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this conduct was gross malpractice or deliberate misuse of the drug. In either case, it does not appear plausible from the available evidence that mefloquine was given to treat malaria. This suggests a darker possibility: that the military gave detainees the drug specifically to bring about the adverse side effects, either as part of enhanced interrogation techniques, experimentation in behavioral modification, or torture for some other purpose. While this Report does not reach a conclusion about the actual motives for this course of conduct, it does explore the legal rules that would apply were it determined that mefloquine was administered not to treat malaria but rather to exploit the neuropsychiatric effects of the drug.

Findings:

This Report demonstrates that the U.S. military routinely administered doses of mefloquine to detainees upon their arrival at GTMO without medical justification:

■ 1250 mg of mefloquine was given to all detainees as a standard measure during inprocessing.

■ Mefloquine is used for treatment of malaria only in mild to moderate cases of infection with the p. vivax or p. falciparum parasite.

■ At GTMO, mefloquine was given to detainees before testing them for malaria, without regard for whether the detainee actually had malaria at all, let alone whether he carried one of the parasites treatable by mefloquine.

■ The standard of care rejects administering mefloquine to persons with a history of mental illness or a family history of mental illness, due to a greatly increased risk of severe adverse side effects for such persons.

■ At GTMO, mefloquine was given to detainees without regard to prior mental health history or family mental health history.

This Report further demonstrates that the U.S. military knew, and any competent medical professional would have known, of the severe side effects caused by mefloquine:

■ Mefloquine was first developed by the United States military.

■ Mefloquine is a quinolone, a drug family the CIA experimented with under a project called MKULTRA that studied psychotropic drugs for behavioral modification for use as a weapon and interrogation tool.

■ As of 2002, Roche USA, the manufacturer of mefloquine under the brand name Lariam, warned of its contraindications and at least some of its severe side effects on the drug’s package insert.

■ Beginning at least as early as 1990, multiple peer-reviewed medical studies documented the severe adverse effects associated with mefloquine.

While it is impossible to make definitive conclusions as to the purposes for this policy without additional information, particularly detainee medical records, the available evidence may support one of several possible conclusions:

■ Gross medical malpractice: If government intended this mefloquine regime for malaria treatment and control, it was done in a manner that jeopardized the health and perhaps the lives of the detainees and that violated basic standards of medical care.

■ Mefloquine was given in order to bring about the adverse effects for one of three reasons. Any of these would likely satisfy the legal definition of torture as articulated by the Department of Justice in 2002.

o As part of a program of enhanced interrogation, the psychotropic effects of mefloquine may have been intended as an aid to breaking a detainee’s resistance. This would be the psychological equivalent of waterboarding.

o As part of an experimental study to gather data on the side effects of mefloquine.

o As a punitive measure.

Methodology

This Report documents the administration of mefloquine to detainees and establishes that the U.S. military’s administration was a violation of normal standards of medical care. The Center for Policy and Research at Seton Hall School of Law typically issues reports based on government documents. In this case, however, that has proved impossible because the government has continually refused to release detainee’s medical records to the detainees or their attorneys. The only medical record available is that of ISN 693.