Where were the doctors?

Surely, he thought, there was a medical staff at Abu Ghraib prison in Baghdad. Somebody must have seen the bruises and treated the injuries that the prisoners had suffered.

So why didn't they speak up?

It's a question that has haunted Miles, 55, a human rights activist and University of Minnesota physician, ever since.

Now, after more than a year of research, he's writing a book on the hidden role of U.S. military medicine in the prisoner abuses that shocked the world.

Miles argues that health professionals turned a blind eye, or worse, to the torture and deaths of some of their patients. "These health professionals could have protested," he said. Instead, "the medical system here became one of the professional arms of a torturing society."

His allegations -- first published in a medical journal last summer -- have infuriated the Pentagon. "We have no evidence that military medical personnel collaborated with interrogators or guards accused or suspected of detainee abuse, or condoned abusive behavior," said James Turner, a spokesman for the Defense Department in Washington.

Miles, though, says the evidence tells another story.

Last month, he opened a lecture to hospital employees in St. Paul with a notorious photo: the picture of two U.S. guards, a man and woman, grinning behind a pile of naked men at Abu Ghraib prison. Miles let the image sink in.

"The question for today is, how does the image of this picture change when we know that there's a health professional in this room?" he asked.

According to witness reports, Miles said, a "nurse medic" was called into the room to examine a prisoner who was having trouble breathing. The medic determined he was having an anxiety attack, and "simply walked off and made no further note of it," Miles said.

Medical workers from other nations have been complicitous in torture before, he said, but this is something new for the United States. "We have suffered enormous damage from this," Miles told a spellbound audience at Regions Hospital. "And the damage goes far beyond Iraq."

Troubling disclosure

Dr. Todd Morris, a Regions surgeon who served in Iraq with the Navy Reserve, admitted he was troubled by the disclosures. "What they did was wrong, and what they did is absolutely crushing to what we [in the military] are trying to do," he said later. "The vast, vast majority of people who are in Iraq in the military are really trying to make the world a better place."

He said military doctors are supposed to treat enemy patients the same as "friendlies," but things can become muddied in this kind of war.

More than a year ago, Miles began hunting for information on the Abu Ghraib scandal on the Internet. He found thousands of government documents on the scandal -- many of them from the military's own investigations -- that had been posted on websites by the Department of Defense and watchdog groups such as the American Civil Liberties Union.

He started poring through them, one by one, looking for the medical side of the story.

His first article, in the British medical journal Lancet in August, created something of an international sensation. He reported that doctors had falsified the death certificates of some of the detainees in Iraq and Afghanistan. He wrote that they had written off suspicious deaths as natural ones -- in one case, attributing a man's death to a heart attack, even though he died in a coma with skull fractures and burns on his feet. Another death certificate said that a prisoner had died of "natural causes" in his sleep -- although the Pentagon later found that he was beaten to death. Beyond that, Miles wrote, evidence showed that doctors had helped design the "psychologically and physically coercive" interrogation techniques that violated the Geneva Conventions.

And he urged an inquiry into the behavior of medical personnel at the detention centers.

Making news

Miles was on vacation in Iceland when his Lancet study hit the news, but he couldn't escape the media fallout. The story was front-page news in Reykjavik. Calls started pouring into his hotel from CNN, the BBC and other news organizations.

The Pentagon responded with an indignant letter to the medical journal, accusing Miles of denigrating "the honorable, and sometimes heroic, efforts of the military medical system ..." The letter, signed by Lt. Gen. Kevin Kiley, the Army's surgeon general, disputed the allegation that death certificates had been altered to cover up homicides and said the investigations were continuing.

Miles, unruffled, stood by all his allegations, and proceeded to add more.

Miles, who ran unsuccessfully for the U.S. Senate as a Democrat in 2000, has devoted much of his career to championing social causes. He once spent months working with torture victims in southeast Asia in the 1970s as medical director of the American Refugee Committee, and he still volunteers at the Center for Victims of Torture in Minneapolis.

So the idea of American involvement in torture holds a special horror for Miles, who also teaches medical ethics. "Torture is prohibited for all, but health professionals serve in a special kind of role," he said. They're in a unique position, he insists, to detect evidence of torture and to do something about it.

"Torture, when it occurs in prisons, is never the result of a few bad apples," he said. It can't thrive, he said, without other people's silence.