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The Defense Department forced
all “war on terror” detainees at the Guantanamo Bay prison to take a
high dosage of a controversial antimalarial drug, mefloquine, an act that an
Army public health physician called “pharmacologic waterboarding.”



The US military administered the drug despite Pentagon knowledge that
mefloquine caused severe neuropsychiatric side effects, including suicidal
thoughts, hallucinations and anxiety. The drug was used on the prisoners
whether they had malaria or not.


The revelation, which has not
been previously reported, was buried in  documents
publicly released by the Defense Department (DoD) two years ago as part of the
government’s investigation into the June 2006 deaths of three Guantanamo
detainees.


Army Staff Sgt. Joe Hickman,
who was stationed at Guantanamo at the time of the suicides in 2006, and has
presented evidence that demonstrates the three detainees could not have died by
hanging themselves, noticed in the detainees’ medical files that they were
given mefloquine. Hickman has been investigating the circumstances behind the
detainees’ deaths for nearly four years.


Interviews with mefloquine and
malaria experts and a review of peer-reviewed journals and government documents
show there were no preexisting cases where mefloquine was ever prescribed for
mass presumptive treatment of malaria.


All detainees arriving at Guantanamo
in January 2002 were first given a treatment dosage of 1,250 mg of mefloquine,
before laboratory tests were conducted to determine if they actually had the
disease, according to a section of the DoD documents entitled “Standard Inprocessing Orders For Detainees.” The 1,250
mg dosage is what would be given if the detainees actually had malaria. That
dosage is five times higher than the prophylactic dose given to individauls to
prevent the disease.


Maj. Remington Nevin,
an Army public health physician, who formerly worked at the Armed Forces Health
Surveillance Center and has written extensively about mefloquine, said in an interview
the use of mefloquine “in this manner … is, at best, an egregious
malpractice.”


The government has exposed
detainees “to unacceptably high risks of potentially severe
neuropsychiatric side effects, including seizures, intense vertigo,
hallucinations, paranoid delusions, aggression, panic, anxiety, severe
insomnia, and thoughts of suicide,” said Nevin, who was not speaking in an
official capacity, but offering opinions as a board-certified, preventive
medicine physician. “These side effects could be as severe as those
intended through the application of ‘enhanced interrogation techniques.'”


Mefloquine is also known by
its brand name Lariam. It was researched by the US Army in the 1970s and
licensed by the Food and Drug Administration in 1989. Since its introduction,
it has been directly linked to serious
adverse effects
, including depression, anxiety, panic attacks, confusion,
hallucinations, bizarre dreams, nausea, vomiting, sores and homicidal and
suicidal thoughts. It belongs to a class of drugs known as quinolines, which
were part of a 1956 human experiment study to investigate “toxic cerebral
states,” as part of the CIA’s MKULTRA mind-control program.


The Army tapped the Walter
Reed Army Institute of Research (WRAIR) to develop mefloquine and it was later
licensed to the Swiss pharmaceutical company F. Hoffman-La Roche. The first
human trials of mefloquine were conducted in the mid-1970s on prisoners, who
were deliberately inoculated with malaria at Stateville Correctional prison
near Joliet, Illinois, the site of controversial antimalarial experimentation in the early 1940s.


The drug was administered to
Guantanamo detainees without regard for their medical or psychological history,
despite its considerable risk of exacerbating pre-existing conditions.
Mefloquine is also known to have serious side effects among individuals under
treatment for depression or other serious mental health disorders, which
numerous detainees were said to have been treated for, according to their attorneys and published reports.


Dr. G. Richard Olds, a
tropical disease specialist and the founding dean of the Medical School at the
University of California at Riverside, said, in
his “professional opinion there is no medical justification for giving a
massive dose of mefloquine to an asymptomatic individual.”


“I also do not see the
medical benefit of treating a person in Cuba with a prophylactic dose of
mefloquine,” Olds said. Mefloquine is “a fat soluble, and as a
result, it does build up in the body and has a very long half-life.This is
important since a massive dose of this drug is not easily corrected and the
‘side effects’ of the medication could last for weeks or months.”


In 2002, when the prison was
established and mefloquine first administered, there were dozens of suicide
attempts at Guantanamo. That same year, the DoD stopped reporting attempted
suicides.


By February 2002, there were
at least 459 detainees imprisoned at Guantanamo. In March of that year,
according to the book “Saving Grace at Guantanamo Bay: A Memoir of a Citizen Warrior
by Montgomery Granger, “the situation” at the prison began
“deteriorating rapidly.”


“There is more and more
psychosis becoming evident in detainees …,” wrote Granger, an Army
Reserve major and medic who was stationed at Guantanamo in 2002. “We
already have probably a dozen or so detainees who are psychiatric cases. The
number is growing.”


“Presumptively
Treating” Malaria


Though malaria is nonexistent
in Cuba, DoD spokeswoman Maj. Tanya Bradsher told Truthout that the US
government was concerned that the disease would be reintroduced into the
country as detainees were transferred to the prison facility in January 2002.


A “decision was
made,” Bradsher said in an email, 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.”


But Granger wrote in his book
that a Navy entomologist was present at Guantanamo in January and February 2002
and during that time only identified insects that were nuisances and did not
identify any insects that were carriers of a disease, such as malaria.


Nevertheless, Bradsher said
the “mefloquine dosage [given to detainees] was entirely for public health
purposes … and not for any other purpose” and “is completely
appropriate.”


“The risks and benefits
to the health of the detainees were central considerations,” she added.


A September 13, 2002, DoD memo
governing the operational use of mefloquine said, “Malaria is not a threat
in Guantanamo Bay.” Indeed, there have only been two to three reported cases of malaria at Guantanamo.


The DoD memo, signed by
Assistant Secretary of Defense for Health Affairs William Winkenwerder, was
sent to then-Rep. John McHugh, the Republican chairman of the House Veterans
Affairs Subcommittee on Military Personnel. McHugh is now Secretary of the
Army.


A Senate staff member told
Truthout the Senate Armed Services Committee was never briefed about malaria
concerns at Guantanamo nor was the committee made aware of “any issue
related to the use of mefloquine or any other anti-malarial drug” related
to “the treatment of detainees.” 


When questions were raised at
a February 19, 2002 meeting of the Armed Forces
Epidemiological Board (AFEB) about what measures the military was taking to
address malaria concerns at Guantanamo, Navy Capt. Alan J. Lund did not
disclose that mefloquine was being administered to detainees as a form of
presumptive treatment.


Yund said the military gave
detainees a different anti-malarial drug known as primaquine and noted that
“informed consent” was “absolutely practiced” prior to
administering drugs to detainees, an assertion that contradicts claims made by
numerous prisoners who said they were forced to take drugs even if they
protested. Yund did not return calls for comment.


Bradsher declined to respond
to a follow-up question about who made the decision to presumptively treat detainees
with mefloquine.


An April 16, 2002, meeting of
the Interagency Working Group for Antimalarial Chemotherapy, which DoD, along
with other federal government agencies, is a part of, was specifically
dedicated to investigating mefloquine’s use and the drug’s side effects. The
group concluded that study designs on mefloquine up to that point were flawed
or biased and criticized DoD medical policy for disregarding scientific fact
and basing itself more on “sensational or best marketed information.”


The Working Group called for
additional research, and warned, “other treatment regimes should be
carefully considered before mefloquine is used at the doses required for
treatment.”


Still, despite the red flags
that pointed to mefloquine as a high-risk drug, the DoD’s mefloquine program
proceeded.


In fact, a June 2004 set of
guidelines issued by the Centers for Disease Control and Prevention (CDC) says
mefloquine should only be used when other standard drugs were not available, as
it “is associated with a higher rate of severe neuropsychiatric reactions
when used at treatment doses.”


According to the CDC,
“‘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).”


A CDC spokesman refused to
comment about the “presumptive treatment” of malaria at Guantanamo
and referred questions to the DoD.


Nevin said, if “mass
presumptive treatment has been given consistently, many dozens of detainees,
possibly hundreds, would almost certainly have suffered such disabling adverse
events.”


“It appears that for
years, senior Defense health leaders have condoned the medically indefensible
practice of using high doses of mefloquine ostensibly for mass presumptive
treatment of malaria among detainees from the Middle East and Asia lacking any
evidence of disease,” Nevin said. “This is a use for which there is
no precedent in the medical literature and which is specifically discouraged
among refugees by malaria experts at the Centers for Disease Control.”


Even proponents of limited
mefloquine usage are seriously questioning the logic behind the DoD’s actions.
Professor James McCarthy, chair of the Infectious Diseases Division of the
Queensland Institute of Medicine in Australia, who is an advocate of the safe
use of mefloquine under proper safeguards, and takes it himself when traveling,
told Truthout he was unaware of the use of mefloquine for mass presumptive
treatment as described by the DoD, but could imagine it under certain
circumstances.


However, when informed that
lab tests were available and the detainees were screened for the blood product
G6PD, used to determine the suitability of certain antimalarial drugs, McCarthy
found the DoD’s use of mefloquine at Guantanamo difficult to understand and
“hard to support on pure clinical grounds as an antimalarial.”


Treatment, Torture or an
Experiment?


Another striking point about
the DoD’s decision to presumptively treat mostly Muslim detainees with
mefloquine beginning in 2002 is that it is the exact opposite of how the DoD
responded to malaria concerns among the Haitian refugees who were held at
Guantanamo a decade earlier.


Between 1991 and 1992, more
than 14,000 Haitian refugees were held in temporary camps set up at Guantanamo.
A large number of Haitian refugees – 235 during a four-month period – were diagnosed with malaria. But instead of presumptively
treating the refugee population at Guantanamo, the DoD conducted laboratory
tests first and only the individuals who were found to be malaria carriers were
administered
chloroquine
.


Another example of how the DoD
approached malaria treatment differently for other subjects is in the case of
Army Rangers who returned from malarial areas of Afghanistan between June and
September 2002 and were infected with the disease at an attack rate of 52.4
cases per 1,000 soldiers.



However, the Rangers did not receive mass presumptive treatment of mefloquine.
They were given other standard drugs after laboratory tests, according to
documents obtained by Truthout.


Nevin said the DoD’s treatment
of Haitian refugees represented “a situation that arguably presented a
much higher risk of disease and secondary transmission, but one which US
medical experts stated at the time could be safely managed through more
conservative and focused measures.”


Why did the government use the
“conservative and focused” approach in treating Haitian refugees and
the Army rangers, but then revert to presumptive mefloquine treatment in the
case of the Guantanamo detainees, who – a month after the prison facility
opened in January 2002 – were stripped of their protections under the Geneva
Conventions?


According to Sean Camoni, a
Seton Hall University law school research fellow, “there is no legitimate
medical purpose for treating malaria in this way” and the drug’s severe
side effects may actually have been the DoD’s intended impact in calling for the
drug’s usage.



Camoni and several other Seton Hall law school students have been working on a
report about mefloquine use on Guantanamo detainees. Their work was conducted
independently of Truthout’s investigation.


A copy of the Seton Hall
report, “Drug Abuse? An Exploration of the Government’s Use of
Mefloquine at Guantanamo,
” says mefloquine’s extreme side effects may
have violated a provision in the antitorture statute  related to the use of “mind
altering substances or other procedures” that “profoundly disrupts
the senses or the personality.”


Legal memos prepared in August
2002 by former DoD attorneys Jay Bybee and John Yoo for the CIA’s torture
program permitted the use of drugs for interrogations. The authority was also
contained in a legal memo Yoo prepared for the DoD less than a year later after
Secretary of Defense Donald Rumsfeld convened a working group to address “policy considerations with
respect to the choice of interrogation techniques.”


In September, Truthout reported that the DoD’s inspector general (IG)
conducted an investigation into allegations that detainees in custody of the US
military were drugged. The IG’s report, which remains classified, was completed
a year ago and was shared with the Senate Armed Services Committee.



Kathleen Long, a spokeswoman for the Armed Services Committee, told Truthout at
the time that the IG report did not substantiate allegations of drugging of
prisoners for the “purposes of interrogation.”


The medical files for detainee
693 released in 2008 shows that, two weeks after he first started taking
mefloquine in June 2002, he was interviewed by Guantanamo medical personnel and
reported he was suffering from nightmares, hallucinations, anxiety auditory and
visual hallucinations, anxiety, sleep loss and suicidal thoughts.


The detainee said he had
previously been treated for anxiety and had a family history of mental illness.
He was diagnosed with adjustment disorder, according to the DoD documents.
Guantanamo medical staff who interviewed the detainee did not state that he may
have been experiencing mefloquine-related side effects in an evaluation of his
condition.


Mark Denbeaux, the director of the Seton Hall Law Center
for Policy and Research, who conducted an independent investigation into the 2006
deaths of the three Guantanamo detainees, said in an interview “almost
every remaining question here would be solved if the [detainees’] full medical
records were released.”


The government has refused to
release Guantanamo detainees’ medical records, citing privacy concerns in some
cases, and assertions that they are “protected” or
“classified” in other instances. The few medical records that have
been released have been heavily redacted.


“A crucial issue is
dosage” Denbeaux said. “Giving detainees toxic doses of mefloquine
has mind-altering consequences that may be permanent. Without access to medical
records, which the government refuses to release, the use of mefloquine in this
manner appears to be grotesque malpractice at best, if not human experimentation
or ‘enhanced interrogation.’ The question is where are the doctors who approved
this practice and where are the medical records?”


Bradsher did not respond to
questions about whether the government kept data about the adverse effects
mefloquine had on detainees.


An absolute prohibition
against experiments on prisoners of war is contained in the Geneva Conventions,
but President George W. Bush stripped war on terror detainees of those
protections. Some of the “enhanced interrogation techniques” also had
an experimental quality.



At the same time detainees were given high doses of mefloquine, Deputy
Secretary of Defense Paul Wolfowitz issued a directive changing the rules on human subject protections
for DoD experiments, allowing for a waiver of informed consent when necessary
for developing a “medical product” for the armed services. Bush also
granted unprecedented authority to the secretary of Health and Human Services
to classify information as secret.


Briefings on Side Effects


As the DoD was administering
mefloquine to Guantanamo prisoners, senior Pentagon officials were being briefed about the drug’s dangerous side effects. During one
such briefing, questions arose about what steps the military was taking to
address malaria concerns among detainees sent to Guantanamo.


Internal
documents
from Roche, obtained by UPI in 2002, indicated that the
pharmaceutical company had been tracking suicidal reactions to Lariam going
back to the early 1990s.


In September 2002, Roche sent
a letter to physicians and pharmacists stating that the company changed its warning labels for
mefloquine.


Roche further said in one of
two new warning paragraphs that some of the symptoms associated with mefloquine
use included suicidal thoughts and suicide and also “may cause psychiatric
symptoms in a number of patients, ranging from anxiety, paranoia, and
depression to hallucination and psychotic behavior,” which “have been
reported to continue long after mefloquine has been stopped.”


Military Struggles


Cmdr. William Manofsky, who is
retired from the US Navy and currently on disability due to post-traumatic
stress disorder and side effects from mefloquine, said those are some of the
symptoms he initially suffered from after taking the drug for several months
beginning in November 2002 after he was deployed to the Middle East to work on
two Naval projects.


In March 2003, “I became
violently ill during a night live-fire exercise with the [Navy] SEALS,”
Manofsky said. “I felt like I was air sick. All the flashing lights from
the tracers and rockets … targeting device made me really sick. I threw up
for an hour straight before being medevac’d back to the Special Forces compound
where I had my first ever panic attack.”


For three years, he had to
walk with a cane due to a loss of equilibrium. Numerous other accounts like
Manofsky’s can be found on the web site lariaminfo.org.


In 2008, Dr. Nevin published a
study detailing a high prevalence of mental health contraindications to the
safe use of mefloquine in soldiers deployed to Afghanistan. Responding in part
to concerns raised by the mefloquine-associated suicide of Army Spc. Juan Torres, internal Army
presentations confirmed that the drug had been widely misprescribed to soldiers
with contraindications, including to many on antidepressants.


A formal policy memo in
February 2009 from Army Surgeon General Eric Schoomaker removed mefloquine as a
“first-line” agent, and changed the policy so that mefloquine would
not be prescribed to Army personnel unless they had contraindications to the
preferred drug, the antibiotic doxycycline. Nor could mefloquine be prescribed
to any personnel with a history of traumatic brain injury or mental illness.


By September 2009, the policy
was extended throughout the DoD.


New prisoners are no longer
arriving at Guantanamo and the prison population has been in decline in recent
years as detainees are released or transferred to other countries. Currently,
the detainee population at Guantanamo is a reported 174.


But Nevin said the
justification the Pentagon offered for using mefloquine to presumptively treat
detainees transferred to the prison beginning in 2002 “betrays a profound
ignorance of basic principals of tropical medicine and suggests extremely poor,
and arguably incompetent, medical oversight that demands further
investigation.”


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