Physicians for Human Rights (PHR) today released evidence it says indicates that the Bush administration conducted "illegal and unethical human experimentation and research" on detainees' response to torture while in CIA custody after 9/11. The group says such illegal activity would violate the Nuremburg Code, and could open the door to prosecutions. Their report is based on publicly available documents, and explores the participation of medical professionals in the CIA's "enhanced interrogation program." Download the full report at phrtorturepapers.org.
Boing Boing spoke with the lead medical author of the report, Dr. Scott Allen, who is co-director of the Center For Prisoner Health and Human Rights at Brown University, and Medical Advisor to PHR.
Boing Boing: The first thing that came to mind as I read this report is that we're really talking about treating a vulnerable population—prisoners, war detainees—like lab rats.
PHR: Correct. I am a former prison doctor and have conducted some research in prisons. I speak from direct experience in understanding what is allowable, and why there is a rigorous regime of human subject protections, especially for vulnerable subject populations.
Boing Boing: What is the significance of the report you and your colleagues are releasing today?
PHR: This is the first report to describe evidence that the CIA interrogation program not only involved torture, but it also involved human experimentation. That experimentation is related to the role of the "medical monitors," the doctors and psychologists who are directed by policy to monitor torture techniques.
As a framing exercise: if you are an M.D. who is tasked with keeping torture safe, you have a practical problem. Set aside the ethical problem for a moment. How do you know how to do it? We were pretty thorough in thinking through it: we scoured the literature and found what experience was on the scientific record about the effects of these techniques. There's one body of evidence out there from torture survivors, which is in our prior report, "Leave No Marks." Everything in that report points to the understanding that this cannot be made safe. It is all very dangerous, and it's designed to harm, so it's ridiculous to think you can make it safe.
The other body of evidence was the experience of investigators who worked with soldiers. In that program they did limited application of these techniques on volunteer subjects. The mock interrogations never went beyond 2 or 3 days, the waterboarding when it happened was limited to 1 or 2 short exposures, and in a technique that was dramatically different than what was applied to detainees in the black sites.
No one really understands the long or short term effects of these techniques.
So, in order to do the job the medical monitors were given to do, it left them two choices, both of which were awful:
One, they could just wing it. You're talking about techniques that carry high risks of PTSD, but also high risks of physical injury and death (we know that there is public evidence that at least 4, maybe as many as 8 detainee deaths are related to these techniques)—you don't want to wing it. So I think it's certainly possible that while they weren't eagerly looking forward to setting up research they might have been backed into this by saying, let's take notes. That citation we note of Appendix F in the CIA 2004 Inspector General's report, the one that describes the directives to doctors, says, 'Take these notes in a very meticulous way about how detainees respond to waterboarding so we can better inform our procedures in future.' That's describing the framework of a research protocol.
Now, whether they considered it research or not is irrelevant. There are some crimes for which you must prove intent. Human subject protections have no such qualifier. Particularly when there's risk for injury to the subject, you've crossed that line.
We believe it's like alchemy: The US government may have wanted scientists to wave a wand and turn an ordinary object into gold. And the scientist who was asked may have believed that this was possible. But it's not. We say that the idea of trying to make [torture] safe is a fool's errand.
Boing Boing: The Bush Administration called the "enhanced interrogation" techniques "safe, legal and effective." What do we know about their effectiveness? Is it possible to study the effectiveness of torture and compare data to "common sense"? Has anyone done this?
PHR: I don't have expertise in this area. But efficacy of these techniques is irrelevant to the legal and moral issues at hand. If they were unethical for medical professionals to participate, and if they were unethical as legal techniques, whether they worked or not is irrelevant. We didn't try to speculate in this report on that particular question of effectiveness. But even if that was the reason, to say, 'We just want to know if what we're doing works better than rapport-building,' it still crosses the line if they did what it appears they did. It would cross the line into research, and human subject protections should kick in. They should have gone before a human subject review board, and protections should have been put in place. And mind you, we say that knowing that it never would have been approved. It never would have passed muster.
Most importantly, no detainee ever would have given consent. They would have had to receive an informed consent document, 'here's what we're doing, here are the risks to you, you can revoke your consent at any time, sign here.' Come on, detainees are not going to consent to that. There was no way for the medical professionals to do this right.
Boing Boing: Is pain something that we understand well enough that it is possible to create objective thresholds and call one side of the line 'torture' and the other side 'not torture'?
PHR: My feeling, and I think it's a consensus feeling, is that this is one of those areas where lawyers want to pretend that scientists have the answers when they don't. If you review pain literature, you will find that ultimately pain is subjective. You can expose any number of people to the same painful stimuli and their responses will widely vary. There's no way of proving that. The experience of people who work in the pain field says that pretty much, people are very direct and straightforward about reporting pain. So, that variability is well-documented, which makes the task of how you calibrate pain to be a fool's errand. How you calibrate it is to ask them, and their answer is the final answer. You can't research beyond that. The thing that is done is to avoid things that are painful, particularly when they're not being done in the best interests of the person, and beyond that you ask, "does it hurt, are you experiencing pain?"
Boing Boing: Does pain correlate with physical or mental damage in most people?
PHR: Again there is variability. Related to the concept of pain is the risk of the body's response. Even though we tend to separate psychology and psychiatry from neurology and the rest of medicine, they are related in a physical process. There's response of hormone levels to stress and pain that are real physical responses. And there's variability in those as well. And then, on top of that, even for those responses there is variability in who's going to go on to develop PTSD, alcoholism, anxiety, suicidality, uncontrollable anger, all the consequences of trauma we're aware of. In other words, the medical profession is not there yet. We know what risks are and who is at risk. But what the lawyers wanted the doctors to do is be really exact about when the line is crossed. They should have been told, 'Sorry, it can't be done. The risk is very high for pain and injury that would cross the legal threshold, and therefore these techniques cannot be used.' That would have been the correct answer based on the science.
Boing Boing: Sleep deprivation is another widely used technique according to this report, and all of the other publicly available documents on torture. How does sleep deprivation affect the brain in terms of our ability to remember and think logically? Why would interrogators believe that sleep deprivation yields accurate confessions or information, when it has a tendency to make people hallucinate?
PHR: There is extensive study on the effect of stress, which is the common final pathway for all these techniques—there are studies on the effects of acute and uncontrollable stress on the brain, which are not helpful on retrieving accurate information. They seem to have effects on the memory center, in a way that makes people confused.
Based on our limited understanding of the science, this doesn't look like a particularly promising way to get reliable information.
We stuck entirely with publicly available government documents describing this program. They are heavily redacted. Many pages are mostly blacked out, and multiple pages in a row are entirely blacked out. If we found evidence of a crime in reviewing the sanitized record, someone who has access to the full record needs to investigate this.
Boing Boing: How would you respond to questions about whether you can call these actions 'experimentation' if they don't follow the scientific method? Some who support the use of 'enhanced interrogation' techniques might argue that you can't call this medical experimentation if it doesn't follow standard procedure.
PHR: Going back to the "grand-daddy" experiments that prompted all of this, everyone thinks about Nuremberg and the Nazis, but remember that the Japanese also did experiments. That doesn't get mentioned as much because there weren't an equivalent to the Nuremberg doctor trials for Japanese doctors. Just as bad if not worse experiments were committed by the Japanese, involving possibly more people. In those cases, the science was even more sloppy and the record-keeping was terrible. For political or deal-making reasons to close the war they didn't prosecute those, but no one would have disputed that they were prosecutable, and it didn't have anything to do with bad science.
Bad science is not a defense.
We believe it's like alchemy: The client—the US government—may have wanted these scientists to wave a wand and turn an ordinary object into gold. And the scientist who was asked may have believed that this was possible. But it's not. We say that the idea of trying to make torture (or at the very least, a technique designed to create acute, severe, uncontrollable stress) 'safe' is a fool's errand. It's junk science. Bad science does not give you a pass.
Boing Boing: Can you talk a little about the background of human experimentation ethics?
PHR: In the course of history there have been a number of unethical experiments on human populations including prisoners. There were experiments in the past—product testing experiments for cosmetics—there was a book written about that called "Acres of Skin," a phrase used by the chief investigator who arranged those prison experiments. Those were experiments that took advantage of the fact that the subjects, prisoners, were vulnerable easy to coerce into participation and convenient.
That was the type of thing that protections that have been put in place try to prevent. There is a very small and narrow window of legitimate and ethical research. That tends to be when we do things like, for example—if someone is already involved in getting experimental HIV treatment in a clinic, and they get picked up on some charge and they spend a brief time in jail, a few weeks, is it permissible for the investigator to come to the jail and for the subject to continue taking the investigational drug... something like that, it's chiefly in subject's interest, and they would have given voluntary consent.
Boing Boing: Where do you and your colleagues go from here, what are you hoping to accomplish?
PHR: We have provided credible evidence of a crime.
When that threshhold is crossed, it then becomes the responsibility of the responsible authorities to thoroughly investigate the allegations.
In this case, we believe there are a number of people we believe should respond, ranging from the office of human subjects protections to the white house and the Department of Justice. We are making an allegation that we have credible evidence of a crime and therefore that should be investigated by the proper authorties in that area. Obviously Congress; we are going to make recommendations that they look into these.
We reviewed only publicly available documents on this subject. Note that we didn't drift into all sorts of other evidence that may be floating around out there, but can't be verified. We stuck entirely with publicly available government documents describing this program. They are heavily redacted. Many pages are mostly blacked out, and multiple pages in a row are entirely blacked out. If we found evidence of a crime in reviewing the sanitized record, someone who has access to the full record needs to investigate this. And they need to investigate it with qualified people who can look into it with expertise on what constitutes human subjects research, and what constitutes research in general.
This Associated Press story includes an administration response saying that this has been looked into multiple times. It has not.
Abuses have been looked into multiple times. The role of health professionals has been looked into in a broad way. But there has never been any investigation into the question of human experimentation.
The administration is being slippery. Their response, as noted in the Associated Press story on our report, is either not true or there is no public record of such an inquiry that we're aware of. If there was, it's incumbent upon them to share at least a sanitized version that specifically looked at human experimentation.
People have suggested it before. But I don't think anyone has raised a credible allegation with verifiable evidence before.
Boing Boing: Looking even beyond whether an investigation will take place, and whether those who may have committed crimes will be brought to justice, what are the implications of this activity, of America conducting medical experiments on the effects of torture on so-called terror suspects we are detaining?
PHR: There are a lot of implications. As someone who's worked in a similar environment, I get very concerned when people who go into service for the U.S. government—in this case the CIA, and on other topics of torture and abuse we could include those in the uniformed services—are asked to do things like this.
I start with the assumption that these are very ethical people who have good moral compasses and who are not themselves looking to do the wrong thing.
One of the terrible things about this story is that we have directed good people in the service of our country to violate their values and the values of their country. That's a terrible thing to ask anyone to do. For them, we need to review what they were asked to do, and see how it happened, so we can make sure it never happens again.
Ultimately this will not help keep America safer, either. You have to factor in all the costs. It's not clear at all that it worked the way they wanted it to work. And at the same time, the fact that we've been revealed now to be hypocprites about our own values cannot help us in the global struggle for the moral high ground.
Boing Boing: What are the odds that this will result in an investigation?
I don't know.
All I can say is that we have done all we can do as citizens, as a small nonprofit.
We have said that we are reporting evidence of a crime. What the authorities do with that, they will own.
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