New Yorker Report on Medical Problems of U.S. Diplomats in Cuba

The November 19, 2018, issue of The New Yorker has a lengthy article about the medical problems experienced by some U.S. diplomats in Cuba starting in late 2016 (and after the U.S. presidential election). [1]

The conclusion, however, is the same as previously reported: some U.S. personnel did suffer injury and the U.S. Government has publicly stated it does not know the cause or perpetrator of these injuries.[2]

But the article does provide greater details about many of the victims having been CIA agents and about the U.S.-Cuba interactions over these incidents.

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[1] Entous & Anderson, Havana Syndrome, New Yorker at 34  (Nov. 19, 2018).

[2] See posts listed in the “U.S. Diplomats Medical Problems in Cuba, 2017-18” section of List of Posts to dwkcommentaries—Topical: CUBA.

Medical Report on U.S. Diplomats with Health Problems Occurring in Cuba 

Since late 2016, some U.S. diplomats, now numbering 24, have suffered various medical problems while stationed in Cuba. Perplexingly investigations by the FBI and other U.S. agencies as well as Cuban investigators over nearly the last 16 months have failed to ascertain the cause or the culprit, if any, of the cause of their problems.[1] On February 14 a new medical report was released on these individuals.

The Medical Report [2[

U.S. physicians at the University of Pennsylvania’s Perelman School of Medicine in an article in the Journal of the American Medical Association (JAMA) have published the  preliminary results of their examination of 21 of these 24 individuals. Here are the key findings of their report:

  • The patients “appeared to have sustained injury to widespread brain networks.”
  • The patients have experienced “persisting disability of a significant nature” involving “hearing, vision, balance and brain symptoms similar to the brain dysfunction seen with concussions, but without histories of head trauma.”
  • In most cases, the affected diplomats reported hearing a loud, painful noise that they later associated with their symptoms, but the physicians concluded, “There is no known mechanism for audible sound to injure the brain” and “it is currently unclear if or how the noise is related to the reported symptoms.”
  • “Viruses or chemical exposures are unlikely,” but could not be “systematically excluded.”
  • “Advanced MRI scans spotted a few changes in some patients in what are called white matter tracts,” but these might be attributed to previous events.
  • “Several of the objective manifestations consistently found in this cohort,” including vision and balance abnormalities, “could not have been consciously or unconsciously manipulated.”

The study’s lead author, Dr. Douglas H. Smith, director of the Center for Brain Injury and Repair at the University of Pennsylvania, said, “This is a preliminary report.We thought it was important to get it out from a public health standpoint.” Nevertheless, “Uniformly, everyone who saw these patients was absolutely convinced. It looked like concussion pathology. Processing speed, inability to remember — those are such classic symptoms we see in concussion. We all believe this is a real syndrome.This is concussion without blunt head trauma.”

JAMA Editorial About the Report [3]

An accompanying JAMA editorial by Drs. Christopher C.Muth and Steven L. Lewis emphasized caution in interpreting the data of this report. It stated, “although the patients were united to some extent by the common locations in which their symptoms first developed, there was some variability between patients in terms of the symptoms that each experienced. The precise time course over which each individual’s symptoms evolved was not provided. Given that evaluations were conducted a mean of 203 days after onset, it remains unclear whether individuals who developed symptoms later were aware of the previous reports of others. Furthermore, the quantitative results for specific tests (eg, neuropsychological tests) are not yet available for all affected patients, so independent assessment as to the scope and severity of deficits among all individuals remains challenging.”

This JAMA editorial also listed several limitations in this case study that “should also urge caution in interpreting the findings.” It concluded, “Before reaching any definitive conclusions, additional evidence must be obtained and rigorously and objectively evaluated.”

Another Reaction to the Report [4]

Another medical expert offered comments. C. Edward Dixon, a professor of neurological surgery at the University of Pittsburgh, who was not involved in the research, said, “The study was conducted by the top concussion research team in the world utilizing state-of-the-art methods” and the findings suggest “a significant brain insult.”

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[1] The problems of these diplomats have been discussed in previous posts listed in the “ U.S. Diplomats Medical Problems in Cuba, 2016-2018” section of List of Posts to dwkcommentaries—Topical: CUBA

[2] Drs. Swanson, Hampton, McKenzie, et al., Neurological Manifestations Among U.S. Government Personnel Regarding Directional Audible and Sensory Phenomena in Havana Cuba, JAMA (Feb. 15, 2018); Assoc. Press, Report Details Harm to Cuba Diplomats, but Offers No Cause, N.Y. Times (Feb. 14, 2018); DeYoung, Doctors find neurological damage to Americans who served in Cuba, Wash. Post (Feb. 14, 2018).

[3] Drs. Muth & Lewis, Editorial: Neurological Symptoms Among U.S. Diplomats in Cuba, JAMA (feb. 15, 2018). 

[4] Kolata, Diplomats in Cuba Suffered Brain Injuries. Experts Still Don’t Know Why, N.Y. Times (Feb. 15, 2018). 

A New Travel Warning for Americans Traveling to Cuba 

 Last Wednesday (September 13), the U.S. State Department issued a warning about Americans traveling to Cuba that was discussed in an earlier post.

On September 18, the Department updated its Cuba Travel Warning after Hurricane Irma had hit and damaged the island.[1] It stated the following:

  • “The Department of State advises U.S. citizens to carefully consider the risks of travel to Cuba while Hurricane Irma recovery efforts are underway.  Major roads are now open in Havana and power and water service has been restored in most of the city, but some parts of the country may be without power and running water. North central Cuba suffered severe damage and should be avoided until further notice. On September 6, the Department authorized the voluntary departure of U.S. government employees and their family members due to Hurricane Irma.”
  • “Travelers should apprise family and friends in the United States of their whereabouts, and keep in close contact with their travel agency, hotel staff, and local officials.”
  • “U.S. citizens in Cuba in need of emergency assistance should contact the Embassy by telephone at +53- 5280-5791 or the Department of State at 1-202-501-4444. At this time, U.S. citizens should not attempt to go to the U.S. Embassy in Havana as it suffered severe flood damage.”

Meanwhile the Cuban government announced that it would help its citizens recover from Hurricane Irma’s devastating swipe at its north coast and rebuild their homes. The plan would have the government finance 50 percent of the cost of construction materials for such rebuilding. Defense councils will certify the extent of damages and the resources necessary to make repairs.[2]

For homes that collapsed or lost their entire roofs, the state will take over interest payments. Defense councils also will consider subsidies for victims whose incomes are too low to purchase all the required construction materials, and those who still owe money on previous construction loans may be granted subsidies.

Hurricane Irma will have a major negative effect on Cuba’s economy. Economist Carmelo Mesa-Lago, a professor emeritus at the University of Pittsburgh, is convinced that GDP will decline over the last six months of this year. Another Cuban economist, Pavel Vidal, who is a professor at Javeriana University in Colombia, thought the hurricane damage “may pump up inflation” and cause ‘financial complications.”

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[1] U.S. State Dep’t, Cuba Travel Warning (Sept. 18, 2017); Rosenberg, US warns would-be Cuban travelers: consider the risks following Hurricane Irma, Miami Herald (Sept. 18, 2017)

[2] Information for the population, Granma (Sept. 18, 2017); Whitefield & Torres, Cuba announces program to repair Irma-damages homes as experts assess damage to economy, Miami Herald (Sept. 18, 2017).