Not long after the Cuban government announced Fidel Castro had been hospitalized, a small group of CIA analysts were trying to determine — from both public and classified sources — just what was wrong with the 79-year-old communist dictator. It wasn't long before they had their best guess: either a bleeding ulcer or acute diverticulitis, both of them in line with Castro's symptoms — extensive internal hemorrhaging and emergency surgery.
For the group, part of the CIA's secretive Medical and Psychiatric Analysis Center (MPAC), it was another medical diagnosis, but it was hardly routine. MPAC is one of the more intriguing parts of the CIA, a unit that has operated out of the public view for more than 40 years, gauging the health of world leaders, large and small.
"At most, there are seven who do this full time," says Dr. Jonathan Clemente, a Charlotte, N.C., physician who has tracked the group and is writing a history of the center entitled, 'Cloak and Doctor.' "Not all are physicians... some are anthropologists, psychologists."
And they have been doing for a long time, since 1962 or 1963, Clemente estimates, with varying degrees of success. But, as he notes, they must be doing something right because they are still doing it.
‘Fallible and ... idiosyncratic’ leaders
In a recent article in the International Journal of Intelligence and Counter Intelligence, Clemente quotes one of the few public statements by those who have worked at the Langley, Va.-based center on the rationale behind such evaluations. Nations, terrorist groups and drug cartels are led by "fallible and sometimes idiosyncratic" individuals, said psychologist Jerrold Post.
And determining the physical and psychological makeup of those individuals — "medical intelligence" — in the words of another former analyst at the center, "contributes to the overall intelligence assessment of the stability of foreign regimes."
Castro, Clemente says, probably has one of the biggest files at the center, mainly because of his longevity but also because of the central role he plays in the life of Cuba and the consequences of a societal collapse once he passes from the scene.
And his most recent medical issue was just one of several recent events surrounding his health that has intrigued MPAC analysts. When Castro tripped and fell on Oct. 21, 2004 while attending a ceremony at Che Guevera's memorial, it had to have set off a stream of questions, he notes.
Cause and effect
"In the case of Castro's fall, the basic question to be answered was what precipitated this fall?" Clemente wrote in his journal article. "Was the floor wet? Was he pushed? Did he have a stroke or heart attack? Does he have vertigo? The leader's long-term ability to govern may be dictated by the nature of the medical event."
How does the CIA go about answering those questions?
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Fidel Castro: The Life of the Cuban Leader
Clemente says the agency uses the same intelligence it uses for other issues: "all sources" — from personal observation to electronic intercepts of medical records to clandestine collection of imagery — that is, finding the photograph or the television outtake that reveals a mole that could be melanoma, a limp that could indicate multiple sclerosis, or simple things like weight or weight gain.
The agency has also sent its analysts to locations where they can get a close-up view of the "patient."
"They try to 'examine' them, meet them, watch them for signs of disease," Clemente says. In the case of Castro, "They may have done that in this case... after all, it's an area of foreign policy that has been going on for a long time."
They also will sometimes get lucky, gathering snippets of conversations here and there: An overheard conversation between Castro and Pope John Paul II during his state visit in 1998 in which Fidel complains about his arthritis; a report in Esquire by the writer Gay Talese in which Castro discussed his diet — complete with his daily calorie intake — with Muhammad Ali during a visit to Cuba. "I eat very little. Very little," he told Ali. "The diet advice I get is never accurate. I eat around 1,500 calories, less than 30 grams of protein, less than that."
What about actuarial data?
And yes, actuarial data is mined. A senior intelligence official, faced in the late 1990s with repeated exile reports of Castro's imminent, responded "his mother lived 'til 92 and his father lived til 84!"
One of the more intriguing possibilities, notes Clemente, is the electronic intercept of digital medical data. Clemente, trained as a radiologist, points to the explosion of such data.
"I am told they don't make much use of that, but I can't believe it," he says. "This stuff is flying around the globe and a lot of it is unencrypted."
One thing they don't put too much stock in: Public statements by governments.
"They look less at the public statements," he says. "There is always an assumption that it is disinformation. They may use it to clue them into the seriousness of the illness, but mostly, they don't trust it, or in the case of Castro, the file would be a baseline, supplementing it with signal intelligence or human intelligence."
Long list of patients
And, of course, Castro is not alone. Clemente presents a laundry list of world leaders, starting with Soviet leader Nikita Khrushchev, the first to be tracked, through Gamel Abdel Nasser, the Egyptian president who died from a diabetes-related condition; the Shah of Iran, who hid his leukemia; Yugoslavian President Marshal Josip Tito, who suffered from high blood pressure; to more recent and in some cases more exotic diseases, including Pope John Paul II, a victim of Parkinson's; Russian President Boris Yeltsin, whose bouts of alcoholism were famous, and Ukrainian presidential candidate Viktor Yushenko, the apparent victim of dioxin poisoning. (Yushenko, Clemente reports, is one example of where an MPAC staffer got up close, being part of the U.S. medical team sent to diagnose and treat his problem.)
And of course, there is Osama bin Laden, who commands no nation but demands U.S. attention. Senior U.S. intelligence officials have told NBC News that Bin Laden, while NOT needing dialysis as widely reported, does have kidney stones, as well as an enlarged heart, chronically low blood pressure and is missing two toes on his foot, requiring his use of a staff. U.S. intelligence also learned that Bin Laden regularly traveled with his own personal physician, leading some to call him a hypochondriac.
NBC News obtained the guts of one world leader's diagnosis, that of the late Serbian President Slobodan Milosevic, completed just before NATO began its bombing campaign in 1998.
"Milosevic does not react well to stress", said a U.S. official reading the profile. "He has violent mood swings in part attributed to adult-onset diabetes and occasionally severe back problems, both of which he suffers from. His weight fluctuates; he tends to put weight on when under stress. When stressed, he becomes an even heavier smoker and drinker than normal. He prefers Scotch and pear brandy. The drinking in particular makes the diabetes worse. He controls the diabetes with insulin."
The center also relies on some top flight medical experts, says Clemente.
"They meet at 'The Farm" — the CIA's training facility near Williamsburg, Va. — semi annually," he says. "There will be high-ranking academic doctors, chosen on basis of peer recommendation and their publications. They will have been polygraphed and received signals intelligence, electronic intercepts, etc. to help the center staff better organize their operations."
And so while Cuban government officials are not issuing regular updates on the condition of El Commandante in Jefe, you can be sure the CIA is.