VETERAN'S NEWS and VIEWS.....: Lariam and Ft. Bragg

dated 8/8/02


From: lariaminfo@yahoo.com (Lariam Action USA)
To: vetcenter@aol.com


Lariam Action USA is trying to reach Somalia vets and any other
servicepeople who believe they have had an adverse reaction -- short or
prolonged -- to Lariam (mefloquine), a common antimalarial agent. Its side
effects range from simple nausea and dizzyness to depression and anxiety
attacks and paranoid behaviors, to suicidal ideas and even suicide.
Lariam was given to US troops in Somalia, Zaire, and elsewhere. It is
currently being used in Afghanistan. United Press International has been
doing a series on Lariam and vets. The most recent story (Aug 7)asks if
Lariam could be a factor in the killings at Ft Bragg. You can read these
stories at www.upi.com (search "lariam').

I am looking for vets who think they had an adverse reaction to Lariam and
would like to talk about it. If this described you, please contact me asap at
lariaminfo@yahoo.com. Regards,
Jeanne Lese, Lariam Action USA, <A
HREF="http://www.lariaminfo.homestead.com">www.lariaminfo.homestead.com</A>

Lariam connection to Bragg killings?


By Mark Benjamin and Dan Olmsted
From the Washington Politics & Policy Desk

From the <A HREF="http://www.upi.com/deskview.cfm?DeskCode=washington">
Washington Politics & Policy Desk</A>
Published 8/7/2002 9:06 AM
<A HREF="http://www.upi.com/print.cfm?StoryID=20020806-063742-8054r">View
printer-friendly version</A>



FAYETTEVILLE, N.C., Aug. 6 (UPI) -- At least one of the four Fort Bragg
soldiers suspected of killing his wife this summer had apparently been taking
an anti-malarial drug associated with aggression, paranoia and suicidal
thoughts, United Press International has learned.

That soldier, Sgt. 1st Class Rigoberto Nieves, shot and killed himself after
shooting his wife, Teresa, in a bathroom of their Fayetteville home on June
11, just two days after returning early from service in Afghanistan,
according to police.

In another case, Sam Pennica of the Cumberland County Sheriff's Office said
he plans to discuss detecting the drug with the county medical examiner in
the case of Sgt. 1st Class Brandon Floyd. Floyd, 30, shot his wife, Andrea,
in their home in Stedman, near Fayetteville, on July 19, then turned the gun
on himself.

"I will bring it to the attention of the medical examiner," Pennica said.

Army troops in Afghanistan are routinely prescribed the anti-malaria drug,
Lariam. An Army medical source familiar with Nieves' duty in Afghanistan,
speaking on condition of anonymity, said he was sure that Nieves had been
given the drug.

Army officials told UPI that they have no plans to look at a possible link
between Lariam and the incidents because they don't believe the drug could
have been a factor.

Maj. Gary Kolb, spokesman for the Army's Special Operations Command, said the
military is conducting a review of the circumstances surrounding the killings
to see what, if anything, can be done to prevent future problems. That review
is focused on marital problems, and Lariam is an unlikely culprit, according
to Kolb, because one of the four soldiers had not been deployed to
Afghanistan or elsewhere and a second had returned from Afghanistan in
January.

"We've had other soldiers go and come back (without a problem) before these
incidents occurred. ... One of the guys was back for seven months, making it
unlikely that (Lariam) would be a factor," Kolb said.

"There were problems in the marriages before this. That is the focus of the
investigation right now."

The four incidents have drawn national attention and sent Army officials
looking for a common thread:

-- Nieves, a Green Beret, shot himself and his wife, Teresa, on June 11 in
the master bathroom of their home in Fayetteville, police said. He had come
back early from Afghanistan two days before, reportedly to deal with personal
or family problems.

-- Master Sgt. William Wright, a special operations soldier, strangled his
wife, Jennifer, at their Fayetteville home on June 29, then buried her body
in a shallow grave, according to authorities. They said he confessed on July
19 and led them to her body. Wright, who had been back from Afghanistan for
about a month, is charged with first-degree murder.

-- Sgt. Cedric Griffin, an Army cook, stabbed his estranged wife to death in
her trailer "at least" 50 times and set her body on fire July 9, authorities
said. He had not been deployed. He is charged with first-degree murder.

-- Sgt. 1st Class Brandon Floyd, 30, shot his wife, Andrea, in their home in
Stedman, near Fayetteville, on July 19, then shot and killed himself. Floyd,
a member of the secret counter-terrorism unit called Delta Force, had gone to
Afghanistan in November and returned in January.

Lariam, also known by the generic name mefloquine, is the Army's drug of
choice to prevent malaria, which is endemic in Afghanistan from May to
November in all but the mountainous central and northeast regions of the
country. The Army's Walter Reed research institute invented the drug. Lariam
is manufactured by the Swiss pharmaceutical giant Hoffmann-La Roche and was
cleared for use in the United States in 1989.

For the majority who tolerate the drug well, Lariam is considered highly
effective at preventing malaria.

Official Army spokesmen would not say whether any of the soldiers involved in
the family shootings had taken Lariam, citing the ongoing investigation. Sgt.
Wright was in Afghanistan during a period when Lariam was dispensed, but it
was unclear whether he took the drug, and his lawyer, Thomas Maher, said he
did not know whether his client had taken it. It was also unknown whether
Floyd took the drug.

The state medical examiner's toxicology report on Nieves said only that there
was no alcohol in his system. A spokesman said no other toxicological tests
had been performed. An autopsy was performed on Floyd but the results are not
yet available.

According to the official product information sheet prepared by the drug
company and approved by the Food and Drug Administration, less frequently
reported side effects include depression, hallucinations, psychotic or
paranoid reactions, anxiety, agitation, aggression and confusion. The label
also warns "suicidal ideation has also rarely been reported, but no
relationship to drug administration has been established."

A two-month investigation published by United Press International in May
found mounting evidence that suggests Lariam has caused such severe mental
problems that in a small percentage of cases it has led to suicide. A UPI
story published July 30 reported that scores of Peace Corps volunteers are
coming forward saying that over the past 12 years they suffered paranoia,
anxiety, hallucinations, memory loss and suicidal behavior they blamed on
Lariam. Some of the reports include problems that patients said have lasted
for years or months after they stopped taking the drug.

The U.S. Labor Department awarded two volunteers workman's compensation for
Lariam-induced psychoses -- one lasting three days, the other an entire year.

In several other countries, reports associating Lariam and violence have been
investigated.

During the Somalia operation in the early 1990s, a Canadian army corporal,
Clayton Matchee, allegedly tortured and killed a 14-year-old boy who had
snuck into the compound. The incident occurred on what troops called Psycho
Tuesday, the day they took their weekly Lariam dose. Matchee subsequently
attempted suicide by hanging and suffered permanent brain damage.

His wife, Marj, told a Canadian newspaper at the time that when her husband
was home from Somalia on leave before the incident, she woke up in the middle
of the night to find his hands around her neck. Marj Matchee said her husband
attributed his behavior to Lariam.

A formal inquiry into the incident concluded that no link to Lariam could be
established "without extensive further investigation."

U.S. Army officials said they never saw any problems among U.S. soldiers
taking Lariam in Somalia. The activist group Lariam Action said that it has
been contacted by 120 veterans of Somalia who said they continue to have
problems with the drug, including 11 who said they have considered or tried
suicide.

The wife of one veteran also wrote in an e-mail to the group that when her
husband returned from Somalia, "he would wake up in the night and choke me or
just about punch me, thinking I was someone from Somalia. He was extremely
angry all the time, and very abusive."



(With assistance from freelance writer J.S. Newton)

Copyright © 2002 United Press International

Sempers,

Roger

I don't post much, but in my humble opinion we need to stop giving Mefloquine(Lariam) to our troops now. It seems to me, untill proven otherwise, that there have been way to many suicides and homicides among Marines & soliders that have taken Mefloquine.

Semper Fi,

Kalbo (Bill)
1st Force Reconnaissance Co. (1990-94)
Somalia & Rwanda

... High stress life style associated with serving in the Armed Forces of the United States. Bad reactions to a relatively unproved drug causing psychotic behaviour in those who've been subjeted to it. Naw. I don't see a connection. Do you! We've never seen this before! (sarcasm) It's getting entirely to old and too common place.

We need to deal with the immediate threat, which is the government acknowledgement of this situation. Then we need to consider how to prevent such wholesale scientific experimentation on the members of of our Armed Services.

Pentagon Plans Expert Probe of Fort Bragg Killings
Thu Aug 22, 6:24 PM ET
By Charles Aldinger

WASHINGTON (Reuters) - The Pentagon ( news - web sites) plans to send a team of experts to Fort Bragg, North Carolina, to investigate whether the recent killings of four women there, allegedly by their Army husbands, are connected, defense officials said on Thursday.


Reuters Photo



Pentagon and Army officials said the probe by medical and other specialists would include whether the killings might be related to a widely used anti-malaria drug which can prompt rare side effects such as rage and suicidal tendencies.

Air Force Maj. Sandy Troeber, a Pentagon spokeswoman, said the epidemiological team was likely to go to Fort Bragg, home of the storied 82nd Airborne Division, in September but that no final decision had been made.

Four Fort Bragg soldiers, including three special operations servicemen who returned home after tours of duty in Afghanistan ( news - web sites), allegedly killed their wives this summer.

In two of the cases, the soldiers killed themselves after shooting their spouses, officials said. In the other two, the servicemen were arrested and are facing charges.

Despite recent reports that the anti-malaria drug mefloquine was now a target for investigators, Army officials who asked not to be identified stressed on Thursday that there was no evidence that it might have triggered the behavior leading to the killings.

Roche Laboratories produces mefloquine under the brand name Lariam and the medication is used by the Army.

ARMY OFFICIAL CAUTIOUS ON DRUG REPORTS

"We don't even know for sure if all four of the men involved here took the drug," one Army official told Reuters. "And thousands and thousands of other troops have taken it without any problem."

Fort Bragg, located near Fayetteville, North Carolina, is the home base for the 82nd Airborne Division and elite U.S. Army commando units, which were dispatched to Afghanistan as part of the U.S. war on terrorism following the Sept. 11 hijacked airplane attacks on New York and Washington.

Officials at the Army's Special Operations Command in Fort Bragg say that domestic killings are very unusual, even among servicemen returning from a war zone. But the command has continued to look into possible common circumstances in the crimes.

In the first incident, the bodies of Sgt. First Class Rigoberto Nieves, 32, who had just returned from Afghanistan, and his wife, Teresa, were found on June 11 in their home outside the base. Both died of gunshot wounds.

In the second, Master Sgt. William Wright, 36, led authorities to the body of his wife, Jennifer, who had been strangled and buried in a shallow grave in a wooded area on the base. Wright, who served in Afghanistan for two months and returned in mid-May, had reported his wife missing on July 1. He was charged by the local sheriff's department with first-degree murder.

On July 19, authorities found the bodies of Sgt. First Class Brandon Floyd, 30, who returned from Afghanistan in January, and his wife, Andrea, at their home off base. Both had been shot to death.

In the fourth incident, Sgt. Cedric Griffin, 28, a Fort Bragg soldier who had not been deployed to Afghanistan, was charged with stabbing his estranged wife, Marilyn, at least 50 times and setting her home on fire on July 9.

Worse than the disease?
As investigators debate its role in a series of military killings, anti-malaria drug mefloquine carries a long, strange history, DAVID AKIN reports
By DAVID AKIN

Saturday, September 14, 2002 – Print Edition, Page F7

It was Master Sergeant William Wright's job in Afghanistan to teach villagers how to find underground water and dig wells.

He had arrived in March, part of the U.S. Army's 96th Civil Affairs Battalion. By May, his tour of duty had ended and he had persuaded his superiors to let him leave a day early so he could surprise his wife, Jennifer, and their three children at their home on the Fort Bragg army base near Lafayetteville, N.C.

But when he arrived home, he was surprised to find his wife sleeping with another man.

Sgt. Wright, who had never been known to act violently, promptly packed up his things and moved out of the house and into army barracks. But he returned home, police say, on June 29, and Jennifer Wright was never seen alive again.

A few weeks later, Sgt. Wright confessed to the strangulation of his former high-school sweetheart. Jennifer Wright, as it turned out, was the second of four Fort Bragg wives to be killed by their husbands in the span of a few weeks.

The killings had a few links. All the couples, say friends and families, had experienced marital troubles. Three of the four accused husbands had served in Afghanistan.

But there was another common denominator: Three of the four men, including Sgt. Wright, had taken mefloquine, a commonly prescribed anti-malarial medication marketed under the trade name Lariam by Swiss drug giant F. Hoffman-Roche Ltd.

Roche concedes that Lariam can cause severe neuropsychiatric disorders, including manic behaviour, acute psychosis with delusions, and aggressive mood swings, in a very small number of cases, about one in 10,000. Investigators have not yet concluded whether Lariam played any role in the Fort Bragg killings, but they are considering it.

The Canadian Somalia Commission of Inquiry also looked at Lariam when it investigated the 1993 beating death of a Somali teenager at the hands of Canadian troops. Many soldiers were given mefloquine while on duty in Somalia.

The commission, which was shut down prematurely by the federal government, was unable to sort out the difficult and complex science of mefloquine and the brain's chemistry. Ultimately, it decided that it could not say if mefloquine played in the events that led to the death of Shidane Arone.

But the commission certainly heard from soldiers and army medical staff that mefloquine provoked numerous psychological side effects among the troops in Somalia. "Ten patients experienced nightmares. . . . One patient heard voices and talked to himself. All were switched to [another anti-malarial agent] with no subsequent problems," its 1997 report said.

One Canadian army major said that the men in his unit used to joke that "if you get somebody angry, he's just going to walk into the old church tower and waste 20 people" and then say, "Oh, sorry, bad mefloquine trip."

Canadians in Somalia got their weekly dose of mefloquine on Wednesdays. The U.S. soldiers took their Lariam pill on Tuesdays, prompting some members of the U.S. forces to dub that day of the week "Psycho Tuesdays."

Canada's Department of National Defence has been prescribing mefloquine for its ground soldiers and navy personnel since 1992, a year before the drug was approved by Health Canada for civilian use. By all accounts, the Canadian mission in Afghanistan was unmarred by any incidents like those of the Somalia scandal -- but the troops did take mefloquine, and some reported strong nightmares and other psychological oddities.

Armies and mefloquine have grown up together -- like most anti-malarial drugs, it is the product of army medical research. Private-sector drug companies rarely initiate malaria research for the simple reason that there is little money to be made in wiping out a disease that affects the world's poorest people. But armies have an incentive to keep their soldiers healthy in the jungle.

"The motivation to pursue research on a malaria vaccine was not so much altruistic as it was imperial," Robert Desowitz wrote in his 1991 book The Malaria Capers. The malaria parasite was first discovered by a surgeon in the French army, and it was a surgeon in the British army who deduced that mosquitoes carried the disease. As the first great colonial powers of the modern world, the French and the British deployed significant resources to combat malaria.

But as their global presence faded, the United States filled the vacuum.

With malaria killing more U.S. soldiers than North Vietnamese bullets, finding a drug that could protect them become a top priority for the U.S. Army's medical researchers by the end of the 1960s.

In 1971, scientists at the Walter Reed Army Institute of Research in Baltimore discovered that quinoline-methanol, a chemical cousin to quinine known as mefloquine, was an excellent chemoprophylactic (a chemical condom) to shield those who took it from malaria.

The World Health Organization, Roche and the Walter Reed researchers agreed to jointly develop the drug and, by 1985, Roche was ready to manufacture it, receiving regulatory approval first in Europe and then later in North America.

It was seen as an important weapon to combat one of the world's leading health problems. Malaria infects more than 500 million people a year and, of those, nearly three million die, according to the World Health Organization.

But anecdotes of bizarre Lariam-influenced behaviour surfaced within a few years of the drug's commercial use.

In 1998, a schoolmaster in England stole £36,000 of school-trip money and then blamed the side effects of Lariam for his aberrant behaviour. Vanessa Brunt, who her family said was a healthy and happy 22-year-old student at Cambridge University, committed suicide in 1999 after receiving doses of Lariam. And this year, a former Democratic Congressman in Philadelphia was charged with defrauding friends and supporters of $10-million (U.S.). He told the judge in the case that he couldn't tell right from wrong because of the side effects of Lariam.

Even as early as 1993, H. A. H. Mashaal, the World Health Organization's senior malariologist from 1957 to 1982, put out the call for a broad review of mefloquine's use and related adverse effects.

But all of this doom and gloom about mefloquine is, according to some researchers, nothing more than the media's uninformed overreaction.

Last year, a group of Canada's top malaria and infectious-disease researchers wrote in the Canadian Medical Association Journal that "real and perceived intolerances to mefloquine have received substantial and occasionally irresponsible coverage in the Canadian media. As a result, many Canadian travellers refuse to take mefloquine, even when it is clearly the most appropriate choice."

They say mefloquine can be a literal lifesaver in certain parts of the world. Roche, too, is standing by its product, although it mailed out warnings this year to U.S. health-care practitioners in which it spelled out some of the potential neuropsychiatric reactions.

As for Master Sergeant William Wright, he remains in jail in North Carolina and faces a trial in the killing of his wife. Prosecutors are sure to point to a jealous husband who strangled his wife in a fit of rage. His lawyer, though, may dust off a pile of scientific studies and point the finger at one of the world's most popular anti-malarial drugs.

Anti-malaria arsenal

Experts say it is vitally important that anyone who travels to a region where there is a risk of malaria talk to their doctor well before travelling, usually six to eight weeks. There is no one drug that is suitable for all, nor is there there a malaria vaccine, though researchers at Oxford University began testing a potential one this summer in Gambia. This list contains the drugs' generic names, followed in brackets by trade names.

Chloroquine (Aralen). For more than 40 years, this has been the most widely used anti-malarial drug. As a result, though, malaria parasites in African and some parts of Asia are now resistant to it.
Mefloquine (Lariam). Now recommended as the first defence by Health Canada, the World Health Organization and the U.S. Centers for Disease Control. Has been a source of controversy due to its rare neuropsychiatric side effects (see main story). Highly effective in sub-Saharan Africa. Less so in some parts of southeast Asia.
Doxycyline (Vibramycin or Doryx). Generally now the choice for a patient who is unable to take chloroquine or mefloquine. Not suitable for pregnant or breast-feeding women, or for young children.
Atovaquone plus proguanil (Malarone). Only recently licensed in Canada, it is as effective as mefloquine and has significantly fewer side effects, but is a significantly more expensive drug.
Primaquine. Somewhat less effective than first-line drugs. Also requires a special blood test before it can be prescribed.

Not recommended
These drugs are no longer sanctioned in Canada, but travellers may see them sold in other countries.
Proguanil (Paludrine). Not recommended for malaria protection by Health Canada.
Pyrimethamine plus sulfadoxine (Fansidar). No longer available in Canada because it can cause severe skin reactions.

Sources: Health Canada; Dr. Jay Keystone, Toronto General Hospital's centre for travel and tropical medicine; The Globe and Mail

The San Francisco Chronicle
Copyright 2002

Sunday, September 15, 2002

TRAVEL MEDICINE

Tricky anti-malaria drug still travelers' first choice
Ulysses Torassa
E-mail Ulysses Torassa at utorassa@sfchronicle.com.

The controversial anti-malaria drug Lariam is back in the news, with speculation that it might be connected to the recent rash of murders and suicides at Fort Bragg, N.C. Three soldiers, each of whom had reportedly been given Lariam (mefloquine) during their tour of duty in Afghanistan, killed their wives this year. Two of them took their own lives as well.

Lariam's manufacturer, Roche Pharmaceuticals, said it was alerting doctors that a small number of people have committed suicide after taking it. (The label already lists suicidal thoughts and other psychiatric problems as potential risks). And last month, the U.S. Food and Drug Administration approved labeling Malarone (atovaquone/proguanil) to say that it has fewer side effects than Lariam.

Both medications are proven to prevent cases of malaria, a sometimes deadly mosquito-borne disease endemic in much of Africa, parts of Asia and South America. Chloroquine was once the drug of choice, but resistant strains of malaria have spread to most of the world. Another preventive treatment, doxycycline, has unpleasant side effects and must be taken daily. Lariam needs to be taken only weekly and has become public health officials' first choice.

But the drug has been dogged by reports that it triggers neurological disturbances, vivid dreams and even psychosis in some who have taken it. A former congressman blamed Lariam for a series of bad business deals that culminated in multiple fraud charges.

Lariam has its defenders. It is cheaper than Malarone -- $10 versus $33 for a week's worth -- and taking it weekly instead of daily means less chance of missing a dose. And officials cite studies that found a relatively low incidence of adverse episodes. Millions of people -- myself included -- have taken it without any problems.

Tom Skinner, a spokesman for the Centers for Disease Control and Prevention, said the agency is reviewing its recommendations for malaria prevention and expects to issue an update early next year. Meanwhile, the CDC stands by its recommendation of Lariam as the first choice for travelers to areas where malaria has become chloroquine resistant. It also lists Malarone, doxycycline and others as useful alternatives.

Army investigators have said they are "pretty sure" Lariam did not play a role in the Fort Bragg killings.

But anti-Lariam activists such as Jeanne Lese of San Rafael want patients to sign an explicit consent form detailing the risks before the drug is prescribed.

"People are . . . not being warned, because the doctors aren't aware there is a problem," said Lese, co-director of Lariam Action USA.



Evening Standard - London
Copyright 2002
Tuesday, September 17, 2002
Drug problem: the Lariam debate

Controversy has surrounded Lariam since it was launched in 1989, and has been linked to several suicides around the world. Its maker, Hoffman-La Roche estimates that only one in 10,000 users will become so ill from side-effects as to require hospital treatment - although other studies have suggested that as many as one in 140 users may suffer temporarily disabling side-effects.

Malaria kills over two million people every year, making it one of the world's deadliest diseases.

Over 30,000 European and American travellers are infected every year with the disease, which spreads from person to person by mosquitos. Early symptoms are often mistaken for flu (a mild fever, chills, headaches, general malaise). Later symptoms include fever, delirium and confusion.

Cerebral malaria is fatal in 20 per cent of cases.

Lariam is 97 per cent effective in preventing malaria, and is recommended for most African countries, all around the Amazon basin, some parts of Central Asia, and South East Asia.

Doctors point out that contracting malaria could be worse than the side effects of Lariam. But in most cases, there are other anti- malarial drugs available.

Possible side-effects of Lariam include convulsions, depression, hallucinations, dizziness, psychosis, loss of balance, headaches, insomnia, abnormal dreams, anxiety, depression, panic attacks, agitation, fatigue, muscle weakness and loss of appetite. The drug is not recommended for anyone with epilepsy, who is pregnant, for scuba divers, or for anyone who has a history of psychological problems or depression.

Psychological effects are known to occur after stopping taking the drug.

Before being licensed, drug trials were conducted largely on soldiers - who were young, male and healthy. Eight out of 10 adults who experienced the most serious sideeffects were women, who tend to weigh less, but take the same dose as men.

A study by Peter Barrett from the Medical Advisory Service Travellers Abroad found that 40 per cent of people experience some kind of side-effect such as nausea, dizziness, strange or vivid dreams, anxiety, depression or seizures.

While most of these effects are short-term, the way the drug works is not fully understood, and in some people the symptoms may last for months or years.

Sydney Morning Herald
Copyright of John Fairfax Group Pty Ltd
Thursday, September 19, 2002
News And Features
Malarial Malaise
Ruth Pollard

The resurgence of the mosquito-borne illness has forced pharmaceutical companies to find new ways to combat the disease. But one drug has possible fatal side effects. Ruth Pollard reports.

THE United States Army is investigating whether it is linked to a series of murders and suicides at its Fort Bragg base in North Carolina, lobby groups oppose its use and its manufacturer, Roche, is sending letters to US doctors warning of its reported links to suicides.

The controversy over the anti-malaria drug mefloquine, sold in Australia as Lariam, has not only reopened debate about the safety of the drug, but has doctors wondering whether, for some travellers, anti-malaria drugs are needed at all.

Mefloquine was developed by the US Army because some strains of malaria were becoming resistant to chloroquine in the late '70s. The drug has come under attack because of the serious, but rare, neuropsychiatric side effects it causes.

One in every 10,000 people who take mefloquine to avoid developing malaria while in areas where mosquitoes are rife experiences severe neuropsychiatric disorders. That rises to one in 1000 to 2000 when it is used as a treatment for malaria because it is used in higher doses, experts say.

Mefloquine is mainly prescribed for people travelling or living in Africa and South America. In South-East Asia and the Pacific, malaria has become resistant to the drug, so doxycycline, another anti-malaria drug, is usually prescribed.

Dr Andrew Fuller, an infectious diseases physician at Melbourne's Alfred Hospital, has seen the neuropsychiatric side effects of mefloquine: "I had a patient who thought he was Jesus Christ. I have a dozen patients who have had symptoms for anything from months to years. I don't prescribe the drug much there are other options, other drugs available."

That said, mefloquine is considered a highly effective preventative for malaria, one of the world's most deadly communicable diseases. Most who take it experience only mild side effects, or none at all.

Investigations are under way in the US over whether there is a connection between mefloquine and four soldiers who killed their wives, and the two who subsequently committed suicide at Fort Bragg. All four had reportedly served in Afghanistan and were allegedly taking mefloquine.

Its manufacturer in the US, Hoffman-La Roche, plans to send written notices to doctors warning that the drug has been linked to reports of suicide, although it has said there was still no evidence that mefloquine can cause people to kill themselves.

"Rare cases of suicidal ideation [thoughts] and suicide have been reported but no relationship to drug administration has been confirmed," it has said.

Mefloquine was first used to prevent malaria in 1985, and since then 14.5 million people have been prescribed the drug for malaria prevention, and 1.6 million for treatment, according to a study in the British Journal of General Practice earlier this year.

Since then "Lariam Action" support groups have been formed in Australia, New Zealand, Britain, the US, Canada, Ireland, Denmark, and Switzerland. Lariam-related lawsuits have been filed (though some have been withdrawn) in Ireland, Canada, Denmark, and the US.

The British study, which reviewed 516 published cases of adverse effects from mefloquine, found alcohol, recreational drugs, hormonal contraception and other medications can be related to severe or prolonged adverse reactions to mefloquine. It warned those with a history of liver or thyroid abnormality in the previous two years should avoid mefloquine.

But it also said: "Mefloquine is a safe and exceptionally useful drug for the mass prophylaxis and treatment of those resident populations in malaria-endemic areas which traditionally abstain from alcohol and hormonal contraception."

One Australian doctor, Bob Cass, the chief medical adviser of the Travel Doctor Group, has called for a total rethink on the prescription of anti-malaria drugs to travellers going to countries with endemic malaria.

"In most major regional centres in, for example, Thailand, including Bangkok, Chiang Mai and Chiang Rai, the risk of contracting malaria is very low, and it is much lower than the risk of side effects from anti-malaria drugs," Cass told the Herald.

"On the other hand, trekking in monsoonal months is a risk, and you need to take prophylaxis."

Cass said doctors should assess where a person was travelling to, and what the individual would do while there, plus any pre-existing health conditions such as depression, epilepsy or bipolar disorder, before prescribing anti-malaria drugs.

"You cannot simply have someone come into your surgery, tell you they're going to Africa, or the Amazon, then open a travel medicine guide, run your finger down the page and say 'malaria and these are the drugs you need to prevent it' it is not as simple as that."

Cass sees many people who travel on their honeymoon. He starts them on a course of mefloquine six weeks before the wedding to see if they tolerate the drug. "If they don't, then we have time to try something else."

And his advice regarding alcohol and mefloquine? "If you are going to get drunk on the day you are meant to take your medication, don't take it delay it a day or two it stays in your blood for a long time, so a couple of days won't make much of a difference."

Roche Australia's medical director, Dr David Kingston, told the Herald the company was not changing or reissuing prescribing guidelines for mefloquine. "Our current guidelines already cover all the warnings ... of severe neuropsychiatric reactions," he said.

These events were rare and usually occurred in people with a history of depression or psychosis, he said. Malaria is a life-threatening disease, and the risks had to be weighed up.

Kingston acknowledged that the product information did not mention suicide, saying there was no scientific evidence linking mefloquine to suicide.

The director of the adverse drug reactions unit at the Therapeutic Goods Administration, John McEwen, said the product information that comes with mefloquine in Australia had "clear statements about ... psychiatric side effects".

"We will be contacting the FDA regarding this in the next month or so ... we are always prepared to relook at an issue if there is a reason to do so. Though it does look to me like factors in the US other than medical factors are driving this debate," he said, alluding to the US Army investigation.

A senior lecturer in Westmead Hospital department of medical parasitology, Dr John Walker, said there was a continuing question mark over mefloquine. "People need to be fairly cautious, particularly if they abuse the sorts of things [alcohol and other drugs] that cause adverse reactions."

But he said it would be drawing a long bow to implicate the drug in the US army murders at Fort Bragg.

"We are talking about people who are trained killers it is clouding the issue to implicate the drug in these deaths," he said. "Tens of thousands of people have taken mefloquine successfully for decades has anyone else been wandering around taking mefloquine and killing their wives?"

Walker warned of the enormous discrepancy in knowledge among doctors when it comes to tropical medicine. "It is vital that you look for pre-existing conditions or other signs that indicate people will be in danger of experiencing side effects if they take these drugs."

Karl Rieckmann, the director of the Australian Army Malaria Institute, worked on the early mefloquine studies in the '70s at the Walter Reed Army Institute in the US. Professor Rieckmann said that while he preferred to take the other commonly prescribed anti-malaria drug, doxycycline, he felt more confident about mefloquine than he did decades ago.

"As long as people keep up their hydration levels and avoid alcohol, and as long as it is not [not] prescribed to people with liver or thyroid problems or a previous history of neuropsychiatric problems, it appears to be safe," he said.

And while the army had always advised soldiers to avoid drinking alcohol when taking any anti-malaria drugs, he acknowledges that this advice may not always be followed.

Mefloquine, which has a high resistance in Asia and the Pacific where most Australian peacekeepers are based, is prescribed only as a second-line drug.

"We have always, for many years, used doxycycline, because Asia is where mefloquine resistance started," said Rieckmann.

Armies often considered compliance a big issue doxycycline was taken daily, whereas mefloquine was taken weekly, which some people found more convenient, he said, explaining one reason for its popularity in the US.

As for the investigations regarding murders and suicides at Fort Bragg in North Carolina?

"Maybe the soldiers had been out on a drinking bout?" Rieckmann said. "One thing people must remember no anti-malaria drug is
completely effective or completely safe."

Sempers,

Roger

Family: Lariam Caused Son's Suicide
Associated Press
September 29, 2002


WASHINGTON - A Marine from Long Island, N.Y., who served in Somalia in 1993 committed suicide seven years later, and his family now believes the anti-malarial drug he was prescribed by the military contributed to his death.
His parents say James Patrick Farrell had no symptoms of mental or emotional problems during high school or in the years before his service in Somalia. He appears to have been a model Marine.

"Patrick was a very likable guy," his mother, Bette, said recently. She and her husband, James, described their son as a handsome, popular student at Manhasset High School, where he graduated in 1984. A captain of the football team, Farrell once played against Vinny Testaverde's Sewanhaka High School team.

But after Farrell returned from Somalia in October 1993, his behavior was marked by delusions, depression, anxiety and confusion, his family said. They said he did not see combat in Somalia, so they could not establish a connection between his behavior and battlefield trauma.

They now suspect the drug Lariam triggered his instability and self-inflicted death on Jan. 31, 2000. He was 33 years old.

The Farrells said they first suspected a Lariam connection when they read about suicides and domestic killings near Fort Bragg, N.C., this summer. "When I saw it, I knew it," Patrick Farrell's brother, Kevin, said of the United Press International report that appeared in the newspaper Newsday. "I didn't have to read it twice."

Three of the soldiers suspected in the Fort Bragg incidents had taken Lariam while deployed in Afghanistan, UPI reported. Two killed themselves.

There is no way to prove whether Lariam caused Farrell's suicide. Drugmakers and government regulators point out that the actions that occur after a person takes a drug are not necessarily caused by the drug.

But by the time Farrell was given Lariam in 1993, the military and the manufacturer, Swiss drug giant Hoffmann-La Roche, were already reporting severe -- and long-lasting -- psychiatric side effects and suicidal thinking among users.

In July, Roche changed Lariam's official product label to include a warning of rare reports of suicide, but said they could not confirm any connection between the deaths and taking the drug. Roche also said for the first time that mental problems could last "long after" taking Lariam.

Soldiers, government workers and travelers have used Lariam since 1989. Around 5 million Americans have taken it, according to Roche, which is licensed by the Army to manufacture it. From 1990 to 2000, Lariam was the government's drug of choice to prevent malaria. In 2000, the Centers for Disease Control and Prevention added doxycycline and Malarone as recommended drugs.

The military continues to hand out weekly Lariam pills to troops in malaria-plagued regions, often over the alternatives, which must be taken daily.

The Farrells said no doctor ever suggested that Lariam could have caused Patrick's problems. The doctor treating him declined to comment.

A Food and Drug Administration official said in an interview last summer that the risk of side effects must always be weighed against the benefits of preventing malaria.

"Suicide in one in perhaps -- I don't know -- 1 million or however many cases you can actually calculate for Lariam may have to be acceptable on the basis for the risk for malaria," said Dr. Leonard Sacks, a medical officer with the FDA.

The Army declined to comment on the Farrell case. The Marine Corps did not return calls seeking comment.

"There are hundreds of thousands of soldiers who have taken mefloquine [Lariam's generic name]," Army spokesman Lt. Col. Ryan Yantis said in August. "We have no indication at this time that this drug is anything other than safe and effective in its proper use."

Farrell's father had served in the Marines and Patrick Farrell enlisted in 1989 after a couple of tries at college. He appears to have flourished, receiving his associate's degree and becoming a certified diver.

In a recommendation for a "meritorious corporal" award, Farrell's commander described him as "a highly motivated, industrious Marine" and "recruit poster-quality." He commended Farrell's "superior intellect and positive personal traits [that] ensure his success as a leader."

Farrell, an electrical equipment repairman, volunteered to serve in Somalia. The Marines prescribed Lariam during his four-month duty there, according to his medical records.

He returned in October 1993 and received an honorable discharge in November.

Family members said his problems were apparent immediately.

"He was different. He had a look. He was not the same guy," his father said. Kevin Farrell said his brother "just had a dead look in his eye."

He was described as unable to socialize or hold down work, failing even to show up for an interview his father had arranged for him at a construction company.

He would disappear for months at a time and once wound up broke in a men's shelter in Albany.

Once home, Farrell drank heavily and was incoherent.

"He would drive around the same roads he had known all his life and he would get lost," his sister Jennifer said.

Farrell received counseling at the Long Island Jewish Medical Center, where his medical records indicate doctors documented severe depression and psychosis during 1998 and 1999.

A therapy record from March 1, 1999, says he told doctors about a "long, convoluted paranoid delusion" and suffering from depression, psychosis, unstable moods and delusional thinking.

The Farrells described two such delusions: Patrick believed that his mother had been gang-raped and his brother had been castrated. "He was always talking about stuff that never happened," Jennifer said.

"There was no sense to it at all," James said about his son's talk.

For the last three years of his life, Patrick Farrell rarely left the house.

On Jan. 31, 2000, he went into his upstairs bedroom with his father's 30-year-old lever-action Winchester rifle. He had been complaining about pain in his head.

A neighbor heard the shot and, through a window, saw Farrell's body briefly propelled by the force of the bullet, his family said.

Bette found his body.

In May, UPI reported that evidence suggests Lariam has caused such severe mental problems that in a small percentage of cases it has led to suicide. FDA databases contain reports of a dozen suicides associated with Lariam between October 1997 and March 2002. Other suicides suspected of being associated with Lariam have occurred as long as two years after the drug was taken.

No suicides had been reported with doxycycline, a common antibiotic prescribed 25 times more often, at 9 million times each year, according to data from IMS Health, a healthcare information company.

Hoffman-La Roche and the military had considered such issues a decade ago. A study published in the Journal of Tropical Medicine and Parasitology in 1993 said that two of 359 Marines given Lariam became so depressed and suicidal they had to be hospitalized. But the study said that U.S. military doctors concluded their symptoms were not due to the drug and the soldiers "were withdrawn from the study."

The study then concluded that Lariam was "well-tolerated" by the Marines.

A year earlier, a report by three scientists employed by Roche found that "serious and occasionally prolonged psychiatric and neurological effects occur in patients" taking Lariam, but that "such events are rare."

Researcher Stefany Moore in Washington contributed to this story.

Sempers,

Roger

http://www.military.com/NewsContent?file=FL_shot_100502

Panel Finds Cause For Bragg Murders
American Forces Press Service
November 7, 2002


Marital discord, high personnel tempo and fear of counseling contributed to five murders at Fort Bragg, N.C., Army officials said today.

During a six-week period in June and July 2002, there were four homicides of active duty soldiers' wives at the base. The soldiers have been accused of the crimes.
In a fifth case, a woman allegedly killed her soldier husband.

Fort Bragg and Army officials have examined the tragic incidents and recommended a number of steps to address these problems. Serious incident review boards, ordered by local commanders, investigated the incidents, as did an epidemiological consultation team from the Department of the Army.

Overall, officials at the post plan to increase awareness of domestic violence incidents and highlight the options open to families having domestic troubles. Post officials also plan to reach out to soldiers and their families living off post.

Fort Bragg leaders have strengthened cooperation with some local jurisdictions and are working to expand cooperation with others.

The base will also sponsor immediate counseling programs for soldiers returning from forward-deployed locations.

The base implemented a toll-free phone number on Nov. 1 that Fort Bragg families can call for help in dealing with a number of issues, including domestic violence. Post officials launched a direct-mail campaign to ensure that all spouses and soldiers have information about the service.

The Army will study the impact personnel tempo has on military families and look at building pilot programs at the base to institute workplace-oriented behavioral healthcare, violence-prevention programs, and unit-based marriage- education programs.

The Army has many programs dealing with domestic abuse. Unfortunately, researchers found that many soldiers do not take advantage of such programs because they feel going for help will adversely impact their careers. An Army working group is developing an action plan that "encourages soldiers to avail themselves of behavioral health services without adverse inference," according to an executive summary of the recommendations.

The epidemiological group eliminated the anti-malarial drug Mefloquine, also known as Lariam, as a cause for the tragic incidents.

Sempers,

Roger

WASHINGTON, Nov. 8 (UPI) -- An Army report released Thursday saying a controversial malaria drug called Lariam was an "unlikely" factor in a cluster of killings and suicides near Fort Bragg, N.C., this summer has sparked claims the military is covering up problems with a drug it invented and licensed.

"Our military said there is no problem with (Lariam) because they developed it," said Rep. Bart Stupak, D-Mich. "The hardest thing to do is develop a drug and then admit there is a problem."

The Army report on the Fort Bragg killings and suicides cites marital problems, increased stress in a post Sept. 11 environment and "flawed" systems for helping troubled soldiers and their families as common threads in a string of five homicides near Fort Bragg in a 43-day period during June and July 2002. Three soldiers involved had been deployed to Afghanistan. Two of those soldiers also committed suicide.

Soldiers and their families are afraid to report or seek help for problems because it is a "career ender," the report said.

But in one of the killings, friends and neighbors of the soldier charged with the murder said the Army is ignoring evidence the drug might have played a role. The Army said Thursday it did not contact those people out of concern about privacy and an ongoing criminal prosecution.

In Afghanistan, where at least two of the soldiers in the Fort Bragg killings took their Lariam pills, a U.S. security expert said the Army is ignoring frightening side effects he has seen first hand.

"The Army does not want (the truth) released," said Tony Deibler, deputy director of U.S. embassy security in Kabul and a security expert for 26 years with the U.S. diplomatic staff. "If we (the government) admit this, we are opening ourselves up to a multi, multi, multi-billion dollar lawsuit. I love my country, but this is what drives that train."

Deibler said he has seen Lariam wreak havoc on soldiers for years, including one Marine at an embassy who hallucinated intruders attacking and shouted, "Get back, they're coming!"

Deibler said Marines guarding the embassy in Kabul take doxycycline -- an alternative to Lariam -- because of concerns about the side effects.

"Lariam is a bad drug," said Deibler. "You take these guys at Fort Bragg. I will bet you a year's pay that these guys were taking it and when they got back, they wigged out."

The report says Lariam, known generically as mefloquine, "does not explain the clustering" of violence because the Army only has evidence that two of the soldiers took the drug in Afghanistan and no mental problems were on file for those soldiers.

The report does not rule out Lariam as a cause in those two cases, but does say Lariam does not explain the strange cluster of violence over a short period of time.

"We are not in a position, nor did we have adequate information to say definitively that the possible ... side effects of Lariam played absolutely no role" in the deaths, said Col. Dave Orman, a psychiatry consultant to the Army Surgeon General, and a member of the review team. "What we can say is that it does not explain the clustering of these cases in that period of time."

Lariam's label warns of psychosis, hallucinations, delusions, paranoia, aggression, tremors, confusion, abnormal dreams and rare reports of suicide. It also says mental problems can last long after taking it. The Walter Reed Army Institute of Research developed Lariam in the 1970s after troops in Vietnam contracted malaria despite taking chloroquine -- then the standard preventive medication.

Friends of one of the soldiers said the report ignores mounting evidence that the drug might have played a role in some of the violence near Fort Bragg.

"No one talked to me from the Army at all," said Debbie Lown, an acquaintance of Master Sergeant William Wright, the one soldier who took Lariam in Afghanistan who did not commit suicide. Wright allegedly strangled his wife, Jennifer. Lown's husband, John, is also a former Special Forces soldier who said Lariam made him lose control of his anger.

The Lowns and other friends and neighbors have described Wright's delusions, paranoia and tremors since he took Lariam in Afghanistan. Jennifer Wright's father, Archie Watson, has described Wright's sudden, uncharacteristic fits of rage after returning. There was no history of domestic violence in their marriage.

The Army cited privacy concerns and ongoing legal proceedings in a decision not to interview friends, family or neighbors who think Lariam might have played a role.

Thursday's report from the Army is the second time in two months the military has signaled that Lariam does not cause significant problems. In September, the Pentagon responded to concern about the drug from House Military Personnel Subcommittee Chairman Rep. John McHugh, R-N.Y. Side effects from Lariam "have been few in number and generally of low severity," the Pentagon wrote.

But the letter to McHugh also notes that the military and Lariam's manufacturer, Hoffmann-La Roche, have funded key scientific studies on Lariam. "This fact suggests at least the possibility of either commercial or institutional bias in the reporting of results," it says.

An internal safety report from Roche, obtained by United Press International, shows that reports of violent behavior have been coming in to the drugmaker and the Food and Drug Administration for nearly a decade. Roche said in a statement to UPI that there is "no medical or scientific evidence" that the drug can cause violent or criminal behavior and that incidents cited in its safety reports are anecdotes, not evidence.

Roche's 1994 safety report cites a 26-year old American woman who experienced "aggression, compulsion to ('stab') attack boyfriend and to use obscenities;" a man who destroyed a hotel room and window while psychotic and in the grip of a paranoid "fear of Nazis" that led to him being imprisoned and hospitalized; and another case described as, "psychosis -- hospitalization required, endangering himself and others."

The 1994 Roche safety report includes a reference to a patient "in U.S. military/Somalia" who was hospitalized suffering from "psychosis, confusion, depression, fatigue, hostility, agitation" and paranoia.

UPI has interviewed a number of soldiers who say Lariam has given them long-term mental problems since the U.S. military began widely using the drug on over 20,000 troops deployed to Somalia in the early 1990s. U.S. Army officials told UPI they never saw evidence of any problems with the drug there.

"There is so much darkness in your brain and so much violence. And you know what you are capable of," said G. Mayes, a member of the Army reserves who was called up in 1993. Mayes said that while she suffered no mental problems before then, the Lariam the Army gave her brought on hallucinations, confusion, depression, paranoia, suicidal thoughts and even thoughts of homicide that she struggles with to this day.

"You know that no one around you is safe. You do whatever you can to maintain the appearance of normalcy. It is all in your eyes and in your head. You know that if somebody pulls the right stunt, you are just going to snap their little neck and leave them there."

Mayes said she once bought a bottle of sleeping pills with the intention of committing suicide, primarily out of concern that she might kill someone else. "I decided to take two pills and think about it. I woke up the next day and put the pills away."

Other soldiers who took Lariam during Operation Enduring Freedom have described potentially deadly consequences from taking it.

A 27-year old Air Force Staff Sgt. named Kevin based in Little Rock, Ark., says he was suffering from tremors, delusions, hallucinations and black outs by the time he took his fifth Lariam pill in Pakistan during operations. That soldier, who wanted to go by his first name only and is on medical leave, said he struggles with frightening flashes of anger that could trigger the unthinkable.

"These guys who killed their wives and then themselves (near Fort Bragg). If they were having a reaction to Lariam I can totally understand why they did it. The patience level goes way down. You feel confused, and the anger and frustration level goes way up," Kevin said.

"The only reason I have not done anything to myself yet is because I think it is a one-way ticket to hell."

Another soldier was recently hospitalized with serious mental problems after taking Lariam in Afghanistan.

"He went, he did his fighting and now he is sick," said that soldier's mother, requesting anonymity because she said she fears retribution from the Army on her son. She said he is hallucinating and suffering from anxiety and depression and that she fears for his life.

"He exhibits all of these side effects. He was a normal human being," she said. "I want this drug off the market ... They are not going to do this to my child."

Congressman Stupak is the third member of Congress to raise questions about Lariam. In July, Sen. Chris Dodd, D-Conn., called for an independent medical investigation to protect the health of Peace Corps volunteers, who are routinely prescribed the drug. In May, McHugh wrote to Secretary of Defense Donald Rumsfeld, asking whether the drug's side effects were causing troops mental problems. His committee continues to work on the issue.

McHugh said about Thursday's report from the Army, "Regarding Lariam, while the Army found it was unlikely to have spurred the violence at Fort Bragg, our committee will focus on the results of a scientific, peer review now under way at the Centers for Disease Control."

A former FDA official said that if Lariam were at fault in killings, it should not be on the market.

"I do not know of any product that would be allowed to generate a psychosis that could stimulate someone to commit murder and be an approved drug," said Gerald F. Meyer, former deputy director of the FDA's Center for Drug Evaluation and Research who is not familiar with Lariam but is an expert on drug safety. "I do not know of any, and I cannot imagine one."

-0-

Contributing: J.S. Newton in Afghanistan

Anti-Malaria Drug Cited In Murder
United Press International
February 21, 2003


CHARLESTON, Ill. - The lawyer for a former Marine convicted of murder will tell an Illinois jury next week that an anti-malaria drug associated with psychotic behavior and aggression triggered the killing, and he should be spared the death penalty.

The case marks the first time that side effects of the drug, called Lariam, have been raised in front of a U.S. jury in a criminal case. Some believe the drug could have played a role in a string of killings by Fort Bragg soldiers last summer, though the Army calls that unlikely.

Anthony Mertz, 26, was convicted Feb. 12 of killing fellow Eastern Illinois University student Shannon McNamara in her Charleston, Ill., apartment on June 12, 2001. The jury is now hearing testimony before deciding whether to sentence him to death. "When the Marines gave Lariam to my client they set in motion a chain of events that caused the death of Shannon McNamara," defense counsel David Williams told United Press International Friday.

In an unusual twist, the defense team first began looking at the drug after an expert for the prosecution asked Mertz during a jailhouse interview about malaria drugs the Marines had given him.

The case has received national attention because if Mertz is sentenced to die, he would be the first person to face execution in Illinois since former Gov. George Ryan emptied death row in January.

Mertz was convicted of breaking into McNamara's apartment and choking her to death with a washcloth during a struggle. Her body was then slashed with a kitchen knife.

During testimony in the death penalty phase, prosecutors introduced witnesses who said Mertz had told them he had murdered another woman, Amy Warner, in June 1999 by stabbing her.

Although the defense will point out that Mertz had a troubled childhood and a drinking problem, they will also argue that Mertz's serious mental problems that made him violent started after he took Lariam as a Marine in Okinawa, Japan, in 1995 and then again in 1997.

"I don't think there was ever a time anybody told us he was violent before he took Lariam," said Michael Dennis, a member of the defense team who interviewed family, friends and fellow Marines after he learned that the prosecution had asked Mertz about malaria drugs in the military.

The prosecution says it was merely trying to anticipate arguments that might be used to keep Mertz off death row. "It comes down to figuring out what the defense is going to rely on," Coles County State's Attorney Steve Ferguson told UPI.

"The particulars of Lariam we know very little about, and it's not appropriate to comment," he said.

The prospect that the drug could trigger homicidal violence was raised last year after a string of murders at Fort Bragg, N.C. In three of the cases, soldiers who had recently returned from Afghanistan were suspected of killing their wives. Two of the soldiers had taken Lariam while deployed there, according to the Army, but it said in a report it was "unlikely" that the drug triggered the string of killings so close together. Two of those soldiers also committed suicide, police said.

Lariam's manufacturer, Swiss drug giant Hoffmann-La Roche, warned for the first time last summer that mental problems such as depression, aggression, psychotic behavior, insomnia and abnormal dreams have been reported to last "long after" a person stops taking the drug, and it also acknowledged rare reports of suicide.

Roche spokesman Terry Hurley said the company had not heard of the Mertz case, but that "there is no reliable scientific evidence that Lariam is associated with violent acts or criminal conduct."

He noted the drug has been taken by more than 25 million people worldwide over 17 years. "The safety of Lariam has extensively been studied and published in the peer-reviewed medical literature. Lariam remains one of the drugs of choice for the prevention and treatment of malaria by leading public health authorities, including the Centers for Disease Control and the World Health Organization."

According to defense attorney Williams, Mertz sought help at a Department of Veterans Affairs hospital in Danville, Ill., in March 1999, eight months after leaving the Marines. He had recently been arrested for drunk driving and had attempted suicide while in jail.

According to the VA doctor's notes, Mertz suffered from major depression, alcohol abuse and had "been thinking about hurting other people so they in return hurt him." The notes indicate Mertz reported feeling depressed for months, that his "concentration is poor" and that he felt helpless and hopeless. The notes said that "sleep remains a problem" and that Mertz also described getting "violent nightmares where he has woken up and found himself choking his girlfriend."

The June 1999 death of Amy Warner, to which witnesses also tied Mertz, was three months after that VA visit. Shannon McNamara was murdered two years after that.

Mertz's military records do not show that he took Lariam, Williams said, but the defense is convinced he did after looking at his record of deployments and talking with Marines who served with him.

Brad Adams of Mandeville, La., said he and Mertz both took Lariam during two separate deployments to Okinawa in 1995 and 1997 while the two served together for over three years in the 1st Battalion 5th Marines. Adams said that in Japan they took Lariam while serving in "expeditionary units" for six months that can be deployed anywhere in the region on short notice.

"I did take the drug in the Marine Corps with Anthony," Adams said. "We were in formation and they handed it out in formation." Adams said he does not remember Mertz exhibiting odd behavior at the time, except for his involvement in bar fights. "I did not notice any kind of change with him and the drug, but I can not really remember. It was a long time ago," said Adams.

In their effort to prevent Mertz's execution, the defense will also portray him as the victim of childhood sexual abuse and neglect when he grew up in Rossville, a small farming community in east-central Illinois, where his grandmother raised him and where he had 13 years of perfect attendance at the local Methodist church. His attorneys will also note Mertz's history of substance abuse.

The defense said Lariam is a legitimate issue to raise as "mitigation" in the death penalty phase because some acknowledged side effects of the drug match Mertz's documented symptoms, and he appears to have become violent only after he began taking the drug.

As a kid in Rossville, Mertz played high school football and baseball and his coach called him a "team player" who never displayed a temper and was not the sort of kid to look for a fight, according to a defense document.

Among Mertz's symptoms after leaving the Marines, violent nightmares in particular have been reported in other cases where some suspect that Lariam triggered violence.

During the Somalia operation in the early 1990s, a Canadian army corporal, Clayton Matchee, allegedly led a group of soldiers who tortured and killed a teenage boy who had snuck into the compound. The incident occurred on what troops called Psycho Tuesday, the day they took their weekly Lariam dose. Matchee subsequently attempted suicide by hanging and suffered permanent brain damage.

Matchee's wife, Marj, told the Ottawa Citizen at the time that when her husband was home from Somalia on leave before the incident, she woke up in the middle of the night to find his hands around her neck. Marj Matchee said her husband attributed his behavior to Lariam.

A formal inquiry into the incident concluded that no link to Lariam could be established "without extensive further investigation."

British Army Lt. Col. Ashley Croft, who advises England's military on malaria prevention, said he believes a link to Lariam is "plausible" in that 1993 incident.

"I do, because this sort of behavior they were experiencing was psychotic and out of character," he told UPI in an interview before the Fort Bragg killings. "I remember my wife and I were in England (and we read) about this story, the Canadians going mad and torturing people. It just seemed to be bizarre and totally out of character. So yes, it seems to me to be plausible."

In addition to the string of incidents at Fort Bragg last summer, the wife of another soldier who had just returned from Afghanistan in December and had taken Lariam said he tried to strangle her. She told UPI that he had been abusive before but that his behavior had frighteningly intensified when he returned.

The U.S. military has consistently said it sees no evidence that the drug has caused serious problems. "While adverse events have been reported among deployed personnel prescribed the drug, they have been few in number and generally of low severity," Assistant Secretary of Defense William Winkenwerder Jr. wrote Rep. John McHugh, R-N.Y., in September in response to concerns he raised about the drug.

"In the cases where adverse events have been reported," he continued, "symptoms normally resolved when the drug was discontinued and the member switched to an alternative product." Two other drugs are also recommended by the Centers for Disease Control and Prevention to ward off malaria.

UPI has interviewed a number of soldiers who were stationed in Afghanistan, Africa, Southeast Asia and elsewhere who say Lariam has triggered suicide attempts, depression, aggression and homicidal urges in them but that the military has discounted their concerns and sometimes told them to keep taking it. In some cases, they say, the military has moved to discharge them for being mentally ill.



Sempers,

Roger

Suicide In Fort Bragg Jail
FAYETTEVILLE, N.C., March 24, 2003


An Army Special Forces soldier charged with killing his wife after returning from Afghanistan nine months ago hanged himself in a jail cell Sunday, officials said.

Master Sgt. William Wright was one of four soldiers at Fort Bragg suspected of killing their spouses in a six-week stretch last summer. The deadly spree forced the Army to re-evaluate how it provided support for soldiers with strained marriages and those readjusting after combat service.

Three of the four soldiers suspected of killing their wives were in Special Forces units. Each of those three have now committed suicide.

The rash of domestic killings led the Army to send a team of medical experts to Fort Bragg to study a wide range of health-related issues that might explain the killings.

Wright, who was 36 at the time of his arrest July 19, was found dead in his cell about 1 a.m., Lt. Glen Mobley of the Cumberland County Sheriff's Department said.

Wright was alone in the cell and a jailer had checked on him a half-hour before he was found. Jail employees unsuccessfully attempted to revive him with CPR, according to the statement.

Wright served with the 3rd Special Forces Group in Afghanistan and returned a few weeks before reporting his wife, Jennifer, missing July 1. He was charged with first-degree murder in her death and had been held in jail since then without bond allowed.

The couple had three boys, ages 6, 9 and 13.

William Wright was one of three Ft. Bragg soldiers who reportedly took Lariam in Afghanistan and then came home and allegedly killed their wives. Side effects of the drug, also known as mefloquine, have been known to include psychotic episodes.

Johnny Lown, a former Army Medic who served with Wright, says, "Bill was not a guy that you'd suspect."

60 Minutes II Correspondent Vicki Mabrey reported in January that Wright was considering using Larium as part of his defense. Lown, now an ordained minister who visited Wright in jail every week, said Wright was "very confused, he was very paranoid, and I was like 'Wow this is not the Bill that I knew'...About the fifth week after that, he was coherent. He was fine. He even said, 'Well, I'm thinking a lot better now.'"

What does Lown think caused his change? "I think it was the medication. It took about two months for the stuff to clear out of your system."

Lown and his unit had names for the days they took Lariam: "Everybody would call it Manic Mondays or Wild Wednesdays."

But a 19-member team, including mental and physical health workers and military clergy who visited the base in August and September, said the drug Lariam was unlikely to have been at fault.

Instead, investigators said the Fort Bragg killings were probably due to existing marital problems and the stress of separation while soldiers are away on duty. Investigators also said military culture discourages soldiers and their families from seeking help when domestic problems can potentially be resolved.

Only one of the four accused of killing their wives remains facing charges.

Army sergeant Cedric Griffin, who is accused of stabbing his wife Marilyn 50 times and setting her on fire July 9, faces death if convicted.

Sgt. 1st Class Rigoberto Nieves, 32, a Special Forces soldier, fatally shot his wife and himself June 11, two days after he had returned from Afghanistan.

Sgt. 1st Class Brandon Floyd, reportedly a member of the secret Delta Force, shot his wife and then killed himself July 19.