US Army delays, alters medical studies under little-known scientific censorship program

Army censors operating at a public relations office in Falls Church, VA, and elsewhere in the U.S. and Europe have quietly reviewed, altered and in several cases blocked publication of medical studies authored by Army doctors and researchers, an investigation by epiNewswire has found. The "Actionable Medical Information" (AMI) review policy was first established with an Army Medical Command (MEDCOM) memo dated December 2, 2005, and renewed in 2006. At least 312 unclassified medical studies and presentations have been reviewed under the policy since its inception, according to an AMI tracking database obtained with the Freedom of Information Act (FOIA). Fewer than half have been approved for public release in their original form. In 2007, 6 percent of papers were denied permission for public disclosure, but so far this year that denial rate has nearly tripled to 17 percent. Public relations officers review each scientific paper or talk prepared by researchers at Walter Reed Army Medical Center and other medical research facilities. Their primary task is to identify papers that may reveal sensitive information from combat theaters, such as injury and death rates for U.S. soldiers, and pass them along to operational security censors, says Ann Ham, the Army Surgeon General's Office public affairs official who heads up MEDCOM's AMI reviews. But dozens of studies listed in the MEDCOM AMI tracking database appear to have fallen well outside the stated scope of the AMI policy, addressing issues unrelated to combat operations, noted Katherine Rabb of the National Coalition Against Censorship's The Knowledge Project: Censorship & Science in New York, NY. Examples include the effects of war on soldiers' children and families, veterans' post- deployment adjustment issues, refugees, suicide, alcoholism, vaccines, sexually transmitted diseases, problems with military health care databases and even the THC content of commercial hemp products. Also reviewed by censors was a study of cancer in veterans of the 1991 Gulf War and hospital-acquired infections. Release of dozens of other studies has been delayed as AMI reviews drag on for months, despite a 5-day time limit for reviews stipulated in the AMI policy memo. Ham failed to respond to requests to explain why studies unrelated to combat operations were reviewed under the AMI program. By telephone, she emphasized that very few researchers are completely denied permission to publish or otherwise release their studies. "We try to work with them, to identify problems and find solutions together so studies don't have to be denied approval," she said. She was unaware of any scientist appealing a denial decision or required changes. Indeed, the AMI appeals board has never convened to reconsider censors' decisions, MEDCOM officials confirm. "It is fairly obvious what the true motivation behind the policy is," said Maj. Remington Nevin, M.D., M.P.H., of the Armed Forces Health Surveillance Center in Silver Spring, MD. "The war on terrorism has provided a convenient excuse to stifle scientific discourse and the release of information on government operations. Those who stand to lose the most from this policy are the service members it was ostensibly designed to protect." Nevin has been threatened with disciplinary action for allegedly violating the AMI policy by writing a letter to Stars & Stripes, an Army newspaper, regarding the inadequacy of the Pentagon's current health surveillance systems for studying the safety of mefloquine, an anti-malarial drug. "If it smells like a duck and walks like a duck, it usually is a duck," said Jim Balassone of the Markkula Center for Applied Ethics, at Santa Clara University. The Army's censorship policy lacks transparency and a clear description of what content will and will not be targeted, Balassone notes. "The censors lack a written policy on what they might change, alter, or delete"or even add. This gives them leeway to censor anything for any reason, unbeknown to the reader." "The Army's AMI review policy is designed to review professional medical research intended for release in a public forum," noted Rabb. She reviewed the documents disclosed to epiNewswire by the Army. (Read her full statement about AMI.) "The policy specifically targets materials that utilize 'any medical information derived from a combat theater'," she said. "It appears that the policy has been used to review medical information other than that derived from a combat theater. The motivation for such review is unclear. The result, however, is an infringement on the public's right to know." Rabb is looking into AMI and other Army censorship policies. "We would like to know more ... about the data actually removed and the reasons for censorship," she said. One policy, several ambiguous reviews The AMI policy creates several separate review processes, including operational security, public relations and medical. "The policy is aimed more at the public relations aspects of release of information than it is on the [medical] 'need to know' aspects," noted Robert Fortner, Director of the Media Research Institute and a professor at Calvin College in Grand Rapids, MI. "As far as I can tell, the appeal process does not include the right to appeal the determination of the medical review, only the right to appeal the decisions of command and public information portions. There may be reasons that make sense for this, but they aren't articulated in the documentation." "The medical review is the least articulated part of the policy," Fortner said, "which raises the question of who is doing the medical review, what their qualifications are to make the judgments required, and what their marching orders are in completing the review." Fortner and other censorship experts worry that in the Army's effort to deny insurgents sometimes-esoteric data, the value of that information to civilian hospitals and public health officials may be overlooked. "The policy seems aimed only at the military issues raised by medical practices in conflict zones, not on their potential value to responding to emerging threats to civilian populations," said Fortner. "It is difficult to know what information is being restricted, or changes required." AMI is just one of a daunting maze of reviews required of Army medical researchers seeking to publish or discuss their studies with other scientists. Asked to describe in general terms the types of changes made to altered studies, Ham refused, saying that such information is "predecisional" and deliberative, and therefore exempt from public disclosure. Only unclassified information about final decisions has to be released to the public, she said. But the changes required of authors by Ham and other AMI program censors do not appear to be "predecisional." Rather, they are pronounced with finality in the tracking database: "author instructed to make changes," "author notified of clearance for public release pending revisions," "approved with specified revisions." "It is heartening that nearly half the papers submitted for review were passed without change, indicating some effort not to be draconian in interpreting the policy, but the reasons for some papers to be delayed, altered or rejected, cannot be determined from the material provided" by the Army, said Fortner. "The cases of most concern to me would be those whose only 'flaw' was raised by public information personnel." Fortner and other censorship experts contacted for this report expressed concern that the AMI policy is being too broadly applied"reaching beyond its originally intended scope and undermining public access to government medical research. "We fear the Army is using this seemingly narrow policy to broadly censor truthful, scientific reaserch," Rabb said. "The National Coalition Against Censorship believes the public has a right to know non-classified, scientific information generated by government researchers. The AMI policy for prepublication review of medical data puts this right at risk." "It is reasonable to review information pertaining to operational security, weapons systems, critical technology and weapons of mass destruction prior to their release," said Edward Herman, who studies government information and censorship policies at the State University of New York at Buffalo. However, he said the AMI policy is "very broad and could cover almost anything the military wants covered." Data gleaned from the AMI tracking database reveal that only 152 of 312 AMI-reviewed studies and presentations have been approved for public release without mention of required revisions. Several categories of de facto denials were evident in the AMI tracking database: * Censors demanded alterations to 46 papers and presentations * 39 studies were still undergoing review as of last month * 36 studies were formally denied permission for public disclosure or were restricted to publishing only for military audiences ("For Official Use Only"designations) * 15 studies had been referred to other agencies for additional reviews * 4 studies were withdrawn from consideration by the authors * 4 studies were submitted too close in time to intended presentation dates to allow for AMI reviews to be cleared for release * No information was available regarding the status of 20 studies Full disclosure? Ham said she does not know whether or not scientists whose manuscripts have been altered at the direction of AMI censors, disclosed this fact to the medical journals publishing their revised papers. There is no Army policy directing them to do so, she admitted. A search by epiNewswire of three medical literature archives"PubMed, ISI Web of Science and Elsevier's Science Direct"failed to identify even a single medical paper disclosing AMI review or resulting alterations among studies published by Army authors in 2007 or 2008. "Without a clear definition of what has been censored, how do readers trust the data and conclusions?" said Balassone. "I could envision some censorship, that if openly disclosed might ensure that the crucial data and judgments are intact, or some form of peer review attesting to that fact." The AMI policy's ambiguities and contradictions leave plenty of room for abuse, experts caution. For example, Herman says, the AMI policy states that materials developed on personal time using personal equipment and open sources do not require clearance, but that unclassified information can be censored from scientific studies, because, according to the 2005 MEDCOM policy memo, "[i]nformation that appears in open sources does not necessarily constitute declassification. The combination of several open source documents may result in a classified document." "This is very silly, unless it is an attempt to prevent publication of almost anything," said Herman. "I question how likely it is two documents available to the public can result in a third document that ought to be legitimately classified." 'Classification by compilation' is supposed to be rare, agrees Steve Aftergood of the Federation of American Scientists Project on Government Secrecy. "And while it may be applicable in some cases to information about sensitive military technologies, it is hard to see how it could reasonably apply to published medical studies," he said. Delays Many papers languish in the AMI review process for months, despite a requirement in the 2005 policy memo that all reviews be completed within 5 days. Of the 39 papers still undergoing review in September 2008, 38 had been awaiting AMI censors' decisions for more than a month. Most had been submitted for review in 2007. MEDCOM seems to be in the habit of flaunting deadlines. The agency took more than a year to disclose the AMI tracking database requested by epiNewswire, despite a 20-day statutory response time limit under the Freedom of Information Act.