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thedrifter
08-06-03, 09:44 AM
08-05-2003

Larium: Lifesaver Drug or Threat to the Troops?



By George Bones

So you’re sucking it up for Uncle Sam in Baghdad, and now you’ve also been ordered to suck up a mefloquine (a.k.a. Larium) pill every week to keep from getting malaria?

Whoa! Larium?

Isn’t that the evil **** that made those dudes at Bragg go off the deep end and whack their wives? Is this another attempt by Big Brother to use GIs as guinea pigs for experimental drugs? What’s the deal? Am I going to wind up as another statistic at SFTT.org?

Okay, first I have to tell you up front that I’m a doctor, and I wear the green uniform. So you might understandably view whatever I tell you with some skepticism. But you should also know that I did a few years as a dumb grunt with stripes on my sleeves before I went to medical school.

When my boss told me during Gulf War I to take those little nerve agent pills called pyridostigmine, I said “yes, sir,” and tossed them in the sand like most of my buddies did.

So should you chuck your malaria pills? Is mefloquine as bad as they say it is?

Well, it ain’t as safe as Tylenol, I can tell you that. But don’t toss your pills just yet. I have given mefloquine to troopers under my care with a clear conscience. I also have taken the stuff myself.

The biggest complaint that most folks have when they take the mefloquine is that it gives them very vivid, and sometimes weird, dreams. In a very few cases it also causes vertigo and nervousness. None of my own patients reported these side effects, but the Army Aviation Center has enough concerns about them that it doesn’t allow anybody on flight status to take mefloquine.

As far as the drug causing homicidal flip-outs, though – I don’t think there is any connection.

What’s that, Doc? You mean that I can drive my fifty-ton tank around when I’m dizzy and having nightmares from my mefloquine pills, but those flyboys get to take a pass? What’s up with that? What do they take to keep from getting malaria? Good question.

The aviators take an antibiotic called doxycycline. Doxycycline doesn’t make you dizzy or cause you to have wicked dreams, but it isn’t perfect either. Doxy makes you much more sensitive to sunlight. Light-skinned folks who take it can get a sunburn that looks like it was caused by a burst of napalm (you can imagine what kind of problems that could cause in a place like Iraq during August). Doxy also gives some people terrible stomach cramps. And you have to take doxycycline every day instead of just once a week like mefloquine.

So should I chuck the mefloquine pills or not, Doc?

That’s up to you. Don’t take mefloquine (or any drug) with blind faith. Having concerns about what drugs you are putting in your body is a healthy practice as far as I’m concerned. There are risks and benefits with any drug. But keep in mind that malaria is serious bad news.

The falciparum variety – the kind that mefloquine protects against – is the worst there is. Malaria is a disease where microscopic, worm-like parasites get in your blood when a mosquito bites you. The parasites set up shop in your liver and your red blood cells and wreak havoc. Falciparum malaria is a killer. Keeping from getting bitten in the first place is the best protection. But if a determined radical Muslim mosquito does get you, mefloquine and doxy are about the only drugs that will give you real protection from the microorganisms that cause malaria.

Personally, I’d rather take doxy than mefloquine. But I tolerate doxy well (I have dark skin), and I don’t have a problem remembering to take a pill every day. If I were in an area where falciparum-carrying mosquitoes lived, and I didn’t have any doxy, I’d take the mefloquine. I’ll take a few vivid dreams over having microscopic worms in my blood cells any day.

Mefloquine is not just used by the military. Thousands of people use it in areas where malaria is common. The vast majority take it without any serious problems. But there are plenty who cannot tolerate the drug. If you are one of them, you should ask for doxycycline. A good Doc should have a supply of doxy for soldiers who can’t tolerate mefloquine.

If you want a perspective from the other side of the coin, visit this website that was put together by an Australian who had a very bad Larium experience. He has a lot of information about the drug and more informative links on his site.

Meanwhile, my recommendation to the troops: If you can’t get any doxy, and you’re thinking about chucking the Larium, you’d better be damned sure that there aren’t any mosquitoes living nearby. It only takes one bite.

George Bones is the pen name for a U.S. Army physician who covers medical issues as a DefenseWatch Contributing Editor. He can be reached at bonesbag911@yahoo.com

TO "LARIAM" OR NOT TO "LARIAM"
http://www.geocities.com/TheTropics/6913/lariam.htm

http://www.sftt.org/cgi-bin/csNews/csNews.cgi?database=DefenseWatch.db&command=viewone&op=t&id=159&rnd=99.42725149500508


Sempers,

Roger
:marine:

Kalbo
08-06-03, 11:31 AM
1st off is Lariam not Larium

I wasn't going tell anyone this for personnal reasons, but I saw a neurotologist (yes, spelled correctly) last week. A neurotologist is a doctor that deals with toxicity of the nervous system. After a hour of tests and interview, he said I have neurological damage. He wants me to have an MRI and audio tests done. The thing is I have a balance problems now, one I didn't have before the Marines. I'm sure I couldn't have gotten through Boot, Airborne, Amphibous Reconnaisse Course, MEU SOC Shooting Package, etc if I had had neurological problems, ie. balance problems. The thing is that it just doesn't stop there. Neurological problems also contribute to psychological and cognitive problems. I've been diagnosed by the VA with severe chronic PTSD with Psychotic features. I'm not saying that I don't have PTSD, Somalia & Rwanda wasn't a Disney Vacation, but I believe that the Psychotic features were due to the Lariam.

If the writer of the above article did some research, he would know that the FDA has again changed the Lariam (Mefloquine) warnings, the 4th change in 13 months. Check this quote from UPI (July 10, 2003)


The Food and Drug Administration has taken the rare step of ordering that patients are warned directly of serious mental problems and reports of suicide linked to a common anti-malaria drug called Lariam

The writer of the article is right about one thing, I've never been warned that tylneol can cause you to have mental problems and possible suicide. Then again, I don't know to many drugs that have this kind of warning. This FDA change is now that the doctor has to tell you to your face that these symptoms can happen.

The author writes
The vast majority take it without any serious problems . This is outright bull****, this is a bull**** statisic put out by Hoffman LaRoche.
The patients did not know which medicine they received; neither did their doctors. After 60 days, 139 (29 percent ) of the people who took Lariam reported at least one psychiatric side effect, and 92 of them (19 percent) rated those effects moderate or severe. Both percentages were roughly double those reported by the Malarone group. Side effects were so severe in the Lariam group that 5 percent of the patients stopped taking the drug, four times the rate of patients who dropped out of the Malarone group. People who don't take their medication, of course, are susceptible to malaria.

“Conclusion: Data herein indicates 1 in 5 individuals prescribed mefloquine reported adverse events with significant rate of therapy discontinuation, placing the traveler at risk of contracting malaria. Findings concur with current controversy over mefloquine use for routine chemoprophylaxis. Adverse response to initial dose of mefloquine taken before departure may warrant alternative prophytlactic regimen.” (From Adverse Events Experienced with Mefloquine Chemoprophylaxis in Travelers from One USA Travel Clinic. [poster presentation] Bonnie Ward, RN, BSN and D. Mathison, MD, Scripps Clinic Travel Clinic, La Jolla, California, presented at the International Society of Travel Medicine Conference, Montreal, June 1999).

This link ( http://www.thecrimson.com/article.aspx?ref=348595 ) for the Harvard Crimson talks about a student's death after taking Lariam. "while rappelling down a cliff, began to unbuckle his harness before he’d reached the ground, as if he did not realize the danger it presented" It's a good thing Marines don't do alot of rapelling (wink).

A recent post of Yahoo Groups "Lariam", a support group for those suffering from the side effects of Lariam.

[QUOTE]I am a new member to this forum. My nephew committed suicide a few weeks ago - 7 months after his return from Afghanistan, where he had served as a Green Beret reservist, and where he had been given Lariam for approximatley 6 months. He had no known history of depression. We are still in shock over this unexpected tragedy and his inexplicable behavior.


This is a good site for a lot of information on Lariam...
http://lariaminfo.homestead.com/


Doxycline and Lariam (Mefloquine) are not the only two choices for Malaria prevention...

MalaroneTM (atovaquone and proguanil hydrochloride) Tablets, demonstrating that the malaria prevention medication has fewer adverse events overall, than the two antimalarials, mefloquine (Lariam®, Roche Pharmaceuticals) and chroloquine/proguanil

IMHO, Give Lariam to the enemy.

Semper Fi,
Bill "Kalbo" Long

Kalbo
08-10-03, 07:57 AM
On July 9, the U.S. Food and Drug Administration ordered that patients who are prescribed the anti-malaria drug mefloquine, which is sold by the trade name Lariam, be warned that the drug has been linked to serious mental problems and even reports of suicide. VOA's Carolyn Weaver takes a closer look at the controversial drug, which has been a lifesaver for some, yet for others, a prescription for unintended damage.


Kristi Anderson, who says Lariam harmed her
VOA photo - C. Weaver

Kristi Anderson was a federal criminal investigator when she traveled to South Africa on vacation in 1991. To protect her against malaria, a potentially fatal infection spread by mosquito bites, Ms. Anderson’s doctor prescribed a drug called mefloquine, sold in the United States under the brand name Lariam.

After the third pill, Ms. Anderson says, she began having constant dizziness, nausea, and panic attacks. “Almost always there was nausea,” she remembers, “but sometimes it was a wave of dizziness or vertigo, and then I would start having this feeling of impending doom, I wanted to get out of where I was, I just wanted to get back home or someplace where I felt safe because I was afraid something terrible might happen.”

Ms. Anderson says her nausea, anxiety and dizziness were so severe that she ultimately had to quit her job. She moved back to California to live with her parents for a year-and-a-half, until she was well enough to go back to work.

But in 1996, she returned to South Africa, again took Lariam and again became violently ill. Only then did she begin to suspect the drug was the cause. She sought a diagnosis at Stanford University’s California Ear Institute, where tests by the medical director documented injury to the part of the brain that controls balance, the vestibular system.

“He told me from the Lariam patients he had seen and what his tests showed, he believed that Lariam was the cause of my vestibular problems and he thought it was the cause of the earlier problems as well,” Ms. Anderson says.


Lariam (trade name mefloquine), a common anti-malaria drug
VOA photo - Carolyn Weaver
The Roche pharmaceutical company, which makes Lariam, declined VOA’s requests for an interview before we first broadcast this story, and again last week. But in the 14 years since mefloquine was approved for use in the United States, Roche has added increasingly serious warnings of possible adverse effects in the package insert given to doctors. It’s a long list that includes, among other things, nausea, vomiting, dizziness, convulsions, depression, hallucinations, psychotic or paranoid reactions, and anxiety.

The Food and Drug Administration’s latest action orders doctors to give patients a new medication guide warning that “Lariam can rarely cause serious mental problems in some patients” and that those side effects may continue. It also says, “There have been rare reports of suicides,” but adds “we do not know if Lariam was responsible.”

Lariam can rarely cause serious mental problems in some patients. There have been rare reports of suicides. We do not know if Lariam was responsible.
Source: US Food and Drug Administration


Last year, Roche settled a lawsuit brought by a woman whose husband committed suicide after taking Lariam. The terms of the settlement were kept secret. More recently, the U.S. Army investigated whether the drug was implicated in several murder-suicides at the Fort Bragg army base in North Carolina last summer. Two of four soldiers who killed their wives and then committed suicide had taken Lariam. The Army’s report on the murders called a connection to Lariam unlikely, but did not exclude it.


Clinic in Mozambique where malaria vaccine trials among children have begun
Photo courtesy Hospital Clinic of University of Barcelona
Malaria is endemic to many parts of Africa and Asia, and kills nearly one million people a year, most of them young children. Others are damaged permanently by the disease. And so despite the new warnings, many tropical health and travel specialists, like physician Martin Wolfe, regard Lariam as an essential drug – and more practical than the alternatives doxycycline or Malarone.

In contrast to those drugs which must be taken daily, Dr. Wolfe notes, Lariam is taken only once a week. “We believe the compliance is better with a drug taken once a week than one taken daily,” he says. “And since we are protecting against a potentially life-threatening disease, we want to do the very best we can to encourage people to take their medication.”

It’s impossible to pin down the incidence, but some experts say the rate of severe reactions is far higher than the one in 10,000 cited in early research by Roche. A study published in 2001 in the journal Clinical Infectious Diseases reported “mild to serious” neuropsychiatric adverse effects in 29% of travelers on Lariam.


Walter Reed Army Institute of Medical Research technician at work on malaria project
VOA photo - C. Weaver
Retired Colonel Wilbur Milhous was among the military scientists who developed Lariam at the Walter Reed Army Institute for Medical Research and then licensed the Roche company to make and sell the drug. But as reports of severe side effects emerged, he says the government promised Roche it would continue to back the drug. “There was clearly an unmet medical need which the drug fulfilled,” Colonel Milhous says. “We were frightened from a U.S. perspective, in terms of national contingencies, what would happen if it were withdrawn?”

The U.S. Army today depends on Lariam, as does the Peace Corps, because of the once-weekly dosing. But as Colonel Milhous says, malaria researchers must always be at work on the next generation of new drugs, because the malaria parasite quickly develops resistance. The best weapon against malaria, he says, would be vaccination. Last week, tests of a new vaccine began on 2,000 children in Mozambique. Earlier trials found the vaccine, created by the SmithGlaxoKline company, safe and effective in adults, though the effects lasted only two months. Investigators hope it will remain effective longer in children.

As for Kristi Anderson, she says her recent brain scans are normal, and her other symptoms have diminished. But she says she began to heal emotionally only when she read a newspaper story about Lariam. “Reading that article released me from this shame of ‘Kristi, you’re some kind of weak person and you better watch out because you’re going to have a nervous breakdown again sometime, you just better be careful,’” she says. “I realized that’s what made me sick - that’s what happened to me, that’s why I became a different person.”


Some footage for this report provided by Reuters, ABC News and the Hospital Clinic of the University of Barcelona.

Kalbo
08-27-03, 09:25 PM
Dear friends,

Senator Dianne Feinstein has launched an inquiry into the
circumstances surrounding the handling and reporting by the Navy of a toxic reaction to Lariam in a San Diego area man who served in Kuwait. We have sent an info package to(Maeve Townsend, Sen. Feinstein's aide , who is handling the project.
I am asking you AND your spouse (if you have one) or parent or someone close, to write a letter about what happened to you.

If you live in California, send your letter(s) direct to Senator
Feinstein -- see below.

If you live in another state, please send the letter (s) to both
your senators and cc Senator Feinstein. (You can get the names and addresses for the entire senate at www.senate.gov -- just pick your state.)

Please write when, where, why you took Lariam. Were you warned? What happened to you? Did you report to FDA?
What did the doctor say when you sought help? What was the cost to you physically, emotionally, monetarily? Please state how long you were ill and if you are completely recovered. Please be brief, one page if possible (two max).

M A I L your letter(s) or cc a copy to

US Senator Dianne Feinstein
c/o Maeve Townsend -- LARIAM
750 B. Street, Suite 1030
San Diego, CA 92101

Please DO NOT send it by email or fax -- this is a special request
from the staff! If you know anyone else with a Lariam story,
please invite them to write to the Senator as well. I know there are more but you are the ones I'm certain live in California.

Please cc me on behalf of Lariam Action USA. I will keep these on
file--Sue has all the petitions -- which might at last get to a Senator who is interested in Lariam!

If you are not a US resident, your letter is less important, so please just send us your good wishes and prayers. This project could break the Lariam info logjam.

My address-- Jeanne Lese
64 El Pavo Real Circle
San Rafael, CA 94903

Thanks a million!
Jeanne Lese, Co-director, Lariam Action USA
www.lariaminfo.homestead.com

Kalbo
09-08-03, 08:14 PM
Navy coverup alleged on drug side effects
By Mark Benjamin and Dan Olmsted
United Press International
Published 9/8/2003 7:05 AM


SAN DIEGO, Sept. 8 (UPI) -- A Naval Reserve commander who volunteered for the Iraq war says the military doctored his medical file to eliminate all traces of an anti-malaria drug that he believes made him severely ill, suicidal and aggressive - and that he has the before-and-after evidence to prove it.

"I was given Lariam. I got sick from Lariam," said Cmdr. William Manofsky, 44, who is based at the Naval Air Warfare Center in China Lake, Calif. "The Navy does not want to talk about Lariam. There is no mention of it in my medical record. I'm pretty upset."

Manofsky said there is no indication in his file of ever being prescribed the drug, although the Navy handed it to him last November; that a page is missing on which "Took Lariam" was written; and that a reference to the drug during an emergency clinic visit on May 13 has mysteriously vanished from the page - even though he has a copy that clearly shows it written there.

Manofsky and his wife, Tori, believe the military is covering up problems with the drug - the Navy's main concern so far, they said, is to try to get the medical records back. A spokesman for the Navy Bureau of Medicine and Surgery would only say that it provides quality care and is working "to resolve the issue."

"The military created the drug," Tori Manofsky said (it was developed by the Walter Reed Army Institute of Research and licensed to Roche). "There is a lot of money involved in the drug. I think there are a lot of careers at stake. Anything that shows a problem with Lariam has to be hidden or covered up somehow by the military. If all these people came back and it was clearly Lariam, there would be lawsuits up the kazoo."

Lariam is the drug that at least two of the soldiers who killed their wives at Fort Bragg last summer took while serving in Afghanistan. Both those soldiers - and a third who apparently had taken the drug - subsequently killed themselves. The drug's label warns of psychosis, aggression, hallucinations and reports of suicide that can occur "long after" someone stops taking it. The Food and Drug Administration this year ordered that everyone prescribed the drug be handed a written statement listing those dangers and warning them to quit taking it if they experience mental problems.

The government and the company that makes Lariam, Swiss drug giant Hoffmann-La Roche, say the drug is safe and effective. The FDA says it doesn't know whether the drug can trigger suicide. Roche says there is no reliable evidence it can trigger violent behavior. The Pentagon says side effects are generally rare and mild and are outweighed by the risk of getting malaria.

Manofsky, who never took Lariam before being deployed to Kuwait last December, became suicidal after returning to California this spring and nearly slugged his wife in a bizarre rage about the way she cast her fishing line. He also suffered seizures, balance problems so severe he sometimes could not stand, panic attacks and depression.

Tori Manofsky became convinced Lariam was the culprit after researching on the Web the medications her husband was taking. On June 26, after several visits to the China Lake clinic in which they raised the Lariam issue but felt they were being ignored, Bill Manofsky went to the clinic to pick up his records on his way to see a neurologist. He flipped through them to make sure Lariam was documented.

"The first thing I noticed was a sheet missing," he said. "Both Tori and I had seen the sheet. Someone had written on an angle, 'Took Lariam' and it was no longer there. There was no entry for being issued Lariam."

Manofsky flipped more pages, looking for the record of a May 13 visit to the clinic. That day, his wife had insisted a Navy doctor write the drug on that record and both had watched him do it. He found the page on which he felt certain that note had been written.

Nothing.

Manofsky knew his memory was shot, that he was acting strangely, and there was no reason for anyone to believe him. But he had a backup. Tori Manofsky - suspicious that Navy doctors were ignoring the drug - secretly photocopied the page after the doctor wrote down "Lariam" on the May 13 visit and briefly left the room.

Tori's copy clearly shows the reference, "Lariam for anti malaria" Underneath that, four other medicines Manofsky was taking also are gone; they are mentioned elsewhere on the visit.

Two independent document examiners consulted by UPI concluded that unless the Manofskys themselves faked the doctor's writing and created bogus copies, only the Navy can explain the omission.

The document experts could find no evidence that writing had been erased from the May 13 record. One of the experts - a former head of an FBI questioned documents office - told UPI that the likeliest scenario is that the clinic made a copy of the May 13 page while the Manofskys were still there, and the doctor wrote "Lariam" on that copy after Tori insisted. That sheet never made it into his medical file.

While such a chain of events could theoretically be accidental, Tori Manofsky believes the Navy knows it has a problem with the drug, and was keeping two sets of records and recording Lariam problems on only one.

UPI contacted the doctor who saw Manofsky on the May 13 visit and asked if he knew anything about changes in the medical record. He declined to comment and said he had been told to refer questions to Twentynine Palms Marine base, which forwarded them to the Navy Bureau of Medicine and Surgery in Washington. Spokesman Brian Badura issued this statement:

"Successful medical treatment relies on accurate information, close cooperation and communication between provider and patient, and follow-up by all parties involved. Navy Medicine makes a concentrated effort to meet the needs of each patient. Due to the number of circumstances surrounding the Manofsky case and the ongoing efforts by Navy Medicine to resolve this issue, we cannot offer additional input at this time."

Several other service members who served in Iraq have told UPI they had serious problems with the drug - including one who says he was afraid of harming his wife and that there was no record of him being prescribed Lariam, either. At least two soldiers were medically evacuated from Iraq with suspected Lariam problems, one an Army officer in charge of 300 soldiers, the other a soldier who felt the way he was treated suggested the Army was "avoiding the Lariam diagnosis." The Army is now discharging him.

End Part 1....

Kalbo
09-08-03, 08:15 PM
The Washington Post reported in July that the military is investigating at least seven suicides among troops in Iraq, among a larger number of deaths classified as "non-combat weapons discharge" or "non-combat related."

The Pentagon hasn't identified any deaths as suicides since the war started.

Earlier this year, two more soldiers deployed out of Fort Bragg who took Lariam in Afghanistan committed suicide after returning home - bringing the number of suicides after that war to at least five. In one case, the soldier's father said he asked Fort Bragg officials if the Lariam given to his son could have played a role. "They have no comment," he told UPI.

The Pentagon insists that there have been few problems with the drug, prescribed to soldiers around the world to prevent malaria. More 25 million people have taken it worldwide, according to the manufacturer, 5 million of them in the U.S.

Assistant Secretary of Defense Dr. William Winkenwerder, Jr., wrote a U.S. congressman last fall that any possible side effects are "greatly outweighed by the drug's effectiveness in preventing the severe consequences of malaria infections" among troops.

In the Fort Bragg homicide-suicides, a team of experts dispatched by the Army Surgeon General's office concluded that Lariam was an "unlikely" explanation for the entire cluster of deaths but acknowledged it had not investigated it in any single case. It blamed the deaths on marital problems.

At the time, critics said some of the Fort Bragg deaths should have been investigated as possibly drug related, especially because there was no history of domestic abuse and all three of the soldiers who had been in Afghanistan killed themselves - both unusual in domestic homicide cases.

A former Roche employee said that Lariam, known generically as mefloquine, is a member of the quinolone family of drugs that can produce severe psychiatric problems in some users.

"Any drug with a quinolone base to it, which includes Lariam, is likely to do this," said Dr. Donald H. Marks, former associate director of clinical research at Roche who now consults with attorneys suing drug manufacturers. "These types of drugs can induce a temporary homicidal or suicidal rage."

The Army puts the rate of severe side effects at 1 in 13,000. A widely reported British study completed in 1996 found that one person in 140 had such serious problems that they temporarily couldn't carry out the function for which they were traveling.

The Manofskys said they were willing to take on the Navy publicly because they are convinced the truth is not being told, and concerned that other soldiers returning from deployments overseas are getting the same treatment.

They showed UPI Bill Manofsky's complete medical file and Navy service record; e-mails from the Navy psychiatrist who treated him before he decided not to work with the Navy any more; a log Tori kept of Bill's symptoms, and all the medicines he was taking including remaining Lariam pills. They gave interviews in California and Washington in which they went over the events almost minute by minute.

The Manofskys outlined this sequence of events.

A 17-year veteran of the Naval Reserve, Manofsky was handed Lariam last November at China Lake before being deployed. There was no prescription written or warning given of possible side effects, and Tori Manofsky said she has since been told by a base medical worker that there were "special instructions for dispensing and documenting" the drug.

Bill Manofsky served active duty at an air base in Kuwait during the war, using his top-secret clearance on a targeting system. But he suffered what he now says were bad Lariam side effects that started in Kuwait and got worse when he got home and kept taking his pills as directed. He's had uncontrollable vomiting and vertigo, depression and anxiety attacks requiring hospitalization. His hands tremble. He stutters and repeats himself. He has frightening seizures.

After 11 years of marriage, Tori said that after taking Lariam, Bill's personality changed drastically from the gentle husband she knew.

The drug is taken weekly while deployed and for four more weeks after a person returns, so Manofsky was still taking the pills when he got back.

Tori kept a journal documenting her husband's problems. An entry for May 2 described his symptoms as "balance off, angry, moody, coping poorly, sad, depressed. What really bothers me is 'aggressive - highly aggressive.'"

The couple tried to go fishing in early May in an effort to relax. But Bill got so angry he scared his wife. When she cast her line in the water, "Bill came over and said, 'Do it this way,'" she wrote in the journal documenting his problems. "He kept saying it over and over - extremely angry!!!"

After she told him she was upset and wanted to stop fishing, "he leaned over me like he was going to slug me in the head and said, 'If you don't do it this way I'm going to ...'" He stopped in the middle of the sentence and backed off. She said that a few hours later he had no memory of the incident.

Bill Manofsky told UPI later that, "I was trying not to pull a Fort Bragg."

"I wanted to make sure Bill had the proper care with Lariam toxicity," Tori said, describing the May 13 visit to the China Lake clinic. The symptoms I read on the Internet matched up with Bill's to a tee. I told the doctor that I thought that Lariam was responsible for his symptoms. I said, 'Doctor, would you write Lariam down.'"

"He wrote everything down and put the clipboard on the bed near Bill's legs. I leaned over and I said, 'Bill, I need to copy this.' They had a copy machine down the hall. I went down and copied it and did not say anything to anybody about it."

Later in May, Manofsky became suicidal. On May 31, Tori said that while she was driving them to a restaurant, "Bill's panic, anxiety and distress became so acute that he proceeded to try and claw his way out of the truck so he could jump out. I kept telling him, 'Bill, it's gonna be OK, it's gonna be OK.' He said he was crawling out of skin, he had to get out of there."

At the restaurant, "Bill went to the bathroom and began vomiting, he then sat on the floor and said repeatedly that he was going to blow his brains out.

The Manofskys say that Bill was referred to a Navy psychiatrist who also seemed to resist the idea that a drug prescribed by the Navy could be causing his problems. She diagnosed him with anxiety and "narcissistic" and "histrionic" personality traits.

Then, on June 26, Bill Manofsky discovered the changes in his medical record.


Copyright © 2001-2003 United Press International

thedrifter
09-09-03, 06:23 PM
Larium does have the side effects listed... just like the Cdr describes

other sites with info on Larium
http://www.geocities.com/TheTropics/6913/lariam.htm

http://www.lariam.com/pi.pdf#page=08

http://www.lariam.com/

http://lariaminfo.homestead.com/



Sempers,

Roger
:marine:

thedrifter
09-22-03, 08:49 PM
CDR William Manofsky has requested assistance from VERPA as follows:
"The best thing to help with right now is to get the word out to the troops
about the potential dangerous side effects of the drug. We are finding that
most of the people issued the drug are not warned. Dan O. has the Roche
label update from July2002. What every military member needs to know about
is in the "WARNINGS" and the "ADVERSE REACTIONS" sections of the document.
THey need to be told that if they are expereiencing any of those side
effects, to go to their corpsman and immediately ask to be switched to
Doxycycline and to ALSO be watched by the corpsman for 2 to 3 months while
the Lariam exits thier systems."
Sent: Monday, September 08, 2003 11:35 AM
Subject: Lariam: latest investigative report


Lariam friends --
UPI's latest investigative report on Lariam is below (document
photos at www.upi.com). Senator Dianne Feinstein has started an
inquiry based on this case, and she wants to hear from other
California military -- active, reserve, or retired -- who had adverse
reactions to Lariam. We need to swamp her with stories!

If you are a military person from California with a toxic reaction to
Lariam, diagnosed or suspected, present or past, please report it to
Senator Feinstein. Download this form and follow directions for
submitting it.
http://www.feinstein.senate.gov/privacy_form.html.

If you are a military person from any other state, please report your
Lariam problem to your own senators and cc Senator Feinstein.
Thanks
Jeanne Lese, Lariam Action USA, www.lariaminfo.homestead.com
_____________________________________________
Navy coverup alleged on drug side effects
By Mark Benjamin and Dan Olmsted
United Press International
Published 9/8/2003 7:05 AM


SAN DIEGO, Sept. 8 (UPI) -- A Naval Reserve commander who volunteered
for the Iraq war says the military doctored his medical file to
eliminate all traces of an anti-malaria drug that he believes made him
severely ill, suicidal and aggressive - and that he has the
> > before-and-after evidence to prove it.
> >
> > "I was given Lariam. I got sick from Lariam," said Cmdr. William
Manofsky, 44, who is based at the Naval Air Warfare Center in China
Lake, Calif. "The Navy does not want to talk about Lariam. There is no
mention of it in my medical record. I'm pretty upset."

Manofsky said there is no indication in his file of ever being
prescribed the drug, although the Navy handed it to him last November;
that a page is missing on which "Took Lariam" was written; and that a
reference to the drug during an emergency clinic visit on May 13 has
mysteriously vanished from the page - even though he has a copy that
clearly shows it written there.
Manofsky and his wife, Tori, believe the military is covering up
problems with the drug - the Navy's main concern so far, they said, is
to try to get the medical records back. A spokesman for the Navy
Bureau of Medicine and Surgery would only say that it provides quality
care and is working "to resolve the issue."

"The military created the drug," Tori Manofsky said (it was developed
by the Walter Reed Army Institute of Research and licensed to Roche).
"There is a lot of money involved in the drug. I think there are a lot
of careers at stake. Anything that shows a problem with Lariam has to
be hidden or covered up somehow by the military. If all these people
came back and it was clearly Lariam, there would be lawsuits up the
kazoo."
Lariam is the drug that at least two of the soldiers who killed their
wives at Fort Bragg last summer took while serving in Afghanistan.
Both those soldiers - and a third who apparently had taken the drug -
subsequently killed themselves. The drug's label warns of psychosis,
aggression, hallucinations and reports of suicide that can occur "long
after" someone stops taking it. The Food and Drug Administration this
year ordered that everyone prescribed the drug be handed a written
statement listing those dangers and warning them to quit taking it if
they experience mental problems.
The government and the company that makes Lariam, Swiss drug giant
Hoffmann-La Roche, say the drug is safe and effective. The FDA says it
doesn't know whether the drug can trigger suicide. Roche says there is
no reliable evidence it can trigger violent behavior. The Pentagon
says side effects are generally rare and mild and are outweighed by
the risk of getting malaria.

Manofsky, who never took Lariam before being deployed to Kuwait last
December, became suicidal after returning to California this spring
and nearly slugged his wife in a bizarre rage about the way she cast
her fishing line. He also suffered seizures, balance problems so
severe he sometimes could not stand, panic attacks and depression.

Tori Manofsky became convinced Lariam was the culprit after
researching on the Web the medications her husband was taking. On June
26, after several visits to the China Lake clinic in which they raised
the Lariam issue but felt they were being ignored, Bill Manofsky went
to the clinic to pick up his records on his way to see a neurologist.
He flipped through them to make sure Lariam was documented.

"The first thing I noticed was a sheet missing," he said. "Both Tori
and I had seen the sheet. Someone had written on an angle, 'Took
Lariam' and it was no longer there. There was no entry for being
issued Lariam."

Manofsky flipped more pages, looking for the record of a May 13 visit
to the clinic. That day, his wife had insisted a Navy doctor write the
drug on that record and both had watched him do it. He found the page
on which he felt certain that note had been written.

Nothing.

Manofsky knew his memory was shot, that he was acting strangely, and
there was no reason for anyone to believe him. But he had a backup.
Tori Manofsky - suspicious that Navy doctors were ignoring the drug -
secretly photocopied the page after the doctor wrote down "Lariam" on
the May 13 visit and briefly left the room.

Tori's copy clearly shows the reference, "Lariam for anti malaria"
Underneath that, four other medicines Manofsky was taking also are
gone; they are mentioned elsewhere on the visit.

Two independent document examiners consulted by UPI concluded that
unless the Manofskys themselves faked the doctor's writing and created
bogus copies, only the Navy can explain the omission.

The document experts could find no evidence that writing had been
erased from the May 13 record. One of the experts - a former head of
an FBI questioned documents office - told UPI that the likeliest
scenario is that the clinic made a copy of the May 13 page while the
Manofskys were still there, and the doctor wrote "Lariam" on that copy
after Tori insisted. That sheet never made it into his medical file.

While such a chain of events could theoretically be accidental, Tori
Manofsky believes the Navy knows it has a problem with the drug, and
was keeping two sets of records and recording Lariam problems on only
one.

UPI contacted the doctor who saw Manofsky on the May 13 visit and
asked if he knew anything about changes in the medical record. He
declined to comment and said he had been told to refer questions to
Twentynine Palms Marine base, which forwarded them to the Navy Bureau
of Medicine and Surgery in Washington. Spokesman Brian Badura issued
this statement:

"Successful medical treatment relies on accurate information, close
cooperation and communication between provider and patient, and
follow-up by all parties involved. Navy Medicine makes a concentrated
effort to meet the needs of each patient. Due to the number of
circumstances surrounding the Manofsky case and the ongoing efforts by
Navy Medicine to resolve this issue, we cannot offer additional input
at this time."

Several other service members who served in Iraq have told UPI they
had serious problems with the drug - including one who says he was
afraid of harming his wife and that there was no record of him being
prescribed Lariam, either. At least two soldiers were medically
evacuated from Iraq with suspected Lariam problems, one an Army
officer in charge of 300 soldiers, the other a soldier who felt the
way he was treated suggested the Army was "avoiding the Lariam
diagnosis." The Army is now discharging him.

The Washington Post reported in July that the military is
investigating at least seven suicides among troops in Iraq, among a
larger number of deaths classified as "non-combat weapons discharge"
or "non-combat related."

continued

thedrifter
09-22-03, 08:51 PM
The Pentagon hasn't identified any deaths as suicides since the war
started.

Earlier this year, two more soldiers deployed out of Fort Bragg who
took Lariam in Afghanistan committed suicide after returning home -
bringing the number of suicides after that war to at least five. In
one case, the soldier's father said he asked Fort Bragg officials if
the Lariam given to his son could have played a role. "They have no
comment," he told UPI.

The Pentagon insists that there have been few problems with the drug,
prescribed to soldiers around the world to prevent malaria. More 25
million people have taken it worldwide, according to the manufacturer,
5 million of them in the U.S.
Assistant Secretary of Defense Dr. William Winkenwerder, Jr., wrote a
U.S. congressman last fall that any possible side effects are "greatly
outweighed by the drug's effectiveness in preventing the severe
consequences of malaria infections" among troops.

In the Fort Bragg homicide-suicides, a team of experts dispatched by
the Army Surgeon General's office concluded that Lariam was an
"unlikely" explanation for the entire cluster of deaths but
acknowledged it had not investigated it in any single case. It blamed
the deaths on marital problems.

At the time, critics said some of the Fort Bragg deaths should have
been investigated as possibly drug related, especially because there
was no history of domestic abuse and all three of the soldiers who had
been in Afghanistan killed themselves - both unusual in domestic
homicide cases.

A former Roche employee said that Lariam, known generically as
mefloquine, is a member of the quinolone family of drugs that can
produce severe psychiatric problems in some users.

"Any drug with a quinolone base to it, which includes Lariam, is
likely to do this," said Dr. Donald H. Marks, former associate
director of clinical research at Roche who now consults with attorneys
suing drug manufacturers. "These types of drugs can induce a temporary
homicidal or suicidal rage."

The Army puts the rate of severe side effects at 1 in 13,000. A widely
reported British study completed in 1996 found that one person in 140
had such serious problems that they temporarily couldn't carry out the
function for which they were traveling.

The Manofskys said they were willing to take on the Navy publicly
because they are convinced the truth is not being told, and concerned
that other soldiers returning from deployments overseas are getting
the same treatment.

They showed UPI Bill Manofsky's complete medical file and Navy service
record; e-mails from the Navy psychiatrist who treated him before he
decided not to work with the Navy any more; a log Tori kept of Bill's
symptoms, and all the medicines he was taking including remaining
Lariam pills. They gave interviews in California and Washington in
which they went over the events almost minute by minute.

The Manofskys outlined this sequence of events.

A 17-year veteran of the Naval Reserve, Manofsky was handed Lariam
last November at China Lake before being deployed. There was no
prescription written or warning given of possible side effects, and
Tori Manofsky said she has since been told by a base medical worker
that there were "special instructions for dispensing and documenting"
the drug.

Bill Manofsky served active duty at an air base in Kuwait during the
war, using his top-secret clearance on a targeting system. But he
suffered what he now says were bad Lariam side effects that started in
Kuwait and got worse when he got home and kept taking his pills as
directed. He's had uncontrollable vomiting and vertigo, depression and
anxiety attacks requiring hospitalization. His hands tremble. He
stutters and repeats himself. He has frightening seizures.

After 11 years of marriage, Tori said that after taking Lariam, Bill's
personality changed drastically from the gentle husband she knew.

The drug is taken weekly while deployed and for four more weeks after
a person returns, so Manofsky was still taking the pills when he got
back.

Tori kept a journal documenting her husband's problems. An entry for
May 2 described his symptoms as "balance off, angry, moody, coping
poorly, sad, depressed. What really bothers me is 'aggressive - highly
aggressive.'"

The couple tried to go fishing in early May in an effort to relax. But
Bill got so angry he scared his wife. When she cast her line in the
water, "Bill came over and said, 'Do it this way,'" she wrote in the
journal documenting his problems. "He kept saying it over and over -
extremely angry!!!"

After she told him she was upset and wanted to stop fishing, "he
leaned over me like he was going to slug me in the head and said, 'If
you don't do it this way I'm going to ...'" He stopped in the middle
of the sentence and backed off. She said that a few hours later he had
no memory of the incident.

Bill Manofsky told UPI later that, "I was trying not to pull a Fort
Bragg."

"I wanted to make sure Bill had the proper care with Lariam toxicity,"
Tori said, describing the May 13 visit to the China Lake clinic. The
symptoms I read on the Internet matched up with Bill's to a tee. I
told the doctor that I thought that Lariam was responsible for his
symptoms. I said, 'Doctor, would you write Lariam down.'"

"He wrote everything down and put the clipboard on the bed near Bill's
legs. I leaned over and I said, 'Bill, I need to copy this.' They had
a copy machine down the hall. I went down and copied it and did not
say anything to anybody about it."

Later in May, Manofsky became suicidal. On May 31, Tori said that
while she was driving them to a restaurant, "Bill's panic, anxiety and
distress became so acute that he proceeded to try and claw his way out
of the truck so he could jump out. I kept telling him, 'Bill, it's
gonna be OK, it's gonna be OK.' He said he was crawling out of skin,
he had to get out of there."

At the restaurant, "Bill went to the bathroom and began vomiting, he
then sat on the floor and said repeatedly that he was going to blow
his brains out.

The Manofskys say that Bill was referred to a Navy psychiatrist who
also seemed to resist the idea that a drug prescribed by the Navy
could be causing his problems. She diagnosed him with anxiety and "narcissistic" and "histrionic" personality traits.

Then, on June 26, Bill Manofsky discovered the changes in his medical
record.


Copyright ?? 2001-2003 United Press International

THE CORPSMAN...week2late@earthlink.net

Barb Cragnotti
VERPA Legislative Coordinat
www.verpa.org

please send your comments to me at: verpalegislative@aol.com



Sempers,

Roger
:marine:

Kalbo
01-17-04, 08:32 AM
An Apology
--------------------------------------------------------------------------------
Dear All,

I recently received the results of a head and c-spine MRI I had done in December 2003. The head MRI indicated that I have one large lesion and 6 smaller lesions in the brain. The c-spine indicated a compressed disk between c-6 and c-7.

I have been a critic of Lariam (Mefloquine) for a long time, as I thought this what was the cause of alot of my physical and mental problems. I don't have a diagnosis yet, but endorse many of the symptoms of MS. I know God will get me through this.

I apologize for any problems this may have caused. Having said this, I still endorse Lariam screening.

Semper Fi,
Bill Long

thedrifter
01-31-04, 08:41 AM
Army Won't Review Lariam In Suicides
United Press International
January 30, 2004


WASHINGTON - The U.S. Army didn't investigate whether a malaria drug it developed could have triggered suicides by soldiers in Iraq, despite a new government suicide warning and complaints from soldiers, a senator and a leading veterans' advocate.

The Pentagon next week is expected to release a report on an elevated number of suicides among Army troops serving in Operation Iraqi Freedom.

Pentagon spokeswoman Martha Rudd told United Press International the Pentagon saw no reason to consider the anti-malaria drug, Lariam, as a possible factor in the suicides. Some troops in Iraq have taken the drug, particularly in the summer months. The Army said the suicide rate spiked in July.

"We don't believe there is any connection between Lariam and suicide," Rudd said. "There is nothing to indicate that is a factor."

The Food and Drug Administration last year ordered that all patients taking the drug receive a written warning that Lariam "can rarely cause serious mental problems in some patients. ... Some patients taking Lariam think about killing themselves, and there have been rare reports of suicides. It is not known whether Lariam was responsible for these suicides."

The FDA said side effects include aggression, paranoia, delusions, depression and psychosis.

"The Pentagon refuses to consider the obvious side effects Lariam produces in the combat scenario," Steve Robinson, a veterans' advocate, told a House Armed Services Committee panel last week.

"The military is ignoring this drug's known side effects," said Robinson, executive director of the National Gulf War Resource Center. "In some cases, they are lying to family members and act as if they are baffled by the high suicide and depression rates."

In October, Sen. Dianne Feinstein, D-Calif., asked Secretary of Defense Donald Rumsfeld to reconsider its use of the drug. "Given the mounting concerns about Lariam as expressed by civilians, service members and medical experts about its known serious side effects, I strongly urge you to reassess the (Defense Department's) policy on the use of Lariam," she wrote Rumsfeld.

Assistant Secretary of Defense Dr. William Winkenwerder Jr., told reporters this month that the Army was studying 19 soldier suicides in Operation Iraqi Freedom. He said that meant the suicide rate for the Army was "a little on the high side," but that "we don't see a trend there in looking at these cases that tells us there is more we might be doing to prevent suicides."

Rudd, the Pentagon spokeswoman, said the 19 suicides do not include any that occurred after soldiers left Iraq or a number of possible suicides there that are still under investigation.

UPI reported last week that since July, at least two soldiers who served in Iraq apparently killed themselves after being admitted to Walter Reed Army Medical Center in Washington, including one who hanged himself with a bedsheet Jan. 12, two days before Winkenwerder talked with reporters.

Rudd would not explain why soldiers who killed themselves outside of Iraq or Kuwait are excluded from the suicide total for Operation Iraqi Freedom, but she said there is no attempt by the Pentagon to hide suicides.

Some service members who took Lariam in Iraq told UPI that the military did not warn them of side effects noted by the FDA. Medical records for some did not reflect use of the pills, even though they still had leftover tablets.

The Army developed the once-a-week Lariam pill, known generically as mefloquine. Use in Iraq is apparently limited -- Army surgeon general spokeswoman Virginia Stephanakis told UPI, "I can tell you we are using almost no Lariam there."

The Colorado Springs (Colo.) Gazette reported that in the year ending this past October, 45,000 U.S. service members worldwide were prescribed Lariam by the military.

"I was never warned, nothing from the manufacturer in the box, nothing from the military. If I had known I would not have taken it," said one soldier who was medically evacuated from Iraq for mental problems after taking Lariam. The soldier, who asked that his name not be used, said he suffered anxiety and major depression and thought about killing himself. "I have no past history of this, never had issues with depression or anxiety and there is no family history."

He said Army doctors switched him immediately to another anti-malaria drug, but that they would not acknowledge Lariam could have triggered his symptoms. Instead, the Army is discharging him because of his mental problems.

Another soldier, Staff Sgt. Georg-Andreas Pogany, was charged with cowardice, an offense punishable by death, after he suffered a panic attack in Iraq when he saw the body of an enemy soldier. The charge was reduced to dereliction of duty and dropped altogether in December. Pogany told UPI he had taken Lariam and believes it may have triggered the attack. Panic attacks are listed under adverse reactions on the drug label.

Pogany said he received no warning about possible problems with the drug. "They gave me this medication just like I pick up my ammunition," Pogany said. "I told them that I felt like I had a nervous breakdown going on. Nobody in that company once asked or suggested that this might be a reaction to this medication."

UPI reported in early 2002 that mounting evidence suggests Lariam has triggered mental problems so severe that in a small percentage of users it has led to suicide. UPI also reported that soldiers involved in a string of murder-suicides at Fort Bragg, N.C., in the summer of 2002 after returning from Afghanistan had taken the drug.

The Army surgeon general dispatched a team to investigate. Their report said that Lariam was an "unlikely" cause for the entire cluster of deaths because not everyone suspected in the homicides had taken it. The team did not examine the drug's possible role in any individual death.

In a subsequent letter to Rep. John McHugh, R-N.Y., the Pentagon's Winkenwerder said that "the current issues regarding the adverse effects of mefloquine raised concerns within the Department of Defense as well as within the health related scientific community worldwide. In concert with other federal agencies, DOD will continue to assess these issues."


Sempers,

Roger
:marine:

thedrifter
02-27-04, 07:21 AM
DOD Now Eyes Lariam In Suicides
United Press International
February 26, 2004

WASHINGTON - The Pentagon reversed course Wednesday and told Congress it would look into whether an anti-malaria drug developed by the Army might be causing suicides, one month after asserting the drug could not be a factor.

Assistant Secretary of Defense for Health Affairs Dr. William Winkenwerder Jr. told a House Armed Services Committee panel he would launch a study into side effects of Lariam, "to include suicide and neuropsychiatric outcomes."

He said the Pentagon would appoint a panel to help design the study, but said it could take months or years to complete. Pentagon health officials also said they would no longer use Lariam in Iraq because the malaria risk does not warrant it.

The Pentagon is studying suicides in Iraq and Kuwait during Operation Iraqi Freedom. Winkenwerder said 21 Army soldiers from units assigned to the operation have committed suicide. Army Surgeon General Lt. Gen. James B. Peake told the panel the Army is investigating another five deaths in Iraq as possible suicides, along with six deaths among soldiers in Iraq who returned to the United States and then killed themselves.

When asked about the suicide investigation late last month, Army spokeswoman Martha Rudd said the Pentagon would not consider Lariam. "We don't believe there is any connection between Lariam and suicide," Rudd said. "There is nothing to indicate that is a factor."

Four of the 21 soldiers who committed suicide in Iraq or Kuwait came from units that took Lariam, the Pentagon health officials said Wednesday. Only one tested positive for Lariam in the blood, they said.

Developed by the Walter Reed Army Institute of Research, Lariam, known generically as mefloquine, is one drug used by soldiers in Iraq to prevent malaria, which is of particular concern in hot summer months. The Food and Drug Administration warns that Lariam can cause psychosis, aggression, paranoia, depression and thoughts of suicide. The FDA also warns of rare reports of suicide among Lariam users, although it says a link has not been established.

The Pentagon has told Congress in the past that side effects from Lariam have not been a problem in the military.

Winkenwerder said Wednesday that the 21 confirmed suicides in Operation Iraqi Freedom mean a rate of 15.8 suicides per 100,000 soldiers per year. He compared that to Army suicide rates of between 9.1 and 14.8 per 100,000 in the Army between 1995 and 2002.

"While every suicide is a tragic loss, the suicide rate for soldiers deployed to OIF is not significantly different from the range of recent annual Army suicide rates," he said Wednesday.

On Jan. 14, Winkenwerder said 18 Army suicides had been confirmed, which he said meant a rate of 13.5 per 100,000. He called this "a very slight increase" above expected suicides and "on the high end of what they've seen in the past." He said then that the Army typically sees a rate of 10-11 suicides per 100,000.

The Pentagon has said it does not count suicides among troops who served in Iraq but returned to the United States before killing themselves. After returning from Iraq, at least two soldiers apparently committed suicide at the Army's Walter Reed hospital in Washington, since July; another apparent suicide occurred last month near Fort Campbell, Ky.

Veterans groups said they are alarmed by the trend.

"I fear that the military is in denial and that they are rationalizing this. As far as we're concerned, we can't even trust the numbers," Wayne Smith, an adviser to the Vietnam Veterans of America Foundation, told UPI this month.

Steve Robinson, a veterans' advocate with the National Gulf War Resource Center, told a House panel last month he was concerned about the mental toll of war on troops, and asked for an investigation into Lariam.

"The military is ignoring this drug's known side effects," said Robinson. "In some cases, they are lying to family members and act as if they are baffled by the high suicide and depression rates."

In October, Sen. Dianne Feinstein, D-Calif., asked Secretary of Defense Donald Rumsfeld to reconsider the military's use of the drug. "Given the mounting concerns about Lariam as expressed by civilians, service members and medical experts about its known serious side effects, I strongly urge you to reassess the (Defense Department's) policy on the use of Lariam," she wrote Rumsfeld.

UPI reported that some soldiers involved in a string of murder-suicides at Fort Bragg, N.C., in the summer of 2002 had taken the drug in Afghanistan.

The Army surgeon general dispatched a team to investigate the deaths. Their report blamed marital problems and the stress of deployment and said that Lariam was an "unlikely" cause for the entire cluster of deaths because not everyone suspected in the homicides had taken it. The team did not examine the drug's possible role in any individual death.

Winkenwerder told Congress Wednesday, "Investigation has not established mefloquine as a cause in DoD murders or suicides." He did not say if the Pentagon would revisit the Fort Bragg deaths.

Sound Off...Why do you think the Pentagon was so reluctant to investigate Lariam more completely?


Sempers,

Roger
:marine:

thedrifter
03-03-04, 07:29 PM
Issue Date: March 08, 2004

Study to look at side effects of antimalarial drugs

By Deborah Funk
Times staff writer

The Pentagon’s top doctor wants to know what side effects service members may experience from antimalaria drugs — particularly the drug that at least one veterans’ advocate suspects may have played a role in the violent behavior and mental-health problems of some troops in recent years.
“I have directed a study to assess the rate of adverse events, to include suicide and neuropsychiatric outcomes, associated with anti-malarial medications, particularly mefloquine, prescribed to deployed service members,” Dr. William Winkenwerder told the House Armed Services total force subcommittee on Feb. 25.

The Pentagon will appoint a panel of experts in malaria and malaria medications to provide guidance on how to conduct the study, which could take up to two years, Winkenwerder said.

Such a study is important, said Lt. Gen. (Dr.) James Peake, the Army’s surgeon general, because soldiers need to have confidence in the drugs provided by the military.

Winkenwerder ordered the study based on concerns raised by service members and others about current antimalaria drugs.

Malaria struck at least 134 U.S. troops last year in Liberia, Afghanistan, Iraq and South Korea.

Mefloquine, also known by its trade name Lariam, is one of four drugs the military most often gives troops when going to places where malaria is present. The Food and Drug Administration says the drug should not be given to people who are depressed or have a recent history of depression, generalized anxiety disorder, psychosis, schizophrenia or other major psychiatric disorders.

The military follows those guidelines, Winkenwerder said.

The other drugs are doxycycline, primaquine and chloroquine. Insect repellent on clothes and on skin, and nets to cover beds, also are used to prevent malaria.

Steve Robinson, executive director of the National Gulf War Resource Center, asked defense officials to look at mefloquine as a possible cause of psychological problems among troops, including several murder-suicides at Fort Bragg, N.C., in 2002 and, more recently, suicides among service members deployed to Iraq.

Winkenwerder and Army officials said investigations have not “established mefloquine as a cause” in military murders or suicides.

Army Spc. Victor Thibeault told lawmakers he stopped taking mefloquine tablets in Afghanistan because of serious side effects. He said it gave him diarrhea and “constant nightmares,” and made him sick for two to three weeks.

“Every soldier I know has problems with Lariam,” he said.

But an assessment team that traveled to Iraq last summer to investigate suicides and other mental-health problems there found that only four of 21 confirmed suicides involved soldiers from units that used mefloquine, Peake said.

Rep. John McHugh, R-N.Y., chairman of the subcommittee, asked defense officials why they use mefloquine if other options are available.

“There obviously is a great deal of controversy over Lariam, whether it’s based in fact or perceived,” McHugh said.

The type of drug used depends on the type of malaria present, whether the drug works in that area and against that form of malaria, and how often it must be taken. Mefloquine needs to be taken only once a week, and doxycycline and primaquine must be taken daily. While chloroquine also is taken weekly, it’s not effective against malaria in some parts of the world, defense officials have said.

http://www.marinetimes.com/story.php?f=0-MARINEPAPER-2681466.php


Sempers,

Roger
:marine:

trollman
03-17-04, 03:26 AM
I took both of these meds at different times and have had no side effects. I'm not surprised by the out rage here against Mefloquine. Several Marines in my unit had severe nausea, dizziness, and nightmares.

:marine:

Kalbo
03-17-04, 08:51 AM
Seventh Iraq war veteran kills himself
By Mark Benjamin
United Press International
Published 3/16/2004 5:32 PM


WASHINGTON, March 16 (UPI) -- A Colorado-based Army Special Forces soldier back from Iraq shot himself in the head in his front yard Sunday night, according to police -- at least the seventh soldier who has committed suicide after serving there.

William Howell, 36, shot himself after following his wife around the yard with a handgun, according to the El Paso County Sheriff's Office. Howell served with the 10th Special Forces group in Iraq and returned to Fort Carson last month, according to the Army.

Another soldier who was attached to that unit in Iraq, Staff Sgt. Georg-Andreas Pogany, has claimed that the 10th Special Forces Group ignored him when he sought help with mental problems there, and then charged him with cowardice instead. Pogany, 32, also says the Army is ignoring the side effects of an anti-malaria drug called Lariam he took with the Special Forces, which has been linked to mental problems, aggression and suicides.

The Army's Special Operations Command did not respond to a question Tuesday about whether Howell had taken the drug or had sought help for mental health concerns.

The El Paso County Sheriff's Department got a phone call just before 9:30 Sunday night from Howell's wife about a "physical disturbance" at their home in Monument. She said her husband had gone to get a gun. Police said the line then went dead. When they called back, Howell said there was no problem.

When police arrived, Howell was following his wife around the yard with a handgun and talking to her. "He was ordered to drop his weapon by one of the officers, but instead placed the weapon to his head and pulled the trigger," the sheriff's office said in a statement. One officer fired at Howell, not realizing whom Howell was shooting at, and hit Howell in the arm. The El Paso County Coroner said Howell died from his own shot.

Howell's wife was treated for a minor head injury. A 13-year-old and two infants were in the house, unharmed.

Police said they have no records of previous domestic disputes involving Howell or his address.

Pogany, the soldier who was charged with cowardice, has said he suffered a debilitating panic attack in Iraq last fall after seeing the body of a mangled Iraqi while with 10th Special Forces. He says he sought help, but was rebuffed, and eventually charged with cowardice, which is punishable by death. The Army has since withdrawn those charges but he continues to fight the Army on others.

In Iraq, the Special Forces had just given Pogany his third Lariam pill when he suffered the attack. The Food and Drug Administration warns that Lariam can cause panic attacks, thoughts of suicide, depression, anxiety, paranoia, delusions and psychosis that can occur long after taking the drug.

A leading veterans' advocate two months ago warned Congress that soldiers who experience mental problems during or after deployments need help and not punishment.

"Nowhere is this apparent disregard for psychological injuries more apparent than in the case of Sgt. Georg-Andreas Pogany, who was charged with cowardice," Steve Robinson, Executive Director of the National Gulf War Resource Center, told a House Armed Services Committee panel on Jan. 21.

Robinson, a former Army Ranger, told UPI that some soldiers have heard about the Pogany case and are afraid of seeking help because of what happened to him. "This Pogany case has had a chilling effect on soldiers coming forward. I have talked to soldiers who have said it," he said.

Robinson also asked Congress to look into Lariam. "This drug needs to be investigated to determine if it is harming and in some cases killing our own soldiers," Robinson told that panel.

It is not clear whether Howell ever asked for help when he returned from Iraq, but Pogany's attorney, Rich Travis, said the Special Forces have created an "atmosphere" that makes soldiers afraid to seek help. "I think it is the Special Forces that does create an atmosphere where you can not approach your commander and ask for help," Travis said. "I don't think it is a leap of logic to think (Howell) knew how Georg was treated by the chain of command. I think it was pretty well known."

Travis also said the Army, which invented Lariam, is now ignoring its side effects.

Three special operations soldiers who served in Afghanistan and had apparently taken Lariam allegedly killed their wives at Fort Bragg in the summer of 2002. Those three soldiers also committed suicide.

In the investigation into the Fort Bragg killings, the Army said that Lariam could not have triggered a cluster of five apparent murders and three suicides from that summer because some suspects did not take Lariam.

Suicides in connection with Operation Iraqi Freedom have become an issue after an unusual spike occurred last summer in Iraq. The Pentagon says 21 Army suicides have been confirmed in Iraq and Kuwait -- reflecting a suicide rate within the normal range. A report on mental health problems in Iraq was ordered last August by the Army surgeon general but has not been released.

According to the Army, six soldiers have killed themselves after returning from Iraq, not counting Howell. UPI reported that one soldier back from Iraq died last July, and another this January, at Walter Reed Army Medical Center. A Fort Campbell soldier who had been in Iraq killed himself in January.

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