September 06, 2007

So which doctor is lying here?

There's a bit of a to-do going on at the British Medical Journal over an allegation by Doctor, indeed Professor Michael Baum that it is "a lie to suggest that the Israel Medical Association is complicit in the ill treatment of prisoners.1" And here's the reference that the little 1 leads us to:
Blachar Y. Medical ethics, the Israel Medical Association, and the state of the World Medical Association; IMA president's response to the open letter in the BMA. BMJ 2003;327:1107.[Free Full Text]

Ok, so it's a lie because the president of the Israeli Medical Association says it is. But let's see what another doctor, Derek Summerfield, has to say about this lie business.
[Professor Baum]...writes that “it is also a lie to suggest that the IMA is complicit in the ill-treatment of prisoners”. A lie, Professor? The reference given to support this conclusion is a response by the President of the IMA to articles of mine in the BMJ in 2003. As one doctor to another I would like to ask Professor Baum directly whether he properly examined the considerable weight of published documentation relevant to this question before he made so unequivocal a statement in the world’s most circulated medical journal.

Firstly, a major point of reference in this literature would be the 1996 Amnesty International report which concluded that Israeli doctors working with the security services “form part of a system in which detainees are tortured, ill-treated and humiliated in ways that place prison medical practice in conflict with medical ethics”. Have you read this Professor Baum, and if you have, on what basis do you dismiss it? The report was entitled “Under constant medical supervision”, an ironic reference to a statement the Israeli authorities had made in defence of conditions in interrogation suites and prisons holding Palestinian detainees. If torture was institutionalised in the everyday treatment of Palestinian men undergoing interrogation, and such men were indeed under constant medical supervision, these doctors could not be but colluding with such practices in defiance of all codes of practice and the WMA’s anti-torture Declaration of Tokyo. Indeed in 1993 a ‘fitness for interrogation’ form to be filled out by Israeli doctors in detention centres came to light- this was medical certification in preparation for interrogation accompanied by torture.

Writing in the Lancet, the head of Physicians for Human Rights Israel (PHRI), a group for whom I have the greatest respect, reported in 2003 that since 1992 they had been attempting to get the IMA to join their opposition to the use of torture, but in vain. Amnesty told me in the 1990s that they too had made various approaches to the IMA on this account and had always been rebuffed. This too has been my experience when I have published articles on this subject in the BMJ and Lancet. In response to one of these, published in the Lancet, the longstanding president of the IMA Dr Yoram Blachar- whom Professor Baum is citing with approval- actually justified the use of “moderate physical pressure” during interrogations. It is not often that the head of a national medical association uses a medical journal to defend practices which the UN Committee Against Torture considered torture. The moral position and strategic line taken over many years by the IMA was well captured by a remark made by Professor Eran Dolev, than IMA Head of Ethics (yes, Ethics!) in an interview in 1999 with a visiting delegation from the Medical Foundation for the Care of Victims of Torture, London (headed by the founder, Helen Bamber OBE). Dolev told them that “a couple of broken fingers” during the interrogation of Palestinians was worthwhile for the information it might garner. In a letter to the Journal of the Royal Society of Medicine, those present collectively verified what Dolev had said. Did your researches turn up this letter, Professor Baum? In the event the IMA President defended Dolev and threatened a law suit, despite the watertight evidence. Indeed 2 years earlier, after a human rights conference in Gaza, I had written to Dolev in his capacity as Head of Ethics. An Israeli physician had told me that a medical colleague had confessed to her that he had removed the intravenous drip from the arm of a seriously ill Palestinian prisoner, and told the man that if he wanted to live, he should co-operate with his interrogators. I asked Dolev to investigate but he never replied, even after reminders.

When an Israeli psychiatrist Dr Ruchama Marton, a psychiatrist, publicised the unethical role that fellow Israeli doctors were playing in detention centres by labelling seriously mentally ill Palestinian detainees as “malingerers”, and denying them treatment, the IMA charged her with slander rather than investigating the allegations.

Torture continues to state policy in Israel. The Israeli human rights documentation centre B’Tselem recently confirmed (April 2007) that almost all Palestinian detainees suffer physical and mental abuse amounting to torture, citing the testimonies of 73 men gathered between July 2005 and January 2006. The IMA maintains a studied silence.

The second major medical ethical question concerns the Fourth Geneva Convention- those sections that guarantee a civilian population unfettered access to medical services and to the essentials for life, and immunity for medical staff. Amongst the bodies who have documented the extent to which the Israeli Defence Force (IDF) has systematically flouted the Convention are Amnesty International (more than 500 critical reports since September 2000), Human Rights Watch, the World Food Programme, the Red Cross, UNICEF, the UN Relief and Works Agency, the WHO, the Israeli organisations Physicians for Human Rights (PHRI) and B’Tselem, the Palestinian organisation Health, Development, Information and Policy Institute, UN Social and Economic Council and various rapporteurs, and aid agencies like Medecins Sans Frontieres. Have you taken a scholarly approach to their reports before committing yourself, Professor Baum?
Now that is an extract from a lengthy "rapid response" to Professor Baum's article. If you follow the link you might figure how the rapid response system works and maybe post a rapid response yourself. I don't know what the registration requirements, if any, are but looking at some of the ludicrous comments before and after this Summerfield chap's one, I'd say that any fool can do it.

But this Summerfield chappie is no fool it seems. Noticing that Professor Baum has not availed of the rapid response facility himself, Summerfield has made his challenge to the Professor more explicit. So let's have that challenge again: In the July 21 BMJ debate on the merits or demerits of an academic boycott of Israel,
Michael Baum, an emeritus professor of surgery, was the author of the essay against a proposed boycott. One of his points was that “it is a lie to suggest that the Israeli Medical Association is complicit the ill-treatment of prisoners”. The reference he provided for this assertion was the response by IMA President Yoram Blachar in the BMJ in 2003 to my open letter of appeal on this subject. The lie, then, was mine. To assert this, on so charged a public issue, and in the world’s most publicised medical journal, is no small matter- it is capable of reassuring those who were harbouring some doubts about medical ethics in Israel, and of increasing the sense of security and indeed impunity with which interrogations of Palestinians are conducted in Israel.(Professor Baum did not seek to rebut the other main charge against the IMA: their refusal to speak out- as the World Medical Association (WMA) mandates- on systematic violations by the Israeli military of the Fourth Geneva Convention-guaranteed rights of a civilian population to unhindered access to the essentials for day-to-day life, including medical services, and for immunity for health professionals at work).

The claim about lying is also of some bearing to my personal reputation as a doctor and human rights campaigner.

I am also one of the main proponents of the call for the expulsion of the Israeli Medical Association from the WMA, and in a lengthy and well referenced rapid response on July 25 I sought to provide a comprehensive resume of the case against the IMA. In so doing I challenged Professor Baum to justify his claim and the scholarship upon which it was based, and to reply at for others following the debate to weigh up. I also sent a copy to his email address. 5 weeks have passed and Professor Baum has not responded. I do not know what his intentions are, but to refuse would seem in the particular circumstances to be unprofessional and unethical. What he wrote is unambiguously an unconditional exoneration of the IMA in the face of “lies” about their conduct. I again appeal to him to justify this.
Go on Professor, give it a go.


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