#FedBullies #EXPOSED! A Gruesome War Crime Renews Concerns About a Malaria Drug’s Psychiatric Side Effects BY GREG MILLER08.15.139:30 AM Robert Bales in 2011. Photo: United States Army Early in the morning of March 11, 2012, Army staff sergeant Robert Bales left his remote outpost in an impoverished region of Kandahar Province, Afghanistan and killed 16 people in two nearby villages. His victims, mostly women and children, were sleeping at the time. Bales shot or stabbed them to death before dragging some of their bodies into a pile and lighting them on fire. His crime is as baffling as it is gruesome. In June, he pleaded guilty to the murders in a military court, telling the presiding judge: “There’s not a good reason in this world for why I did the horrible things I did.” ‘I like to say this drug is like a horror show in a pill.’ In the weeks since his guilty plea, there’s been growing speculation that a drug meant to prevent malaria may have played a role in the murders. In certain circles, including the military, the Peace Corps, and other organizations that send people into malarial zones for long periods of time, the drug – known as mefloquine — has long had a bad reputation for setting nerves on edge and causing nightmares. In some cases, mefloquine can mess with the mind in more serious ways, causing confusion, hallucinations, and paranoia. On July 29, the FDA added a black box — its strongest warning — to the label of the drug, citing neurological and psychiatric side effects that can last months or years after someone stops taking it. “I like to say this drug is like a horror show in a pill,” said Remington Nevin, a former Army physician who’s now an epidemiologist at Johns Hopkins University. In a recent paper, Nevin argues that the drug’s effects on the brain and behavior make it likely to become increasingly important in forensic psychiatry. Although mefloquine has been eyed as a possible contributing factor in previous killings, so far apparently no one has argued successfully in court that the drug made someone less culpable for a crime. Bales’s defense team did not raise the issue during his trial, but they still could do so at his sentencing hearing on August 19. “If it’s seen as mitigating in the Bales case, I could certainly see this coming up in a lot of cases where people might say ‘mefloquine made me do it,’” said Elspeth Cameron Ritchie, a former Army psychiatrist and a coauthor with Nevin on the recent paper. A Troubled Past Mefloquine is a puzzling drug with an unusual history. It was discovered by the U.S. Army during the Vietnam war. The military realized that in many parts of the world, the malaria parasite was evolving resistance to a drug called chloroquine, which was the standard antimalaria drug of the time. American soldiers in Hue, Vietnam in 1967. Photo: National Archives and Records Administration Mefloquine was identified from a pool of more than 250,000 compounds screened for their ability to stop these chloroquine-resistant malaria strains, according to a 2007 paper by British physician Ashley Croft. The drug had the added advantage of requiring just one dose a week instead of one a day. The Army handed off the compound to F. Hofmann-La Roche, which gained FDA approval for the drug in 1989 and marketed it under the trade name Lariam. “The underpinning safety and pharmacokinetic studies which should have been performed prior to the licensing of Lariam … were never carried out,” Croft wrote. When the first careful clinical trials to assess how well the drug is tolerated by healthy people were finally reported 12 years later, they turned up evidence of common neuropsychiatric side effects, including strange or vivid dreams, insomnia, dizziness, and anxiety. Croft speculates that the FDA would not have approved the drug if the results of those trials had been available before 1989. In the intervening years, anecdotal evidence that the drug can have devastating consequences has piled up. A smattering of case reports have linked the drug to suicide. In one particularly horrible example, a 27-year-old man with no prior history of mental illness committed suicide by stabbing himself in the head and torso with a knife. A recent investigative report by the Irish broadcaster RTÉ implicated mefloquine in a cluster of suicides among Irish Defense Forces deployed on peacekeeping missions. Perhaps most famously, the drug was investigated as a contributing factor in the murder-suicides at Fort Bragg in 2002, when four soldiers, three of whom had recently returned from Afghanistan, killed their wives, and two of them killed themselves. (A military panel concluded that mefloquine was an unlikely factor in the killings, instead placing the blame on marital problems and the stress of deployment.) Nevin and Ritchie both say they saw the drug’s effects during their time in the military. Ritchie served in Somalia. “I think it was my first day there, a young man was evacuated out of there screaming and yelling, and it was found that he’d taken five mefloquine tablets,” she said. “He was supposed to be taking them once a week and he took them once a day.” In Afghanistan, Nevin says the drug took a toll on his unit in more subtle ways. “Even though everyone may not become clinically ill, the bell curve for anxiety, irritability, and restless sleep is going to shift, and that can have dramatic effects on a unit,” Nevin said. “We were being affected by the drug.” Perhaps more disturbingly, mefloquine was sometimes given out indiscriminately.
Posted on: Thu, 15 Aug 2013 17:16:25 +0000
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