Scientists Are Still Fighting Over What Made US Diplomats In Cuba Ill

The Journal of the American Medical Association published letters today critical of a study it published six months ago claiming that US diplomats in Cuba had suffered brain injuries.

Ten scientists have published letters in the Journal of the American Medical Association criticizing the first medical review of the US diplomats in Cuba who were reportedly targets of a “sonic attack.”

In letters published by JAMA on Tuesday, the scientists complained that the authors of a February study in the journal failed to include “mass hysteria” as one of the possible causes of the symptoms that the diplomats reported. Such “mass psychological outbreaks” usually take place in high-stress environments, and all involved begin exhibiting the similar, real physical symptoms.

The critics also said the study’s authors did not include information on whether the diplomats had known one another, and included no testing on hearing and balance — even though “a presumed sonic weapon attack would affect the inner ear more preferentially than any other part of the body, including the brain.” The inner ear is critical to balance.

The letters are the latest broadside in what has become a contentious scientific battle that has raged since the Trump administration first used the reports of “sonic attacks” on diplomats in Cuba to justify withdrawing diplomats from the island, expelling Cuban diplomats from Washington, cutting back on contacts between the United States and Cuba, and advising US citizens not to travel to the island.

Some scientists challenged the State Department’s assertions that some sort of sonic attack was responsible for the vague symptoms diplomats complained of, including hearing loss and cloudy thinking, and the US government eventually stopped using the word “attack” to describe what took place. But the US also declared that Havana was too dangerous to allow diplomats’ families to live there.

The February JAMA article was touted as the first scientific assessment of the evidence. In it, University of Pennsylvania researchers ruled out a sonic attack, neurological illness from a tropical virus, or poisoning as possible explanations. Rather, the 21 individuals they examined showed a “constellation” of symptoms that suggested concussions, without the head trauma. “If you didn’t know their history, they would look to you like other concussion patients,” the study’s lead author, Randel Swanson, told BuzzFeed News at the time.

The study also said they displayed cognitive dysfunction and abnormalities.

The letters published Tuesday were all critical of the authors’ conclusions. Written by physicians and researchers from a variety of states and nations, the letters questioned the assessment, saying the authors had not done critical tests and had improperly interpreted the results of cognitive tests. Crucially, according to one expert, the Penn team had failed to consider evidence that the illness could be a form of a mass psychological outbreak — for which there is no immediate external cause.

Robert Bartholomew, an American-born medical sociologist at Botany Downs Secondary College in New Zealand, and a main proponent of the idea that diplomats were or are suffering a psychological outbreak, argued that the authors of the study were unduly dismissive of “mass psychogenic illness,” also known as “mass hysteria,” because there was no rapid onset and recovery. “However,” Bartholomew wrote, “the second most common type of mass psychogenic illness begins slowly and persists for months or years and often features neurological symptoms.”

Bartholomew also criticized the study’s lack of “social network analysis” — determining whether patients actually knew one another. For a mass psychological outbreak to occur, the individuals involved would have needed to know one another; the study notes that some of the individuals involved did not know one another.

But Bartholomew said relying on the patients for that information was inadequate since the study took place 203 days after the first victims reported their symptoms. They may have misremembered contacts, or, he argues, the patients didn’t actually need to know one another personally. They only needed to know others were ill.

Earlier this year, a US government employee in China reported similar symptoms, and US Secretary of State Mike Pompeo said the two cases were “very similar and entirely consistent.”

Other scientists and doctors — from Edinburgh, UK; Bochum, Germany; Salisbury, North Carolina; Denver, Colorado; Covington, Louisiana; and New Brunswick, New Jersey — wrote in too.

Gerard Gianoli and James Soileau of the Ear and Balance Institute in Covington, joined by P. Ashley Wackym of Rutgers University's Robert Wood Johnson Medical School, noted that the study didn’t include testing on hearing and balance, even though “a presumed sonic weapon attack would affect the inner ear more preferentially than any other part of the body, including the brain.”

Robert Shura and Holly Miska of the Salisbury Veterans Affairs Medical Center and Jason Kacmarski of the Veterans Affairs Eastern Colorado Health Care System criticized the study for what they said was its “improper interpretation of objective cognitive test results.” They write that the University of Pennsylvania researchers chose a more “liberal cutoff” to define impairment than would normally be used in research settings. Their conclusion that the patients “had significant areas of cognitive weakness and/or impairment,” they write, is based on a “misapplication of common interpretive classification systems.”

The letters also challenged the idea that a disorder or mass psychogenic illness is somehow less real or more the fault of the individuals involved than, say, a concussion. “Although diagnostic caution is warranted, functional neurological disorders are common genuine disorders that can affect anyone,” wrote Jon Stone and Alan Carson of Edinburgh and Stoyan Popkirov of Bochum, adding, “including hardworking diplomatic staff.”

In a response published in JAMA immediately below the letters, the University of Pennsylvania team defended its work, writing that the chronic symptoms they found “are entirely different” from those seen in mass psychogenic disorders. They also said they “must continue to withhold certain sensitive information,” although they do not say why and do admit the US State Department cleared the study as a public health matter.

The US government has sent FBI agents to Cuba to study the illness, but has yet to reach a conclusion on its cause. In July, the Centers for Disease Control and Prevention joined the investigation into what injured the diplomats.

The Cuban Embassy in Washington did not immediately reply to request for comment. The American Foreign Service Association, which represents US diplomats, would not comment prior to publication of the letters, which they had not seen. JAMA declined to comment on why the criticism was published six months after the study, or whether the US government pressured it into publishing the study in the first place.

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