refer to mefloquine during the AFEB briefing because, “I do not recall being involved in any consultations regarding the use of mefloquine at Guantánamo and do not recall being aware that it was being used there.”

Yund declined to comment further.

Shimkus could not say why Yund was unaware that mefloquine was being used as a form of mass presumptive treatment at Guantánamo.

The use of mefloquine at Guantánamo was not mentioned during numerous other AFEB briefings, particularly one held in May 2003, where concerns were raised by members of the board about the drug’s severe neuropsychiatric side effects, which US military personnel who had taken mefloquine in 250 mg prophylactic doses had been complaining about.

Red Flags Raised

Shimkus said he was aware of the alternatives and noted that at one point the antibiotic drug doxycycline and Malarone were under consideration, but the latter had only been approved by the Department of Defense in 2000 and had not been in widespread use yet. Mefloquine, Shimkus said, was considered efficient and effective.

But at an April 16, 2002, meeting of the Interagency Working Group for Antimalarial Chemotherapy, which included Defense Department representatives, participants concluded that study designs on mefloquine were flawed or biased and based on “sensational or [at] best marketed information.”

The Working Group, which included representatives from the State Department, the CDC and FDA, stated, “Sufficient evidence exists to raise the question whether the neuropsychiatric adverse events of mefloquine are frequent enough and severe enough to warrant limiting its use.” The group called for additional research, and warned, “Other treatment regimes should be carefully considered before mefloquine is used at the doses required for treatment.”

Additionally, in October 2002, William Winkenwerder, the assistant secretary for defense, admitted that “recent press articles and scientific studies have raised concerns regarding the adverse effects associated with mefloquine use.”

Winkenwerder’s admission was made in a letter written in response to questions raised by John McHugh, then chair of the subcommittee on military affairs for the House Armed Services Committee. The letter said, “recent peer-review reports” showing adverse events levels associated with mefloquine are “much higher than previously reported.” Winkenwerder told McHugh, now secretary of the Army, that the CDC had initiated a review in 2001, which was then still underway, of all chemoprophylactic drugs, including mefloquine.

Shimkus said he did not believe Winkenwerder was part of the consulting team who signed off on administering treatment doses of mefloquine to detainees. But Shimkus said the policy was “well-known in the [military] medical community.” Winkenwerder did not respond to calls for comment.

The use of mefloquine as a mass presumptive treatment at Guantánamo continued until at least July 2005, despite the presence of ongoing warnings.

In June 2004, the CDC issued a new set of guidelines on malaria treatment, which warned that mefloquine “is associated with a higher rate of severe neuropsychiatric reactions when used at treatment doses,” and recommended that mefloquine be used “only when … [other] options cannot be used.”

As far back as 1990, the CDC warned in a set of recommendations for malaria prevention for travelers that mefloquine should not be used for presumptive self-treatment “because of the frequency of side effects, especially dizziness, which has been associated with therapeutic dosages of mefloquine.”

“This was a one time treatment only [for detainees],” Shimkus said. “My focus on mefloquine was specifically for preventing malaria from occurring.”

However, other Guantánamo documents obtained by Truthout say that on February 28, 2002, 59 detainees allegedly refused to take medication, including antimalarial drugs, and noted that the “series must start over.” It is unclear whether this included readministration of mefloquine, or whether the “series” described included further antimalarial doses of primaquine or cholorquine, also administered to the detainees.

Maj. Remington Nevin, an Army public health physician, who formerly worked at the Armed Forces Health Surveillance Center and has written extensively about mefloquine, previously told Truthout the decision to administer high doses of the drug, even as a one-time treatment “is, at best, an egregious malpractice.”

Nevin added, “many dozens of detainees, possibly hundreds” likely experienced side effects “as severe as those intended through the application of ‘enhanced interrogation techniques.’”

Truthout was unable to locate a single malaria expert who was willing to go on the record to defend the government’s policy of mass presumptive treatment of the disease using mefloquine or any other antimalarial drug.

Shimkus told Truthout that, “clinically,” he could not recall if any detainees experienced any side effects associated with taking mefloquine, but if they did, that data would have been noted in their medical records.

“We have robust medical records,” Shimkus said. “If anything occurred that was a cause for concern it would have been documented in their medical records.”

But the government has refused to release Guantánamo detainees’ medical records to the media or to their attorneys citing, among other reasons, privacy concerns.

As first documented in a separate report on mefloquine use at Guantánamo published earlier this month by Seton Hall University School of Law’s Center for Policy and Research, medical files for detainee 693 [Salah al-Salami], released by the Defense Department in connection with his alleged suicide at the prison facility in June 2006, contradict Shimkus’s assertions. Those records show that two weeks after the detainee was given mefloquine in June 2002, he was interviewed by Guantánamo medical personnel and reported that he was suffering from nightmares, hallucinations, anxiety, auditory and visual hallucinations, sleep loss and suicidal thoughts.

A Guantánamo medical officer who interviewed the detainee, however, did not state that the detainee may have been experiencing mefloquine-related side effects in notes he took evaluating the detainee’s condition.

Shimkus dismissed the significance of the medical officer’s failure to connect the detainee’s psychological state to the possible side effects resulting from mefloquine, stating that the medical officer may have been unaware “the patient had taken [the drug], because there was a lot of turnover of staff at that point.”

Scott Allen and Vince Iacopino, medical doctors affiliated with Physicians for Human Rights, a doctors’ organization based in Cambridge, Massachusetts, said, “the questionable use of mefloquine for malaria prevention at Guantánamo underscore the need for transparency of detention policies and procedures” at the prison facility.

“Benefits Outweighed Risks”

Shimkus, who is a nurse by training, acknowledged that the mass presumptive treatment of malaria using mefloquin was unprecedented. However, he said the “benefits outweighed the risks.”

When asked, Shimkus did not indicate that contraindications for the use of mefloquine, such as pre-existing cases of post-traumatic stress disorder, anxiety, seizures, or other mental illness, which would have heightened mefloquine’s side effects, were ever pursued for the individual detainees. He simply reiterated that the benefits of administering treatment doses of mefloquine outweighed the risks.

Yet, when told that the Defense Department took a radically different approach a decade earlier, when thousands of Haitian refugees housed at Guantánamo were first tested to determine if they had malaria and, only then, were given a treatment dosage of a different medication, chloroquine, if they had the disease, Shimkus said war on terror detainees “were a different cohort of individuals.”

“You have to remember that this was in the context of February 2002,” Shimkus said. “The detainees came from Afghanistan and other areas that may have been chloroquine resistant.”

Moreover, in two articles published in 2002, Shimkus claimed statistics showed that 40 percent of Afghanistan’s population was infected with malaria. But according to figures from the World Health Organization, in 2002, the number infected in Afghanistan was about 13 percent.

Shimkus also indicated that malaria cases at Guantánamo could have led to a public health crisis at the base, and reintroduction of malaria into Cuba. Once an outbreak begins, Shimkus told Truthout, one “loses control” of the situation and there is an epidemic.

However, when the CDC examined the influx of tens of thousands of refugees to the United States from hyper-epidemic sub-Saharan Africa, where the falciparum form of malaria kills more than a million people yearly, they concluded that “sustained malaria transmission” in a nonmalarial endemic country, like the US, from this population “would be unlikely.”

Still, the CDC called for mass presumptive treatment (with a drug other than mefloquine) of these refugees before they came to the US — mainly because they feared many US doctors wouldn’t recognize malaria symptoms — but noted that such mass presumptive treatment from other parts of the world, including Afghanistan, was not recommended, because “the risk and cost of post-arrival presumptive treatment currently outweighs the potential benefits.”

Of the more than 700 detainees held at Guantánamo, only four tested positive for malaria, all in January and February 2002.

But Shimkus still defended the mass administration of mefloquine, saying, “One [infection] is too many.” Shimkus said he believes he and other military officials “made the right policy decisions based on the information we had to prevent the introduction of malaria” in Cuba and protect the health of the detainees.

Shimkus said after he retired from the military he became involved with the Open Society Institute, funded by the Soros Foundation, and has since taken a role in the work the organization has done to raise awareness about abusive interrogation measures contained in the Army Field Manual.

Andy Worthington is the author of The Guantánamo Files: The Stories of the 774 Detainees in America’s Illegal Prison (published by Pluto Press, distributed by Macmillan in the US, and available from Amazon — click on the following for the US and the UK) and of two other books: Stonehenge: Celebration and Subversion and The Battle of the Beanfield. To receive new articles in your inbox, please subscribe to my RSS feed (and I can also be found on Facebook and Twitter). Also see my definitive Guantánamo prisoner list, updated in July 2010, details about the new documentary film, “Outside the Law: Stories from Guantánamo” (co-directed by Polly Nash and Andy Worthington, currently on tour in the UK, and available on DVD here), my definitive Guantánamo habeas list and the chronological list of all my articles, and, if you appreciate my work, feel free to make a donation.

21 Responses

  1. Tashi Farmilo-Marouf says...

    Very Interesting Article.
    Evil actions can be hidden or covered up by alleged good intentions.
    I can just imagine the justifications that a person must tell their conscience, “I am just treating Malaria, even if the side affects of mefloquine produce torturous effects on the detainee. I am only following orders. And besides they are ‘bad guys’ they must deserve it.”
    What I ask myself is: When is torture ever justified?
    The answer: Never.
    Charge the detainees. Prosecute them in real courts of law, with due process and sentence them if they are guilty.
    That is called justice.

  2. Tweets that mention More Evidence of Medical Experimentation at Guantánamo | Andy Worthington -- Topsy.com says...

    [...] This post was mentioned on Twitter by Andy Worthington, tosexyformy. tosexyformy said: The #Guantanamo experiment crimes..just unfolding. Read this http://bit.ly/gHrlA0 [...]

  3. Andy Worthington says...

    Absolutely, Tashi. What a great tragedy for the prisoners that President Obama was unable to see that there were only two viable options to rid the US of the stain of Guantanamo: charging the prisoners (in federal court) or releasing them.

  4. Andy Worthington says...

    On Facebook, Doug Tarnopol wrote:

    Holy f*ck. Appalling.

  5. Andy Worthington says...

    Aleksandra Łojek-Magdziarz wrote:

    Shocking.

  6. Andy Worthington says...

    Doug Tarnopol wrote:

    Actually, none of us should be shocked. This is what gulags always lead to. Sigh. Good thing O is about to make it permanent, via executive order.

  7. Andy Worthington says...

    Sharon Askew wrote:

    Shimkus told Truthout he could not recall specific details of his discussions with the Cubans. Is that because Cuban doctors are aware of this drug and the dangers and would not have recommended using it? Maybe that is why Shimkus can not recall the discussions with the Cuban doctors.

  8. Andy Worthington says...

    Jason Leopold wrote:

    Andy, once again Jeff and I are very grateful for the kind words, your commentary and that you have taken the time to spread the word about this important story. Speaking for myself, I have been very disappointed by the fact that the medical community has remained silent following these revelations. We’ll have additional reports coming out in the weeks ahead.

  9. Andy Worthington says...

    Thanks for the comments, everyone.
    And Jason, that’s very kind of you, but it’s the least I can do to help you and Jeff promote your important work.
    Silence from the medical community is disappointing, as is silence from the American people as a whole.
    As the 9th anniversary of the opening of Guantanamo approaches, and 174 men are still held, it seems, sadly, that no one much cares about them anymore, or about the many gruesome things that have taken place there over the years.
    I hadn’t counted on quite such colossal indifference nine years on, and, to be honest, am struggling to envisage what new approach might stir people out of their torpor.

  10. Andy Worthington says...

    Frances Madeson wrote:

    Andy,
    I am writing to Tom Frieden, Director of the U.S. Center for Disease Control, to demand, oops, I mean request, that his office publically weigh in on this issue. Maybe others would enjoy doing the same. http://www.cdc.gov/about/leadership/leaders/Frieden.htm

    Here’s his e-mail address: ftdh@cdc.gov

    and snail mail:

    Centers for Disease Control and Prevention
    1600 Clifton Rd
    Atlanta, GA 30333

    Hells bells, while I’m at it, I think I’ll pop for another 44 cents and direct a letter to our Surgeon General as well. http://en.wikipedia.org/wiki/Regina_Benjamin

    Her address is:
    Office of the Surgeon General
    5600 Fishers Lane
    Room 18-66
    Rockville, MD 20857

    I hope they’ll respond before some official reads their silence as an okay to, I don’t know, spread small pox in woolen blankets to indigenous peoples (otherwise known as us). What am I saying? They’ve been there and done that.

  11. Andy Worthington says...

    Thanks, Frances. That’s excellent.

  12. Andy Worthington says...

    Jason Leopold wrote:

    Thank you, Frances. Jeff and I have been doggedly pursuing a comment from CDC for months. They refused.

  13. Andy Worthington says...

    Tashi Farmilo-Marouf Artist wrote:

    I wonder if the real purpose behind Guantanamo was to gain information (by whatever means necessary) and was never really intended as a ‘prison’ in the first place.

  14. Andy Worthington says...

    Well, yes, Tashi, that and experimentation end up being the most valid explanations for what Guantanamo was about when it was set up.

  15. Andy Worthington says...

    Jason Leopold wrote:

    One of the things that stands out in the Senate Armed Services Committee report on the treatment of prisoners there is how at least one senior military official referred to it as a “battle lab.” Wilkerson has already said the “vast majority” of prisoners were innocent. And we know prisoners were also interrogated

  16. Andy Worthington says...

    Yes, Jason: torture, human/medical experimentation and false confessions — the rationale for Guantanamo.
    And this is what Obama’s ended up treating as some kind of difficult detention legacy?! He’s missed the point big time.

  17. Andy Worthington says...

    Jason Leopold wrote:

    Did you get a chance to see his news conf today and his comments on Guantanamo? I’ll send you the transcript if you didn’t see it. I’d like to meet the people that actually buy his BS.

  18. Andy Worthington says...

    Please do send the transcript, Jason. I’m struggling to keep up. My son’s ill and I’m exhausted, but I need to do a proper analysis of what’s going on.

  19. Antimalarials as Torture: Damning Evidence from Guantanamo « Freewheel Burning says...

    [...] Allegations of medical experimentation at Guantanamo have persisted for years. The awful mix of torture and medicine raises specters of Josef Mengele and Unit 731. It blatantly violates the central tenet of the Hippocratic Oath that deliberately protects against needless treatment and promotes the welfare of patients. What’s worse, we paid for it. Countless Americans who don’t understand the necessity of due process, the Geneva convention and human rights lent their full support. [...]

  20. More Evidence of Medical Experimentation at Guantánamo « Dandelion Salad says...

    [...] Posted on December 22, 2010 by dandelionsalad by Andy Worthington Featured Writer Dandelion Salad http://www.andyworthington.co.uk 22 December, [...]

  21. “High-Value Detainee” Abu Zubaydah Blinded By Bush Administration - OpEd says...

    [...] has been admirably chronicled by Jason and the psychologist and blogger Jeff Kaye — see here and here), played a major part in the Bush administration’s “War on Terror,” and must, one day, be [...]

Leave a Reply

Back to the top

Back to home page

Andy Worthington

Investigative journalist, author, filmmaker, photographer and Guantanamo expert
Email Andy Worthington

The Guantánamo Files book cover

The Guantánamo Files

The Battle of the Beanfield book cover

The Battle of the Beanfield

Stonehenge: Celebration & Subversion book cover

Stonehenge: Celebration & Subversion

Outside The Law DVD cover

Outside the Law: Stories from Guantánamo

RSS

Posts & Comments

World Wide Web Consortium

XHTML & CSS

WordPress

Powered by WordPress

Designed by Josh King-Farlow

Please support Andy Worthington, independent journalist:

Archives

In Touch

Follow me on Facebook

Become a fan on Facebook

Subscribe to me on YouTubeSubscribe to me on YouTube

Andy's Flickr photos

Campaigns

Categories

Tag Cloud

Afghans Al-Qaeda Andy Worthington Bagram British prisoners CIA torture prisons Clive Stafford Smith Close Guantanamo David Cameron Guantanamo Habeas corpus Hunger strikes Lewisham London Military Commission NHS NHS privatisation Photos President Obama Reprieve Save Lewisham A&E Shaker Aamer Taliban Torture UK austerity UK protest US Congress US courts WikiLeaks Yemenis