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Pharmacologic Waterboarding
December 2, 2010 8:28 AM   Subscribe

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.

Meanwhile:

The [Guantanamo] prison camps spokesman, Navy Cmdr. Bradley Fagan, says it is U.S. Southern Command policy to no longer reveal the exact number of detainees being shackled by guards into restraint chairs for twice daily feedings. ... As prison camps spokesman, Fagan has clamped a new level of secrecy on the Pentagon's practice of pumping protein shakes into the stomachs of captives who refuse to eat meals catered to the prison camps by Defense Department contractors.
posted by Joe Beese (73 comments total) 3 users marked this as a favorite

 
Your post is based on a link to Truth-Out?
posted by Chocolate Pickle at 8:30 AM on December 2, 2010 [5 favorites]


I'm getting an Unable to connect to database server message on the main link, which instructs me to install Drupal with a link that goes to a blank page. Am I doing something wrong?
posted by shakespeherian at 8:34 AM on December 2, 2010


"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."

Maybe we should wait until Bill Keller gets the Government's permission and prints this in the NY Times?
posted by Eyebeams at 8:34 AM on December 2, 2010 [7 favorites]


Well, the article has a link to the Dod documents, so it looks legit. I'm too lazy to follow the trail, though.

It would not surprise me in the least. The whole raison d'etre of the Dod vis-a-vis "Gitmo" is to skirt just the other side of some interpretations of legal, for some ill-defined purpose.

This story fits that model perfectly.
posted by clvrmnky at 8:35 AM on December 2, 2010 [4 favorites]


Is Truth-Out not reliable? I don't know enough about them to judge. This looks pretty well documented, though, and is pretty appalling. One of the big places where I differ with Obama is in not prosecuting ANYONE for war crimes or torture, let alone the higher Bush administration officials.

And Congress is never going to close Guantanamo because it means moving "terrorists" into the home district of some rep or senator, and there's the perception that the area would become a prime target for attacks (even though simply moving them to a military prison somewhere in the states should be enough).

I really wish Cuba would get ballsy and force us out.
posted by klangklangston at 8:36 AM on December 2, 2010 [6 favorites]


.
posted by AElfwine Evenstar at 8:38 AM on December 2, 2010


Sourcewatch for Truthout
posted by adamvasco at 8:39 AM on December 2, 2010


Wikileaks tells me the Obama Admin actively worked to protect the Bush war criminals from a Spanish investigation. So, we have complicity and condoned acts of torture...one has to wonder what political gain there was to this. America is lost.
posted by Chuffy at 8:42 AM on December 2, 2010 [6 favorites]


Easy enough to badmouth the Bush administration on this sort of thing. Now the new guy on the block seems like-minded:

http://www.rawstory.com/rs/2010/12/obama-spain-bush-torture-prosecution/
posted by Postroad at 8:43 AM on December 2, 2010 [1 favorite]


Your comment is based on a link to Sourcewatch?
posted by notyou at 8:48 AM on December 2, 2010 [4 favorites]


The Madrid Cables from Scott Horton; commentry Andrew Sullivan.
El Pais: - US Embassy conspired to derail cases in Spain's High Court
posted by adamvasco at 8:50 AM on December 2, 2010 [2 favorites]


Your post is based on a link to Truth-Out?

I admit that having had Howard Zinn on their Board of Advisers proves that they Hate America.

Still, if Henry Rollins and Brian Eno both like them, I figure they can't be all bad.

I mean, I don't see any ranting about the lizard people on the web site. If you have a specific criticism to make of their reliability, I invite you to make it.
posted by Joe Beese at 8:52 AM on December 2, 2010 [3 favorites]


"Easy enough to badmouth the Bush administration on this sort of thing. Now the new guy on the block seems like-minded:"

I can understand Obama's efforts to get this derailed, even though I disagree with him in the extreme on it. And while fighting to undermine prosecutions of torture is terrible, I do think it's still worse to actually torture.
posted by klangklangston at 8:57 AM on December 2, 2010


^ It's probably something you mum mentioned.
posted by adamvasco at 8:59 AM on December 2, 2010


Odd coincidence: I just got my daughter's prescription for antimalarial drugs (upcoming family vacation in an endemic area) yesterday, and I get mine and my wife's tomorrow. Mefloquine and pretty much every other antimalarial are effective prophylactics: we start taking them days before entering a high risk area and keep taking them until after we leave.

I'm not saying there's nothing awful going on here... but I'd like to hear about the awfulness from someone who doesn't think "OMG they used antimalarials on people who don't have malaria!!1!" is a well-informed point.
posted by roystgnr at 9:02 AM on December 2, 2010 [4 favorites]


This seems like a non-story which has been grossly overinflated. Lariam can have freak side-effects, but it's an efficacious medicine for malaria, and if the government wanted to ensure that none of the prisoners had malaria this would be one way to do it. They administered an appropriate dose for treatment. If they wanted to torture the prisoners, there are literally dozens of other ways to have done so which don't entail the use of a legitimate and proven medication.
posted by clockzero at 9:03 AM on December 2, 2010 [2 favorites]


If you have a specific criticism to make of their reliability, I invite you to make it.

I don't know anything at all about Truthout, but there was that whole thing about them leaking the news that Karl Rove had been indicted in the grand jury investigation of the Plame affair.
posted by shakespeherian at 9:08 AM on December 2, 2010


So, we have complicity and condoned acts of torture...one has to wonder what political gain there was to this.

It got the Republicans onboard with the Public Health Initiative that has resulted in insurance companies brought to heel and free, good-quality healthcare for all.
posted by DU at 9:08 AM on December 2, 2010


I took mefloquine as a precautionary measure when I was in an area with malaria risk. There are cheaper prophylactics, but you have to take them daily as opposed to weekly. The nightmares that I had while on the drug revolved mostly around bugs crawling inside my mosquito net, with occasional serial killing.

Getting outraged about the use of potentially nightmare-inducing precautionary medicine seems to cheapen the more horrifying "enhanced interrogation techniques" being used at Guantanamo. There are legitimate criticisms to make about the US Government and its treatment of prisoners - I'm not sure this is one of them.
posted by ChuraChura at 9:08 AM on December 2, 2010 [4 favorites]


I'd like to hear about the awfulness from someone who doesn't think "OMG they used antimalarials on people who don't have malaria!!1!" is a well-informed point

From the link:

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."

---

if the government wanted to ensure that none of the prisoners had malaria this would be one way to do it

Also from the link:

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... That dosage is five times higher than the prophylactic dose given to individauls to prevent the disease.
posted by Joe Beese at 9:09 AM on December 2, 2010 [7 favorites]


Hell, psychiatrists all over the country prescribe medications that have the very rare (but real) side effect of...death.
posted by edgeways at 9:12 AM on December 2, 2010


Having seen how basic legislative processes have gone over the past couple of years, are there really still people who think it would be possible to carry out some kind of fair, criminal prosecution of the Bush admin for torture and other crimes in this country? If just passing a fairly unambitious health care reform proposal can lead to a fire storm of litigation and what's shaping up to be a second nullification crisis, is there really any reason to think even the most nobly well-intentioned political effort to retroactively apply justice in the case of the Bush administration's abuses (which only slightly less than half the country still seem to view as little more than business-as-usual) would stand any chance of not ending in chaos? I understand the desire to see justice served, but I can't for the life of me imagine how that could ever be the outcome in the current political and cultural climate.
posted by saulgoodman at 9:14 AM on December 2, 2010 [2 favorites]


but I'd like to hear about the awfulness from someone who doesn't think "OMG they used antimalarials on people who don't have malaria!!1!" is a well-informed point.

Of course, the difference being an insignificant little detail called Informed Consent
posted by mikelieman at 9:15 AM on December 2, 2010 [2 favorites]


I really wish Cuba would get ballsy and force us out.

There's ballsy and then there's suicidal.
posted by The 10th Regiment of Foot at 9:16 AM on December 2, 2010 [2 favorites]


From the link:

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."

What's in that elided part? Anyway, since he doesn't really explain why it's egregious malpractice, I'm not convinced of the point. Let's say that the government is not acting in good faith and had no intention of treating malaria: even then, administering lariam would be be unnecessary, but that doesn't seem equivalent to egregious malpractice. It's not like they performed unnecessary invasive surgeries or anything.

Also from the link:

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... That dosage is five times higher than the prophylactic dose given to individauls to prevent the disease.


Yes, the treatment dose for anti-malarials is usually higher than the prophylactic dosage. That's true for many of them.
posted by clockzero at 9:18 AM on December 2, 2010 [2 favorites]


I understand the desire to see justice served, but I can't for the life of me imagine how that could ever be the outcome in the current political and cultural climate.

Morals and ethics still obligate one to try. And from a practical standpoint, it makes the Right (and the RWNM) have to open a second defensive front.
posted by DU at 9:19 AM on December 2, 2010


The truth is only political if you are on the wrong side of it.

Also, despising government abuse is the very definition of patriotism for your country. You cannot pretend to defend the values of the Constitution if you violate them in the process. I really do not understand how we went from prosecuting the Japanese for war crimes for this sort of behavior to committing it ourselves in the span of sixty years.
posted by notion at 9:21 AM on December 2, 2010 [4 favorites]


Of course, the difference being an insignificant little detail called Informed Consent

From your link: Impairments to reasoning and judgment which may make it impossible for someone to give informed consent include such factors as basic intellectual or emotional immaturity, high levels of stress such as PTSD or as severe mental retardation, severe mental illness, intoxication, severe sleep deprivation, Alzheimer's disease, or being in a coma.

Immaturity: certainly for the minors in custody.
Stress: yes.
PTSD: yep.
Severe mental illness: how bad does the torture have to get before this applies?
Intoxication: ok, maybe not this one.
Severe sleep deprivation: you betcha!
Alzheimer's: maybe not.
Coma: in some cases I'm sure this applies.
posted by The 10th Regiment of Foot at 9:21 AM on December 2, 2010 [1 favorite]


Yes, the treatment dose for anti-malarials is usually higher than the prophylactic dosage. That's true for many of them.

The treatment dose was applied to everyone, before it was determined if they needed treatment.

churachura had crawling bug nightmares on the prophylactic dose. I bet the treatment dose - forcibly administered in a military prison where waterboarding and force feeding are occurring - would be a real barrel of laughs.
posted by Joe Beese at 9:26 AM on December 2, 2010


If you're saying that the torture victims at Guantanamo were unable to give consent, I suppose there are formal medical diagnosis of their inability to provide Informed Consent on file for us to verify?
posted by mikelieman at 9:29 AM on December 2, 2010


January 2009: "President Obama issued three executive orders Thursday ... including one requiring that the Guantanamo Bay detention facility be closed within a year."

We're waiting, Mr. President.
posted by swerve at 9:34 AM on December 2, 2010 [2 favorites]


We're waiting, Mr. President.

Talk to Congress?
posted by nomadicink at 9:42 AM on December 2, 2010 [2 favorites]


We're waiting, Mr. President.

Talk to Congress?


Exactly. A presidential executive order is about the strongest tool a President has for directly making an outcome happen. The rest is up to, you know, all the other people whose feet you could be holding to the fire to help give Obama's order the force it should have under ordinary circumstances, not demanding the President somehow magically grant himself the power to make the rest of the government do whatever he says on command.
posted by saulgoodman at 9:52 AM on December 2, 2010


Your post is based on a link to Truth-Out?

Yeah, it always pisses me off when posts link to highly respected non-profit news outlets that produce investigative reports/journalism that not only bring salient and important facts to light but is used as a legitamite source by The LA Times, 60 Minutes, CNN and the biased tabloid The United States House of Representatives.

Damn independent news outlets! You and Critical Thinking are ruining Metafilter!
posted by Chipmazing at 9:54 AM on December 2, 2010 [3 favorites]


I still haven't heard seen any of you committed activists seriously challenge Governor Cuomo or any of the other governors and politicos who, like congress, have directly intervened at every step to block the detainees from facing trials so that Guantanamo can be closed. It's absurd. It's like you can only see the world as being made up of everyone else and Obama.
posted by saulgoodman at 9:58 AM on December 2, 2010 [1 favorite]


But, but, but...HE PROMISED US!!!
posted by nomadicink at 10:00 AM on December 2, 2010 [1 favorite]


Judging from CDC's site for region-specific recommendations for malaria prophylaxis, it seems travelers are at no increased risk for malaria in Cuba. So I am puzzled why the decision to medicate the prisoners at Guantanamo. Unless this is in preparation for transport to a more malaria prone area, I don't see the reason.
posted by Pantalaimon at 10:25 AM on December 2, 2010 [1 favorite]


A high dose is the standard treatment for malaria, and a low dose for prevention. This seems pretty odd. On the other hand, I took the stuff for six months.
posted by Nothing at 10:33 AM on December 2, 2010


saulgoodman: I still haven't heard seen any of you committed activists seriously challenge Governor Cuomo or any of the other governors and politicos who, like congress, have directly intervened at every step to block the detainees from facing trials so that Guantanamo can be closed.

You're right, and I apologize for the whiny BUT HE PROMISED derail (though an executive order is somewhat more than a promise, it's still not up to Obama alone).
posted by swerve at 10:46 AM on December 2, 2010


I mean, I don't see any ranting about the lizard people on the web site. If you have a specific criticism to make of their reliability, I invite you to make it.

If they're covering up the Lizard People, how can we possibly trust them?
posted by steambadger at 11:15 AM on December 2, 2010 [5 favorites]


@roystgnr, there is a lot of good information out there about this drug, and the various side-effects one could expect, and it is all based on good, hard science Many people just have weird, lucid dreams. But for some people it is a descent into a half-awake madness, murder and suicide.

Your doctor should have warned you about the side-effects, and asked about your medical history. Because the problem can become a situation where the problems compound until you do something very, very stupid.

In some countries it isn't even an option for you if you have the right sort of medical history; an informed doctor will not even write the script.

It is pretty clear that the DoD is using these side-effects as a way to skirt legalities to potentially psychologically pressure subjects in order to break them down in some manner. Perhaps all it amounts to is some bad dreams, and maybe some tired subjects during "questioning." This does not excuse the malfeasance and malpractice.

The DoD knows how this drug works on a population, because they have been studying closely how it affects a population of deployed troops over the last several years. This is also well-documented.
posted by clvrmnky at 11:20 AM on December 2, 2010 [2 favorites]


and the biased tabloid The United States House of Representatives.

Actually, that one isn't so far off.
posted by The 10th Regiment of Foot at 11:23 AM on December 2, 2010


I guess we know where the secret black ops bases where these guys were being housed were located then.
posted by The 10th Regiment of Foot at 11:29 AM on December 2, 2010


While I was initially really bugged by this, and I still think it's extremely dubious medicine, I just happened to already be logged into a drug database, double checking something for my girlfriend, and figured I'd look at the drug's adverse effects. I'm now a lot less worried, noting that the incidence of hallucinations, etc. is less than 1 in 10000. I'm just going to toss that section of the monograph here, because I don't think I can link to it.
NOTE: Serious adverse reactions in patients following a prophylactic dose of mefloquine should be reported to the Centers for Disease Control and Prevention (CDC) Malaria Section 770—488—7760.

The most frequently observed adverse experience with mefloquine therapy is nausea/vomiting (3%). Other frequently reported (>= 1% of patients) adverse reactions during therapy with mefloquine include abdominal pain, anorexia, and diarrhea. Dyspepsia has also been noted.

Skin rash (unspecified) is reported in > 1% of patients on mefloquine. Other infrequently reported adverse events include alopecia, pruritus, and urticaria, and telogen effluvium (loss of resting hair). Stevens-Johnson Syndrome and erythema multiforme have also been reported with mefloquine therapy, however, serious adverse reactions to mefloquine therapy have been rarely reported and may be difficult to distinguish from the symptoms of acute malaria infection.

Frequently reported (>= 1% of patients) adverse reactions during therapy with mefloquine include vestibular disorders such as tinnitus and hearing impairment.

Neuropsychiatric events occur in roughly 1 out of 10,000 users of mefloquine and include vertigo, visual impairment, and central nervous system disturbances. Occasionally, more severe neuropsychiatric disorders have been reported such as seizures, syncope, sensory and motor neuropathies (including paresthesias, tremor and ataxia), agitation or restlessness, aggression, anxiety, confusion, depression, encephalopathy, forgetfulness, hallucinations, insomnia, mood changes/mood swings, emotional lability, nightmares, panic attacks, and psychosis or paranoid reactions. Rare cases of suicidal ideation and suicide have been reported though no relationship to drug administration has been confirmed. In post-marketing data, vertigo, dizziness, memory impairment, and loss of balance have been reported to continue for months after mefloquine has been discontinued. Headache has also been noted in > 1% of patients.[28301]

QT prolongation has been reported when mefloquine is used in combination with certain other drugs such as halofantrine (see Drug Interactions). Post-marketing cardiovascular adverse reactions include chest pain (unspecified), hypertension, hypotension, palpitations, sinus tachycardia, first degree AV block, ECG changes, irregular heart rate, and extrasystoles have been noted in >= 1% of patients, while sinus bradycardia is seen in <>= 1% of patients using mefloquine include arthralgia or myalgia, chills, fatigue, and fever. Asthenia has been reported in <>

Noting all that, this does seem like a bit of wolf-crying over "MKULTRA mind control," as Truth-Out alluded. More prisoners likely got tinnitus.
posted by klangklangston at 11:44 AM on December 2, 2010 [4 favorites]


Huh, that's weird. The live preview showed that blockquote as unclosed, then I retyped it and previewed the normal way, and it showed it closed, then posting opened it up again. I wonder what the deal is.
posted by klangklangston at 11:45 AM on December 2, 2010


You're right, and I apologize for the whiny BUT HE PROMISED derail (though an executive order is somewhat more than a promise, it's still not up to Obama alone).

That's actually my main grievance with certain critics on the left right now: not that they're necessarily being too hard on Obama, but that, in the process, they're effectively giving far more malicious and egregiously bad actors who at specific points in time are actually empowered to effect key outcomes in the right direction a free pass. Obama has become a lightning rod that's effectively taking all the political hits that would be more effectively directed at, you know, the 99.9999999% of the rest of the US government that actually has the responsibility and authority for creating and implementing policy. The effective re-branding of the Health Care policy that Obama specifically deferred to congress to craft as "ObamaCare" is just one example of how this dynamic is being exploited, politically, to capitalize on people's instinctive desire to find a single, recognizable human face at which to direct their ire.
posted by saulgoodman at 11:53 AM on December 2, 2010 [1 favorite]


Ack. I've gotta step letting this recurring derail get the best of me. On topic:

Noting all that, this does seem like a bit of wolf-crying over "MKULTRA mind control," as Truth-Out alluded. More prisoners likely got tinnitus.

For me, it's a little too soon to know if this particular issue is as serious as hyped, or just another opportunity to remind everyone that the DOD did shameful and criminal things in Iraq and Afghanistan.
posted by saulgoodman at 11:59 AM on December 2, 2010


(Not suggesting that's a bad thing, either, even though I don't see any realistic possibility of justice being served in the near future.)
posted by saulgoodman at 12:00 PM on December 2, 2010


Klang, awesome there.

Truthout is less than reliable in a lot of ways. Unfortunate that we have our own Fox-news like sources these days.

Obviously the torture there under Bush was terrible and had to be stopped and hurt the US. But it is morally wrong to let prisoners starve themselves to death.
posted by Ironmouth at 3:09 PM on December 2, 2010


hurt the US as well.

FTFM
posted by Ironmouth at 3:10 PM on December 2, 2010


was hoping today's beese post was going to be on the Cheney indictment.
posted by Ironmouth at 3:12 PM on December 2, 2010


Odd coincidence: I just got my daughter's prescription for antimalarial drugs (upcoming family vacation in an endemic area) yesterday, and I get mine and my wife's tomorrow. Mefloquine and pretty much every other antimalarial are effective prophylactics: we start taking them days before entering a high risk area and keep taking them until after we leave.

I'm not saying there's nothing awful going on here... but I'd like to hear about the awfulness from someone who doesn't think "OMG they used antimalarials on people who don't have malaria!!1!" is a well-informed point.


I personally know someone who used a related mediacation - i.e. chloroqine. She ended up, after taking the drug for about six weeks, with severe anxiety, minor delusions, tinnitus, and co-morbid clinical depression. She never saw it coming, and thought she had a brain tumor. Almost one year of medical and psychiatric intervention was necessary. She still has tinnitus, and has recovered nicely from the psychological side effects, but she went through living hell. Be *careful* with this stuff - make sure dosages are carefully adjusted for weight, and also be sure to constantly monitor all who are taking the drug for seemingly minor changes in behavior. My friend (a working peer) told me that the first symptom she noticed was a feeling of extreme homesickness - way over the top from what she would normally experience while traveling; that was followed by the onset of severe, relentless anxiety. She finished her trip to Asia stopping in airport doctor wards, getting shot up with Valium, just to calm herself down. Tinnitus followed, capped off by her depression.

I'm told that are warnings on bottles of that stuff, now, but it seems that all quinine derivatives have this potential. There are also other severe side effects, like relentless, macabre nightmares; severe dissociation; and visual hallucination. Again, be careful.
posted by Vibrissae at 3:34 PM on December 2, 2010


But it is morally wrong to let prisoners starve themselves to death.

Pardon, what? If I was in prison and doomed to be tortured for the rest of my life, you can bet I'd do everything I could to die ASAP.
posted by LastOfHisKind at 3:51 PM on December 2, 2010 [1 favorite]


But it is morally wrong to let prisoners starve themselves to death.

Glad we got that cleared up and there are no moral issues with Gitmo anymore now.
posted by Djinh at 4:15 PM on December 2, 2010


Is the Seton Hall University School of Law Center for Policy & Research reliable enough for you guys?

The prophylactic dosage of mefloquine, 250 mg, is much smaller than the treatment dose given to GTMO detainees, 1250 mg, and is administered once per week as opposed to the single dose used for treatment purposes. Severe adverse side effects do occur during prophylactic use, but adverse effects during use for treatment are far more common and more severe, probably due to the larger dosage. Use of mefloquine, even when used to treat a confirmed case of the disease, is contraindicated when the patient has a history of certain disorders.

Detainees were given 1250 mg of mefloquine during inprocessing at GTMO; 750 mg as
an initial dose and 500 mg 12 hours later. There is no indication that the routine administration of mefloquine to arriving detainees considered each detainee’s medical history. Administering the drug at the higher treatment dose without previously determining the need for any treatment was a dramatic departure from the accepted standard of medical care.
(source, pg. 5)

The frequency and severity of adverse effects increases dramatically at the higher
treatment dosage. A survey of 20 published prospective studies of mefloquine administered at the treatment dosage of 1250 mg concluded that “the incidence of serious neuropsychiatric reaction is higher when mefloquine is used for treatment rather than prophylaxis” and that the risk is dose-dependent. The profiles of adverse events in those instances were similar to those under prophylactic use; the risk factors and adverse effects remained the same. Another study of healthy individuals who took the treatment regimen at the same dose given to the detainees (1250 mg) found an unexpected high frequency of side effects reported by all 22 subjects, with symptoms lasting three weeks or longer.
(source, pg. 10)

Hey look they are also "crying wolf over MKULTRA mind control", imagine that.

The U.S. military was aware of the risk of severe adverse neuropsychological effects of
mefloquine before the establishment of the GTMO detention facility. As early as 1955, and possibly earlier, the CIA was experimenting with quinolines, the chemical family to which mefloquine belongs, as part of MKULTRA, a program of research in behavioral modification. Quinolines were included in a study of the “curare-like”—a type of poison used on native blow darts—effects of thiols, and another study that investigated toxic cerebral states. The stated aim of the latter study was to “understand the mechanism of such states as toxic delirium, uremic coma, and cerebral toxicity from poisoning.” The potential use of these drugs in an interrogation setting was a stated purpose for the study: “an adversary service could use such drugs to produce anxiety or terror in medically unsophisticated subjects unable to distinguish drug-induced psychosis from actual insanity.” From this family of chemicals, mefloquine was developed under the U.S. Army Antimalarial Drug Development Program in the 1960s.

At least as early as 1991, neuropsychiatric adverse effects of therapeutic doses of mefloquine had been reported in scientific studies. In 1993, Senator Dianne Feinstein asked the Pentagon to look for alternatives to mefloquine after media reports cited possible links between Lariam and suicides and other erratic behavior. In 2002, Dr. William Winkenwerder, the Assistant Secretary of Defense for Health Affairs, acknowledged that concerns had been raised by peer-reviewed reports that adverse event rates were much higher than previously reported. Dr. Winkenwerder reiterated that “health care providers, including those within the DoD, must weigh the benefits of the drug against the possibility of adverse reactions in some individuals.” This was to be done in part by considering “the severity of the disease, characteristics unique to the patient to whom they are prescribing the drug, [and] other medications the individual might be taking.” The Defense Department was further aware that “sufficient evidence exists [in 2002] to raise the question whether the neuropsychiatric adverse events of mefloquine are frequent enough and severe enough to warrant limiting its use for the prevention and treatment of chloroquine-resistant malaria.” Because the most “severe adverse events reported with mefloquine have occurred during its use as treatment for documented infection with chloroquine resistant P. falciparum, other treatment regimens should be carefully considered before mefloquine is used at the doses required for treatment.” The sources cited by that Department of Defense memo were studies ranging from 1989 to 2001.
(source, pgs. 19-21)
posted by AElfwine Evenstar at 4:29 PM on December 2, 2010


Note that the detainees were given the treatment dose(which was cited in the first link of the fpp) not the prophylactic dose that Klangklangston was referring to.
posted by AElfwine Evenstar at 4:43 PM on December 2, 2010


I've taken the prophylactic dose of mefloquine. My dreams were a bit more vivid, but nothing earth-changing. I did know one person who just couldn't tolerate it and had to take an alternate anti-malarial (maybe doxycycline?), but no one who was climbing the walls and freaking totally out.

Preventatively giving treatment doses seems reasonable if a high percentage of the inmates were showing up positive for malaria -- you wouldn't want to wait for someone to show symptoms and in the meantime infect half the camp plus all the Cubans nearby. Anecdotally, from people I know who had to take the treatment dosages, it's not much fun but a lot better than malaria fevers.

tl;dr: compared to the actual abuses and torture at Guantanamo, this seems like small potatoes at worst, and fairly sensible medicine at best.
posted by Forktine at 5:43 PM on December 2, 2010


and fairly sensible medicine at best.

Except that's not true. Did you read the link and quotes I posted?
posted by AElfwine Evenstar at 6:30 PM on December 2, 2010


And while fighting to undermine prosecutions of torture is terrible, I do think it's still worse to actually torture.

---

compared to the actual abuses and torture at Guantanamo, this seems like small potatoes at worst...


Could either of you have imagined 20 years ago that you would someday say things like this?
posted by Joe Beese at 6:43 PM on December 2, 2010



Except that's not true. Did you read the link and quotes I posted?



The quotes, yes. The link (actually a pdf download) I read the first few pages, but am not really interested enough to read all 32 pages.

A) I wouldn't be surprised if the military was hoping for a certain level of freak-out on the part of the detainees. That's not cool, but also not nearly as gross a violation as a lot of the other stuff they were doing. So my outrage-filter is remaining set on low for this one, sorry.

B) In my experience, mefloquine is used widely and without a lot of care for preventative psychological screening. Probably it should be -- like I said above, I knew someone who couldn't handle it even at prophylactic dosages, and the people I knew who had to take treatment dosages found it to be not much fun. But (in my purely anecdotal experience) that care isn't taken, so what the report alleges strikes me as fairly unexceptional. I'm not so much defending it as just shrugging and thinking it sounds more like casually bad medicine than it does torture.

So yeah, I'm sure they could have done a lot better, but compared to the seriously Bad Things that were (and probably still are) ongoing in Gitmo, this just doesn't sound like such a big deal to me. There's a ton of things worth being outraged by, and a lot of people who deserve to go to jail for their involvement.
posted by Forktine at 6:45 PM on December 2, 2010



Could either of you have imagined 20 years ago that you would someday say things like this?


Yes, because there has always been relative levels of awfulness in the world. What I didn't imagine was that two years later it would be Obama who was continuing to shelter the torturers and keep the facilities open.
posted by Forktine at 6:47 PM on December 2, 2010 [2 favorites]


"The prophylactic dosage of mefloquine, 250 mg, is much smaller than the treatment dose given to GTMO detainees, 1250 mg, and is administered once per week as opposed to the single dose used for treatment purposes."

Quoted for emphasis. That's 5x the prophylactic dose. Therefore, anecdotes about the safety and efficacy of the prophylactic dose are not particularly illuminating.
posted by dialetheia at 7:35 PM on December 2, 2010 [2 favorites]


What I didn't imagine was that two years later it would be Obama who was continuing to shelter the torturers and keep the facilities open.

On the other hand, he did sign the Lily Ledbetter Act.
posted by Joe Beese at 8:14 PM on December 2, 2010


This is really quite thin, and the Seton Hall study seems written to maximize the negatives. For example:

The prophylactic dosage of mefloquine, 250 mg, is much smaller than the treatment dose given to GTMO detainees, 1250 mg, and is administered once per week as opposed to the single dose used for treatment purposes. (p5)

OK, that's the dose you'd take if you were going somewhere that involved a risk of malaria exposure.

For mild to moderate cases of malaria diagnosed in adults, a treatment dosage of 1250 mg is indicated when the malaria strain is caused by P. vivax or mefloquine-susceptible strains of P. falciparum. (p6)

Which was what the detainees were given. and as the article says, there's no great risk of malaria in Cuba - although it might be that this says more about Cuba's public health system than its semi-tropical location. But as you can see on this map, malaria is endemic in most of the Middle East and Indian subcontinent. So there's a reasonable probability that at least some detainees would be infected with or carriers of malaria.

Of course they should have been individually screened, but not all of these people will know their own medical histories very well, and in the time it takes to evaluate everyone you could have it spreading among inmates and/or those guarding them. Outbreaks of disease in prison camps are well known in wartime, so my guess is that they were trying to prevent this, albeit in a ham-fisted and negligent way. So, how bad are the risks?

Mefloquine, at any dose, is known to cause adverse neuropsychiatric effects such as
anxiety, paranoia, hallucinations, aggression, psychotic behavior, mood changes, depression, memory impairment, convulsions, loss of coordination (ataxia), suicidal ideation, and possibly suicide. As many as 25% of persons who have taken mefloquine reported such severe side effects...


That last sentence cites an Army Times news report from 2009...many years after people started arriving at Guantanamo. And what is says is this: "A 2004 study by the Walter Reed Institute of Research said mefloquine produces severe seizures and hallucinations and hospitalizations in one out of 10,000 people who take it, and dizziness, headache, insomnia and vivid dreams in up to 25 percent of patients."

So the Seton Hall study is conflating a 0.01% risk of severe side effects with a 25% risk of mild side effects - a 2500-fold exaggeration. Such carelessness from people who are trained in legal research dooms the credibility of the entire paper. But it gets worse.

A U.S. military service member reported the following adverse effects from a weekly regimen of mefloquine at the lower prophylactic dosage. The adverse effects began soon after the first dose, and gradually grew worse as more doses were taken. Though he took the drug for only six months, his symptoms persisted for well over a year after his last dose.

The weekly prophylactic dose - 250mg. On page 5 we were informed that because the drug collects in fatty tissues that it has a longish half-life in the body. And he took this weekly for 6 months. So that would suggest he had consumed a total of 6500mg. Why we are supposed to consider the resultant symptoms of sustained consumption (in spite of poor tolerance to the drug) can be usefully compared to the possible effects of a single dose I have no idea.

I read the rest of it but I'm too lazy to quote more. I appreciate that it's possible to have a bad reaction to the dose detainees were given. The medical case history describing that is certainly tough reading. But the probability of such an extreme reaction was very low. 775 detainees were brought to Guantanamo, so it seems like there is a ~8% chance that one of them had a severe reaction. I imagine the military considered that low risk level quite acceptable, and their careless clinical policy was motivated by laziness more than anything else.

Bad, dangerous policy, which reflected a careless attitude towards the medical risks. But the evidence for it being any sort of systematic abuse is really thin, and the disregard for accuracy in the report makes it even thinner.
posted by anigbrowl at 9:19 PM on December 2, 2010 [1 favorite]


Oops - accidentally deleted the paragraph about the detainee who reported a poor reaction and his medical priors. But the remarks went to the same substantive point. I still feel a lot more offended about the detainees kneeling on concrete with hoods over their heads that I do about this.
posted by anigbrowl at 9:23 PM on December 2, 2010


Is the Seton Hall University School of Law Center for Policy & Research reliable enough for you guys?"

Well, no, but thanks for the misplaced appeal to authority.

Here's where I find your hectoring tone frustrating: The quote from the Seton Hall University School of Law Center for Policy and Research demonstrates the same thing that everyone has already conceded, that it was dangerous for Guantanamo doctors to feed mefloquine to detainees. However, just saying that using the treatment dosage has a higher incidence of adverse effects doesn't prove that the "more" is meaningful, or any more meaningful than the relatively low dosage. Two other reasons why I don't find your link to Seton Hall all that compelling is that they misstated the typical treatment dosage, which is 750mg, then 500mg six hours later according to the Gideon Infectious Diseases guide, and that in their pdf, they misspell Guantanamo. Just sound it out, Seton Hall.

Hey look they are also "crying wolf over MKULTRA mind control", imagine that.

And again, the hectoring tone. Listen, that the CIA experimented with something doesn't mean that it worked (see: psychics, the Bay of Pigs, and the Shah of Iran). Likewise, just proving that it can have neurological effects isn't anything that isn't up there in the monograph. But the incidence of those are fairly low. Is it shitty to take someone in your care and dose them up with a drug? Is it "egregious malpractice"? Yeah.

Is it "Psychological waterboarding"? Hell no, and trying to act like your pull quotes prove it is and everyone else can't read is just obnoxious.
posted by klangklangston at 9:47 PM on December 2, 2010 [3 favorites]


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posted by clavdivs at 10:53 PM on December 2, 2010


The only thing obnoxious going on here is you putting words in my mouth or trying to divine my intent. I don't remember ever claiming that "psychological waterboarding" was taking place. Did you guys(anigbrowl and klangklangston) read the conclusion? Neither I nor the authors claim that we can know with any certainty that torture by the administration of mefloquine took place. In my opinion it seems like a distinct possibility given what we know about what else was going on there. Unfortunately the government won't release the medical records so what actually took place will remain, as the paper points out, hidden.

The purpose of the paper was to analyze the possibility of whether the administering of mefloquine in treatment doses to detainees could be legally considered torture and came to the conclusion that yes it could be considered torture. The fact that you don't have that big a problem with what happened isn't really that convincing as your opinion isn't the law. What is convincing is a legal argument. That is their opinion and I am sure that there are other legal views that run contrary to their findings. One would think that we would want to err on the side of caution when it comes to torture so I find their argument to be convincing. But the whole thing is shrouded in so much secrecy and obfuscation that it's likely we will never know the full extent of the horrors that took place or are currently taking place at GTMO.

Did you use the term hectoring because I had my text in bold? Because I don't find my brief comments in a wall of text very hector like. I used the bold to set my remarks off from the aforementioned wall of text. Didn't mean for it to come off as Hectoring so sorry if it did.
posted by AElfwine Evenstar at 11:10 PM on December 2, 2010 [1 favorite]


HA! nice links clavdivs.....Anslinger that son of a bitch...
posted by AElfwine Evenstar at 11:15 PM on December 2, 2010


"The only thing obnoxious going on here is you putting words in my mouth or trying to divine my intent. I don't remember ever claiming that "psychological waterboarding" was taking place."

Dude, it's right in the post's title. C'mon now. I didn't say you said it, I said that in consideration of the linked article versus what I found pretty quickly by looking around a bit at the top level medical literature, the claims in the article are hyperbole. But it's pretty damn fair to take the words right there from the top, innit?

"Neither I nor the authors claim that we can know with any certainty that torture by the administration of mefloquine took place."

They certainly want to imply it. And the implication is of dubious worth.

"In my opinion it seems like a distinct possibility given what we know about what else was going on there."

But your opinion is not proof, and it is reckless to speculate in the absence of proof.

"The purpose of the paper was to analyze the possibility of whether the administering of mefloquine in treatment doses to detainees could be legally considered torture and came to the conclusion that yes it could be considered torture."

It could be torture. It's certainly a violation of prisoner rights and medical ethics. It's not a loss to focus on the thing we know for certain, especially since the larger charge is more contentious and politically laden. In fact, concentrating on the certainty makes the argument stronger rationally, rather than stronger emotionally, which is what focusing on the word "torture" does. Focusing on emotional arguments rather than rational ones makes us stupider and poisons discourse.

"The fact that you don't have that big a problem with what happened isn't really that convincing as your opinion isn't the law."

But… an academic paper arguing that an action could legally be construed as torture also isn't the law. It's an opinion on what the law is, and it's one that has some pretty obvious flaws, as have been mentioned here.

"One would think that we would want to err on the side of caution when it comes to torture so I find their argument to be convincing."

Whether or not we should "err on the side of caution" is not a support of the statement "their argument is convincing." At best, it's an argument from consequences. That's like saying that because I find cookies delicious, they are medically necessary. And look, I even have some experts who say that in some cases cookies could be medically necessary! (I am actually eating cookies right now and they're delicious.)

"But the whole thing is shrouded in so much secrecy and obfuscation that it's likely we will never know the full extent of the horrors that took place or are currently taking place at GTMO."

Which means that focusing our energies on things that can be proven, like that dosing people with a couple of horse pills of anti-malarials is bad medicine and inhumane. It's wrong to expose people to risks without their consent even if they don't suffer from those risks. But there's also a fairly plausible explanation for dosing the prisoners in the way that they were. Incompetence isn't malice, and without more information there's just no way to tell. It's OK to guess, but trying to hold out your guess as more correct than anyone else's guess, especially since you don't seem to have any medical, legal or military knowledge that the rest of us don't, is silliness.

"Did you use the term hectoring because I had my text in bold? Because I don't find my brief comments in a wall of text very hector like. I used the bold to set my remarks off from the aforementioned wall of text. Didn't mean for it to come off as Hectoring so sorry if it did."

Yeah, I think that was a big part of it. It's also the "you guys" and throwing the "cry wolf" back at me without realizing that your quote didn't support the conclusions for the same reason that the Truth-Out article didn't support the MKUltra implications.

But I appreciate that, and tried to tone down my response so it wasn't just needlessly fighty.
posted by klangklangston at 11:45 PM on December 2, 2010


Dude, it's right in the post's title. C'mon now. I didn't say you said it

No but you said:

trying to act like your pull quotes prove it is and everyone else can't read is just obnoxious.

Which was not my intent even though you may have took it as such.

Yeah, I think that was a big part of it. It's also the "you guys" and throwing the "cry wolf" back at me without realizing that your quote didn't support the conclusions for the same reason that the Truth-Out article didn't support the MKUltra implications.

The only implication of the MKULTRA reference is that the government has been using this stuff for quite some time and knows what the effects are. Which is used to lead into the legal argument about "specific intent". The fact that the government has tested this stuff seems pretty well supported to me. Other than that I don't know what conclusions you are referring to. In retrospect it was needlessly fighty of me to, as you said, throw the "cry wolf" reference back at you. It unfortunately led to some unnecessary head butting and for that I am sorry.

As for everything else yeah I pretty much agree with what you said. Well not everything but it's getting late and I don't feel like splitting hairs at this late hour. But yeah as you said better to focus on something concrete....like closing GTMO.
posted by AElfwine Evenstar at 12:26 AM on December 3, 2010


The Irrelevance of Wikileaks' Guantánamo Revelations
posted by AElfwine Evenstar at 10:40 AM on December 3, 2010


Incompetence isn't malice, and without more information there's just no way to tell.

Then if I understand your position, it is that the incompetent drugging forced upon the prisoners - an incompetence one might even consider rising to the level of "egregious malpractice" - one which created a measurable and, in the circumstances, entirely unnecessary risk of severe psychological distress, should - in the absence of evidentiary documents that the government withholds from us on the grounds of "national security" - be assumed simple gross negligence, rather than an adjunct to the physical torture being practiced at that prison.

Is that it, more or less?
posted by Joe Beese at 11:50 AM on December 3, 2010 [1 favorite]


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