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.


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