EXCLUSIVE: Controversial Drug Given to All Guantanamo Detainees Akin to Pharmacologic Waterboarding

[Guest guest]

mefloquine is Lariam

\http://www.truth-out.org/controversial-drug-given-all-guantanamo-detainees-amounted-pharmacologic-waterboarding6558

EXCLUSIVE: Controversial Drug Given to All

Guantanamo Detainees Akin to "Pharmacologic Waterboarding"

Wednesday 01

December 2010

by: Leopold and Kaye, t r u t h o u t

| Investigative Report

The Defense Department forced all "war on terror" detainees at the

Guantanamo Bay prison to take a high dosage of a controversial

antimalarial drug, mefloquine, an act that an Army public health

physician called "pharmacologic waterboarding."

The US military administered the drug despite Pentagon knowledge

that mefloquine caused severe neuropsychiatric side effects,

including suicidal thoughts, hallucinations and anxiety. The drug

was used on the prisoners whether they had malaria or not.

The revelation, which has not been previously

reported, was buried in documents

publicly released by the Defense Department (DoD) two years ago as

part of the government's investigation into the June 2006 deaths

of three Guantanamo detainees.

Army Staff Sgt. Joe Hickman, who was stationed at

Guantanamo at the time of the suicides in 2006, and has presented

evidence that demonstrates the three detainees could not have died

by hanging themselves, noticed in the detainees' medical files

that they were given mefloquine. Hickman has been investigating

the circumstances behind the detainees' deaths for nearly four

years.

Interviews conducted over the past two months

with tropical disease experts and a review of Defense Department

documents and peer-reviewed journals show there were no

preexisting cases where mefloquine was ever prescribed for mass

presumptive treatment of malaria.

All detainees arriving at Guantanamo in January

2002 were first given a treatment dosage of 1,250 mg of

mefloquine, before laboratory tests were conducted to determine if

they actually had the disease, according to a section of the DoD

documents entitled "Standard Inprocessing Orders For Detainees."

The 1,250 mg dosage is what would be given if the detainees

actually had malaria. That dosage is five times higher than the

prophylactic dose given to individauls to prevent the disease.

Maj. Remington Nevin, an Army public health

physician, who formerly worked at the Armed Forces Health

Surveillance Center and has written extensively about mefloquine, said

in an interview the use of mefloquine "in this manner ... is, at

best, an egregious malpractice."

The government has exposed detainees "to

unacceptably high risks of potentially severe neuropsychiatric

side effects, including seizures, intense vertigo, hallucinations,

paranoid delusions, aggression, panic, anxiety, severe insomnia,

and thoughts of suicide," said Nevin, who was not speaking in an

official capacity, but offering opinions as a board-certified,

preventive medicine physician. "These side effects could be as

severe as those intended through the application of 'enhanced

interrogation techniques.'"

Mefloquine is also known by its brand name

Lariam. It was researched by the US Army in the 1970s and licensed

by the Food and Drug Administration in 1989. Since its

introduction, it has been directly linked to serious adverse effects, including

depression, anxiety, panic attacks, confusion, hallucinations,

bizarre dreams, nausea, vomiting, sores and homicidal and suicidal

thoughts. It belongs to a class of drugs known as quinolines,

which were part of a 1956 human experiment study to investigate

"toxic cerebral states," as part of the CIA's MKULTRA mind-control

program.

The Army tapped the Walter Army Institute of

Research (WRAIR) to develop mefloquine and it was later licensed

to the Swiss pharmaceutical company F. Hoffman-La Roche. The first

human trials of mefloquine were conducted in the mid-1970s on

prisoners, who were deliberately inoculated with malaria at

Stateville Correctional prison near Joliet, Illinois, the site of

controversial antimalarial experimentation in the early

1940s.

The drug was administered to Guantanamo detainees

without regard for their medical or psychological history, despite

its considerable risk of exacerbating pre-existing conditions.

Mefloquine is also known to have serious side effects among

individuals under treatment for depression or other serious mental

health disorders, which numerous detainees were said to have been

treated for, according to their attorneys and published

reports.

Dr. G. Olds, a tropical disease

specialist and the founding dean of the Medical School at the

University of California at Riverside, said,

in his "professional opinion there is no medical justification for

giving a massive dose of mefloquine to an asymptomatic

individual."

"I also do not see the medical benefit of

treating a person in Cuba with a prophylactic dose of mefloquine,”

Olds said. Mefloquine is "a fat soluble, and as a result, it does

build up in the body and has a very long half-life.This is

important since a massive dose of this drug is not easily

corrected and the ‘side effects’ of the medication could last for

weeks or months."

In 2002, when the prison was established and

mefloquine first administered, there were dozens of suicide

attempts at Guantanamo. That same year, the DoD stopped reporting

attempted suicides.

By February 2002, there were at least 459

detainees imprisoned at Guantanamo. In March of that year,

according to the book "Saving Grace at Guantanamo Bay: A Memoir of a

Citizen Warrior" by Montgomery Granger, "the situation" at

the prison began "deteriorating rapidly."

"There is more and more psychosis becoming

evident in detainees ...," wrote Granger, an Army Reserve major

and medic who was stationed at Guantanamo in 2002. "We already

have probably a dozen or so detainees who are psychiatric cases.

The number is growing."

"Presumptively Treating" Malaria

Though malaria is nonexistent in Cuba, DoD

spokeswoman Maj. Bradsher told Truthout that the US

government was concerned that the disease would be reintroduced

into the country as detainees were transferred to the prison

facility in January 2002.

A "decision was made," Bradsher said in an email,

to "presumptively treat each arriving Guantanamo detainee for

malaria to prevent the possibility of having mosquito-borne [sic]

spread from an infected individual to uninfected individuals in

the Guantanamo population, the guard force, the population at the

Naval base or the broader Cuban population."

But Granger wrote in his book that a Navy

entomologist was present at Guantanamo in January and February

2002 and during that time only identified insects that were

nuisances and did not identify any insects that were carriers of a

disease, such as malaria.

Nevertheless, Bradsher said the "mefloquine

dosage [given to detainees] was entirely for public health

purposes ... and not for any other purpose" and "is completely

appropriate."

"The risks and benefits to the health of the

detainees were central considerations," she added.

A September 13, 2002, DoD

memo governing the operational use of mefloquine said,

"Malaria is not a threat in Guantanamo Bay." Indeed, there have

only been two to three reported cases of malaria at

Guantanamo.

The DoD memo, signed by Assistant Secretary of

Defense for Health Affairs Winkenwerder, was sent to

then-Rep. McHugh, the Republican chairman of the House

Veterans Affairs Subcommittee on Military Personnel. McHugh is now

Secretary of the Army.

A Senate staff member told Truthout the Senate

Armed Services Committee was never briefed about malaria concerns

at Guantanamo nor was the committee made aware of "any issue

related to the use of mefloquine or any other anti-malarial drug"

related to "the treatment of detainees."

When questions were raised at a February 19, 2002 meeting of the Armed

Forces Epidemiological Board (AFEB) about what measures the

military was taking to address malaria concerns at Guantanamo,

Navy Capt. Alan J. Lund did not disclose that mefloquine was being

administered to detainees as a form of presumptive treatment.

Yund said the military gave detainees a different

anti-malarial drug known as primaquine and noted that "informed

consent" was "absolutely practiced" prior to administering drugs

to detainees, an assertion that contradicts claims made by

numerous prisoners who said they were forced to take drugs even if

they protested. Yund did not return calls for comment.

Bradsher declined to respond to a follow-up

question about who made the decision to presumptively treat

detainees with mefloquine.

An April 16, 2002, meeting of the Interagency

Working Group for Antimalarial Chemotherapy, which DoD, along with

other federal government agencies, is a part of, was specifically

dedicated to investigating mefloquine's use and the drug's side

effects. The group concluded that study designs on mefloquine up

to that point were flawed or biased and criticized DoD medical

policy for disregarding scientific fact and basing itself more on

"sensational or best marketed information."

The Working Group called for additional research,

and warned, "other treatment regimes should be carefully

considered before mefloquine is used at the doses required for

treatment."

Still, despite the red flags that pointed to

mefloquine as a high-risk drug, the DoD's mefloquine program

proceeded.

In fact, a June 2004 set of guidelines issued by

the Centers for Disease Control and Prevention

(CDC) says mefloquine should only be used when other standard

drugs were not available, as it "is associated with a higher rate

of severe neuropsychiatric reactions when used at treatment

doses."

According to the CDC, "'presumptive treatment'

without the benefit of laboratory confirmation should be reserved

for extreme circumstances (strong clinical suspicion, severe

disease, impossibility of obtaining prompt laboratory

confirmation)."

A CDC spokesman refused to comment about the

"presumptive treatment" of malaria at Guantanamo and referred

questions to the DoD.

Nevin said, if "mass presumptive treatment has

been given consistently, many dozens of detainees, possibly

hundreds, would almost certainly have suffered such disabling

adverse events."

"It appears that for years, senior Defense health

leaders have condoned the medically indefensible practice of using

high doses of mefloquine ostensibly for mass presumptive treatment

of malaria among detainees from the Middle East and Asia lacking

any evidence of disease," Nevin said. "This is a use for which

there is no precedent in the medical literature and which is

specifically discouraged among refugees by malaria experts at the

Centers for Disease Control."

Even proponents of limited mefloquine usage are

seriously questioning the logic behind the DoD's actions.

Professor McCarthy, chair of the Infectious Diseases

Division of the Queensland Institute of Medicine in Australia, who

is an advocate of the safe use of mefloquine under proper

safeguards, and takes it himself when traveling, told Truthout he

was unaware of the use of mefloquine for mass presumptive

treatment as described by the DoD, but could imagine it under

certain circumstances.

However, when informed that lab tests were

available and the detainees were screened for the blood product

G6PD, used to determine the suitability of certain antimalarial

drugs, McCarthy found the DoD's use of mefloquine at Guantanamo

difficult to understand and "hard to support on pure clinical

grounds as an antimalarial."

Treatment, Torture or an Experiment?

Another striking point about the DoD's decision

to presumptively treat mostly Muslim detainees with mefloquine

beginning in 2002 is that it is the exact opposite of how the DoD

responded to malaria concerns among the Haitian refugees who were

held at Guantanamo a decade earlier.

Between 1991 and 1992, more than 14,000 Haitian

refugees were held in temporary camps set up at Guantanamo. A

large number of Haitian refugees - 235 during a four-month period

- were diagnosed with malaria. But instead of

presumptively treating the refugee population at Guantanamo, the

DoD conducted laboratory tests first and only the individuals who

were found to be malaria carriers were administered chloroquine.

Another example of how the DoD approached malaria

treatment differently for other subjects is in the case of Army

Rangers who returned from malarial areas of Afghanistan between

June and September 2002 and were infected with the disease at an

attack rate of 52.4 cases per 1,000 soldiers.

However, the Rangers did not receive mass presumptive treatment of

mefloquine. They were given other standard drugs after laboratory

tests, according to documents obtained by Truthout.

Nevin said the DoD's treatment of Haitian

refugees represented "a situation that arguably presented a much

higher risk of disease and secondary transmission, but one which

US medical experts stated at the time could be safely managed

through more conservative and focused measures."

Why did the government use the "conservative and

focused" approach in treating Haitian refugees and the Army

rangers, but then revert to presumptive mefloquine treatment in

the case of the Guantanamo detainees, who - a month after the

prison facility opened in January 2002 - were stripped of their

protections under the Geneva Conventions?

According to Camoni, a Seton Hall University

law school research fellow, "there is no legitimate medical

purpose for treating malaria in this way" and the drug's severe

side effects may actually have been the DoD's intended impact in

calling for the drug's usage.

Camoni and several other Seton Hall law school students have been

working on a report about mefloquine use on Guantanamo detainees.

Their work was conducted independently of Truthout's

investigation.

A copy of the Seton Hall report, "Drug Abuse? An Exploration of the Government's

Use of Mefloquine at Guantanamo," says mefloquine's extreme

side effects may have violated a provision in the antitorture statute related to the use of

"mind altering substances or other procedures" that "profoundly

disrupts the senses or the personality."

Legal memos prepared in August 2002 by former DoD

attorneys Jay Bybee and Yoo for the CIA's torture program

permitted the use of drugs for interrogations. The authority was

also contained in a legal memo Yoo prepared for the DoD less than

a year later after Secretary of Defense Rumsfeld convened a

working group to address "policy

considerations with respect to the choice of interrogation

techniques."

In September, Truthout

reported that the DoD's inspector general (IG) conducted an

investigation into allegations that detainees in custody of the US

military were drugged. The IG's report, which remains classified,

was completed a year ago and was shared with the Senate Armed

Services Committee.

Kathleen Long, a spokeswoman for the Armed Services Committee,

told Truthout at the time that the IG report did not substantiate

allegations of drugging of prisoners for the "purposes of

interrogation."

The medical files for detainee 693 released in

2008 shows that, two weeks after he first started taking

mefloquine in June 2002, he was interviewed by Guantanamo medical

personnel and reported he was suffering from nightmares,

hallucinations, anxiety auditory and visual hallucinations,

anxiety, sleep loss and suicidal thoughts.

The detainee said he had previously been treated

for anxiety and had a family history of mental illness. He was

diagnosed with adjustment disorder, according to the DoD

documents. Guantanamo medical staff who interviewed the detainee

did not state that he may have been experiencing

mefloquine-related side effects in an evaluation of his condition.

Mark Denbeaux, the director of the Seton

Hall Law Center for Policy and Research, who conducted an

independent investigation into the 2006 deaths of the three

Guantanamo detainees, said in an interview "almost every remaining

question here would be solved if the [detainees'] full medical

records were released."

The government has refused to release Guantanamo

detainees' medical records, citing privacy concerns in some cases,

and assertions that they are "protected" or "classified" in other

instances. The few medical records that have been released have

been heavily redacted.

"A crucial issue is dosage" Denbeaux said.

"Giving detainees toxic doses of mefloquine has mind-altering

consequences that may be permanent. Without access to medical

records, which the government refuses to release, the use of

mefloquine in this manner appears to be grotesque malpractice at

best, if not human experimentation or 'enhanced interrogation.'

The question is where are the doctors who approved this practice

and where are the medical records?"

Bradsher did not respond to questions about

whether the government kept data about the adverse effects

mefloquine had on detainees.

An absolute prohibition against experiments on

prisoners of war is contained in the Geneva Conventions, but

President W. Bush stripped war on terror detainees of those

protections. Some of the "enhanced interrogation techniques" also

had an experimental quality.

At the same time detainees were given high doses of mefloquine,

Deputy Secretary of Defense Wolfowitz issued a directive changing the rules on human

subject protections for DoD experiments, allowing for a waiver of

informed consent when necessary for developing a "medical product"

for the armed services. Bush also granted unprecedented authority

to the secretary of Health and Human Services to classify

information as secret.

Briefings on Side Effects

As the DoD was administering mefloquine to

Guantanamo prisoners, senior Pentagon officials were being briefed about the drug's dangerous side

effects. During one such briefing, questions arose about what

steps the military was taking to address malaria concerns among

detainees sent to Guantanamo.

Internal

documents from Roche, obtained by UPI in 2002, indicated

that the pharmaceutical company had been tracking suicidal

reactions to Lariam going back to the early 1990s.

In September 2002, Roche sent a letter to

physicians and pharmacists stating that the company changed its warning

labels for mefloquine.

Roche further said in one of two new warning

paragraphs that some of the symptoms associated with mefloquine

use included suicidal thoughts and suicide and also "may cause

psychiatric symptoms in a number of patients, ranging from

anxiety, paranoia, and depression to hallucination and psychotic

behavior," which "have been reported to continue long after

mefloquine has been stopped."

Military Struggles

Cmdr. Manofsky, who is retired from the

US Navy and currently on disability due to post-traumatic stress

disorder and side effects from mefloquine, said those are some of

the symptoms he initially suffered from after taking the drug for

several months beginning in November 2002 after he was deployed to

the Middle East to work on two Naval projects.

In March 2003, "I became violently ill during a

night live-fire exercise with the [Navy] SEALS," Manofsky said. "I

felt like I was air sick. All the flashing lights from the tracers

and rockets ... targeting device made me really sick. I threw up

for an hour straight before being medevac'd back to the Special

Forces compound where I had my first ever panic attack."

For three years, he had to walk with a cane due

to a loss of equilibrium. Numerous other accounts like Manofsky's

can be found on the web site lariaminfo.org.

In 2008, Dr. Nevin published a study detailing a

high prevalence of mental health contraindications to the safe use

of mefloquine in soldiers deployed to Afghanistan. Responding in

part to concerns raised by the mefloquine-associated suicide of Army Spc. , internal

Army presentations confirmed that the drug had been widely

misprescribed to soldiers with contraindications, including to

many on antidepressants.

A formal policy memo in February 2009 from Army

Surgeon General Schoomaker removed mefloquine as a

"first-line" agent, and changed the policy so that mefloquine

would not be prescribed to Army personnel unless they had

contraindications to the preferred drug, the antibiotic

doxycycline. Nor could mefloquine be prescribed to any personnel

with a history of traumatic brain injury or mental

illness.

By September 2009, the policy was extended

throughout the DoD.

New prisoners are no longer arriving at

Guantanamo and the prison population has been in decline in recent

years as detainees are released or transferred to other countries.

Currently, the detainee population at Guantanamo is a reported

174.

But Nevin said the justification the Pentagon

offered for using mefloquine to presumptively treat detainees

transferred to the prison beginning in 2002 "betrays a profound

ignorance of basic principals of tropical medicine and suggests

extremely poor, and arguably incompetent, medical oversight that

demands further investigation."

This work by Truthout is licensed under a Creative Commons Attribution-Noncommercial 3.0

United States License.

[Guest guest]

mefloquine is Lariam

\http://www.truth-out.org/controversial-drug-given-all-guantanamo-detainees-amounted-pharmacologic-waterboarding6558

EXCLUSIVE: Controversial Drug Given to All

Guantanamo Detainees Akin to "Pharmacologic Waterboarding"

Wednesday 01

December 2010

by: Leopold and Kaye, t r u t h o u t

| Investigative Report

The Defense Department forced all "war on terror" detainees at the

Guantanamo Bay prison to take a high dosage of a controversial

antimalarial drug, mefloquine, an act that an Army public health

physician called "pharmacologic waterboarding."

The US military administered the drug despite Pentagon knowledge

that mefloquine caused severe neuropsychiatric side effects,

including suicidal thoughts, hallucinations and anxiety. The drug

was used on the prisoners whether they had malaria or not.

The revelation, which has not been previously

reported, was buried in documents

publicly released by the Defense Department (DoD) two years ago as

part of the government's investigation into the June 2006 deaths

of three Guantanamo detainees.

Army Staff Sgt. Joe Hickman, who was stationed at

Guantanamo at the time of the suicides in 2006, and has presented

evidence that demonstrates the three detainees could not have died

by hanging themselves, noticed in the detainees' medical files

that they were given mefloquine. Hickman has been investigating

the circumstances behind the detainees' deaths for nearly four

years.

Interviews conducted over the past two months

with tropical disease experts and a review of Defense Department

documents and peer-reviewed journals show there were no

preexisting cases where mefloquine was ever prescribed for mass

presumptive treatment of malaria.

All detainees arriving at Guantanamo in January

2002 were first given a treatment dosage of 1,250 mg of

mefloquine, before laboratory tests were conducted to determine if

they actually had the disease, according to a section of the DoD

documents entitled "Standard Inprocessing Orders For Detainees."

The 1,250 mg dosage is what would be given if the detainees

actually had malaria. That dosage is five times higher than the

prophylactic dose given to individauls to prevent the disease.

Maj. Remington Nevin, an Army public health

physician, who formerly worked at the Armed Forces Health

Surveillance Center and has written extensively about mefloquine, said

in an interview the use of mefloquine "in this manner ... is, at

best, an egregious malpractice."

The government has exposed detainees "to

unacceptably high risks of potentially severe neuropsychiatric

side effects, including seizures, intense vertigo, hallucinations,

paranoid delusions, aggression, panic, anxiety, severe insomnia,

and thoughts of suicide," said Nevin, who was not speaking in an

official capacity, but offering opinions as a board-certified,

preventive medicine physician. "These side effects could be as

severe as those intended through the application of 'enhanced

interrogation techniques.'"

Mefloquine is also known by its brand name

Lariam. It was researched by the US Army in the 1970s and licensed

by the Food and Drug Administration in 1989. Since its

introduction, it has been directly linked to serious adverse effects, including

depression, anxiety, panic attacks, confusion, hallucinations,

bizarre dreams, nausea, vomiting, sores and homicidal and suicidal

thoughts. It belongs to a class of drugs known as quinolines,

which were part of a 1956 human experiment study to investigate

"toxic cerebral states," as part of the CIA's MKULTRA mind-control

program.

The Army tapped the Walter Army Institute of

Research (WRAIR) to develop mefloquine and it was later licensed

to the Swiss pharmaceutical company F. Hoffman-La Roche. The first

human trials of mefloquine were conducted in the mid-1970s on

prisoners, who were deliberately inoculated with malaria at

Stateville Correctional prison near Joliet, Illinois, the site of

controversial antimalarial experimentation in the early

1940s.

The drug was administered to Guantanamo detainees

without regard for their medical or psychological history, despite

its considerable risk of exacerbating pre-existing conditions.

Mefloquine is also known to have serious side effects among

individuals under treatment for depression or other serious mental

health disorders, which numerous detainees were said to have been

treated for, according to their attorneys and published

reports.

Dr. G. Olds, a tropical disease

specialist and the founding dean of the Medical School at the

University of California at Riverside, said,

in his "professional opinion there is no medical justification for

giving a massive dose of mefloquine to an asymptomatic

individual."

"I also do not see the medical benefit of

treating a person in Cuba with a prophylactic dose of mefloquine,”

Olds said. Mefloquine is "a fat soluble, and as a result, it does

build up in the body and has a very long half-life.This is

important since a massive dose of this drug is not easily

corrected and the ‘side effects’ of the medication could last for

weeks or months."

In 2002, when the prison was established and

mefloquine first administered, there were dozens of suicide

attempts at Guantanamo. That same year, the DoD stopped reporting

attempted suicides.

By February 2002, there were at least 459

detainees imprisoned at Guantanamo. In March of that year,

according to the book "Saving Grace at Guantanamo Bay: A Memoir of a

Citizen Warrior" by Montgomery Granger, "the situation" at

the prison began "deteriorating rapidly."

"There is more and more psychosis becoming

evident in detainees ...," wrote Granger, an Army Reserve major

and medic who was stationed at Guantanamo in 2002. "We already

have probably a dozen or so detainees who are psychiatric cases.

The number is growing."

"Presumptively Treating" Malaria

Though malaria is nonexistent in Cuba, DoD

spokeswoman Maj. Bradsher told Truthout that the US

government was concerned that the disease would be reintroduced

into the country as detainees were transferred to the prison

facility in January 2002.

A "decision was made," Bradsher said in an email,

to "presumptively treat each arriving Guantanamo detainee for

malaria to prevent the possibility of having mosquito-borne [sic]

spread from an infected individual to uninfected individuals in

the Guantanamo population, the guard force, the population at the

Naval base or the broader Cuban population."

But Granger wrote in his book that a Navy

entomologist was present at Guantanamo in January and February

2002 and during that time only identified insects that were

nuisances and did not identify any insects that were carriers of a

disease, such as malaria.

Nevertheless, Bradsher said the "mefloquine

dosage [given to detainees] was entirely for public health

purposes ... and not for any other purpose" and "is completely

appropriate."

"The risks and benefits to the health of the

detainees were central considerations," she added.

A September 13, 2002, DoD

memo governing the operational use of mefloquine said,

"Malaria is not a threat in Guantanamo Bay." Indeed, there have

only been two to three reported cases of malaria at

Guantanamo.

The DoD memo, signed by Assistant Secretary of

Defense for Health Affairs Winkenwerder, was sent to

then-Rep. McHugh, the Republican chairman of the House

Veterans Affairs Subcommittee on Military Personnel. McHugh is now

Secretary of the Army.

A Senate staff member told Truthout the Senate

Armed Services Committee was never briefed about malaria concerns

at Guantanamo nor was the committee made aware of "any issue

related to the use of mefloquine or any other anti-malarial drug"

related to "the treatment of detainees."

When questions were raised at a February 19, 2002 meeting of the Armed

Forces Epidemiological Board (AFEB) about what measures the

military was taking to address malaria concerns at Guantanamo,

Navy Capt. Alan J. Lund did not disclose that mefloquine was being

administered to detainees as a form of presumptive treatment.

Yund said the military gave detainees a different

anti-malarial drug known as primaquine and noted that "informed

consent" was "absolutely practiced" prior to administering drugs

to detainees, an assertion that contradicts claims made by

numerous prisoners who said they were forced to take drugs even if

they protested. Yund did not return calls for comment.

Bradsher declined to respond to a follow-up

question about who made the decision to presumptively treat

detainees with mefloquine.

An April 16, 2002, meeting of the Interagency

Working Group for Antimalarial Chemotherapy, which DoD, along with

other federal government agencies, is a part of, was specifically

dedicated to investigating mefloquine's use and the drug's side

effects. The group concluded that study designs on mefloquine up

to that point were flawed or biased and criticized DoD medical

policy for disregarding scientific fact and basing itself more on

"sensational or best marketed information."

The Working Group called for additional research,

and warned, "other treatment regimes should be carefully

considered before mefloquine is used at the doses required for

treatment."

Still, despite the red flags that pointed to

mefloquine as a high-risk drug, the DoD's mefloquine program

proceeded.

In fact, a June 2004 set of guidelines issued by

the Centers for Disease Control and Prevention

(CDC) says mefloquine should only be used when other standard

drugs were not available, as it "is associated with a higher rate

of severe neuropsychiatric reactions when used at treatment

doses."

According to the CDC, "'presumptive treatment'

without the benefit of laboratory confirmation should be reserved

for extreme circumstances (strong clinical suspicion, severe

disease, impossibility of obtaining prompt laboratory

confirmation)."

A CDC spokesman refused to comment about the

"presumptive treatment" of malaria at Guantanamo and referred

questions to the DoD.

Nevin said, if "mass presumptive treatment has

been given consistently, many dozens of detainees, possibly

hundreds, would almost certainly have suffered such disabling

adverse events."

"It appears that for years, senior Defense health

leaders have condoned the medically indefensible practice of using

high doses of mefloquine ostensibly for mass presumptive treatment

of malaria among detainees from the Middle East and Asia lacking

any evidence of disease," Nevin said. "This is a use for which

there is no precedent in the medical literature and which is

specifically discouraged among refugees by malaria experts at the

Centers for Disease Control."

Even proponents of limited mefloquine usage are

seriously questioning the logic behind the DoD's actions.

Professor McCarthy, chair of the Infectious Diseases

Division of the Queensland Institute of Medicine in Australia, who

is an advocate of the safe use of mefloquine under proper

safeguards, and takes it himself when traveling, told Truthout he

was unaware of the use of mefloquine for mass presumptive

treatment as described by the DoD, but could imagine it under

certain circumstances.

However, when informed that lab tests were

available and the detainees were screened for the blood product

G6PD, used to determine the suitability of certain antimalarial

drugs, McCarthy found the DoD's use of mefloquine at Guantanamo

difficult to understand and "hard to support on pure clinical

grounds as an antimalarial."

Treatment, Torture or an Experiment?

Another striking point about the DoD's decision

to presumptively treat mostly Muslim detainees with mefloquine

beginning in 2002 is that it is the exact opposite of how the DoD

responded to malaria concerns among the Haitian refugees who were

held at Guantanamo a decade earlier.

Between 1991 and 1992, more than 14,000 Haitian

refugees were held in temporary camps set up at Guantanamo. A

large number of Haitian refugees - 235 during a four-month period

- were diagnosed with malaria. But instead of

presumptively treating the refugee population at Guantanamo, the

DoD conducted laboratory tests first and only the individuals who

were found to be malaria carriers were administered chloroquine.

Another example of how the DoD approached malaria

treatment differently for other subjects is in the case of Army

Rangers who returned from malarial areas of Afghanistan between

June and September 2002 and were infected with the disease at an

attack rate of 52.4 cases per 1,000 soldiers.

However, the Rangers did not receive mass presumptive treatment of

mefloquine. They were given other standard drugs after laboratory

tests, according to documents obtained by Truthout.

Nevin said the DoD's treatment of Haitian

refugees represented "a situation that arguably presented a much

higher risk of disease and secondary transmission, but one which

US medical experts stated at the time could be safely managed

through more conservative and focused measures."

Why did the government use the "conservative and

focused" approach in treating Haitian refugees and the Army

rangers, but then revert to presumptive mefloquine treatment in

the case of the Guantanamo detainees, who - a month after the

prison facility opened in January 2002 - were stripped of their

protections under the Geneva Conventions?

According to Camoni, a Seton Hall University

law school research fellow, "there is no legitimate medical

purpose for treating malaria in this way" and the drug's severe

side effects may actually have been the DoD's intended impact in

calling for the drug's usage.

Camoni and several other Seton Hall law school students have been

working on a report about mefloquine use on Guantanamo detainees.

Their work was conducted independently of Truthout's

investigation.

A copy of the Seton Hall report, "Drug Abuse? An Exploration of the Government's

Use of Mefloquine at Guantanamo," says mefloquine's extreme

side effects may have violated a provision in the antitorture statute related to the use of

"mind altering substances or other procedures" that "profoundly

disrupts the senses or the personality."

Legal memos prepared in August 2002 by former DoD

attorneys Jay Bybee and Yoo for the CIA's torture program

permitted the use of drugs for interrogations. The authority was

also contained in a legal memo Yoo prepared for the DoD less than

a year later after Secretary of Defense Rumsfeld convened a

working group to address "policy

considerations with respect to the choice of interrogation

techniques."

In September, Truthout

reported that the DoD's inspector general (IG) conducted an

investigation into allegations that detainees in custody of the US

military were drugged. The IG's report, which remains classified,

was completed a year ago and was shared with the Senate Armed

Services Committee.

Kathleen Long, a spokeswoman for the Armed Services Committee,

told Truthout at the time that the IG report did not substantiate

allegations of drugging of prisoners for the "purposes of

interrogation."

The medical files for detainee 693 released in

2008 shows that, two weeks after he first started taking

mefloquine in June 2002, he was interviewed by Guantanamo medical

personnel and reported he was suffering from nightmares,

hallucinations, anxiety auditory and visual hallucinations,

anxiety, sleep loss and suicidal thoughts.

The detainee said he had previously been treated

for anxiety and had a family history of mental illness. He was

diagnosed with adjustment disorder, according to the DoD

documents. Guantanamo medical staff who interviewed the detainee

did not state that he may have been experiencing

mefloquine-related side effects in an evaluation of his condition.

Mark Denbeaux, the director of the Seton

Hall Law Center for Policy and Research, who conducted an

independent investigation into the 2006 deaths of the three

Guantanamo detainees, said in an interview "almost every remaining

question here would be solved if the [detainees'] full medical

records were released."

The government has refused to release Guantanamo

detainees' medical records, citing privacy concerns in some cases,

and assertions that they are "protected" or "classified" in other

instances. The few medical records that have been released have

been heavily redacted.

"A crucial issue is dosage" Denbeaux said.

"Giving detainees toxic doses of mefloquine has mind-altering

consequences that may be permanent. Without access to medical

records, which the government refuses to release, the use of

mefloquine in this manner appears to be grotesque malpractice at

best, if not human experimentation or 'enhanced interrogation.'

The question is where are the doctors who approved this practice

and where are the medical records?"

Bradsher did not respond to questions about

whether the government kept data about the adverse effects

mefloquine had on detainees.

An absolute prohibition against experiments on

prisoners of war is contained in the Geneva Conventions, but

President W. Bush stripped war on terror detainees of those

protections. Some of the "enhanced interrogation techniques" also

had an experimental quality.

At the same time detainees were given high doses of mefloquine,

Deputy Secretary of Defense Wolfowitz issued a directive changing the rules on human

subject protections for DoD experiments, allowing for a waiver of

informed consent when necessary for developing a "medical product"

for the armed services. Bush also granted unprecedented authority

to the secretary of Health and Human Services to classify

information as secret.

Briefings on Side Effects

As the DoD was administering mefloquine to

Guantanamo prisoners, senior Pentagon officials were being briefed about the drug's dangerous side

effects. During one such briefing, questions arose about what

steps the military was taking to address malaria concerns among

detainees sent to Guantanamo.

Internal

documents from Roche, obtained by UPI in 2002, indicated

that the pharmaceutical company had been tracking suicidal

reactions to Lariam going back to the early 1990s.

In September 2002, Roche sent a letter to

physicians and pharmacists stating that the company changed its warning

labels for mefloquine.

Roche further said in one of two new warning

paragraphs that some of the symptoms associated with mefloquine

use included suicidal thoughts and suicide and also "may cause

psychiatric symptoms in a number of patients, ranging from

anxiety, paranoia, and depression to hallucination and psychotic

behavior," which "have been reported to continue long after

mefloquine has been stopped."

Military Struggles

Cmdr. Manofsky, who is retired from the

US Navy and currently on disability due to post-traumatic stress

disorder and side effects from mefloquine, said those are some of

the symptoms he initially suffered from after taking the drug for

several months beginning in November 2002 after he was deployed to

the Middle East to work on two Naval projects.

In March 2003, "I became violently ill during a

night live-fire exercise with the [Navy] SEALS," Manofsky said. "I

felt like I was air sick. All the flashing lights from the tracers

and rockets ... targeting device made me really sick. I threw up

for an hour straight before being medevac'd back to the Special

Forces compound where I had my first ever panic attack."

For three years, he had to walk with a cane due

to a loss of equilibrium. Numerous other accounts like Manofsky's

can be found on the web site lariaminfo.org.

In 2008, Dr. Nevin published a study detailing a

high prevalence of mental health contraindications to the safe use

of mefloquine in soldiers deployed to Afghanistan. Responding in

part to concerns raised by the mefloquine-associated suicide of Army Spc. , internal

Army presentations confirmed that the drug had been widely

misprescribed to soldiers with contraindications, including to

many on antidepressants.

A formal policy memo in February 2009 from Army

Surgeon General Schoomaker removed mefloquine as a

"first-line" agent, and changed the policy so that mefloquine

would not be prescribed to Army personnel unless they had

contraindications to the preferred drug, the antibiotic

doxycycline. Nor could mefloquine be prescribed to any personnel

with a history of traumatic brain injury or mental

illness.

By September 2009, the policy was extended

throughout the DoD.

New prisoners are no longer arriving at

Guantanamo and the prison population has been in decline in recent

years as detainees are released or transferred to other countries.

Currently, the detainee population at Guantanamo is a reported

174.

But Nevin said the justification the Pentagon

offered for using mefloquine to presumptively treat detainees

transferred to the prison beginning in 2002 "betrays a profound

ignorance of basic principals of tropical medicine and suggests

extremely poor, and arguably incompetent, medical oversight that

demands further investigation."

This work by Truthout is licensed under a Creative Commons Attribution-Noncommercial 3.0

United States License.

[Guest guest]

mefloquine is Lariam

\http://www.truth-out.org/controversial-drug-given-all-guantanamo-detainees-amounted-pharmacologic-waterboarding6558

EXCLUSIVE: Controversial Drug Given to All

Guantanamo Detainees Akin to "Pharmacologic Waterboarding"

Wednesday 01

December 2010

by: Leopold and Kaye, t r u t h o u t

| Investigative Report

The Defense Department forced all "war on terror" detainees at the

Guantanamo Bay prison to take a high dosage of a controversial

antimalarial drug, mefloquine, an act that an Army public health

physician called "pharmacologic waterboarding."

The US military administered the drug despite Pentagon knowledge

that mefloquine caused severe neuropsychiatric side effects,

including suicidal thoughts, hallucinations and anxiety. The drug

was used on the prisoners whether they had malaria or not.

The revelation, which has not been previously

reported, was buried in documents

publicly released by the Defense Department (DoD) two years ago as

part of the government's investigation into the June 2006 deaths

of three Guantanamo detainees.

Army Staff Sgt. Joe Hickman, who was stationed at

Guantanamo at the time of the suicides in 2006, and has presented

evidence that demonstrates the three detainees could not have died

by hanging themselves, noticed in the detainees' medical files

that they were given mefloquine. Hickman has been investigating

the circumstances behind the detainees' deaths for nearly four

years.

Interviews conducted over the past two months

with tropical disease experts and a review of Defense Department

documents and peer-reviewed journals show there were no

preexisting cases where mefloquine was ever prescribed for mass

presumptive treatment of malaria.

All detainees arriving at Guantanamo in January

2002 were first given a treatment dosage of 1,250 mg of

mefloquine, before laboratory tests were conducted to determine if

they actually had the disease, according to a section of the DoD

documents entitled "Standard Inprocessing Orders For Detainees."

The 1,250 mg dosage is what would be given if the detainees

actually had malaria. That dosage is five times higher than the

prophylactic dose given to individauls to prevent the disease.

Maj. Remington Nevin, an Army public health

physician, who formerly worked at the Armed Forces Health

Surveillance Center and has written extensively about mefloquine, said

in an interview the use of mefloquine "in this manner ... is, at

best, an egregious malpractice."

The government has exposed detainees "to

unacceptably high risks of potentially severe neuropsychiatric

side effects, including seizures, intense vertigo, hallucinations,

paranoid delusions, aggression, panic, anxiety, severe insomnia,

and thoughts of suicide," said Nevin, who was not speaking in an

official capacity, but offering opinions as a board-certified,

preventive medicine physician. "These side effects could be as

severe as those intended through the application of 'enhanced

interrogation techniques.'"

Mefloquine is also known by its brand name

Lariam. It was researched by the US Army in the 1970s and licensed

by the Food and Drug Administration in 1989. Since its

introduction, it has been directly linked to serious adverse effects, including

depression, anxiety, panic attacks, confusion, hallucinations,

bizarre dreams, nausea, vomiting, sores and homicidal and suicidal

thoughts. It belongs to a class of drugs known as quinolines,

which were part of a 1956 human experiment study to investigate

"toxic cerebral states," as part of the CIA's MKULTRA mind-control

program.

The Army tapped the Walter Army Institute of

Research (WRAIR) to develop mefloquine and it was later licensed

to the Swiss pharmaceutical company F. Hoffman-La Roche. The first

human trials of mefloquine were conducted in the mid-1970s on

prisoners, who were deliberately inoculated with malaria at

Stateville Correctional prison near Joliet, Illinois, the site of

controversial antimalarial experimentation in the early

1940s.

The drug was administered to Guantanamo detainees

without regard for their medical or psychological history, despite

its considerable risk of exacerbating pre-existing conditions.

Mefloquine is also known to have serious side effects among

individuals under treatment for depression or other serious mental

health disorders, which numerous detainees were said to have been

treated for, according to their attorneys and published

reports.

Dr. G. Olds, a tropical disease

specialist and the founding dean of the Medical School at the

University of California at Riverside, said,

in his "professional opinion there is no medical justification for

giving a massive dose of mefloquine to an asymptomatic

individual."

"I also do not see the medical benefit of

treating a person in Cuba with a prophylactic dose of mefloquine,”

Olds said. Mefloquine is "a fat soluble, and as a result, it does

build up in the body and has a very long half-life.This is

important since a massive dose of this drug is not easily

corrected and the ‘side effects’ of the medication could last for

weeks or months."

In 2002, when the prison was established and

mefloquine first administered, there were dozens of suicide

attempts at Guantanamo. That same year, the DoD stopped reporting

attempted suicides.

By February 2002, there were at least 459

detainees imprisoned at Guantanamo. In March of that year,

according to the book "Saving Grace at Guantanamo Bay: A Memoir of a

Citizen Warrior" by Montgomery Granger, "the situation" at

the prison began "deteriorating rapidly."

"There is more and more psychosis becoming

evident in detainees ...," wrote Granger, an Army Reserve major

and medic who was stationed at Guantanamo in 2002. "We already

have probably a dozen or so detainees who are psychiatric cases.

The number is growing."

"Presumptively Treating" Malaria

Though malaria is nonexistent in Cuba, DoD

spokeswoman Maj. Bradsher told Truthout that the US

government was concerned that the disease would be reintroduced

into the country as detainees were transferred to the prison

facility in January 2002.

A "decision was made," Bradsher said in an email,

to "presumptively treat each arriving Guantanamo detainee for

malaria to prevent the possibility of having mosquito-borne [sic]

spread from an infected individual to uninfected individuals in

the Guantanamo population, the guard force, the population at the

Naval base or the broader Cuban population."

But Granger wrote in his book that a Navy

entomologist was present at Guantanamo in January and February

2002 and during that time only identified insects that were

nuisances and did not identify any insects that were carriers of a

disease, such as malaria.

Nevertheless, Bradsher said the "mefloquine

dosage [given to detainees] was entirely for public health

purposes ... and not for any other purpose" and "is completely

appropriate."

"The risks and benefits to the health of the

detainees were central considerations," she added.

A September 13, 2002, DoD

memo governing the operational use of mefloquine said,

"Malaria is not a threat in Guantanamo Bay." Indeed, there have

only been two to three reported cases of malaria at

Guantanamo.

The DoD memo, signed by Assistant Secretary of

Defense for Health Affairs Winkenwerder, was sent to

then-Rep. McHugh, the Republican chairman of the House

Veterans Affairs Subcommittee on Military Personnel. McHugh is now

Secretary of the Army.

A Senate staff member told Truthout the Senate

Armed Services Committee was never briefed about malaria concerns

at Guantanamo nor was the committee made aware of "any issue

related to the use of mefloquine or any other anti-malarial drug"

related to "the treatment of detainees."

When questions were raised at a February 19, 2002 meeting of the Armed

Forces Epidemiological Board (AFEB) about what measures the

military was taking to address malaria concerns at Guantanamo,

Navy Capt. Alan J. Lund did not disclose that mefloquine was being

administered to detainees as a form of presumptive treatment.

Yund said the military gave detainees a different

anti-malarial drug known as primaquine and noted that "informed

consent" was "absolutely practiced" prior to administering drugs

to detainees, an assertion that contradicts claims made by

numerous prisoners who said they were forced to take drugs even if

they protested. Yund did not return calls for comment.

Bradsher declined to respond to a follow-up

question about who made the decision to presumptively treat

detainees with mefloquine.

An April 16, 2002, meeting of the Interagency

Working Group for Antimalarial Chemotherapy, which DoD, along with

other federal government agencies, is a part of, was specifically

dedicated to investigating mefloquine's use and the drug's side

effects. The group concluded that study designs on mefloquine up

to that point were flawed or biased and criticized DoD medical

policy for disregarding scientific fact and basing itself more on

"sensational or best marketed information."

The Working Group called for additional research,

and warned, "other treatment regimes should be carefully

considered before mefloquine is used at the doses required for

treatment."

Still, despite the red flags that pointed to

mefloquine as a high-risk drug, the DoD's mefloquine program

proceeded.

In fact, a June 2004 set of guidelines issued by

the Centers for Disease Control and Prevention

(CDC) says mefloquine should only be used when other standard

drugs were not available, as it "is associated with a higher rate

of severe neuropsychiatric reactions when used at treatment

doses."

According to the CDC, "'presumptive treatment'

without the benefit of laboratory confirmation should be reserved

for extreme circumstances (strong clinical suspicion, severe

disease, impossibility of obtaining prompt laboratory

confirmation)."

A CDC spokesman refused to comment about the

"presumptive treatment" of malaria at Guantanamo and referred

questions to the DoD.

Nevin said, if "mass presumptive treatment has

been given consistently, many dozens of detainees, possibly

hundreds, would almost certainly have suffered such disabling

adverse events."

"It appears that for years, senior Defense health

leaders have condoned the medically indefensible practice of using

high doses of mefloquine ostensibly for mass presumptive treatment

of malaria among detainees from the Middle East and Asia lacking

any evidence of disease," Nevin said. "This is a use for which

there is no precedent in the medical literature and which is

specifically discouraged among refugees by malaria experts at the

Centers for Disease Control."

Even proponents of limited mefloquine usage are

seriously questioning the logic behind the DoD's actions.

Professor McCarthy, chair of the Infectious Diseases

Division of the Queensland Institute of Medicine in Australia, who

is an advocate of the safe use of mefloquine under proper

safeguards, and takes it himself when traveling, told Truthout he

was unaware of the use of mefloquine for mass presumptive

treatment as described by the DoD, but could imagine it under

certain circumstances.

However, when informed that lab tests were

available and the detainees were screened for the blood product

G6PD, used to determine the suitability of certain antimalarial

drugs, McCarthy found the DoD's use of mefloquine at Guantanamo

difficult to understand and "hard to support on pure clinical

grounds as an antimalarial."

Treatment, Torture or an Experiment?

Another striking point about the DoD's decision

to presumptively treat mostly Muslim detainees with mefloquine

beginning in 2002 is that it is the exact opposite of how the DoD

responded to malaria concerns among the Haitian refugees who were

held at Guantanamo a decade earlier.

Between 1991 and 1992, more than 14,000 Haitian

refugees were held in temporary camps set up at Guantanamo. A

large number of Haitian refugees - 235 during a four-month period

- were diagnosed with malaria. But instead of

presumptively treating the refugee population at Guantanamo, the

DoD conducted laboratory tests first and only the individuals who

were found to be malaria carriers were administered chloroquine.

Another example of how the DoD approached malaria

treatment differently for other subjects is in the case of Army

Rangers who returned from malarial areas of Afghanistan between

June and September 2002 and were infected with the disease at an

attack rate of 52.4 cases per 1,000 soldiers.

However, the Rangers did not receive mass presumptive treatment of

mefloquine. They were given other standard drugs after laboratory

tests, according to documents obtained by Truthout.

Nevin said the DoD's treatment of Haitian

refugees represented "a situation that arguably presented a much

higher risk of disease and secondary transmission, but one which

US medical experts stated at the time could be safely managed

through more conservative and focused measures."

Why did the government use the "conservative and

focused" approach in treating Haitian refugees and the Army

rangers, but then revert to presumptive mefloquine treatment in

the case of the Guantanamo detainees, who - a month after the

prison facility opened in January 2002 - were stripped of their

protections under the Geneva Conventions?

According to Camoni, a Seton Hall University

law school research fellow, "there is no legitimate medical

purpose for treating malaria in this way" and the drug's severe

side effects may actually have been the DoD's intended impact in

calling for the drug's usage.

Camoni and several other Seton Hall law school students have been

working on a report about mefloquine use on Guantanamo detainees.

Their work was conducted independently of Truthout's

investigation.

A copy of the Seton Hall report, "Drug Abuse? An Exploration of the Government's

Use of Mefloquine at Guantanamo," says mefloquine's extreme

side effects may have violated a provision in the antitorture statute related to the use of

"mind altering substances or other procedures" that "profoundly

disrupts the senses or the personality."

Legal memos prepared in August 2002 by former DoD

attorneys Jay Bybee and Yoo for the CIA's torture program

permitted the use of drugs for interrogations. The authority was

also contained in a legal memo Yoo prepared for the DoD less than

a year later after Secretary of Defense Rumsfeld convened a

working group to address "policy

considerations with respect to the choice of interrogation

techniques."

In September, Truthout

reported that the DoD's inspector general (IG) conducted an

investigation into allegations that detainees in custody of the US

military were drugged. The IG's report, which remains classified,

was completed a year ago and was shared with the Senate Armed

Services Committee.

Kathleen Long, a spokeswoman for the Armed Services Committee,

told Truthout at the time that the IG report did not substantiate

allegations of drugging of prisoners for the "purposes of

interrogation."

The medical files for detainee 693 released in

2008 shows that, two weeks after he first started taking

mefloquine in June 2002, he was interviewed by Guantanamo medical

personnel and reported he was suffering from nightmares,

hallucinations, anxiety auditory and visual hallucinations,

anxiety, sleep loss and suicidal thoughts.

The detainee said he had previously been treated

for anxiety and had a family history of mental illness. He was

diagnosed with adjustment disorder, according to the DoD

documents. Guantanamo medical staff who interviewed the detainee

did not state that he may have been experiencing

mefloquine-related side effects in an evaluation of his condition.

Mark Denbeaux, the director of the Seton

Hall Law Center for Policy and Research, who conducted an

independent investigation into the 2006 deaths of the three

Guantanamo detainees, said in an interview "almost every remaining

question here would be solved if the [detainees'] full medical

records were released."

The government has refused to release Guantanamo

detainees' medical records, citing privacy concerns in some cases,

and assertions that they are "protected" or "classified" in other

instances. The few medical records that have been released have

been heavily redacted.

"A crucial issue is dosage" Denbeaux said.

"Giving detainees toxic doses of mefloquine has mind-altering

consequences that may be permanent. Without access to medical

records, which the government refuses to release, the use of

mefloquine in this manner appears to be grotesque malpractice at

best, if not human experimentation or 'enhanced interrogation.'

The question is where are the doctors who approved this practice

and where are the medical records?"

Bradsher did not respond to questions about

whether the government kept data about the adverse effects

mefloquine had on detainees.

An absolute prohibition against experiments on

prisoners of war is contained in the Geneva Conventions, but

President W. Bush stripped war on terror detainees of those

protections. Some of the "enhanced interrogation techniques" also

had an experimental quality.

At the same time detainees were given high doses of mefloquine,

Deputy Secretary of Defense Wolfowitz issued a directive changing the rules on human

subject protections for DoD experiments, allowing for a waiver of

informed consent when necessary for developing a "medical product"

for the armed services. Bush also granted unprecedented authority

to the secretary of Health and Human Services to classify

information as secret.

Briefings on Side Effects

As the DoD was administering mefloquine to

Guantanamo prisoners, senior Pentagon officials were being briefed about the drug's dangerous side

effects. During one such briefing, questions arose about what

steps the military was taking to address malaria concerns among

detainees sent to Guantanamo.

Internal

documents from Roche, obtained by UPI in 2002, indicated

that the pharmaceutical company had been tracking suicidal

reactions to Lariam going back to the early 1990s.

In September 2002, Roche sent a letter to

physicians and pharmacists stating that the company changed its warning

labels for mefloquine.

Roche further said in one of two new warning

paragraphs that some of the symptoms associated with mefloquine

use included suicidal thoughts and suicide and also "may cause

psychiatric symptoms in a number of patients, ranging from

anxiety, paranoia, and depression to hallucination and psychotic

behavior," which "have been reported to continue long after

mefloquine has been stopped."

Military Struggles

Cmdr. Manofsky, who is retired from the

US Navy and currently on disability due to post-traumatic stress

disorder and side effects from mefloquine, said those are some of

the symptoms he initially suffered from after taking the drug for

several months beginning in November 2002 after he was deployed to

the Middle East to work on two Naval projects.

In March 2003, "I became violently ill during a

night live-fire exercise with the [Navy] SEALS," Manofsky said. "I

felt like I was air sick. All the flashing lights from the tracers

and rockets ... targeting device made me really sick. I threw up

for an hour straight before being medevac'd back to the Special

Forces compound where I had my first ever panic attack."

For three years, he had to walk with a cane due

to a loss of equilibrium. Numerous other accounts like Manofsky's

can be found on the web site lariaminfo.org.

In 2008, Dr. Nevin published a study detailing a

high prevalence of mental health contraindications to the safe use

of mefloquine in soldiers deployed to Afghanistan. Responding in

part to concerns raised by the mefloquine-associated suicide of Army Spc. , internal

Army presentations confirmed that the drug had been widely

misprescribed to soldiers with contraindications, including to

many on antidepressants.

A formal policy memo in February 2009 from Army

Surgeon General Schoomaker removed mefloquine as a

"first-line" agent, and changed the policy so that mefloquine

would not be prescribed to Army personnel unless they had

contraindications to the preferred drug, the antibiotic

doxycycline. Nor could mefloquine be prescribed to any personnel

with a history of traumatic brain injury or mental

illness.

By September 2009, the policy was extended

throughout the DoD.

New prisoners are no longer arriving at

Guantanamo and the prison population has been in decline in recent

years as detainees are released or transferred to other countries.

Currently, the detainee population at Guantanamo is a reported

174.

But Nevin said the justification the Pentagon

offered for using mefloquine to presumptively treat detainees

transferred to the prison beginning in 2002 "betrays a profound

ignorance of basic principals of tropical medicine and suggests

extremely poor, and arguably incompetent, medical oversight that

demands further investigation."

This work by Truthout is licensed under a Creative Commons Attribution-Noncommercial 3.0

United States License.

[Guest guest]

mefloquine is Lariam

\http://www.truth-out.org/controversial-drug-given-all-guantanamo-detainees-amounted-pharmacologic-waterboarding6558

EXCLUSIVE: Controversial Drug Given to All

Guantanamo Detainees Akin to "Pharmacologic Waterboarding"

Wednesday 01

December 2010

by: Leopold and Kaye, t r u t h o u t

| Investigative Report

The Defense Department forced all "war on terror" detainees at the

Guantanamo Bay prison to take a high dosage of a controversial

antimalarial drug, mefloquine, an act that an Army public health

physician called "pharmacologic waterboarding."

The US military administered the drug despite Pentagon knowledge

that mefloquine caused severe neuropsychiatric side effects,

including suicidal thoughts, hallucinations and anxiety. The drug

was used on the prisoners whether they had malaria or not.

The revelation, which has not been previously

reported, was buried in documents

publicly released by the Defense Department (DoD) two years ago as

part of the government's investigation into the June 2006 deaths

of three Guantanamo detainees.

Army Staff Sgt. Joe Hickman, who was stationed at

Guantanamo at the time of the suicides in 2006, and has presented

evidence that demonstrates the three detainees could not have died

by hanging themselves, noticed in the detainees' medical files

that they were given mefloquine. Hickman has been investigating

the circumstances behind the detainees' deaths for nearly four

years.

Interviews conducted over the past two months

with tropical disease experts and a review of Defense Department

documents and peer-reviewed journals show there were no

preexisting cases where mefloquine was ever prescribed for mass

presumptive treatment of malaria.

All detainees arriving at Guantanamo in January

2002 were first given a treatment dosage of 1,250 mg of

mefloquine, before laboratory tests were conducted to determine if

they actually had the disease, according to a section of the DoD

documents entitled "Standard Inprocessing Orders For Detainees."

The 1,250 mg dosage is what would be given if the detainees

actually had malaria. That dosage is five times higher than the

prophylactic dose given to individauls to prevent the disease.

Maj. Remington Nevin, an Army public health

physician, who formerly worked at the Armed Forces Health

Surveillance Center and has written extensively about mefloquine, said

in an interview the use of mefloquine "in this manner ... is, at

best, an egregious malpractice."

The government has exposed detainees "to

unacceptably high risks of potentially severe neuropsychiatric

side effects, including seizures, intense vertigo, hallucinations,

paranoid delusions, aggression, panic, anxiety, severe insomnia,

and thoughts of suicide," said Nevin, who was not speaking in an

official capacity, but offering opinions as a board-certified,

preventive medicine physician. "These side effects could be as

severe as those intended through the application of 'enhanced

interrogation techniques.'"

Mefloquine is also known by its brand name

Lariam. It was researched by the US Army in the 1970s and licensed

by the Food and Drug Administration in 1989. Since its

introduction, it has been directly linked to serious adverse effects, including

depression, anxiety, panic attacks, confusion, hallucinations,

bizarre dreams, nausea, vomiting, sores and homicidal and suicidal

thoughts. It belongs to a class of drugs known as quinolines,

which were part of a 1956 human experiment study to investigate

"toxic cerebral states," as part of the CIA's MKULTRA mind-control

program.

The Army tapped the Walter Army Institute of

Research (WRAIR) to develop mefloquine and it was later licensed

to the Swiss pharmaceutical company F. Hoffman-La Roche. The first

human trials of mefloquine were conducted in the mid-1970s on

prisoners, who were deliberately inoculated with malaria at

Stateville Correctional prison near Joliet, Illinois, the site of

controversial antimalarial experimentation in the early

1940s.

The drug was administered to Guantanamo detainees

without regard for their medical or psychological history, despite

its considerable risk of exacerbating pre-existing conditions.

Mefloquine is also known to have serious side effects among

individuals under treatment for depression or other serious mental

health disorders, which numerous detainees were said to have been

treated for, according to their attorneys and published

reports.

Dr. G. Olds, a tropical disease

specialist and the founding dean of the Medical School at the

University of California at Riverside, said,

in his "professional opinion there is no medical justification for

giving a massive dose of mefloquine to an asymptomatic

individual."

"I also do not see the medical benefit of

treating a person in Cuba with a prophylactic dose of mefloquine,”

Olds said. Mefloquine is "a fat soluble, and as a result, it does

build up in the body and has a very long half-life.This is

important since a massive dose of this drug is not easily

corrected and the ‘side effects’ of the medication could last for

weeks or months."

In 2002, when the prison was established and

mefloquine first administered, there were dozens of suicide

attempts at Guantanamo. That same year, the DoD stopped reporting

attempted suicides.

By February 2002, there were at least 459

detainees imprisoned at Guantanamo. In March of that year,

according to the book "Saving Grace at Guantanamo Bay: A Memoir of a

Citizen Warrior" by Montgomery Granger, "the situation" at

the prison began "deteriorating rapidly."

"There is more and more psychosis becoming

evident in detainees ...," wrote Granger, an Army Reserve major

and medic who was stationed at Guantanamo in 2002. "We already

have probably a dozen or so detainees who are psychiatric cases.

The number is growing."

"Presumptively Treating" Malaria

Though malaria is nonexistent in Cuba, DoD

spokeswoman Maj. Bradsher told Truthout that the US

government was concerned that the disease would be reintroduced

into the country as detainees were transferred to the prison

facility in January 2002.

A "decision was made," Bradsher said in an email,

to "presumptively treat each arriving Guantanamo detainee for

malaria to prevent the possibility of having mosquito-borne [sic]

spread from an infected individual to uninfected individuals in

the Guantanamo population, the guard force, the population at the

Naval base or the broader Cuban population."

But Granger wrote in his book that a Navy

entomologist was present at Guantanamo in January and February

2002 and during that time only identified insects that were

nuisances and did not identify any insects that were carriers of a

disease, such as malaria.

Nevertheless, Bradsher said the "mefloquine

dosage [given to detainees] was entirely for public health

purposes ... and not for any other purpose" and "is completely

appropriate."

"The risks and benefits to the health of the

detainees were central considerations," she added.

A September 13, 2002, DoD

memo governing the operational use of mefloquine said,

"Malaria is not a threat in Guantanamo Bay." Indeed, there have

only been two to three reported cases of malaria at

Guantanamo.

The DoD memo, signed by Assistant Secretary of

Defense for Health Affairs Winkenwerder, was sent to

then-Rep. McHugh, the Republican chairman of the House

Veterans Affairs Subcommittee on Military Personnel. McHugh is now

Secretary of the Army.

A Senate staff member told Truthout the Senate

Armed Services Committee was never briefed about malaria concerns

at Guantanamo nor was the committee made aware of "any issue

related to the use of mefloquine or any other anti-malarial drug"

related to "the treatment of detainees."

When questions were raised at a February 19, 2002 meeting of the Armed

Forces Epidemiological Board (AFEB) about what measures the

military was taking to address malaria concerns at Guantanamo,

Navy Capt. Alan J. Lund did not disclose that mefloquine was being

administered to detainees as a form of presumptive treatment.

Yund said the military gave detainees a different

anti-malarial drug known as primaquine and noted that "informed

consent" was "absolutely practiced" prior to administering drugs

to detainees, an assertion that contradicts claims made by

numerous prisoners who said they were forced to take drugs even if

they protested. Yund did not return calls for comment.

Bradsher declined to respond to a follow-up

question about who made the decision to presumptively treat

detainees with mefloquine.

An April 16, 2002, meeting of the Interagency

Working Group for Antimalarial Chemotherapy, which DoD, along with

other federal government agencies, is a part of, was specifically

dedicated to investigating mefloquine's use and the drug's side

effects. The group concluded that study designs on mefloquine up

to that point were flawed or biased and criticized DoD medical

policy for disregarding scientific fact and basing itself more on

"sensational or best marketed information."

The Working Group called for additional research,

and warned, "other treatment regimes should be carefully

considered before mefloquine is used at the doses required for

treatment."

Still, despite the red flags that pointed to

mefloquine as a high-risk drug, the DoD's mefloquine program

proceeded.

In fact, a June 2004 set of guidelines issued by

the Centers for Disease Control and Prevention

(CDC) says mefloquine should only be used when other standard

drugs were not available, as it "is associated with a higher rate

of severe neuropsychiatric reactions when used at treatment

doses."

According to the CDC, "'presumptive treatment'

without the benefit of laboratory confirmation should be reserved

for extreme circumstances (strong clinical suspicion, severe

disease, impossibility of obtaining prompt laboratory

confirmation)."

A CDC spokesman refused to comment about the

"presumptive treatment" of malaria at Guantanamo and referred

questions to the DoD.

Nevin said, if "mass presumptive treatment has

been given consistently, many dozens of detainees, possibly

hundreds, would almost certainly have suffered such disabling

adverse events."

"It appears that for years, senior Defense health

leaders have condoned the medically indefensible practice of using

high doses of mefloquine ostensibly for mass presumptive treatment

of malaria among detainees from the Middle East and Asia lacking

any evidence of disease," Nevin said. "This is a use for which

there is no precedent in the medical literature and which is

specifically discouraged among refugees by malaria experts at the

Centers for Disease Control."

Even proponents of limited mefloquine usage are

seriously questioning the logic behind the DoD's actions.

Professor McCarthy, chair of the Infectious Diseases

Division of the Queensland Institute of Medicine in Australia, who

is an advocate of the safe use of mefloquine under proper

safeguards, and takes it himself when traveling, told Truthout he

was unaware of the use of mefloquine for mass presumptive

treatment as described by the DoD, but could imagine it under

certain circumstances.

However, when informed that lab tests were

available and the detainees were screened for the blood product

G6PD, used to determine the suitability of certain antimalarial

drugs, McCarthy found the DoD's use of mefloquine at Guantanamo

difficult to understand and "hard to support on pure clinical

grounds as an antimalarial."

Treatment, Torture or an Experiment?

Another striking point about the DoD's decision

to presumptively treat mostly Muslim detainees with mefloquine

beginning in 2002 is that it is the exact opposite of how the DoD

responded to malaria concerns among the Haitian refugees who were

held at Guantanamo a decade earlier.

Between 1991 and 1992, more than 14,000 Haitian

refugees were held in temporary camps set up at Guantanamo. A

large number of Haitian refugees - 235 during a four-month period

- were diagnosed with malaria. But instead of

presumptively treating the refugee population at Guantanamo, the

DoD conducted laboratory tests first and only the individuals who

were found to be malaria carriers were administered chloroquine.

Another example of how the DoD approached malaria

treatment differently for other subjects is in the case of Army

Rangers who returned from malarial areas of Afghanistan between

June and September 2002 and were infected with the disease at an

attack rate of 52.4 cases per 1,000 soldiers.

However, the Rangers did not receive mass presumptive treatment of

mefloquine. They were given other standard drugs after laboratory

tests, according to documents obtained by Truthout.

Nevin said the DoD's treatment of Haitian

refugees represented "a situation that arguably presented a much

higher risk of disease and secondary transmission, but one which

US medical experts stated at the time could be safely managed

through more conservative and focused measures."

Why did the government use the "conservative and

focused" approach in treating Haitian refugees and the Army

rangers, but then revert to presumptive mefloquine treatment in

the case of the Guantanamo detainees, who - a month after the

prison facility opened in January 2002 - were stripped of their

protections under the Geneva Conventions?

According to Camoni, a Seton Hall University

law school research fellow, "there is no legitimate medical

purpose for treating malaria in this way" and the drug's severe

side effects may actually have been the DoD's intended impact in

calling for the drug's usage.

Camoni and several other Seton Hall law school students have been

working on a report about mefloquine use on Guantanamo detainees.

Their work was conducted independently of Truthout's

investigation.

A copy of the Seton Hall report, "Drug Abuse? An Exploration of the Government's

Use of Mefloquine at Guantanamo," says mefloquine's extreme

side effects may have violated a provision in the antitorture statute related to the use of

"mind altering substances or other procedures" that "profoundly

disrupts the senses or the personality."

Legal memos prepared in August 2002 by former DoD

attorneys Jay Bybee and Yoo for the CIA's torture program

permitted the use of drugs for interrogations. The authority was

also contained in a legal memo Yoo prepared for the DoD less than

a year later after Secretary of Defense Rumsfeld convened a

working group to address "policy

considerations with respect to the choice of interrogation

techniques."

In September, Truthout

reported that the DoD's inspector general (IG) conducted an

investigation into allegations that detainees in custody of the US

military were drugged. The IG's report, which remains classified,

was completed a year ago and was shared with the Senate Armed

Services Committee.

Kathleen Long, a spokeswoman for the Armed Services Committee,

told Truthout at the time that the IG report did not substantiate

allegations of drugging of prisoners for the "purposes of

interrogation."

The medical files for detainee 693 released in

2008 shows that, two weeks after he first started taking

mefloquine in June 2002, he was interviewed by Guantanamo medical

personnel and reported he was suffering from nightmares,

hallucinations, anxiety auditory and visual hallucinations,

anxiety, sleep loss and suicidal thoughts.

The detainee said he had previously been treated

for anxiety and had a family history of mental illness. He was

diagnosed with adjustment disorder, according to the DoD

documents. Guantanamo medical staff who interviewed the detainee

did not state that he may have been experiencing

mefloquine-related side effects in an evaluation of his condition.

Mark Denbeaux, the director of the Seton

Hall Law Center for Policy and Research, who conducted an

independent investigation into the 2006 deaths of the three

Guantanamo detainees, said in an interview "almost every remaining

question here would be solved if the [detainees'] full medical

records were released."

The government has refused to release Guantanamo

detainees' medical records, citing privacy concerns in some cases,

and assertions that they are "protected" or "classified" in other

instances. The few medical records that have been released have

been heavily redacted.

"A crucial issue is dosage" Denbeaux said.

"Giving detainees toxic doses of mefloquine has mind-altering

consequences that may be permanent. Without access to medical

records, which the government refuses to release, the use of

mefloquine in this manner appears to be grotesque malpractice at

best, if not human experimentation or 'enhanced interrogation.'

The question is where are the doctors who approved this practice

and where are the medical records?"

Bradsher did not respond to questions about

whether the government kept data about the adverse effects

mefloquine had on detainees.

An absolute prohibition against experiments on

prisoners of war is contained in the Geneva Conventions, but

President W. Bush stripped war on terror detainees of those

protections. Some of the "enhanced interrogation techniques" also

had an experimental quality.

At the same time detainees were given high doses of mefloquine,

Deputy Secretary of Defense Wolfowitz issued a directive changing the rules on human

subject protections for DoD experiments, allowing for a waiver of

informed consent when necessary for developing a "medical product"

for the armed services. Bush also granted unprecedented authority

to the secretary of Health and Human Services to classify

information as secret.

Briefings on Side Effects

As the DoD was administering mefloquine to

Guantanamo prisoners, senior Pentagon officials were being briefed about the drug's dangerous side

effects. During one such briefing, questions arose about what

steps the military was taking to address malaria concerns among

detainees sent to Guantanamo.

Internal

documents from Roche, obtained by UPI in 2002, indicated

that the pharmaceutical company had been tracking suicidal

reactions to Lariam going back to the early 1990s.

In September 2002, Roche sent a letter to

physicians and pharmacists stating that the company changed its warning

labels for mefloquine.

Roche further said in one of two new warning

paragraphs that some of the symptoms associated with mefloquine

use included suicidal thoughts and suicide and also "may cause

psychiatric symptoms in a number of patients, ranging from

anxiety, paranoia, and depression to hallucination and psychotic

behavior," which "have been reported to continue long after

mefloquine has been stopped."

Military Struggles

Cmdr. Manofsky, who is retired from the

US Navy and currently on disability due to post-traumatic stress

disorder and side effects from mefloquine, said those are some of

the symptoms he initially suffered from after taking the drug for

several months beginning in November 2002 after he was deployed to

the Middle East to work on two Naval projects.

In March 2003, "I became violently ill during a

night live-fire exercise with the [Navy] SEALS," Manofsky said. "I

felt like I was air sick. All the flashing lights from the tracers

and rockets ... targeting device made me really sick. I threw up

for an hour straight before being medevac'd back to the Special

Forces compound where I had my first ever panic attack."

For three years, he had to walk with a cane due

to a loss of equilibrium. Numerous other accounts like Manofsky's

can be found on the web site lariaminfo.org.

In 2008, Dr. Nevin published a study detailing a

high prevalence of mental health contraindications to the safe use

of mefloquine in soldiers deployed to Afghanistan. Responding in

part to concerns raised by the mefloquine-associated suicide of Army Spc. , internal

Army presentations confirmed that the drug had been widely

misprescribed to soldiers with contraindications, including to

many on antidepressants.

A formal policy memo in February 2009 from Army

Surgeon General Schoomaker removed mefloquine as a

"first-line" agent, and changed the policy so that mefloquine

would not be prescribed to Army personnel unless they had

contraindications to the preferred drug, the antibiotic

doxycycline. Nor could mefloquine be prescribed to any personnel

with a history of traumatic brain injury or mental

illness.

By September 2009, the policy was extended

throughout the DoD.

New prisoners are no longer arriving at

Guantanamo and the prison population has been in decline in recent

years as detainees are released or transferred to other countries.

Currently, the detainee population at Guantanamo is a reported

174.

But Nevin said the justification the Pentagon

offered for using mefloquine to presumptively treat detainees

transferred to the prison beginning in 2002 "betrays a profound

ignorance of basic principals of tropical medicine and suggests

extremely poor, and arguably incompetent, medical oversight that

demands further investigation."

This work by Truthout is licensed under a Creative Commons Attribution-Noncommercial 3.0

United States License.