August 7,
2013
Crazy
Pills
By
DAVID STUART MacLEAN
CHICAGO —
ON Oct. 16, 2002, at 4 p.m., I walked out of my apartment in Secunderabad,
India, leaving the door wide open, the lights on and my laptop humming. I don’t
remember doing this. I know I did it because the building’s night watchman saw
me leave. I woke up the next day in a train station four miles away, with no
idea who I was or why I was in India. A policeman found me, and I ended up
strapped down, hallucinating in a mental hospital for three days.
The cause
of this incident was drugs. And these drugs had been recommended to me by the
Centers for Disease Control and Prevention.
I had been
prescribed mefloquine hydrochloride, brand name Lariam, to protect myself from
malaria
while I was in India on a Fulbright fellowship.
Since
Lariam was approved in 1989, it has been clear that a small number of people who
take it develop psychiatric symptoms like amnesia,
hallucinations,
aggression and paranoia, or neurological problems like the loss
of balance, dizziness or ringing
in the ears. F. Hoffmann LaRoche, the pharmaceutical company that marketed
the drug, said only about 1 in 10,000 people were estimated to experience the
worst side effects. But in 2001, a randomized double-blind study done in the
Netherlands was published, showing that 67 percent of people who took the drug
experienced one or more adverse effects, and 6 percent had side effects so
severe they required medical attention.
Last week,
the Food
and Drug Administration finally acknowledged the severity of the
neurological and psychiatric side effects and required that mefloquine’s label
carry a “black box” warning of them. But this is too little, too late.
There are
countless horror stories about the drug’s effects. One example: in 1999, an Ohio
man, back from a safari in Zimbabwe, went down to the basement for a gallon of
milk and instead put a shotgun to his head and pulled the trigger. Another: in
Somalia in 1993, a Canadian soldier beat a Somali prisoner to death and then
attempted suicide. “Psycho Tuesday” was the name his regiment had given to the
day of the week they took their Lariam.
Lariam is
no longer sold under its brand name in the United States, and our military
finally caved in to pressure and stopped prescribing it to the majority of its
soldiers in 2009. But some are still getting it; lawyers for Staff Sgt. Robert
Bales, who has pleaded guilty to killing 16 Afghan civilians in 2012, said he
had taken the drug. And the generic version is still the third most prescribed
anti-malaria drug here, with about 120,000 prescriptions written in the first
half of this year.
Make no
mistake: mefloquine does a good job protecting against malaria (and unlike some
other anti-malaria drugs, it can be used during pregnancy
and has to be taken only weekly). It just works at a significant risk, the full
extent of which we’re still discovering.
The new
F.D.A. warning advises people taking mefloquine to call their doctor’s office if
they experience side effects. Fine advice, except that by the time most people —
business travelers, Peace Corps volunteers, students studying abroad — start to
notice the side effects, they are thousands of miles away, frequently out of
cellphone service.
Most
worrying of all, the announcement notes that the drug’s neurological side
effects — dizziness, loss of balance or ringing in the ears — may last for
years, or even become permanent. I suspect that it’s only a matter of time
before that black box tells us that the psychiatric effects may become permanent
too.
More than
a decade has passed since my last dose of Lariam, and I still experience depression,
panic
attacks, insomnia
and anxiety that were never a part of my life before.
We
have a generation of soldiers and travelers with this drug ticking away in their
systems. In June of last year, Remington Nevin, a former Army preventive
medicine officer and epidemiologist, testified in front of a Senate
subcommittee that he was afraid that Lariam “may become the ‘Agent Orange’ of
our generation, a toxic legacy that affects our troops and our veterans.”
Science is
a journey, but commerce turns it into a destination. Science works by making
mistakes and building off those mistakes to make new mistakes and new
discoveries. Commerce hates mistakes; mistakes involve liability. A new miracle
drug is found and heralded and defended until it destroys enough lives to make
it economically inconvenient to those who created it.
Lariam is
a drug whose side effects impair the user’s ability to report those side effects
(being able to accurately identify feelings of confusion means that you probably
aren’t that confused). The side effects leave no visible scars, no objective
damage. But if Lariam were a car, if psychological or neurological side effects
were as visible as broken bones, it would have been pulled from the market years
ago.
It’s a
prescription I wish I had left unfilled.
David
Stuart MacLean is the author of the forthcoming memoir “The Answer to the
Riddle Is Me.”
__._,_.___
"Keep on, Keepin' on" "Colonel Dan"
Dan Cedusky, Champaign IL, Col, USA, Ret,
Member: AM LEGION, DAV, AMVETS, MOAA, NGAUS, IL SAL, NGAIL,
NAUS, VFW Aux.
IL State Director The Uniformed Services Disabled Retirees (USDR)
Fellow at The Foreign Policy Research Institute (FPRI)
See my web site at:
http://www.angelfire.com/il2/VeteranIssues
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