Havana Syndrome: Exploitation of Medicine for Political Gain

"Havana syndrome" has made the headlines since 2016, when Western diplomats in Cuba reported a constellation of neurological symptoms such as brain fog, tinnitus, vertigo, and visual symptoms in the setting of reported auditory and sensory stimuli (Asadi-Pooya, 2022). Various investigations have sought to elucidate the etiology of this condition (Swanson et al., 2018). Early studies suggested that nontraumatic injury to brain networks was implicated in the clinical presentation of these individuals, with some authors reporting changes in white matter (WM) tracts, WM volume, and functional connectivity on magnetic resonance imaging (MRI; Verma et al., 2019). There has been a low threshold in suspecting foul play by geopolitical adversaries among much of the media and American intelligentsia, with "sonic attacks" via pulsed microwave radiation implicated as a potential etiology from the beginning.

Havana, Cuba, where diplomats were first reported to exhibit the neurological phenomena of "Havana Syndrome"

Source: Alex Azabache / Unsplash

Neurobiological Investigations

However, this has not held up to scientific scrutiny. The Office for the Director of National Intelligence (ODNI) deemed that sonic attacks were “highly unlikely” to be the etiology for these individuals’ clinical presentations (Bartholomew & Baloh, 2024). A National Institutes of Health probe found no evidence of MRI-detectable brain injury or significant differences in WM volume or functional connectivity in these individuals compared to controls (Pierpaoli et al., 2024).

Furthermore, Chan et al. (2024) conducted a comprehensive study in 86 U.S. diplomatic staff and their family members, analyzing neuropsychological, vestibular, and other clinical testing, as well as biomarkers such as glial fibrillary acidic protein when compared to controls. They found that, while the patients with anomalous health incidents (AHIs) demonstrated increased rates of neurobehavioral symptoms such as fatigue, depression, and imbalance, there were no significant differences between the participants in terms of most neuropsychological, cognitive, visual, or auditory testing, or in blood markers (Chan et al., 2024). Therefore, based on the available evidence, there is currently no discernable neurobiological correlate or mechanism of "foul play" to account for these AHIs.

"Mass Psychogenic Illness"

Among the leading critics of the hysteria surrounding this condition have been American medical sociologist Robert Bartholemew and neurologist Robert Baloh, who attributed this clinical phenomenon to "mass psychogenic illness" (MPI; Bartholomew & Baloh, 2024). This has led to much outcry among the U.S. media and political elite, as well as among those suffering from those symptoms, who misinterpreted this claim as being dismissive of these symptoms altogether (Bartholomew & Baloh, 2024). This is not the case; Bartholomew reiterates that these symptoms are real and that MPI is not a phenomenon to which "weak-minded persons" are susceptible (Bartholomew & Baloh, 2024). These are a constellation of neurological symptoms that have certainly caused significant distress and impairment, and they, as I do, share concern for the patients and wish for the permanent resolution of their symptoms (Bartholomew & Baloh, 2024; Chan et al., 2024). However, the fact remains that a clear neurobiological correlate or mechanism underlying this condition in these individuals has not been demonstrated to this point (Bartholomew & Baloh, 2024).

Of note, Stanford microbiologist David Relman wrote an editorial on the Chan et al. study in JAMA (Relman et al., 2024). Relman had emphasized that a subset of individuals had noted a sudden onset and a high-pitched sound in their head, accompanied by a feeling of pressure and symptoms of vertigo, dizziness, headache, and cognitive dysfunction (Relman et al., 2024). Moreover, the subjects claimed that these symptoms were location-dependent, disappearing when leaving a location and recurring when returning to said location (Relman et al., 2024).

This editorial would inevitably plant the seed of potential plausibility of sonic weaponry or foul play. The problem here is that this alone does not provide substantive (or indeed, any) evidence of foul play using "sonic weaponry." Moreover, as Bartholomew points out, human hearing is not always reliable and can be subject to error even when trying to determine the source of a reported auditory stimulus. The burden of proof for foul play is on the accuser to provide clear-cut evidence for such. What we have seen so far is not.

The Overreach of Politics Into Medicine

That has not stopped our political elite and media from sticking to this theory of foul play. As of April 2024, there are still Senate hearings and "60 Minutes" news segments exploring Havana syndrome as a tool of Russian warfare (Pelley, 2024; Clancey, 2024). This is particularly pertinent in light of escalating geopolitical tensions between the collective West and Russia. The bigger issue is the overreach of politics into medicine through framing these AHIs as being sequelae of sinister acts by a geopolitical adversary.

Neurological disorders are the leading cause of morbidity worldwide (Steinmetz et al., 2024). As a resident physician in this field, I stress the necessity to invest our resources appropriately into tackling these neurological conditions and improving the lives of patients suffering from them. Undoubtedly, such AHIs deserve scrutiny and should be investigated, and patients suffering from them need to be managed accordingly. However, exploiting a medical phenomenon with unsubstantiated theories as part of a modern-day "Red Scare" conspiracy by the media and political elite and wasting resources in a Sisyphean search for an elusive weapon of geopolitical warfare are what rightfully outrage Bartholemew, Baloh, and others in the scientific community.

Much of the public discourse on "Havana syndrome" has not involved a large enough contingent of the neurological community. We need to have greater participation by actual, objective medical specialists and scientists in the discourse and investigation of these AHIs and not allow them to be co-opted and exploited for political grandstanding. This is essential when mistrust in health care providers and institutions in favor of pseudoscience is all too prevalent.