CIA Physicians and Research on Torture
Doctors and psychologists the CIA employed to monitor its “enhanced interrogation” of terror suspects came close to, and may even have committed, unlawful human experimentation, a medical ethics watchdog has alleged.
Physicians for Human Rights (PHR), a not-for-profit group that has investigated the role of medical personnel in alleged incidents of torture at Guantánamo, Abu Ghraib, Bagram and other US detention sites, accuses doctors of being far more involved than hitherto understood.
PHR says health professionals participated at every stage in the development, implementation and legal justification of what it calls the CIA’s secret “torture programme….”
It’s important to note that (at least as reported by the Guardian) what’s at issue, here, is not the simple presence of physicians and psychologists at interrogation sessions; it’s the notion that they were there doing research. According to the PHR’s press release…
The [CIA Inspector General’s] report details how the CIA relied on medical expertise to rationalize and carry out abusive and unlawful interrogations. It also refers to aggregate collection of data on detainees’ reaction to interrogation methods. PHR is concerned that this data collection and analysis may amount to human experimentation and calls for more investigation on this point….
Now, on one hand, the fact that detainees were used as research subjects without their consent might be thought of as the worst of their problems. I suspect that when you’re being waterboarded, the fact that the guy in the white coat standing in the corner didn’t ask your permission to take notes isn’t your foremost worry. But think of it this way: if there’s anything worse than being tortured, it might just be being tortured with the additional knowledge that your torturers are using you as a way of learning how to torture others more effectively.
Interestingly, notwithstanding the focus on consent in the Guardian and in the PHR’s press release, the PHR’s full report barely mentions consent as an issue, or research more generally for that matter. This raises the question of whether the research ethics angle, here, is considered an important one by PHR, or whether research ethics rules are being used (rightly or wrongly) as a tool to achieve other objectives.
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p.s., back in May, Nancy posted this related item: Research on torture: Should we put limits on what topics researchers can study?
Research Ethics Blog 
In Naomi Klein’s book “The Shock Doctrine” there is a chapter on McGill researcher Ewen Cameron who’s CIA funded research with LSD and electroshock treatments eventually found it’s way into CIA torture manuals. Dr. Cameron experimented on patients who had “consented” to his research in ways that some might regard as bordering on the criminal. Ironically, Dr. Cameron testified at the Nuremberg War Crimes trials, where the first research codes of ethics were developed.
The research ethics angle is the role of medical professionals in the development of detention and interrogation techniques as demonstrated in the CIA Inspector General Report (the IG Report).(1) This post considers whether the IG Report documents unethical data collection and analysis by examining the fundamental issues confronting IRBs.
• Does the Common Rule? Yes.
Pursuant to Executive Order 12333 the CIA is one of 17 federal departments and agencies that have adopted the Common Rule. The Common Rule stipulates agency heads retain final judgment as to whether a particular activity is covered (45CFR46.101(c). The IG Report reveals no documentation of an exemption from the Common Rule.
• Is it human research? Yes.
Did the Detention and Interrogation Program include human experimentation? Did it seek to develop generalizable knowledge? The IG Report describes a systematic investigation designed to develop and contribute to generalizable knowledge in waterboard interrogation. For example, Appendix F, the medical support guidelines, (the Guidelines), clearly defines goals and roles commonly associated with research providing clinically descriptive standard and enhanced interrogation techniques culminating with the waterboard and concluding with the following Note:
NOTE: In order to best inform future medical judgments and recommendations, it is important that every application of the waterboard be thoroughly documented: how long each application (and the entire procedure) lasted, how much water was used in the process (realizing that much splashes off), how exactly the water was applied, if a seal was achieved, if the naso- or oropharynx was filled, what sort of volume was expelled, how long was the break between applications, and how the subject looked between each treatment. (F:10)
The goal aims at the development of generalizable knowledge on the use of the waterboard in the interrogation of the targeted subject detainees. The perversity of the use of the terms “subject” and “treatment” in this context is breathtaking to anyone concerned with human subject research protection.
It is the interrogator who is tasked with the application of first aid to an unresponsive subject (F:9). Only if the interrogator’s intervention fails to restore normal breathing is aggressive medical intervention required. The physician’s primarily role in waterboard interrogation is observation and documentation for research purposes and medical practice only in extremis (F:9).
• Is the risk-to-benefit analysis socially beneficial? No.
The IG Report documents, according to the Chief, Medical Services:
OMS was neither consulted nor involved in the initial analysis of the risk and benefits of EITs [enhanced interrogation techniques] . . . there was no a priori reason to believe that applying the waterboard with the frequency and intensity with which it was used by the psychologist/interrogators was either efficacious or medically safe. (¶43fn26)
Moreover,
. . . A number of officers expressed concern that a human rights group might pursue them for activities [redacted] . . . (¶231)
Whether the authors were making a point, or due to proofreading oversight, ¶266 repeats, verbatim, the warning raised in ¶19:
The Agency faces potentially serious long-term political and legal challenges as a result of the CTC Detention and Interrogation Program, particularly its use of EITs and the inability of the U.S. Government to decide what it will ultimately do with terrorist detained by the Agency.
The IG Report anticipated the appointment of a special prosecutor to investigate torture and the PHR call for an investigation of the role of medical and psychological professionals in the Detention and Interrogation Program and remedies including accountability for war crimes and reparations.
Renée LLanusa-Cestero, M.A., C.I.P.
(1) Central Intelligence Agency Inspector General Special Review ~ Counterterrorism Detention and Interrogation Activities, 7 May 2004, at http://www.aclu/org/safefree/totrure/40832res20090824.html.