Lariam Concerns Hit Scientific Journal, International Press as Army Gives New Figures for Use of Anti-Malarial Drug

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Over the past week, concerns about the anti-malarial Lariam--facing scrutiny after the Afghan massacre allegedly committed by a local solider--have gotten even more attention. Stories about the drug have appeared everywhere from military-oriented publications to the Canadian and German press. Meanwhile, an Army doctor who has turned Lariam into a personal research project has come out with a new paper.

Remington Nevin (pictured above), an epidemiologist at a Louisiana Army hospital, begins his article in the journal Travel Medicine and Infectious Disease by reporting on a 24-year-old who took the drug (also known as mefloquine) in Spain on his way to Africa. Within 12 hours of the man taking his first dose, Nevin writes:

"The patient experienced the onset of unease, anxiety, and foreboding, which increased over the next two days. By the third day he was reporting intermittent mumbling, auditory hallucinations and a sense of the presence of a nearby nondescript female. On the fifth day, he told his spouse in the U.S. by telephone that he felt 'dark' and had the 'devil inside' of him.

Things only got worse with subsequent doses, after which the man also began reporting short-term memory loss, according to Nevin.

Those are the same kind of symptoms reported by others, including members of a new group called Veterans Against Lariam, co-founded by a Lakewood man who served in Somalia. The darkest reputed side effects, such as hallucinations and what some have called "psychotic" episodes, have led former top Army psychiatrist Elspeth Ritchie to wonder whether Staff Sgt. Robert Bales might have taken Lariam before his shooting spree in Afghanistan.

The military was cagey about its use of Lariam in the days following the massacre. But in a recent e-mail exchange with Seattle Weekly, Army spokesperson Maria Tolleson concedes that the Army still uses the drug--albeit very rarely. In 2011, she writes, Lariam prescriptions represented only 1.12 percent of all prescriptions given for malaria drugs.

The military used to dispense the drug much more widely. In fact, speaking with SW last week, Alan Magill, a malaria specialist affiliated with the Walter Reed Army Institute of Research, explains that the drug was developed by the military after the Vietnam War. At the time, there was an urgent need for new drugs given the rise of malaria strains resistant to chloroquine, then the go-to anti-malarial.

The picture changed after people began reporting side effects from Lariam, and alternate drugs were developed. Magill, who has edited travel advisory books for the CDC, calls Malarone the "drug of choice" for short-term travelers. Still, he says that drug is expensive and not good for the longer term. And he is wary of condemning Lariam based on anecdotal reports.

He stresses that he has not seen randomized, double-blind studies--the gold standard of science--that show the extreme side effects people are reporting.

Nevin's paper does not meet that standard. Instead, it presents a scientific theory that attempts to explain such side effects, namely that they are caused by "limbic encephalopathy" (an inflammation of the brain) and lasting brain injuries induced by Lariam.

"I'm impressed," says Ritchie, talking over breakfast last Friday on a trip to Joint Base Lewis-McChord for a retirement function. She calls Nevin's reasoning "good and sound." Still, she concedes of his theory, "I think it needs more scientific research to verify it."

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