Report accuses C.I.A. of experimenting on detainees

Evidence suggests health professionals played an unethical role

Physicians for Human Rights

A report issued in June by Physicians for Human Rights, and a more recent commentary in the Aug. 4 issue of the Journal of the American Medical Association, strongly condemn the presence of physicians and psychologists during the interrogation of suspected terrorists detained by the C.I.A.

The medical professionals were explicitly directed by the Central Intelligence Agency to be present to ensure that the suffering inflicted on the detainees remained within legal limits established by former President George W. Bush. During his administration, forms of torture such as waterboarding were redefined as “enhanced interrogation techniques.”

The report, titled “Experiments in Torture,” alleges that health professionals employed by the C.I.A.’s Office of Medical Services (OMS) were told to record the effects of waterboarding—as well as diapering, loud music, isolation, slapping and other tactics. The medical personnel were also ordered to gather data that could then be used to make subsequent applications of the procedures less harmful and more effective at making detainees submit.

The professional opinions and observations of OMS physicians reportedly led to the switch to the use of a saline solution in waterboarding, to reduce the risk of detainees contracting pneumonia or hyponatremia. The latter condition is marked by low sodium levels in the blood, caused by “free water intoxication,” and can lead to brain herniation, coma or death.

Other changes to protocol included the introduction of a specially designed plank to quickly position a detainee upright in case of choking, as well as the placement of detainees on a liquid diet prior to waterboarding. That way, any vomit would be less likely to cause choking or aspiration pneumonia.

Such systematic collection of information, its translation into “generalizable knowledge,” and its subsequent application are all central to the definition of research. And so, according to the report, the detainees who were interrogated may also have been human research subjects.

But because the detainees did not give informed consent to the alleged experimentation, the report concludes that anyone who observed or participated in the interrogations is guilty of breaking long-standing law protecting human research subjects.


“The whole point of ‘enhanced’ interrogation methods was to inflict pain, anxiety and fear in the hope of gaining useful intelligence,” says Leonard Rubenstein, J.D., a lawyer and visiting scholar at the Center for Public Health and Human Rights at Johns Hopkins Bloomberg School of Public Health. “And if data collection took place, it was just one of multiple dimensions of medical participation in torture of detainees by the C.I.A.”

From 1996 to 2009, Rubenstein was director, and then president, of Physicians for Human Rights (PHR), a nonprofit founded in 1986 that investigates the health consequences of human-rights violations and works to stop them. PHR, which shared the 1997 Nobel Peace Prize as a founding member of the International Campaign to Ban Landmines, has documented the systematic use of psychological and physical torture by U.S. personnel against detainees in a series of reports issued since 2005.

The new report is carefully worded in saying that the observation of interrogated detainees “may” be seen as the conduct of research by health professionals. The report also states that it draws its conclusions by patching together information from heavily redacted U.S. government documents, and that many relevant documents remain classified.

“The report makes clear that the evidence is suggestive, rather than conclusive,” says Rubenstein. Whether the activities in question actually constitute research depends on “how systematic data collection was. And that information can only come from a fuller investigation.”

The 27-page report calls for a comprehensive federal probe and lists nine recommendations targeted at the White House, Congress and even the United Nations special rapporteur on torture. Two days after issuing the report, PHR—along with a broad coalition of human rights, health and religious groups—filed a federal complaint against the C.I.A. with the U.S. Department of Health and Human Services Office for Human Research Protections.

Rubenstein helped review the report and says, because of the secretiveness of the C.I.A., details remain unknown, even on basic questions such as who collected and recorded data. According to Rubenstein, the health professionals in question were probably a combination of staff and contract employees of the agency’s Office of Medical Services. And whereas the military detained thousands of suspected terrorists across Iraq, Afghanistan and at Guantanamo Bay, the number of detainees in C.I.A. custody was much smaller—but also uncertain, as the C.I.A. has refused to disclose who was held.

“They were held at hidden C.I.A. ‘black sites,’ whose locations still remain classified,” Rubenstein says.

Aside from the issue of medical professionals’ complicity in torture (see sidebar), the U.S. Common Rule stands at the heart of the debate over violations in law. It requires that informed consent be obtained from all human subjects in federally funded research.

Wording of the rule also expresses a worry that prisoners, because of their detention, may be coerced into consenting to research.

“The C.I.A. is one of 17 federal agencies required by law to adhere to The Common Rule when conducting federally funded research on human beings,” states PHR’s written complaint to the Office of Human Research Protections.

The C.I.A. continues to deny that it conducted human subject research on its detainees.

[Note: Rubenstein will be the guest speaker at the Sept. 13 session of the Johns Hopkins Berman Institute of Bioethics “Seminar Series.” Talks are held on the second and fourth Mondays of the month, usually in the Johns Hopkins Bloomberg School of Public Health. Start time is 12:15 p.m., and lunch is provided.]

~ Michael Pena

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Leonard Rubenstein
Michael Pena

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