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Chapter One

THE LONG ROAD TO SALMAN PAK

There is incomprehension of why Iraq is persisting so strongly with both refusing to make the facts known about its biological weapons program and why it is so insistent on blocking the Commission's own effort to reach those facts.

United Nations report, October 6, 1997

MURDER AND MEDICINE

About 30 miles south of Baghdad, nestled in a bend of the Tigris River, sits the military town Salman Pak, long considered the heart of Iraq's biological warfare establishment. In August 1991 a team of United Nations (U.N.) experts arrived in Salman Pak to inspect the remains of the facilities, which had been bombed during the Gulf War. They found little but scorched earth. Just two weeks before, the Iraqis had razed what was left of the laboratory structures and burned any documents that survived the Allied bombardment.

    One tantalizing item remained, however, that gave a clue about some of the activity at Salman Pak: a chamber that could be used to expose subjects to bacteria, of the right size to hold "large primates, including the human primate," as one of the U.N. inspectors delicately explained.

    Over the next several years Iraqi officials continued to defy the conditions of the peace agreement by placing countless obstacles in the way of inspectors charged with assessing Iraq's past and current biological and chemical warfare capacity. Gradually, though, the U.N. officials' dogged labors paid off, and by late 1997 they hadaccumulated indisputable evidence of field trials of biological weapons, including some involving human beings.

    Human experiments were one aspect of their war preparation about which the Iraqis were particularly sensitive. Not only would they show that the Iraqis had illegally continued their weapons programs, they would undermine Iraq's moral high ground among the countries that sympathized with the country's suffering under U.N. sanctions. In early 1998 the inspectors surprised the Iraqis by pursuing the human experiments issue. Few now recall that it was this issue that provoked the first Iraqi shutdown of United Nations Special Commission (UNSCOM) operations. "The speculation," said a former U.N. inspector at the time, "is that it probably has to do with unsavory activities—unethical experimentation."

    The UNSCOM team was led by American Scott Ritter, whose service in the Marines years before fueled Iraqi suspicions of spying. Saddam Hussein's subsequent challenges to the U.N. operation precipitated a series of international crises during which UNSCOM's activities were partly suspended, each giving the Iraqis time to clean up surviving evidence. Ritter, who later resigned from UNSCOM in protest of U.S. weakness toward Iraq, himself recalled the circumstances in a December 1998 article in The New Republic:

In January of this year, we embarked on an effort to expose Iraq's use of biological and chemical agents on live human test subjects.... We had received evidence that 95 political prisoners had been transferred from the Abu Gharib Prison to a site in western Iraq, where they had been subjected to lethal testing under the supervision of a special unit from the Military Industrial Commission, under Saddam's personal authority. But, just as we began moving in on facilities housing documents that would support our contention (for instance, transfer records of prisoners), Iraq woke up to the danger and ceased all cooperation with us.

    Prior to the U.N. team's aborted efforts to obtain the prison records, the facts that they learned about Iraqi field tests were grisly. Prisoners were tied to stakes, bombarded with deadly bacteria and gases from bombs a few feet away or dropped from an aircraft, and died in agony. At other times they were locked in chambers while anthrax was sprayed from jets mounted in the ceiling. Death came from internal hemorrhaging. In one experiment Iranian war prisoners were the "test subjects"; in another, Iraqi criminals and Kurds were used. The Kurdish leader Massoud Barzani claims to have evidence that 2,000 Kurdish men who were abducted in 1982 were used to test Iraq's first generation of chemical weapons.

    The continuing Iraqi weapons inspections crisis is part of a new chapter in national security policy following the cold war. American defense planners have realized that, in the hands of rogue states or terrorists, weapons that they had largely ignored for decades pose a substantial threat to the United States in the post-cold war era. Bacteria like the ones that cause anthrax and botulism, and chemicals like nerve gas, are hard to control and deliver effectively but relatively inexpensive to produce and transport. And they could wreak havoc among civilians, especially in heavily populated areas. Government officials are now trying to make up for years of neglect and develop defenses against the danger of biological and chemical weapons. U.S. intelligence officials have estimated that seventeen countries were probably doing research on germ weapons in 1998, as compared to only three in 1979.

    What the general public usually doesn't realize, however, is that human testing in connection with these agents, both to identify protections against biological and chemical weapons and to develop the weapons themselves, has a long and international history. In this the Iraqis are not unique. Nor are the Iraqis unique in proceeding with the use of human beings as "guinea pigs" (a term that true research volunteers hate), while at the same time worrying about public opinion at home and abroad if the facts were to become widely known.

    Other post-cold war adversaries of the West may also have had a history of illicit human experiments, even involving Kosovar Albanians. A U.S. chemical weapons expert told me a story related to him by Radovan Fuchs, Croatia's deputy minister of science and technology. In 1987 or 1988 Fuchs, who is trained as a veterinarian and chemist, traveled from Zagreb to Kosovo in response to a request from officials at an ethnic Albanian girls' school. Over one hundred students had become ill with a number of odd symptoms, including hallucinations. At first a pesticide that had been used nearby was suspected, but Fuchs's team confirmed the presence of benzodiazepine (BZ) in the school's water supply. BZ is a hallucinogen related to lysergic acid diethylamide (LSD) that had been weaponized during the cold war by only two countries: the United States and Yugoslavia. Following this result, Fuchs was instructed by authorities in Belgrade to cease his investigation and return to Zagreb.

    In spite of the unhappy history I will describe in this book, the United States has never descended into the depravity of some countries. Nevertheless, although American military-medical experiments have generally been conducted for defensive purposes, especially since World War II, the line between offensive and defensive military experiments—and the knowledge needed to conduct them—is not always easy to draw. As a result, for more than fifty years American officials have struggled with the knowledge that their practices could easily be lumped into some very bad company. Undeniably, in some cases these practices were so reckless that the association was deserved.

    As I will show, the potential for national disgrace in human testing of "unconventional weapons" or "weapons of mass destruction" has been a constant source of tension in American defense planning since the end of World War II. Though human experiments for military purposes were conducted during the war, and though they were sometimes done in secret, they were not generally regarded as a potential source of embarrassment. It was, after all, a time of national crisis when all were expected to do their part. It was also before the world learned how far Hitler's doctors had gone in service of the Nazi war effort. As the first several chapters explain, the revelations of the Nazi doctors' crimes put American defense planners in a tough position as they prepared for a possible World War III.

    Today and ever since the end of the World War II, the universal sensitivity about human experiments is coupled with the fact that they are probably unavoidable in the real world of national security. Textbook theories, laboratory experiments, and computer and animal models can only go so far. At some point, when information is needed about how human beings will react to new forms of weaponry, human experiments will have to be done. Odds are that the United States will have to continue in this business. In a dangerous world one might well argue that it would be irresponsible for us not to do so. The painful problem before contemporary Americans, as for previous generations, is how this work can be done without contradicting the values of democracy and human rights that we profess to uphold.

APARTHEID'S SECRET WEAPONS

Iraq was not the only nation-state engaged in the development of chemical and biological weapons during the 1980s. A report commissioned by the South African Truth and Reconciliation Commission (TRC), chaired by Nobel Peace Prize winner Bishop Desmond Tutu, uncovered the former Apartheid regime's secret medical research program during its investigations that concluded in 1998. As usual, human experiments were an important part of the development effort.

    The TRC was formed to uncover the unscrupulous means used by both apartheid and anti-apartheid forces prior to the creation of the current government. At the TRC's request, an investigation of South Africa's former biological and chemical weapons was filed by the Netherlands Institute for Southern Africa (NIZA), funded by the Dutch government. Among the incidents reviewed in the report was one that occurred on January 16, 1982, when 300 to 400 Mozambican troops were attacking Renamo rebels in their stronghold in southern Mozambique near the South African border. The rebels were supported by the white South African government. According to the NIZA report:

As they approached the camp on foot in box formation one company forming each side of the box a white jeeptype vehicle was seen in the vicinity of the camp. At about this time, also an unidentified light aircraft was seen flying above the area. The troops passed into the recently deserted Renamo base. They left the base again and a few kilometres away they came under limited small arms fire, not more than 15 shots. They took cover and then an explosion occurred overhead within the outline of the box between 150 and 250 feet above their heads, releasing a dense cloud of black smoke which then dissipated. The wind was blowing towards the rear of the formation.

After 15 minutes the first complaints occurred: "It became very hot. Some of us were going crazy," told Second Lieutenant Joaquim Jonassa. He said they felt severe chest pains, were tired and thirsty, and when they drank water the next morning some of them vomited. Others said they had difficulty seeing. (Guardian 28/1/92) [an internal reference in this passage]. As a consequence a considerable disorganization of the troops occurred.

    The troops' "disorganization" resulted in four deaths and two injuries during the uncontrolled shooting. Despite the remote chance that the incident was caused by dehydration from severe heat, the report concludes that "there remains a fair possibility that the above incident was, however, an example of the testing of chemical weapons in a combat situation against foreign soldiers as part of South Africa's chemical and biological weapons programme." In its final report the TRC stated that it found the dehydration theory "unlikely."

    A mere field test with nerve gas does not give the full measure of the innovative quality of the South African weapons program. In some ways it provides a preview of future biological weapons, which I describe in the last chapter, including an attempt to target a specific racial group with a biological agent in order to cause mass sterility. Among the targets of the commission is a program sponsored by the former Apartheid government called Operation Coast. Besides various chemical and biological weapons developed in the project to harass or kill individuals opposed to apartheid, the commission has also investigated "claims of research on infertility drugs that targeted the Black population." The Dutch researchers for the commission concluded that "further study of these chemical and biological weapons related facts will show that human rights' violations were committed under this programme."

    For military reasons the white South Africans and the Iraqis would have wanted to keep their biological and chemical weapons programs secret. But for political reasons, they had even more reason to keep secret the human experiments aspect of those programs, so as not to alienate their few allies. For while weapons programs might be defensible as part of national security, the bad odor associated with human testing is virtually universal. Echoes of the Nazi doctors can be heard in the TRC's final report: "The image of white-coated scientists, professors, doctors, dentists, veterinarians, laboratories, universities and front companies, propping up apartheid with the support of an extensive international network, was a particularly cynical and chilling one."

    Days after Bishop Tutu's commission report was released, the London Times carried an Associated Press report from South African sources that the Israeli government was attempting to develop an "ethno-bomb," a biological weapon that could target Arabs. In light of the genetic similarity between Arabs and Jews, who are both semitic peoples and must therefore share nearly all their genes, this would be a considerable technical achievement. An unnamed Israeli scientist at Nes Tziyona, Israel's military biological institute, is quoted as saying that, despite the challenges, "they have, however, succeeded in pinpointing a particular characteristic in the genetic profile of certain Arab communities, particularly the Iraqi people."

    Responding to the report, a member of the Israeli parliament recalled the Jews' experience with racial medicine in the concentration camp experiments. "Morally, based on our history, and our tradition and our experience, such a weapon is monstrous and should be denied." The Israeli prime minister's spokesman dismissed the allegations out of hand. In fact, the timing of the report was suspicious: It appeared in mid-November 1998, just as the United States was preparing air strikes against Iraq for violating the terms of its UNSCOM agreement.

    Whatever the truth behind these stories, they highlight the fact that any innovative military program, whether for offensive or defensive purposes, must at some point involve human experiments. Governments have never been eager to acknowledge this fact, because it raises ethical questions that can jeopardize an entire national security research program. Even many people who do not find biological or chemical weapons inherently more objectionable than conventional weapons have a hard time defending the experiments needed to develop them or to defend against them. The topic of medical-military human experiments will always lie within the shadow of the Nuremberg trials of the Nazi doctors.

DUCK AND COVER

Many Americans over the age of 40 have felt a strange sense of déjà vu in the recent scare about biological and chemical weapons. We can recall being marched to school basements for "duck and cover" civil defense drills, and many of us had cellars at home where canned goods were stored against the possibility of a long siege following a nuclear war. In fact, in the fear it can engender and its power to disrupt civilian populations, atomic warfare has much in common with biological and chemical threats. And the history of the production and defense of these "unconventional" weapons since 1945 binds atomic, biological, and chemical war preparations closely together. All were part of defense planners' strategizing in the late 1940s and 1950s, and all created a perceived need for human experiments. These experiments were usually the dark and embarrassing side of what was thought to be military necessity.

    In the United States, while fears about biological and chemical weapons were being faced in 1997 and 1998, headlines also appeared about the aftereffects of atomic testing. Although the U.S. government was reassuring civilians in the 1950s that atomic bomb testing posed no health problems, in 1997 the National Cancer Institute concluded that 10,000 to 75,000 extra thyroid cancers had been caused by the increased radiation in the atmosphere. To make matters worse, at the same time that health concerns were being dismissed, federal officials were warning film manufacturers that atomic fallout could damage their products. In the words of Iowa Senator Tom Harkin, "It is really odd that the Government warned Kodak about its film but wouldn't warn the general public about the milk it was drinking."

    The thyroid damage from nuclear weapons was not caused by a medical experiment, but by a military exercise. Yet radium was used from the 1940s though the 1960s in many doctors' offices for the treatment of ear infections, especially in the armed forces. Between 8,000 and 20,000 service members, as well as many of their dependents, received the treatment, which involved placing small rods in the nostrils to relieve inflammation. One 1982 Johns Hopkins University study suggested that the treatment, by then out of favor because of radiation risks, might lead to higher rates of head and neck cancer.

    These stories pointed to the great interest in the uses of nuclear radiation for both military and medical purposes. Early in April 1999 the University of Cincinnati announced that it had settled a lawsuit for $5 million with families of ninety cancer patients. It had long been charged that from 1960 to 1971 Dr. Eugene Saenger had engaged in harmful total-body and partial-body irradiation experiments with terminally ill patients. Dr. Saenger is a distinguished radiologist whose work was partly supported by the Pentagon.

    Also making headlines in the late 1990s was the fact that atomic energy was also used in activities that combined military purposes and medical projects. In 1997, on New Year's Eve, the Quaker Oats cereal company joined with the Massachusetts Institute of Technology (MIT) to settle a lawsuit brought by a group of unwitting test subjects from the 1950s. The victims were then young boys at the Fernald School in Waltham, Massachusetts, where they were fed cereal containing trace amounts of radiation to identify the pathway of nutrients in the human digestive system. Their parents had given permission for them to be in a special club at the state school for children who were supposed to be "mentally retarded," but no mention was made of the radiation. Although unharmed by the very low doses to which they were exposed, an MIT spokesman agreed in 1998 that their civil rights—the right to give informed consent to being in an experiment—had been violated. The $1.85 million settlement covered about thirty of the alumni of Fernald's "Science Club."

    The studies at Fernald and another school called Wrentham point up another problem: the scope of the term national security experiments. If the term is taken narrowly, then only human experiments that provide direct and foreseeable information relevant to the national defense will be included. An example is the development of vaccines against a biological weapon. But I believe that the term must be taken in a broader sense, to include any study supported partly because it might yield results that can be applied to military purposes, however remote from the security context the study seems to be. Especially with regard to the early radiation studies, the latter interpretation more closely matches the facts, and that understanding of the scope of national security experiment will be used in this book.

    The radioactive material for the Fernald project came from another sponsor, the Atomic Energy Commission (AEC). The AEC was a civilian agency responsible for the nation's nuclear resources. For reasons of national security and public health, how the human body absorbed and eliminated radiation were critical questions in the early 1950s, only a few years after the Soviets developed their own atomic bomb. Was this a justifiable experiment at the time? Or was it an unacceptable violation of the boys' civil rights? How far can a nation-state based on democratic principles of individual rights go to defend itself in the modern world of weapons of mass destruction? May it use medicine, the craft dedicated to healing, as a party to its self-defense? Is it appropriate for physicians to involve themselves in such work? Have the rules changed over the decades, and how are these matters handled today? These questions reveal the way moral intricacies are unavoidably woven into scientific and technical problems in the use of human beings in military medical research.