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.

Unreported Detainee Deaths at Guantanamo in Jan-Feb 2002?

Originally posted at Firedoglake/MyFDL

According to the transcript (PDF) of a February 19, 2002 meeting of the Armed Forces Epidemiological Board (AFEB), "[a] number of the detainees have died of the wounds that they arrived with" at Guantanamo. This statement came from Captain Alan "Jeff" Yund, a preventive medicine doctor and the Navy's liaison officer to the AFEB, as he discussed "mortuary affairs" at Guantanamo, part of a larger discussion on health issues at the new prison facility. [Update: See here for a transcript of the AFEB meeting, as the older link apparently is dead.]

During the meeting, Captain Yund identified himself as working directly with Admiral Steven Hart, the Director of Navy Medicine Research and Development, as well as "a number of other admirals."

Yund's full quote is as follows, on pg. 108 of the transcript (bold added):

Mortuary affairs is an important but hopefully small aspect of the activities of the [Guantanamo] hospital. A number of the detainees have died of the wounds that they arrived with. So there's attention being paid to doing the things with the body that would be appropriate for their culture.

In a December 7 email interview with Captain Yund, who is now retired, Yund stated he does "not recall that I was ever very directly involved in detainee health issues" at Guantanamo. Accordingly, he said the following in regards to his statement about detainee deaths:

"I did not make that statement from personal or direct knowledge. It may have come from CAPT Shimkus’ presentation, or possibly from conversations or meetings with other Navy Preventive Medicine personnel colleagues. It is not the type of statement I would have made without having learned it from a source I considered reliable."

The reference to "CAPT Shimkus" is to Captain Albert J. Shimkus, commanding officer of the U.S. Naval Hospital at Guantanamo at the time, and JTF 160 chief surgeon. Captain Lund explained that he remembered hearing a "a detailed and fascinating account" of "events and issues" at Guantanamo, though he couldn't remember the date or place. This is the "presentation" to which Captain Yund refers in his explanation above.

In a telephone interview on December 13 with Captain Shimkus, who now is an Associate Professor in National Security Decision Making at the U.S. Naval War College, Shimkus expressed shock over the claims there were any deaths at Guantanamo while he was there. (Captain Shimkus left Guantanamo in August 2003.) He said that "no deaths occurred" while he was there, but that he did speak at the time of the task force preparing for possible deaths. He could not offer any explanation for what Captain Yund reported.

In the AFEB transcript itself, there is no surprise or other comment or correction made on on Yund's announcement concerning detainee deaths. The meeting was also attended by other military medical staff, civilian medical advisers, and upper-levels of the DoD bureaucracy, including Admiral Hart, and Assistant Secretary of Defense for Force Health Protection and Readiness, Dr. William Winkenwerder, and his deputy, Ellen Embrey. The meeting, held at the Island Club, North Island Naval Air Station, San Diego, was chaired by Dr. Steven Ostroff from the Centers for Disease Control.

By all accounts, in the initial days of prisoner transfer to Guantanamo, a number of detainees arrived with serious battle wounds. Notes from a doctor working at the facility, dated February 22, 2002, which I reviewed, discuss the previous day's cardio-thoracic and neurosurgeries. A thoracotomy (excision of a portion of a lung) was said to have been performed on detainee "205." The same day's notes also describe an incident in which a detainee was handcuffed via a broken arm.

In response to my initial inquiry on 2002 detainee deaths at Guantanamo, Major Bradsher replied fully as follows:

The first detainee death at Guantanamo Bay was in June 2006. The [June 16] press
release is below:
http://www.defense.gov/releases/release.aspx?releaseid=9656

The press release refers to the "three detainees who died of apparent suicides on June 10, 2006," and is a summary of the disposition of the remains.

After receiving this first communication from DoD's press operations office, I asked for further clarification, and in particular "as to why a Captain at an Armed Forces Epidemiological Board meeting in Feb. 2002 would refer to earlier deaths at Guantanamo, ostensibly from battlefield wounds."

Major Bradsher responded, "I can't speak for Captain Yund. As I have stated before, the first detainee fatality in Guantanamo was in June 2006."

At this point, what we have is a mystery. There are no other reports regarding early battlefield deaths among the prisoners rendered to Guantanamo. We know that some of them arrived on litters, and needed immediate medical attention. We know that officials there even expected some deaths. But DoD maintains that no deaths prior to June 2006 occurred, and the principal reporter to the AFEB meeting on this subject, Captain Yund, does not remember the statement, though he notes "it is not the type of statement I would have made without having learned it from a source I considered reliable."

Dr. Steven Miles, author of Oath Betrayed: Torture, Medical Complicity, and the War on Terror, shared his reaction to news of the possible deaths reported here:

This is an enormously important event. I have tried, without success to have the DoD or the media, clarify the huge inconsistencies in prisoner death reporting to no avail. My article on this remains unpublished by the medical media and by Slate etc.

The uncertainty over what really occurred in the early days at Guantanamo was accentuated by recent revelations by Truthout.org and Seton Hall University of Law's Center for Policy and Research on the mass administration of the drug mefloquine to detainees who arrived at Guantanamo. Ostensibly described as an antimalarial measure, there are numerous reasons to question its use, not least because of its well-known high rates of neuro-psychiatric side effects, and also because such mass empiric treatment of mefloquine has never occurred and experts found such use potentially harmful and without medical justification.

Truthout has promised further investigation into the mefloquine scandal, including interviews with some of the principles involved, in a report to be published in the coming week.

There is a tremendous need for Congressional and/or independent investigations that have full mandate and subpoena power to ferret out the truth about what has occurred at Guantanamo and other U.S. "war on terror" prisons. The biggest obstacle to this, besides the Pentagon and the GOP, is the Democratic Party leadership itself, which refuses to undertake or fund such investigations, and whose leader in the White House, President Barack Obama, opposes -- against treaty obligations described in Article 12 of the Convention Against Torture -- such investigations.