Hallucinations. Paranoia. Confusion. Severe anxiety. Unusual behavior.
Why would we want to unnecessarily expose people - especially soldiers - to these side effects?
Unfortunately, that is exactly what we are doing. The symptoms listed above are just some of the officially acknowledged side effects associated with Lariam, an anti-malaria drug commonly prescribed to U.S. soldiers serving abroad, Peace Corps volunteers, business travelers, and tourists. And - as the official medication guide acknowledges - these symptoms can persist long after someone goes off the drug. Yet despite the fact that safer and equally effective malaria prophylactics are available, the use of Lariam to prevent malaria remains a common practice.
The story of Lariam is a window into the world of pharmaceuticals, where the precautionary principle is ignored and dangerous drugs continue to be readily prescribed long after legitimate safety concerns have been raised. It's a story of even greater concern given the relatively recent emergence of prescription drug advertisements on TV, where calming music and cheerful family pictures belie the overwhelming litany of side effects and contraindications. Lariam's alarming side effects are not widely known - even amongst the physicians prescribing it - despite detailed descriptions in the scientific literature of the neuropsychiatric injuries and behavioral disturbances caused by taking the drug.
I can tell you about some of these side effects from personal experience. On a trip to Tanzania, I suffered a frightening psychological reaction to Lariam that involved being plagued by almost unbearable feelings of fear and panic. This was not normal anxiety; I knew immediately and intuitively that these symptoms were caused by the drug. My body was shaking uncontrollably in a state of panic, yet a part of my mind remained lucid. I've had malaria before, and experiencing the side effects of Lariam was worse than the symptoms of malaria.
These side effects continued for several years after I stopped taking Lariam. Only after the damage had been done did I discover that these sorts of symptoms are far from rare. So why wasn't I warned?
My doctor, a very competent and professional tropical medicine specialist, didn't warn me about how common these side effects are because he himself didn't know. The information provided to physicians by the drug companies and the FDA at the time I was prescribed Lariam indicated that these sorts of side effects were rare and of no major concern. Unfortunately, this is empirically false, as has been documented in both the scientific literature and the popular press.
The medical literature is filled with case studies of the shocking ways people have reacted to Lariam, including one titled "Suicide by Skull Stab Wounds: A Case of Drug-Induced Psychosis" about a 27 year old man with no history of mental illness who took his own life in horrific fashion; it was determined that Lariam-induced psychosis was the cause. A Sixty Minutes story called "The Dark Side of Lariam" examined several cases of the drug's long-lasting and debilitating side effects. This American Life broadcasted aterrifying and fascinating story about an American man on Lariam who suddenly woke up on a train platform in India with no memory of whom he was or why he was there.
But perhaps more disturbing than these stories of travelers responding badly to Lariam are the unmeasured and largely unknown consequences Lariam has had for soldiers and their families. It was the longstanding policy of the military to order all soldiers and personnel stationed in malaria-endemic areas to take Lariam. Questions were raised about Lariam's involvement in a series of murder-suicides at Fort Bragg in 2002. In 2004, Staff Sergeant Georg Andreas Pogany, the first soldier accused of cowardice since the Vietnam War, was cleared of all charges after his attorney argued that Lariam caused his erratic behavior. Last April, Dr. Elspeth Cameron Ritchie, the former top mental health specialist for the Office of the Army Surgeon General, wrote a column in Time suggesting that Lariam could be a contributing factor to the massacre committed by Staff Sergeant Robert Bales in Afghanistan earlier this year. Whether or not Lariam played a role in these high profile events, the very fact that respected medical professionals think that such a thing is possible should be cause for great concern.
Yet despite recent and long-overdue moves by the military, change is happening at far too slow a pace. A military study found that one out of seven soldiers with contraindicated psychiatric conditions such as PTSD was prescribed Larium anyway. Every time I hear about another suicide or atrocity committed by current or former military personnel, I have to wonder whether the toxic mix of PTSD and Lariam might be playing a role. Why are we unnecessarily prescribing a medication to soldiers at the same time that other soldiers are using the side effects of that drug as a defense for murder?
Like many other drugs, Lariam was never properly tested before being put into widespread use. Its history reads like something out of an airport paperback conspiracy thriller. It was developed in the aftermath of the Vietnam War, when a group of United States military scientists was given an unprecedented amount of money to conduct the largest and most expensive drug exploration the planet had ever seen. After years of secret work and an examination of over 250,000 molecules, the scientists chose compound #142490, known pharmacologically as mefloquine hydrochloride. In 1975 and 1976, the military tested this experimental drug on inmates in Illinois and Maryland prisons. Pleased with the results, the military handed the drug and the accompanying manufacturing process and clinical trial data over to Swiss pharmaceutical giant Hoffman-LaRoche, apparently for no charge. Hoffman-LaRoche secured quick FDA approval of Lariam in 1989, despite the fact that its safety had never been tested on a normal volunteer population of healthy civilians.
When this type of trial was finally undertaken more than a decade later, over two-thirds of the study participants reported at least one adverse side effect. As Dr. Ashley M. Croft, an expert in travel and tropical medicine, wrote in the Journal of the Royal Society of Medicine, "Had this same understanding of mefloquine been available prior to its licensing, as it should have been, it is certain that the FDA and the other national licensing authorities which approved Lariam for use prophylactically, in and around 1989, would not at the time have endorsed this drug."
In other words, soldiers, government employees, and travelers have been used as uninformed experimental subjects in a long-term study by the military and the pharmaceutical industry.
This needs to stop. The tragedy of the Lariam story is that alternative prophylactics have been available for over a decade. Malarone in particular is a drug that is widely recognized to be both highly successful at preventing malaria and have fewer side effects than other medications. The catch? It costs slightly more than Lariam, running about $30 a week instead of $3. Should this matter? Doesn't it make sense from both a moral and a financial perspective to prevent mental health catastrophes before they occur? Bill Manofsky - a Navy Commander who was forced into medical retirement because of PTSD and neurological problems the Navy acknowledged were related to Lariam - put it succinctly: "How much does a .50-caliber round cost? They're worried about $4 a pill and they're willing to spend $5 for a round?"
At a time when more active-duty US soldiers are dying from suicide than combat, we should be particularly vigilant about safeguarding the mental health of the men and women who serve us in uniform. As Staff Sergeant Pogany asked after the cowardice charges against him - which included the possibility of execution - were dismissed, "What are we doing giving drugs that cause hallucinations, confusion, and psychotic behavior to people that carry weapons and hold secret clearances? It doesn't pass the common-sense test."
by Larry Cohen
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