Medical News & Exposé
epi
U.S. Army delays, alters medical studies under obscure
censorship program, epiNewswire investigation finds
Policy 'stifles scientific discourse,' says an Army epidemiologist; medical
journals are not informed papers have been censored
Since 2006 U.S. Army censors have scrutinized hundreds of medical studies,
scientific posters, abstracts and Powerpoint presentations authored by doctors and
scientists at Walter Reed and other Army medical research centers—part of a little-
known prepublication review process called "Actionable Medical Information Review."
More than 300 scientific documents have been reviewed by Army censors to date,
according to documents obtained by epiNewswire. Fewer than half of them have been
cleared for public disclosure in their original form, but officials refuse to describe
changes even in general terms.
The program is intended to deny Iraqi and Afghan insurgents sensitive data such as
combat injury and death rates. But dozens of studies reviewed under the program did
not involve research related to combat operations. Instead, they described potentially
controversial topics like the effects of war on soldiers' children, hospital-acquired
infections, post-deployment adjustment issues, refugees, suicide, alcoholism,
vaccines, cancer among veterans and problems with military health care databases.
An Army epidemiologist has been threatened with disciplinary action for allegedly
violating the policy after sending a letter to Stars & Stripes lamenting the Pentagon's
inadequate resources for tracking and studying diseases—as Congress requires.
Read the National Coalition Against Censorship's
The Knowledge Project: Censorship & Science
statement on the Army's policy
October 21, 2008—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 per
-cent.
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.
“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."