Sunday, June 24, 2012

Are Politics Why IMAP Won't Publish Until 2013 Their Report on Doctors and Torture?

In 2010, the Institute on Medicine as a Profession (IMAP), along with the Soros-financed Open Society Institute (OSI) convened a Task Force on Preserving Medical Professionalism in National Security Detention Centers. On June 1, 2012, I received an email notification that the TF report "is now complete." But much to my surprise, the report was not due for release, however, until "early 2013."

Entitled "Doing Harm: Physician Participation in Interrogation and Torture, it is the result of two years of analysis by the Task Force, which was comprised of human rights, legal and medical experts," the email said. "They analyzed the role that health professionals played in the torture and interrogation of detainees at Abu Ghraib and Guantanamo. This topic has never been investigated in such depth and contains original research, analysis and policy recommendations."

IMAP has published a brief excerpt from the introduction to the report at their website. Here it is in toto:
“Everyone concerned with the integrity of medical professionalism and respect for human rights considers the participation of physicians in the interrogation and torture of military prisoners to be an egregious and alarming violation of the precepts of medical ethics and international conventions. Medical oaths and international declarations unambiguously prohibit and condemn such behavior. Nevertheless, in the aftermath of 9/11, these violations occurred at the detention camps in Abu Ghraib and Guantanamo. How did physicians and other health professionals come to participate in these activities? Why were accepted principles and codes ignored? What we can we learn from these events to prevent future occurrences? These are the central questions this report addresses—and although their significance is self-evident, they are by no means simple to answer.”
The Task Force Includes a Guantanamo Official

Initially, the task force membership was not public, but at the insistence of Jason Leopold and myself, IMAP published the list of members on their website. It's a formidable listing of experts in medical abuse and torture and medical ethics. It includes anti-torture candidate for presidency of the American Psychological Assocation, Steven Reisner; physicians Vincent Iacopino and Brig. Gen. (ret.) Stephen Xenakis, who wrote a PLoS research article last year concluding that military medical personnel at Guantanamo "neglected and/or concealed medical evidence of intentional harm" of detainees; Physicians for Human Rights Chairman of the Board Robert Lawrence; former American Psychiatric Association president Steven Sharfstein; ethicist George Annas; Deborah Popowski from Harvard's International Human Rights Clinic, and a number of others.

Interestingly, the IMAP TF included a former Guantanamo medical official, Captain (ret.) Albert Shimkus, Jr., who had been Chief Surgeon for JTF-160 at Guantanamo until mid-2003, and commanding officer at the Naval Base Hospital during the same period. Shimkus was not a doctor, but a nurse practitioner. Currently he teaches National Security Affairs at the U.S. Navy War College.

Of much importance to me, and presumably my readers, he was the official who signed off on the medical SOP that dosed every detainee entering Guantanamo with treatment-level doses of the anti-malaria drug mefloquine (also known as Lariam).

The unprecedented use of the drug, whose controversial history of side effects was already a subject of debate and research within the Department of Defense and CDC, was criticized by some public health experts. It was also the subject of an investigation by the Seton Hall Law Center for Policy and Research, published the same time as Jason Leopold and I issued the first of our Guantanamo mefloquine reports. The bulk of the public health field, however, stayed quiet on the subject; none came out in support of the measure, however.

More recently, government documents show that anti-malaria drugs were once used by the CIA as chemical "incapacitants." It remains an open question whether mefloquine was used in such a fashion on the Guantanamo prisoners, but the fact that two suicides at the facility were tested specially for the presence of meflqoquine at autopsy years after the administration of mefloquine raises questions about use of the drug on these detainees, and in general on all the prisoners.

The TF members I spoke to were nonplussed by the presence of Shimkus on the panel. None of the TF members had reacted strongly to the mefloquine revelations, although two members, Iacopino and Dr. Scott Allen, did say "the questionable use of mefloquine for malaria prevention at Guantanamo underscores the need for transparency of detention policies and procedures” at the prison facility. At the time they gave this quote to Leopold and myself, we were unaware that they were on the IMAP TF panel with Shimkus, and they did not reveal that to us.

Another TF panel member told me that by April 2011, the TF had only met twice. Shimkus was present at both meetings, and seemed "regretful and decent."

Captain Shimkus has always been responsive to my queries to him about the Guantanamo-mefloquine story, although responsive doesn't mean fully open. He explained there were things that were classified and he was unable to talk about, or was told specifically not to talk about. In addition, he never seemed "regretful" about anything he did or policies undertaken from a medical standpoint at Guantanamo. He disagreed with the conclusions of Drs. Iacopino and Xenakis about medical neglect and/or cover-up at Guantanamo, and he maintained, in more than one interview, that he consulted on the mefloquine SOP and it was undertaken for public health reasons and was nothing more than that.

The Politics of Delay

According to IMAP's tax return covering 2009, IMAP spent over $70,000 on a project looking at "Medical Professionalism and Dual Loyalty," a task force of military/department of defense experts; legal and human rights experts, and medical experts; to develop institutional mechanisms for preventing involvement of health professionals in interrogation and detainee abuse." This certainly seems a noble undertaking.

By 2010, according to IMAP tax records, it would seem this project metamorphosed into the Task Force on Preserving Medical Professionalism in National Security Detention Centers, with expenses over $92,000. And now the TF has completed its work, but the report won't be published until 2013. On June 12 I wrote to IMAP Chief Operating Officer, Michael Pardy, and asked him why the big delay.

Pardy wrote back the next day, explaining, "The publication date is tentative. We are moving it along as quickly as possible."

I felt that was still too vague for reporting purposed, so I wrote back:
OK, but for the purposes of an article I'm writing, the announced tentative publication date is still early 2013, is that correct? I really don't understand if the report is "done," that the publication could take so long. Either you are much more poorly funded than I thought (and I don't believe that is the case), or it appears to me the publication is being held back until after the election for political purposes.

Also, I was wondering if you could say if the report intends to cover at all the issue of the Behavioral Science Consultation Teams [BSCT] run by the Department of Defense?
I have yet to get a reply. Other task force members I asked about the delay in publishing, or the BSCT issue either didn't know, or did not answer my query. One person did say that the medical-ethical controversies over use of doctors and the force-feeding of detainees would be addressed in the report.

There is nothing in the delay in publishing that is nefarious, necessarily. And who really cares, in the end, what IMAP publishes or not, as the details are meant for medical journals and the medical or public policy elite, and not read by the general public?

But the question of medical ethics in the context of the US military's "war on terror" and DoD and CIA history in relation to torture and interrogation, including use of doctors and psychologists in the interrogation of detainees, in the monitoring of torture, and the construction of individualized torture protocols, is of high relevance and interest to the public at large.

I suspect, as I mentioned in the email to Pardy, the delay is due to the elections, with the intent to bury the problematic torture issue since it embarrasses the administration before its more liberal or human rights supporters. The embarrassment stems from President Obama's policy of non-accountability for the Bush-era torture program. His administration does not support the "looking back" at these issues that would bring about prosecutions, more investigations, or other forms of accountability. And the administration's supporters and backers pretty closely toe the party line on such things.

But it is sickening to think that human beings suffer in isolation and under indefinite detention, endure brutal ERF beatings, not to mention ongoing interrogations under the Army Field Manual's Appendix M protocols, in part because it would be politically inopportune to highlight their abuse before November 2012. In essence, the issue of detainee abuse is subordinated to the exigencies of American electoral politics.

Appendix M, by the way, includes, besides isolation, use of sleep deprivation and forms of sensory deprivation, which the manual advocates using in combination with the techniques that induce "debility" in prisoners (for instance, dietary manipulation), as well as use of techniques that produce emotional abuse ("Ego Down") and fear-generating treatment or manipulation of phobias, all with the intention of breaking-down the detainee... for what? Guantanamo is a "strategic interrogation center," according to government sources, and the interrogations there are not about operationally imminent intelligence, e.g. the so-called ticking bomb.

The answer is: for production of intelligence agents for use by the government, as well as the production of more false confessions, and cooperation with show trials, just as, for instance, Stalin used such torture when similar forms of prisoner abuse and interrogation was used by the NKVD once upon a time. It is possible as well that certain forms of experiments are conducted on these prisoners under the auspices of field trials of various instruments, procedures, or detention policies.

IMAP should heed its supposed call for change in the area of medical ethics and quickly publish their findings for the public. At the very least, an Executive Summary of the report could be published online. There is no excuse not to do this.

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