A Guantanamo Connection? Documents Show CIA Stockpiled Antimalaria Drugs as "Incapacitating Agents"

Listen to my interview with Peter B. Collins discussing this story

A Truthout analysis of historical records concerning government research and nonmedical use of antimalarial medications has revealed that such drugs were the objects of experimental research under the CIA's MKULTRA program. Even more, one of these drugs, cinchonine, was illegally stockpiled by the CIA as an "incapacitating agent."

Antimalarial drugs were studied as part of the CIA's mind control program MKULTRA. Cinchonine, an antimalarial drug derived from chichona bark, was one of the drugs used by the operational components of MKULTRA, code-named MKNAOMI and MKDELTA. The CIA worked with researchers for the Army's Special Operations Division, a secret component of the US Army Chemical Corps based at Fort Detrick, to develop delivery systems for the drugs.

Revelations concerning CIA interest in use of antimalarial drugs would be of historical interest, as it has never been written about before. But such interest gains contemporary significance in the light of actions taken by the Department of Defense (DoD) in the "war on terror," and the fact that a key DoD expert on antimalarial drugs was a psychiatrist involved in training personnel for Guantanamo interrogations.

In January 2002, the DoD deliberately decided that all incoming detainees at Guantanamo would be given a full treatment dose of the controversial antimalarial drug mefloquine, also known as Lariam. The purpose was supposedly to control for a possible malaria outbreak, in deference to concerns from Cuban officials.

But specialists in malaria prevention have said they have never heard of such presumptive treatment for malaria by mefloquine in this type of situation. Furthermore, a summary of antimalarial measures at Guantanamo given to Army and Center for Disease Control (CDC) medical officials at a February 19, 2002, meeting of the Armed Forces Epidemiological Board failed to describe the mefloquine procedure approved a month earlier.

Was mefloquine used at Guantanamo to help produce a state of "learned helplessness" in detainees? Were experiments conducted on adverse side effects of mefloquine on the prisoners held there?
Some years ago, this might have been considered a crazy scenario to even consider. While there is no smoking gun that can prove mefloquine was used for nefarious purposes, a strong case can be made that use of the drug at Guantanamo was not related to malaria control.

Antimalaria Drugs and MKULTRA

The revelation concerning cinchonine came from hearings the Senate's Church Committee held in September 1975 on CIA "Unauthorized Storage of Toxic Agents." The agency's illegal stockpile of chemicals and drugs, which included the antimalarial drug cinchonine, was supposed to have been destroyed by order of President Nixon in December 1969.

At the time of the president's order, the US had also signed an international agreement that such chemical and biological weapons would be destroyed, so the revelation of the CIA's stockpiling of such substances was highly embarrassing to the US government at the time.

At the behest of Congressional investigators, the CIA provided an inventory of all "lethal" and "incapacitating agents" they had kept contrary to presidential order. On this list, the CIA indicated it held two grams of cinchonine, stored as an incapacitating agent, that is, a substance meant to temporarily disable an individual. Temporary incapacitant or not, the CIA inventory listing for cinchonine states, "Overdose leads to severe cardiac convulsions, nausea and vomiting."

In separate testimony from another Senate investigation, a CIA-linked researcher, Dr. Charles F. Geschickter, told Sen. Edward Kennedy in 1977 hearings that the CIA was interested in antimalarial drugs that "had some, shall I say, disturbing effects on the nervous system of the patients." Geschickter's CIA researchers became interested in these antimalarial drugs as part of the work they were doing in the CIA's MKULTRA program. Dr. Geschickter ran the Geschickter Fund for Medical Research, and the Kennedy hearings also revealed how the fund laundered money for MKULTRA projects.

According to MKULTRA documents released as part of a related Senate investigation in 1977, research into quinolines, the class of drugs that include cinchonine, quinine and the modern antimalarial drug mefloquine (Lariam), was part of MKULTRA subprojects 43 and 45.

The CIA prior to the Congressional investigations destroyed most records concerning MKULTRA and chemical, biological and bacteriological research. Moreover, according to Senate testimony by former CIA Director William Colby, many of the organizational directions concerning both research and operationalization of such weapons were never written down.

An Antimalarial "Incapacitant"

Cinchonine is a quinine-derived drug and similar in some ways to the artificial quinine derivative antimalarial drug mefloequine, also known as Lariam. Mefloquine, a product of Army research, has been the subject of numerous controversies over its side-effect profile, and as recently as 2009, the DoD significantly cut back on its use for the military.

The stockpiling of cinchonine as an "incapacitating" agent was directly contrary to Nixon's order that all such toxic and bacteriological stockpiles held by the DoD and the CIA be destroyed. Other incapacitating agents held by the CIA for years after the disposal order included the powerful hallucinogen BZ; the anticholinergic drug Cogentin; digitoxin; and Phencyclidine HCL, commonly known as "Angel Dust"; among other drugs.

The CIA's stockpile of dangerous substances also included numerous "lethal agents," including shellfish toxin; cobra venom; fish toxin; and numerous substances only known by their code names ("E-4640," "F-270" etc.). It is not known if any of the lethal or incapacitating agents were ever used, or if so, by whom or where. (The one exception the CIA admitted to was the use of an arsenic suicide pill provided to Francis Gary Powers, a U-2 pilot shot down over the Soviet Union in 1960. Powers did not use the pill.)

According to Senate testimony, the stockpile was discovered after a review of secret programs ordered by Colby. Originally, the various drugs and weaponized biological substances were kept at the Army's Fort Detrick compound and were apparently moved later to a CIA storage facility.

The neurological side-effects of mefloquine are similar to the side effects of cinchonine. Cinchonism (or quinism) includes such side-effects as blurred vision, tinnitus, skin rashes, vertigo, nausea, headaches and other even life-threatening serious health problems. Mefloquine has been cited for neurological, but also psychological side-effects, including depression, anxiety, panic attacks, confusion, hallucinations, bizarre dreams and suicidal and homicidal behavior. The effects can be long or short-term.

But even the "short-term" effects can be debilitating, as one military doctor, Captain Monica Parise, told a group of other physicians at a government meeting in May 2003. Parise told the meeting of the Armed Forces Epidemiological Board (AFEB) that "there are a host of other more acute less severe neuropsychiatric issues that occur short-term [with mefloquine], such as insomnia, strange dreams, fatigue, lack of energy, inability to concentrate and some people have reported that those effects have lasted a very long time."

Parise noted that it takes "three, four, or five months to really wash the drug out of your system," and that she'd "heard that there might be some data in DoD ... that might shed light" on how the drug had "ruined people's lives." As we shall see, a psychiatrist present at this same meeting was also involved in training other psychiatrists to assist Guantanamo interrogators.

Administering Mefloquine to All the Guantanamo Detainees

In December 2010, Truthout and Seton Hall School of Law's Center for Policy and Research revealed that it was medical standard operating procedure (SOP) to give all arriving detainees full treatment doses of the antimalarial drug mefloquine upon arrival at the US prison camp. The military's own newspaper, Stars and Stripes, followed up with their own story a few weeks later.

[Update, 6/9/2012: Both the Truthout and Seton Hall investigations also noted the CIA's MKULTRA research into the quinoline family of drugs. The Seton Hall report described how "potential use of these drugs in an interrogation setting was a stated purpose for the [CIA] study."]

A treatment dose of mefloquine is five times the amount taken weekly by those who use the drug for prophylactic purposes. Larger doses are associated with a higher percentage of side effects.

The Truthout investigation showed that at the time the SOP was put in place, internal discussions within the DoD and an Interagency Malaria Working Group were expressing strong doubts about the serious neuropsychiatric side effects of the drug. Despite this, the surgeon general of the JTF-160 Task Force at Guantanamo signed off on the unprecedented mefloquine protocol.

The chief surgeon, who also served as commander of the Navy Hospital at the base, was Capt. Albert Shimkus. Shimkus told Truthout in late 2010 that he had first sought consult regarding the use of malaria drugs from an assortment of agencies, including officials from the CDC, the Navy Environmental Health Center (NEHC) and the Armed Forces Medical Intelligence Center at Fort Detrick, Maryland. All three agencies have told Truthout they were not involved in this decision or had no documents related to such consultation.

Shimkus told Truthout in a phone interview last October that the US State Department "would have been involved" in discussions about malaria concerns at Guantanamo, though he maintained no State Department officials were directly involved in the "clinical decision making."

In June 2004, the CDC announced, "'presumptive treatment' without the benefit of laboratory confirmation should be reserved for extreme circumstances (strong clinical suspicion, severe disease, impossibility of obtaining prompt laboratory confirmation)." Hence, "presumptive treatment" - the mass administration of a drug without knowing whether or not it is actually necessary - is reserved for situations when there is no possibility of laboratory confirmation of malaria, but that was not the case at Guantanamo.

Yet, even a year later, the mefloquine SOP was renewed at Guantanamo.

DoD spokeswoman Maj. Tanya Bradsher told Truthout, "A decision was made to presumptively treat each arriving Guantanamo detainee for malaria to prevent the possibility of having mosquito-borne [sic] spread 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."

According to Bradsher, "The mefloquine dosage was entirely for public health purposes to prevent the introduction of malaria to the Guantanamo area and not for any other purpose." Nevertheless, when hundreds of contract workers from malaria-endemic countries such as India and the Philippines were brought by Halliburton subsidiary Kellogg Brown and Root (KBR) to build the new Guantanamo Delta Block in 2002, there was no DoD scrutiny of any exposure by these workers to malaria.

According to Bradsher, KBR alone was responsible for its own workers, belying a concern over possible reintroduction of malaria to Cuba, which, according to Captain Shimkus, had produced State Department concerns when it came to the arriving detainees.

In his October 2011 interview, Shimkus also said he sent "pretty detailed reports" regarding the mefloquine decision to JTF-160's Commanding Officer, Marine Corps Brig. Gen. Michael R. Lehnert. He had nothing further to say about a statement made to Truthout a year earlier in which he stated that he had been told not to talk about the mefloquine decision.

When Shimkus was asked if he was aware of any detainees who had suffered psychiatric problems because of drugs administered to them, he said, "Maybe. That's confidential," adding a moment later, "No for that."

He also rejected the opinions of two medical researchers who wrote in PLoS Medicine in April 2011 that "medical doctors and mental health personnel assigned to the DoD neglected and/or concealed medical evidence of intentional harm" to detainees. "They have an opinion and it should be out there," Shimkus said.

Army Mefloquine "Specialist" Trained Psychiatrists for Interrogations

A top psychiatrist working for the Office of the Assistant Secretary of Defense for Health Affairs (OASD-HA), Col. Elspeth Cameron Ritchie, traveled to Guantanamo in October 2002, purportedly to investigate a spurt of suicide attempts among the detainees. Within weeks, according to the AFEB minutes cited earlier, she attended an "experts" meeting on "Malaria Chemoprophylaxis" at the CDC in January 2003 that considered problems with the "neuropsychiatric adverse drug reactions" of mefloquine. Indeed, according to the AFEB speaker, Captain Parise, they specifically included a psychiatrist - presumably Ritchie - in their discussions.

Did Colonel Ritchie bring knowledge of the effects of mass mefloquine administration at Guantanamo to this meeting? We don't know and Colonel Ritchie, now retired from the military and chief clinical officer for the District of Columbia's Department of Mental Health, would not return a request for comment. A public spokesperson for OASD-HA told Truthout it had no connection with any decision to use mefloquine at Guantanamo.

It would be strange, if not highly unlikely that, given the widespread interest in mefloquine adverse reactions at the DoD and contemporaneous statements that the DoD was conducting research on this, that the effects of the Guantanamo mefloquine SOP were never examined.

Ritchie's involvement in mefloquine issues can also be ascertained by the fact that, in 2004, Ritchie, by then "Psychiatry Consultant" to Army Surgeon General Kevin Kiley, gave a presentation to the DoD's Deployment Health Clinical Center on the "Neuropsychiatric Side-Effects of Mefloquine."

Of convergent interest is the fact that, according to Dr. Ritchie, she taught psychiatrists slotted for assignment to the military's Behavioral Science Consultation Teams (BSCTs) working at Guantanamo and possibly elsewhere. She is, at this point, the only known person potentially linking military activities surrounding both mefloquine and interrogations or torture.

According to an Army surgeon general description of BSCT training during the period Colonel Ritchie was involved, such training included instruction in methods of inducing "learned helplessness."

"Learned helplessness" is a condition of near-total psychological breakdown produced by inability to escape an extreme set of stressors. Its study is associated with the work of psychologist Martin Seligman, who did research on the subject as far back as the 1960s. In the 1990s, all the Survival, Evasion, Resistance and Escape schools except the Navy school discontinued the use of the waterboard in their training program precisely because it tended to produce "learned helplessness" in its students, the opposite of the kind of effect they were seeking.

A Guantanamo Autopsy Tests for Mefloquine

The months-long period of time it takes for mefloquine to leave the system may have been involved with a decision to test a detainee at Guantanamo who had committed suicide for the presence of mefloquine in his bloodstream. But the detainee, whose autopsy report included toxicology results that show he was tested specially for mefloquine, had been at Guantanamo for five years at the time of his death.

Abdul Rahman Al Amri entered Guantanamo in February 2002 and would have been given a treatment dose of mefloquine at that time. We do not know why he would have been tested for its presence over five years later. All but one of the other detainees for whom we have autopsy reports due to purported suicides were not tested for mefloquine, showing such testing was not standard procedure.

Al Amri was also found dead with his hands bound behind his back, and his death as well as that of 2009 suicide Mohamed Salih Al Hanashi are under investigation by the UN Special Rapporteur for Extrajudicial Executions, primarily because of Truthout's coverage of these events.

A Plausible Hypothesis

The discovery that the CIA researched antimalarial drugs as part of its mind control program and, moreover, operationalized at least one of these drugs as an "incapacitating agent" means that the hypothesis that mefloquine was used for similar purposes at Guantanamo is not inconsistent with a known pattern of governmental behavior.

There are many reasons to question the supposed use of mefloquine at Guantanamo for purely public health purposes. Consider the following:

-- The mass use of treatment levels of mefloquine at Guantanamo was unprecedented.

-- The drug was limited to only one group of potential malaria carriers.

-- Use of mefloquine for presumptive treatment continued for years past the point when the DoD was already manifestly aware of the drug's dangers.

-- The mefloquine SOP was hidden from medical authorities at the Armed Forces Epidemiological Board.

-- Finally, there is the fact no government agency will admit to advising use of the drug, even when a Guantanamo medical officer states they were involved.

As a result of all the above, it appears highly possible that the motive for the drug's use was to psychologically disorient and physically debilitate all or some portion of incoming prisoners.

Copyright Truthout.org - Reprinted with permission (Original URL)

Former Guantanamo Psychiatrist Promotes Dubious Drug Theory on Afghan Killings

Originally posted at Truthout.org

A tag team of two contributors to Time Magazine's Battleland blog have misrepresented the facts concerning the possibility that Staff Sgt. Robert Bales may have been under the influence of the controversial antimalarial drug mefloquine (also known as Lariam) when he allegedly killed 17 men, women and children in two villages outside Kandahar last March.

Using false information; faulty interpretation of documents and innuendo; and in one case, withholding key disclosures regarding their background, these authors took a serious issue - the dangerous psychiatric and neurotoxic effects of mefloquine on some people and the history of the use of this drug by the military - and twisted it to further an agenda that just happened to match US interests in limiting speculation about the Kandahar massacre to Bales.

One of the two authors, Mark Benjamin, who years ago had written a number of articles on mefloquine's terrible side-effects, published his article on Bales and mefloquine at Huffington Post.

The other author, a former top Army psychiatrist, Elspeth Cameron Ritchie, has written three articles for Time's Battleland that have strongly suggested Bales' alleged crime was linked to mefloquine use. She recently also gave an interview on the topic to Nina Shapiro at Seattle Weekly.

Ritchie's background in certain aspects is not well known and certainly is surprising, given the mefloquine issue. Currently, she is chief clinical officer for the District of Columbia's Department of Mental Health. But back in 2002, she was Lieutenant Colonel Ritchie, program director for mental health policy for the assistant secretary of defense for health affairs and consultant on suicidal detainees at Guantanamo. Interestingly, this was at the same time all incoming detainees were forced to take large treatment doses of mefloquine, even as she likely had access to their medical records.

In addition, at an unspecified time between 2002 and 2007, she trained psychiatrists for Behavioral Science Consultation Teams (BSCT) that worked closely with Guantanamo interrogators. While the UN and numerous human rights groups have decried the use of health professionals in interrogations, Ritchie continues to defend the policy.

An "Emergency" Review of Mefloquine?

When it was first leaked that a single soldier, part of an Army Stryker Brigade, was in custody for the March 11 killings of up to 17 men, women and children in two villages near a counterinsurgency-inspired "Village Stability Platform" [VSP]), the horror of the massacre made it difficult to understand how the soldier - later identified as Staff Sgt. Robert Bales - could have done the killings.

Accordingly, a slew of news media reports focused on Bales' family life, his police record, his associates, the history of his duty postings and the possibility of his having post-traumatic stress disorder (PTSD), even while the Department of Defense (DoD) was quickly pulling off the Internet as many references to and pictures of Bales from military sources that it could. Meanwhile, reports were leaking out, including a major investigative piece by Australian SBS reporter Yalda Hakim, broadcast on March 28 atCNN, that a number of witnesses, including those in US custody, were saying there was more than one soldier present at the killings and perhaps as many as 20.

It is not surprising that some of the speculation surrounding the DoD's account of Bales as a lone shooter should focus upon what drugs he had been taking. One of the drugs discussed, mefloquine, is a controversial antimalarial drug known to have possible psychiatric and neurotoxic side effects. The first article proposing a Bales-mefloquine link appeared in the March 16 edition of Counterpunch.

But it wasn't until Benjamin's March 25 Huffington Post article that the mefloquine hypothesis took off in the press, leading to interviews for Benjamin at Democracy Now! and CNN. The reason for the heightened interest was Benjamin's contention that nine days after the killings, "a top-level Pentagon official ordered a widespread, emergency review" of how the drug was administered to troops. The implication was that a mefloquine-induced psychosis in Bales was possibly connected to the murders. [As described below, Benjamin's contention was later dropped, but the original version, including the quotes above, can be viewed at this linked web site.]

Yet, as a March 27 Truthout critique of Benjamin's article noted, there was no "widespread, emergency review" of mefloquine undertaken after the Kandahar killings, undermining the very premises of The Huffington Post piece. Benjamin had mistaken a March 20 "tasker" memo by a regional US medical command for the original order, which had been given by the assistant secretary of defense for health affairs (ASD-HA) back on January 17.

In his article, Benjamin quoted a March 20 Battleland post by Ritchie where she first raised the Bales-mefloquine link:

"'One obvious question to consider is whether he was on mefloquine (Lariam), an antimalarial medication,' Elspeth Cameron Ritchie wrote this week in TIME's "Battleland" blog, noting that the drug is still used in Afghanistan. "'This medication has been increasingly associated with neuropsychiatric side effects, including depression, psychosis and suicidal ideation.'"

In an email response to queries from Truthout, Benjamin would not comment upon any collaboration between himself and Ritchie. "My discussions with people who may or not be my sources will remain private."

Subsequently, Ritchie returned the favor to Benjamin, mentioning his Huffington Post article in an April 2 Battleland post. Ritchie asked "whether mefloquine or other toxic exposures - to licit or illicit drugs - might have been a contributing factor in the Afghan massacre."

Bales' attorney has picked up on the Benjamin-Ritchie mefloquine angle, telling CNN that he was interested in mefloquine as one of many possible drugs that might have affected his client's behavior.

Army Policy on Antimalarial Drugs

Bales was assigned to the Army's Third Stryker Brigade and, as such, his medical protocols fell under Central Command (CENTCOM) policy. According to CENTCOM rules, the antibiotic doxycycline, not mefloquine, is to be used for all malaria prophylaxis in Afghanistan, unless specifically medically contraindicated. This has been the case since, as Benjamin himself reported, the DoD in 2009 pulled back from use of Lariam except in special circumstances.

Moreover, according to CENTCOM orders, all departing soldiers are given "enough [antimalarial] medication for their deployment" when they leave the US. For soldiers deploying to Afghanistan, that medication has been overwhelmingly doxycycline, not mefloquine. There is no evidence that Bales was ever prescribed mefloquine, and while the Army's January review was prompted by known failures to prescribe the drug correctly, there is no evidence that this happened to Bales.

According to prescription figures provided to Truthout by DoD officials, mefloquine prescriptions have been declining for some time. In 2011, the Army gave out 169,690 scripts for doxycycline to 151,802 soldiers. (The DoD could not say if all of these were for malaria, or for other antibiotic use.) At the same time, only 1,780 soldiers (utilizing 1,921 scripts) were prescribed mefloquine, down approximately one-third from 2009 levels.

Bales' Stryker unit was part of I Corps stationed at Joint Base Lewis-McCord. In 2011, there were 6,566 scripts written for I Corps personnel and only 150 for mefloquine. On December 2, 2002, right around the time of Bales' actual deployment, the Army's policy changed again and mefloquine was downgraded from a second-line to a third-line malaria prophylactic drug. While none of the above proves Bales did or did not take mefloquine in Afghanistan, it makes the likelihood quite small.

[UPDATE 4/20 9:55 pm PST: The statistics for the number of DoD prescriptions of antimalarials were derived from the DOD Pharmaeconomic Center, which, as a DoD official explained to Truthout, "can pull data stateside because that reporting system exists." However, "this record of systems for visibility from Afghanistan (or Iraq) back to the states does not exist." Hence, there is no way to specifically say how many prescriptions of mefloquine (or any other antimalarial drug) was given inside Afghanistan. The official added, "within theater they certainly have visibility as to what is being dispensed and to who."

Yet, as explained in the article, as someone deployed from a stateside base to Afghanistan, Bales would have been prescribed enough antimalarial medication for his entire deployment before he left. Hence, assuming Bales correctly was prescribed doxycycline upon deployment, one would have to posit that Bales somehow lost his medication and then wrongly was prescribed mefloquine by some doctor in theater. There is no evidence or claim to date that this ever happened, though anecdotal reports have suggested that some events like this have occurred from time to time.]

Amplifying the problem with Benjamin and Ritchie's hypothesis concerning Bales and mefloquine is Ritchie's own contrasting history concerning mefloquine policy, some of it known and some of which can only be presumed or remain subject to speculation.

Ritchie, Guantanamo and Mefloquine

Ritchie had gone to Guantanamo, by her own account, four times. In October 2002, Ritchie indicated she first went to Guantanamo in order to "review all the suicidal gestures among the detainees." She said she "recommended many basic changes."

One can't say exactly how effective her recommendations were, in part because DoD figures concerning the number of suicide attempts and gestures by Guantanamo detainees has changed over the years and because the DoD labels some of the suicide gestures as attempts at "self-harm," but not suicide. But one damning report by BBC in 2005 noted that, in the year after Ritchie left, there were "350 incidents of self-harm, including 120 'hanging gestures."

In a 2003 New York Times article, a Guantanamo spokesman, Capt. Warren Neary, is quoted as saying that in the "18 months since the detention camp opened," there had been 28 suicide attempts by 18 individuals." "Most of those attempts" had been made in the first six months of 2003, that is, in the period just after, or even during, Ritchie's intervention on Guantanamo suicides.

As a physician, Ritchie likely reviewed the medical records for some or many of the detainees under her review. As previously reported at Truthout, the records would have shown that every detainee had been administered treatment doses of mefloquine upon arrival.

The treatment dose is a single 1,250 mg dose, versus the weekly 250 mg dose given for malaria prophylaxis, and what Bales would have taken (if he had taken mefloquine) upon arrival in Afghanistan.

Both treatment and prophylaxis dosages of mefloquine can cause serious side effects, according to medical reports. An April 16, 2002, meeting of the Interagency Working Group for Antimalarial Chemotherapy, which included DoD officials, the Working Group warned, "other treatment regimes should be carefully considered before mefloquine is used at the doses required for treatment." At this point, mefloquine had been given in treatment doses to all incoming detainees for three months and the policy would continue for years to come.

[UPDATE, May 19, 2012: The minutes of an Armed Forces Epidemiological Board Meeting on May 20, 2003 describes the presence of "Cameron Ritchie" at the IWG group meeting in January 2003. The speaker, Dr. Monica Parise, noted that the group specifically looked at the neuropsychiatric side effects of mefloquine. While the "serious reactions" were said to be "pretty rare," something along the order of "1 in 200 or so up to 1 in 10,000 of seizures or major psychiatric problems," she noted "there are a host of other more acute less severe neuropsychiatric issues that occur short-term, such as insomnia, strange dreams, fatigue, lack of energy, inability to concentrate, and some people have reported that those effects  have lasted a very long time."

Parise continued (bold emphasis added): "I've heard cases that this has just ruined people's lives. I don't if anybody  -- I had heard that there may be some data in DOD about how some of the studies that might shed light on that, but I've not seen anything in terms of effect on the brain. But I don't really think we have a good explanation of what that is. I mean, as I mentioned, at the meeting there was discussion -- and we did have a psychiatrist there -- of, well, are people susceptible, are they susceptible to these problems and this drug has brought that out?"

Presumably this psychiatrist was Dr. Ritchie.]

An Army physician who has published many journal articles on mefloquine called the mass presumptive treatment with mefloquine "pharmacological waterboarding."

Truthout's investigation determined that no US soldiers or contractors, even those brought from malarial-endemic regions by Halliburton subsidiary KBR, were administered presumptive doses of any anti-malaria drug, including mefloquine at Guantanamo.

Ritchie has never spoken out on the detainees' mefloquine dosing, which continued at least through 2005. She did not return a request for comment for this article.

Ritchie returned to Guantanamo in 2007 and/or 2008 to work in a forensic capacity on psychiatric evaluations of prisoners slated for trial by military commissions. In one high-profile evaluation, of Salim Hamden - whose case ultimately led to the Hamden v. Rumsfeld Supreme Court case in 2006, which threw out the first version of the military commissions as violations of the Uniform Code of Military Justice and the Geneva Conventions - Ritchie disagreed with the defense psychiatrist that Hamden, who had been tortured, suffered from PTSD and found him "manipulative."

In any case, Ritchie certainly would have looked at the medical records for the detainees she examined and could hardly have overlooked the presence of mefloquine. Given Ritchie's interest in suicide and her history of consulting on suicides at Guantanamo, one wonders if she were aware of the toxicology results for reported 2007 Guantanamo "suicide" Abdul Rahman Al Amri, which made special note of looking for mefloquine in his blood.

As reported by Truthout, the UN Special Rapporteur on extrajudicial, summary or arbitrary executions is looking into the Al Amri case, as well as that of 2009 reported suicide, Mohammad Al Hanashi.

Ritchie and the BSCTs

It is not known if Ritchie did more at Guantanamo, however, in an October 2008 article at Psychiatric News examining ongoing controversies over the use of psychiatrists in military interrogations at Guantanamo and elsewhere, Ritchie revealed she had taken a leading role in bringing psychiatrists onto the BSCTs. "The Army requires psychiatrists to complete a 136-hour course before taking part in interrogations," the article said. "Ritchie has taught parts of that program and said that four psychiatrists have attended it so far."

Ritchie may have taught the BSCTs when she worked in the Office of the Army Surgeon General (OASG) under Maj. Gen. Kevin Kiley. In 2006, a controversy arose when it was discovered that Kiley's office had continued to recommend the use of psychiatrists in interrogations, despite a policy statement from the American Psychiatric Association against use of doctors or psychiatrists in interrogations.

An October 20, 2006 OASG/MEDCOM policy memo issued by Kiley discussed BSCT training, including instruction in the "application" of "learned helplessness" "to the interrogation/debriefing processes."

"Learned helplessness" is a psychological syndrome so named by psychologist Martin Seligman, who was invited by the CIA to lecture on the topic at a Navy Survival, Evasion, Resistance and Escape school in May 2002. Both James Mitchell and Bruce Jessen have said they relied on the theory in their construction of a torture program for the CIA that same year.

An important 2007 article by Dr. Steven Miles in the American Journal of Bioethics looked closely at the experience of psychiatrists and psychologists working for the BSCT at Guantanamo. The article focused on the interrogation of Mohammad Al Qahtani in late 2002, an interrogation the Guantanamo military commissions convening authority admitted amounted to torture.

"Clinicians were integral to this abusive interrogation," Miles wrote.

In the 2008 Psychiatric News article, Ritchie defended the use of psychiatrists in interrogations, claiming, "Psychologists and psychiatrists are experts at enhancing rapport.... They also can counteract behavioral drift, the spiraling down of interrogation into a culture of coercion." Ritchie also defended the BSCT policy in an interview with NPR in September 2008. NPR said Ritchie contended "at the beginning of the war on terror, there was misunderstanding of 'what the rules were' for interrogations." Ritchie added, ""We don't try to defend (that)."

Ritchie has not changed her beliefs in these regards over the years. In the 2012 book "Women in Psychiatry: Personal Perspectives," Ritchie wrote, "Although controversial in the American Psychiatric Association and the media, I continue to believe that psychologists and forensic psychiatrists can contribute in a very positive way to legal, safe and effective interrogation."

A Mefloquine "Expert"

In January 2003, not long after she first went to Guantanamo, Ritchie, then working in the office of the assistant secretary of defense for health affairs, attended an "Experts Meeting" on malaria chemoprophylaxis organized by the Department of Health and Human Services and the Centers for Disease Control (CDC). A year later, in 2004, Ritchie, now "Psychiatry Consultant to the Army Surgeon General," gave a presentation to the DoD's Deployment Health Clinical Center on the "Neuropsychiatric Side-Effects of Mefloquine."

No published work by Ritchie could be found that referenced mefloquine or anti-malaria treatment or medication. Ritchie mentioned, as if in passing, her 2004 presentation in an April 4 article at Battleland two days after this author informed an anti-Lariam activist of its existence. In a very brief posting, Ritchie wrote, "There is a lot more in the literature since a 2004 talk I gave on the neuropsychiatric effects of the medication. There followed a flood of anecdotal information and articles in the media, but rigorous scientific literature was limited."

In fact, there were dozens, if not hundreds of studies and articles on mefloquine prior to her 2004 talk. Indeed, a 2004 review article on antimalarial drug toxicity in the journal Drug Safety listed dozens of peer-reviewed articles on mefloquine, its efficacy as a drug and its potential side effects. In the same year, the CDC issued guidelines indicating mefloquine should only be used when other standard drugs were not available, as it "associated with a higher rate of severe neuropsychiatric reactions when used at treatment doses."

In her April 4 article, Ritchie coyly did not indicate what the substance of her 2004 presentation was, nor what data she drew upon. For full disclosure sake, she should release her paper or notes pertaining to that presentation.

Why Push a Bales-Mefloquine Link?

Both Benjamin and Ritchie appear to have had an agenda: to make it appear far more probable than any facts would admit that Bales could have gone psychotic on mefloquine.

None of their articles ever considers that Bales may not have acted alone, or that indeed, is not proven to have killed anyone in those hamlets where 17 died. Most of all, their stories ignore problems with the DoD's narrative of events, with charges by Bales' attorney that the DoD has hidden evidence from his defense team, or, as this USA Today article notes, "blocked them from interviewing survivors and are withholding evidence of the March 11 attacks ..."

Key evidence that eyewitnesses to the attacks saw helicopters, men with walkie-talkies and upwards of 15 soldiers, as evidenced by this CNN interview and this Global Post article, is never mentioned by Ritchie or Benjamin.

Lacking such balanced reporting, it would seem the anti-torture journalist Benjamin and the former trainer for Guantanamo interrogation consultants have joined up to help promote the mainstream narrative of Bales as a single and possibly deranged killer. Together, they were quite successful in spreading the idea that Bales might have gone crazy from mefloquine.

Deranged Bales may have been, but whether his actions, if proven, were taken alone or as part of a larger US military or Special Forces operation that dark March night are matters for full investigation.

Why the Huffington Post Needs to Immediately Retract Mark Benjamin's Afghanistan Massacre Report

Originally published at Truthout
This article reflects an updates included in the original Truthout article

A March 25 article by Mark Benjamin at The Huffington Post seriously misled readers about a link between the controversial antimalarial drug mefloquine and the mass murder in Afghanistan attributed to Staff Sgt. Robert Bales. Relying on a document he wrongly identified, and with zero evidence backing up his claims, Benjamin's headline stated "Military Scrambles to Limit Malaria Drug Just After Afghan Massacre." As a matter of journalistic ethics, Benjamin should apologize to his readers and retract the story.

The article begins with a dishonestly crafted lede that links the Afghan massacre with a "task order" memo from a Department of Defense (DoD) command regarding a review of mefloquine procedures, and goes on to suggest that Sgt. Robert Bales, a victim of traumatic brain injury, may have gone psychotic from use of mefloquine and possibly committed the killings under influence of the drug. Furthermore, the article strongly implied that DoD possibly knew this and then implemented an "emergency review" of mefloquine procedures nine days after the Afghan killings.

UPDATE: Instead of issuing the retraction I called for, Mark Benjamin, in yet another deceptive move aimed at misleading his readers, quietly rewrote his Huffington Post story hours after this report was published Wednesday morning without informing those readers that he made substantial changes to his original report. Nor did Benjamin point out to his readers that he quietly rewrote his story and changed the headline nearly four hours after we exposed the errors contained in his original report. Notably, the lede to Benjamin's story, which formed the basis for the entirety of his claims that a Defense Department review revolving around the administration of mefloquine for US troops was ordered after the Afghanistan massacre, no longer makes that argument because, as this report notes, the initial review was ordered before Sgt. Robert Bales allegedly murdered 16 people. Readers who now visit the Huffington Post link where Benjamin's story was originally published will be find a very different story. But this is how his report originally appeared when it was published Monday. I encourage you to compare the two. My report was published, as the time stamp below my byline shows, at 10:44 am. The rewrite to Benjamin's story was posted at 2:35 pm.

But nothing in the record suggests this is true. The word "emergency" is never used [UPDATE: Benjamin changed "emergency" in his original report to "urgent" after I pointed out the word was never used.] in the one document Benjamin cites, and an actual examination of the full documentary record shows that the mefloquine review described in the article was actually ordered last January.

Despite these serious flaws, Benjamin's article caused a sensation in the press, being picked up by many news outlets, including interviews with Benjamin on the topic at both CNN and Democracy Now!.

But in an email to Truthout, a DoD official strongly refuted Benjamin's claims, explaining that the task order referenced by the Huffington Post author originated in a January 17, 2012, memo from Assistant Secretary of Defense for Health Affairs Dr. Jonathan Woodson. Despite Benjamin's reporting, the review order was not issued nine days after the Afghanistan murders, nor was it limited to Afghanistan, but involved five different regional commands.

The official explained that the delay in implementing the review in the Afghan theatre was due to the absence of a key individual. The urgency in the March 20 task order (sometimes called a "tasker") referenced by Benjamin was due to a deadline for the conclusion of the review set back in January.
The official told Truthout:

Army Medical Command did receive the ASD [Assistant Secretary of Defense] Health Affairs tasking memo in mid-January, but due to the absence of the tasking individual on a temporary duty assignment for several weeks, the request to review the Army's program was not staffed and pushed out to the five regional medical commands until March 5th with a suspense date of March 15th. The Regions expressed that this was not enough time so they were given until March 20th to reply. This still put us well within the 90-day window provided by the original tasker in January. This review has no relation whatsoever to the incident in Afghanistan, as borne out by the dates when the tasker was initiated by ASD-Health Affairs in mid-January and later by the Army Medical Command to its subordinate regions on March 5th.

The official noted other problems with the Benjamin story. The link to what Benjamin called the "task order from Woodson, obtained by the Huffington Post," was actually to "a tasking document from one of the Army Medical Command regions - specifically the Southern Regional Medical Command, annotated in the incorrectly identified memo as 'SRMC'."

It appears Benjamin relied upon an implementing order by a lower command, but even with an update to his story a day later, the Huffington Post journalist insisted on linking this document to the Afghanistan killings. In his update [UPDATE: the "update" Benjamin posted was changed to a "correction" in the rewritten version of his story], Benjamin incomprehensibly kept pushing the March 20 order, which he claimed "shows that one part of the Army issued a new, urgent call to complete the Jan. 17 request from Woodson within six days." But Benjamin must know this is false, and there was nothing "new" about the order.

Truthout has obtained the original January 17 memo, which can be downloaded here. Woodson expressed concern that, "[s]ome deploying Service members have been provided mefloquine for malaria prophylaxis without appropriate documentation in their medical records and without proper screening for contraindications."

Some five months earlier, Sen. Dianne Feinstein (D-California) had issued a press release expressing her concern that mefloquine had been administered to military personnel without the safeguards put in place by a 2009 DoD protocol. Moreover, according to her press release, "These service members are now suffering from ... preventable neurological side effects."

While Benjamin never makes the point directly, if his mefloquine hypothesis about Bales and the killings were true, it would be the first mass murder attributable to mefloquine ever recorded in the roughly four decades of its use.
Yet, Benjamin admitted in his story that there is no evidence Bales ever took mefloquine, noting that DoD will neither confirm nor deny it. Even more, there is no evidence that if he did, he suffered ill effects, much less a reaction that led to the killings of 17 men, women and children on the night of March 13.

Benjamin states that military officials cited "privacy rules" as the reason they could not say whether Bales took mefloquine or not. But Benjamin appears dubious about this, and in his March 26 update to his story, continues to complain, "The Pentagon still will not say if Bales was wrongly given mefloquine."

In fact, the Federal 1996 Health Insurance Portability and Accountability Act, also known as HIPAA, forbids the release of medical information, including by the military, "except for specifically permitted purposes" (see DoD 6025.18-R, paragraph C1.2.1). Such purposes can include criminal investigations, but not releases to the press.

To be fair, Democracy Now! has also emphasized the nondisclosure of Bales' medical information in its story on the possible Bales-mefloquine link, and also never mentions federal law prohibiting such disclosure.

No Mention of Eyewitnesses

Benjamin's article, like a similar piece on Time Magazine's Battleland blog, which Benjamin cites, never mentions that there were eyewitnesses to the Afghan killings who have provided a very different story as to what happened in the March 11 pre-dawn hours of the massacre. The Battleland article was written by Elspeth Cameron Ritchie, a former Army psychiatrist at Guantanamo.

One eyewitness report in the Global Post quoted Massouma, a woman who lives in the village of Najiban, where 12 people were killed, as saying at the time of the killings that there were helicopters flying overhead. She said the uniformed soldier that entered her home was speaking into a walkie-talkie.
According to the report, the soldier, "had a radio antenna on his shoulder. He had a walkie-talkie himself, and he was speaking into it," Massouma said.

"After the soldier with the walkie-talkie killed her husband, she said he lingered in the doorway of her home," the report continued. "'While he stood there, I secretly looked through the curtains and saw at least 20 Americans, with heavy weapons, searching all the rooms in our compound, as well as my bathroom,' she said."

In another example of eyewitness evidence, Jefferson Morley at Salon pointed out a March 17 Afghanistan Outlook report describing an Afghan Parliamentary investigation, which spent two days "interviewing the bereaved families, tribal elders, survivors and collecting evidences at the site in Panjwai district." The investigation found, "there were 15 to 20 American soldiers, who executed the brutal killings."

The Global Post article also reported that the International Security Assistance Force (ISAF) turned away reporters who came to interview survivors of the shootings at a hospital at Kandahar Airfield. "'The wounded survivors, who saw everything of the massacre, are crucial to the story,' said one of the frustrated reporters. 'But the Americans didn't allow us to talk to them.'"

While there have been conflicting accounts of the massacre, Benjamin's article followed the DoD claims that Sgt. Bales was the sole soldier involved, then sought reasons to explain the actions of the supposed lone killer. The reader was never informed there may be other evidence that would make the mefloquine narrative superfluous.

Bales was charged with the murders on March 23.

Mefloquine Controversies

Benjamin, with reporter Dan Olmstead, covered the controversy over the use of the antimalarial drug mefloquine in the military. The reporters wrote story after story exposing the slowness, ineptitude and possibly corruption that allowed a dangerous drug to be continuously prescribed to armed forces personnel. So, it may be understandable that Benjamin still harbors passion for the topic. Additionally, Benjamin was correct when he told Amy Goodman at Democracy Now! that the recent DoD review shows that DoD, "seems to be violating its own rules."

Yet, curiously, he has remained silent, including in his most recent article, on investigations that revealed an unprecedented mass dosing of Guantanamo detainees. The supposed presumptive treatment for malaria of all incoming Guantanamo detainees was standard operating procedure, as documents revealed. One medical expert described the use of the drug, which was administered at doses five times that typically administered prophylactically to US soldiers serving in malarial regions, as "pharmacological waterboarding."

[Full disclosure: this author, along with Jason Leopold, conducted these investigations, which were published at Truthout. Seton Hall School of Law's Center for Policy and Research conducted their own investigation and released a report, while the story was later reported as well by the military's own paper, Stars and Stripes.]

Benjamin and "Tall Tale" Journalism 

One of the strangest aspects of Benjamin's article is that it comes not long after Benjamin himself strongly criticized an article by Scott Horton at Harper's Magazine. The article, which won the National Magazine Award for Reporting last year, revealed evidence of a cover-up in the 2006 deaths of three detainees at Guantanamo - deaths the military attributed to suicide.

Benjamin chided Horton for relying on witnesses "who did not witness much," and relying on "alleged inconsistencies and weaknesses in the government's investigation to buttress his narrative that something fishy was going on." He referred readers to another article by his former Salon.com collaborator, Alex Koppelman, who wrote a scathing critique of Horton's article for Adweek. Koppelman called Horton's investigation "a tall tale," and chided Horton for, "less methodical reporting and more conspiracy building, favoring the evidence that supports the conspiracy view and minimizing the evidence that does not."

Koppelman's own criticisms were debunked by this author in an article at Firedoglake last June. But Koppelman's verdict on Horton is an apt judgment upon Benjamin's own recent mefloquine article, which misrepresented government documents, minimized or buried evidence that would refute his claims, and implied a conspiracy and coverup without a shred of evidence that would support his view.

Even sadder, neither editors at Huffington Post, nor major media outlets like CNN, Democracy Now! or others ever fact-checked or even questioned Benjamin's assertions, which were patently untrue. To date, no media outlet that carried Benjamin's story has issued any retraction or substantive correction.