Specialists from Cuba reject notion of health attacks and brain damage in U.S. diplomats

On September 13, 2018 a meeting took place in Washington D.C. between U.S. and Cuban expert scientists to exchange on the health symptoms reported by U.S. diplomats accredited in Havana. The Cuban multidisciplinary group of experts, made up of 9 scientists and physicians, all members of a panel at the Cuban Academy of Science, was led by Ambassador Johana Tablada, Deputy Director General for U.S. Affairs, at the Cuban Ministry of Foreign Affairs and the Ambassador of Cuba in Washington D.C., José R. Cabañas. The U.S. team was led by Ambassador Kenneth Merten, Principal Deputy Assistant Secretary of State, and composed of medical personnel of the U.S. Department of State.

Before the holding of these meeting, the Cuban team had reviewed the scarce information about the alleged incidents submitted by the United States Embassy, the publications by a medical team from the University of Pennsylvania, (specially an article published by the Journal of the American Medical Association (JAMA), and the works by other scientists, as well as the conclusions of police investigations conducted separately by the authorities of the Cuban Ministry of the Interior and the United States Federal Bureau of Investigations (FBI).

In the meeting, the Cuban team received a summary of the information previously reported in JAMA describing the results of medical examination and some of the diplomats. The Cuban team presented their analysis of the shortcomings of this study, challenged its main conclusions and the scientific interpretation of the  symptoms presented to them.

At the end of the exchange, the Cuban experts verified that the information provided is unable to support the hypothesis of health attacks and brain damage suggested so far by the Department of State, as well as the explanations of the symptoms which according to the Department of State, were reported by their diplomats.

The Cuban experts particularly reaffirmed that with the information exchanged it is not possible to demonstrate the existence of a new neurological medical syndrome of brain lesion type, nor it is possible to assert that a brain damage like those caused by a blow to the head  was produced without cranial trauma. This idea is impossible.

They observed that the medical evidence presented has serious limitations. The majority of the cases described show symptoms such as: headaches, nausea, dizziness, subjective balance and sleep disorders, which are caused by functional disorders and conditions such as: hypertension, stress and many others with high prevalence in the U.S. and worldwide. The accuracy of the reports could have also been affected by the average of 203 days that lapsed from the time the alleged incidents took place to the date when medical research was conducted.   

The neuro-psychological tests, considered to be more objective, were assessed with unusual criteria which, applied to a group of healthy individuals, would qualify all of them as ill. If the internationally established  criteria would have been applied only two subjects could be considered afflicted, the cause of which, could be attributed to different pre-existing conditions.   

According to those studies, only three individuals were found to have mild or moderate hearing loss, with each audiogram showing correspondence with three different diseases that were probably preexisting.

The neuro-images showed no evidence of brain damage. Two individuals showed mild signs and a third one showed moderate signs that, according to the JAMA report, are not specific, are present in many diseases and could be attributed to processes that occurred before those persons travelled to Cuba. It has been impossible for the Cuban experts to access these images.

The scientific studies, the Cuban police and FBI investigations, as well as the information shared by the Department of State shows a lack of evidence of any kind of attack or deliberate act. The Cuban delegation rejected categorically the use of the term attack when there is no evidence whatsoever that support the term. The US officials underscored that they did not have an explanation for the incidents.

Cuba expressed its willingness to cooperate and reiterated that it is its highest interest to find an explanation to the reports described. As of February 2017, when the U.S. Embassy in Havana informed the Ministry of Foreign Affairs about the alleged "acoustic attacks" against some officials of said diplomatic mission, Cuba has requested and provided the highest cooperation to clarify what happened, and early on suggested to hold a meeting between medical experts from both countries.

The Cuban delegation regretted the lack of access to clinical data and to the doctors who assessed the diplomatic personnel who reported health symptoms. Nevertheless, the Cuban team considers that today’s meeting was a positive step, and yet insufficient. To date, the scientific and medical exchange has only taken place indirectly through the publication of scientific articles, political statements and regrettable press leaks.

The Cuban medical team extended an invitation to the U.S. investigation team to hold another scientific exchange in Havana in the near future that can be also attended by those professionals who treated the U.S. diplomats.

MEMBERS OF THE CUBAN TEAM OF EXPERTS WHO ATTENDED TO THE MEETING BETWEEN EXPERTS FROM CUBA AND THE UNITED STATES

1.    Mitchell Joseph Valdés Sosa. PhD in Medical Sciences and Senior Researcher. General Director of the Cuban Center for Neurosciences. Coordinator of the National Group of Neurophysiology of the Ministry of Public Health. Chairman of the Latin American Society of Neurophysiology. Member Emeritus of the Cuban Academy of Sciences

2.    Nelson Gómez Viera, PhD in Medical Sciences and Senior Researcher. Master of Science in Clinical Epidemiology. Second Grade Specialist in Neurology and Senior Professor. Chief of the Neurology Department at the “Hermanos Ameijeiras” Hospital. Member of the Cuban Academy of Sciences.

3.    Pedro Antonio Valdés Sosa. PhD in Medical Sciences, Deputy Director of the Cuban Center for Neuroscience. Member Emeritus of the Cuban Academy of Sciences. Coordinator Cuban Human Brain Mapping Project.

4.    Antonio Paz Cordovéz. Second Grade Specialist in Otolaryngology. Head of the Cochlear Implant Group. President of the Cuban Society of Otolaryngology. Maitre de Stage at George Portman Institute.

5.    Manuel Jorge Villar Kuscevic. PhD in Medical Sciences. Head of Otolaryngology and the Head and Neck Surgery Department at the "Enrique Cabrera" Hospital. Maitre de Stage at George Portman Institute.

6.    Miguel Blanco Aspiazu. PhD in Medical Sciences. Chairman of the Cuban Society of Internal Medicine. Full Professor at the "Dr. Carlos J. Finlay” School of Medical Sciences.

7.    Dionisio Zaldívar Pérez. PhD in Psychological Sciences at Havana University School of Psychology.

8.    Alexis Lorenzo Ruiz. PhD in Psychological Sciences and full professor at Havana University School of Psychology.

9.    Dr. Miriam de la Osa O´Reilly. Chief of the "Hermanos Ameijeiras" Hospital Psychiatric Department and president of the Cuban Association of Psychiatry.

EXECUTIVE SUMMARY OF THE ASSESSMENT BY THE CUBAN SCIENTIFIC PANEL OF MEDICAL REPORTS REGARDING THE HEALTH OF U.S. DIPLOMATS AND THEIR FAMILIES PREVIOUSLY STATIONED IN HAVANA

The Academy of Sciences of Cuba has created the Cuban Scientific Panel (CSP) to examine the evidence regarding the alleged “attacks” on US embassy staffers and their families stationed in Havana. For more than a year the CSP has requested medical information. The only data available is the article of Swanson et al. (2018), henceforth referred to as “the report”. This was published by the Journal of the American Medical Association (JAMA) and describes the examinations carried out by a medical team at the University of Pennsylvania (UPENN) at the request of the US State Department. This article was accompanied by a critical, but usually disregarded, JAMA editorial highlighting the many limitations of this study that precluded firm conclusions. Subsequently, articles in specialized journals also analyzed methodological flaws of the report. In fact, later JAMA published 4 letters to the editor by different groups of scientists that contained further objections to which the authors of the report paper replied.

These publicly available reports have been analyzed by the Cuban Scientists as well as all the additional evidence available to Cuba, including an extensive literature search of the scientific literature.

In spite of the limited data, the CSP identifies that the central thesis of the report is that a “new neurological syndrome” has been discovered. It is described as due to brain damage present in the 21 cases, with a common etiology related to the hearing of unusual sounds. Unfortunately, this thesis is inconsistent with the data presented for the following reasons:

•         The report has severe methodological limitations (many surprisingly pointed out in the editorial by JAMA), that preclude firm conclusions and certainly do not lead to the definition of a novel syndrome.
•         The report overemphasizes meager and inconsistent cognitive deficits. An unusually broad dentition of neuropsychological deficits was used that would classify most healthy subjects as ill. In the opinion of the CSP and other respected neuropsychologists, the JAMA article represents a case of poor neuropsychology; clinically inappropriate, and methodologically improper.
•         The findings of Balance/vestibular disorders are inconclusive. In fact, conclusion, nausea, dizziness, and subjective balance disorders can be present in functional conditions and many diseases.
•         The report lists unspecific oculomotor disturbances that may be due to many causes that are frequent.
•         Despite what is claimed in the report, there are very few cases with verified hearing loss. Only 3 individuals with mild to moderate hearing loss were found, with audiograms consistent with diverse preexisting conditions. Despite prominence given to auditory sensations in introduction and exposure sections, very audiological limited assessment.
•         There is overinterpretation of nonspecific findings of sleep disorders and headaches since both conditions are frequent in general population and consistent with other explanations, such as anxiety and chronic stress.
•         There is complete absence of positive Neuroimaging findings indicating brain injury, much less evidence of “widespread brain networks”.
•         It is inadequate to consider sound as an indicator of etiology. Neither US nor Cuban authorities found evidence of any type of attacks on the diplomats from the US embassy in Cuba.
•         There is a lack of a credible hypothetical agent producing brain-injury in the subjects. Several types of weapons having been alleged to be involved First sound was proposed which was rapidly discredited. Now microwaves weapons are invoked, a possibility the prestigious US scientists recognize as impossible.
•         There is an unjustified dismissal of psychological factors. Although a few subjects were probably ill due to pre-existing conditions or acquired diseases, this small community was informed of alleged “attacks” by their government and had an emergency evacuation. All the conditions for psychological disturbances including collective stress and mass psychogenic disorders were present.
•         There is a failure to demonstrate brain damage and a novel syndrome’ the presented data only points to very few (perhaps 2/3) subjects with possible cognitive dysfunctions which could be due to preexisting conditions or diseases (or simply age), and certainly not an unverified “head trauma without trauma” in the 21 cases. The conclusion of injury to widespread brain networks is not supported by scientific data.

In summary:

1.       The cases do not have homogenous symptoms, and those that exist in the majority can be explained by frequent conditions and disorders.
2.       There is no clinical, neuropsychological, or imaging evidence of brain injury in US diplomats or family incurred in Cuba
3.       Therefore, there is no evidence for a “new neurological syndrome”
4.       There is no credible mechanism for brain injury associated with abnormal sound perceptions.
5.       It is extremely unfortunate that research hypothesis that has not substantiated or submitted to independent scrutiny as part of the normal scientific are taken as facts.
The CSP is willing to collaborate and to openly share information with its US counterparts to find a definitive, solid and real explanation of the incidents involving US diplomats and their families in Havana.

(Cubaminrex)