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The Lancet, Current Issue, Volume 370, Number 9590, 8 September
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The Lancet 2007; 370:823

DOI:10.1016/S0140-6736(07)61402-0 

Correspondence 

Biko to Guantanamo: 30 years of medical involvement in torture 

David
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ster&search_cluster=thelancet&search_sort=date&restrictname_author=author&re
stricttype_author=author&restrictterm_author=nicholl0dj&restrictdesc_author=
David J Nicholl> J Nicholl a,   Trefor
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ster&search_cluster=thelancet&search_sort=date&restrictname_author=author&re
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refor Jenkins>  Jenkins b,   Steven
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ster&search_cluster=thelancet&search_sort=date&restrictname_author=author&re
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even H Miles> H Miles c,   William
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ster&search_cluster=thelancet&search_sort=date&restrictname_author=author&re
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illiam Hopkins>  Hopkins d,   Adnan
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ster&search_cluster=thelancet&search_sort=date&restrictname_author=author&re
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Adnan Siddiqui>  Siddiqui e   and   Frank
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ster&search_cluster=thelancet&search_sort=date&restrictname_author=author&re
stricttype_author=author&restrictterm_author=boulton0f&restrictdesc_author=F
rank Boulton>  Boulton f,   on behalf of 260 other signatories

This week marks the 30th anniversary of the death of anti-apartheid activist
Steve Biko while being detained by South African security police. Initially,
the Minister of Justice suggested Biko had died of a hunger strike; however,
the inquest revealed that he had died of the consequences of head injuries
sustained during police interrogation, and identified gross inadequacies in
the medical treatment from the two doctors responsible for his care,
including the falsification of records. The regulatory authorities failed to
take firm action, and it was only grass-roots efforts by doctors that led,
almost 8 years later, to Benjamin Tucker being found guilty of improper and
disgraceful conduct and being struck off the medical register; Ivor Lang was
found guilty of improper conduct and was given a caution and a reprimand.1

There are strong parallels between the Biko case and the ongoing role of US
military doctors in Guantanamo Bay and the War on Terror. Last year,2 we
suggested that the physicians in Guantanamo force-feeding hunger strikers
should be referred to their professional bodies for breaching
internationally accepted ethical guidelines. One of us (DJN) lodged formal
complaints with the medical boards for Georgia and California as well as
pointing out to the American Medical Association (AMA) that the former
hospital commander at Guantanamo, John Edmondson, was a member.3 After 18
months, there had been no reply from the AMA, the Californian authorities
stated that they "do not have the jurisdiction to investigate incidents that
occurred on a federal facility/military base", and the authorities in
Georgia stated that the "complaint was thoroughly investigated" but "the
Board concluded that there was not sufficient evidence to support
prosecution". Yet an analysis of the same affidavit by the Royal College of
Physicians concluded that "in England, this would be a criminal act".

The UK government has refused a request from the British Medical Association
for a group of independent doctors to assess the detainees4 and, to date,
there has been no formal report on the three alleged suicides in Guantanamo
that took place in June, 2006.

The resolution of the Biko case was instrumental in the rehabilitation of
the South African Medical and Dental Council and the Medical Association of
South Africa, which had been subject to boycotts during the apartheid years.
The failure of the US regulatory authorities to act is damaging the
reputation of US military medicine. No health-care worker in the War on
Terror has been charged or convicted of any significant offence despite
numerous instances documented including fraudulent record keeping on
detainees who have died as a result of failed interrogations.5 We suspect
that the doctors in Guantanamo and elsewhere have made the same mistake as
Tucker who, in 1991, in expressing remorse and seeking reinstatement, said
"I had gradually lost the fearless independence.and become too closely
identified with the organs of the State, especially the Police force.I have
come to realise that a medical practitioner's first responsibility is the
wellbeing of his patient, and that a medical practitioner cannot subordinate
his patient's interest to extraneous considerations."1

The attitude of the US medical establishment appears to be one of "See no
evil, hear no evil, speak no evil".

DJN reviewed the legal record of a detainee who had allegedly been denied
medical treatment, at the request of his attorney, and wrote an affidavit
pro bono based on this review. There was no compensation for this work.

Web Extra Material

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Webappendix. 

References

1 <> . McLean GR, Jenkins T. The Steve Biko affair: a case study in Medical
Ethics. Dev World Bioethics 2003; 3: 77-102. 

2 <> . Nicholl DJ, Atkinson HG, Kalk J, et alon behalf of 255 other doctors.
Forcefeeding and restraint of Guantanamo Bay hunger strikers. Lancet 2006;
367: 811. Full
<http://www.thelancet.com/journals/lancet/article/PIIS0140673606683268/fullt
ext> Text | Full-Text
<http://download.thelancet.com/pdfs/journals/0140-6736/PIIS0140673606683268.
pdf?clusterid=thelancet&mis=.pdf> PDF (39 KB) | CrossRef

3 <> . Nicholl DJ. Guantanamo: a call for action. Good men need to do
something. BMJ 2006; 332: 854-855. 

4 <> . Nicholl DJ and 119 other doctors, Doctors at Guantanamo. The Times
Sept 18, 2006
http://www.timesonline.co.uk/tol/comment/debate/letters...
<http://www.timesonline.co.uk/tol/comment/debate/letters/article642161.ece> 
(accessed Aug 10, 2007).. 

5 <> . Miles SH. Oath betrayed: torture, medical complicity and the War on
Terror. New York: Random House, 2006:. 

Back  <> to top 

Affiliations

a. Department of Neurology, City Hospital, Birmingham B18 7QH, UK
b. Division of Human Genetics, National Health Laboratory Service and
University of the Witwatersrand, Johannesburg, South Africa
c. Center for Bioethics, University of Minnesota, Minneapolis, MN, USA
d. Medical Foundation for the Care of Victims of Torture, London, UK
e. CAGE Prisoners, London, UK
f. MEDACT, The Grayston Centre, London, UK

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