Army gave Congress bad data on suicides

UPI ^ | 9/7/04 | Dan Olmsted; Mark Benjamin

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WASHINGTON, Sept. 7 (UPI) -- The Army has acknowledged giving Congress incorrect information about use of an anti-malaria drug in units in which suicides occurred in Iraq last year.

The Army's top medical official testified in February that no more than four of the deceased soldiers could have taken the drug, called Lariam, which the Food and Drug Administration says can cause mental problems. But the Army now says that number may be as high as 11 -- nearly half the total number of suicides the Army said occurred in Iraq during 2003.

The Army says it stopped using Lariam, also called mefloquine, in Iraq at the end of 2003. Since then, the suicide rate among soldiers there has fallen by more than half, Army officials also confirmed. They cited better Army suicide prevention efforts.

A veterans' advocate said the Pentagon should investigate the decrease in suicides since Lariam use stopped. "If Lariam is one of the things that has changed, they need to take it seriously and look into it," said Steve Smithson, assistant director for the American Legion's National Veterans Affairs Rehabilitation Commission. "Obviously, something has changed."

In a statement to United Press International confirming that the testimony before Congress was wrong, Army medical officials said any suggestion Lariam could have triggered last year's spike in suicides would be "a great disservice to our soldiers and to the general public." A spokeswoman said the Army has told Congress of the error.

The Walter Reed Army Institute of Research developed Lariam in the 1960s and 1970s as malaria became resistant to another drug, making troops vulnerable. It was cleared by the FDA for use in the United States in 1989.

The Army surgeon general dispatched a team to Iraq last year to investigate increased suicides among soldiers there and released a report in March. The Army eventually confirmed 24 suicides in Iraq in 2003, or a rate of 18 suicides per 100,000 soldiers. The Army acknowledged that suicide rate is higher than the Army average in recent years, of about 12 per 100,000.

In testimony before Congress, Army Surgeon General James B. Peake said Lariam did not cause the increase in suicides in Iraq last year, in part because only four of the soldiers who committed suicide came from units that took Lariam.

"The issue of Lariam does come up" in considering the higher rate of Iraq suicides, but "only four soldiers were in units taking Lariam," Peake told the House Armed Services Total Force Subcommittee on Feb. 25. "We do not believe that this represents the big causal factor in our suicide rate." Only one soldier had mefloquine in his system during an autopsy, he added.

In a written statement to United Press International, the Army now says "more current information" shows that the number of soldiers in units taking Lariam was 11 out of 24. Eight of those 11 soldiers were in units where Lariam was the preferred anti-malaria drug, and three in units where either Lariam or a common antibiotic drug was prescribed instead.

The FDA says science does not prove a link between Lariam and suicide, but it warns of rare reports of suicide among users. The FDA also warns that Lariam can cause depression, hallucinations, aggression and psychosis. Lariam is in a class of drugs that can linger in the body and dissolve in the brain; the FDA warns that side effects have been reported to last long after someone stops taking it.

"We do know the documented side effects of this medicine, but the key causes of the suicides were failed intimate relationships, legal and financial problems," Peake said in his testimony. "The same kind of issues that you see back home related to suicides seem to be the predominant triggers in theater as well." (Peake since has retired and the surgeon general's office declined to make anyone available for an interview.)

Army officials said the team sent to Iraq to investigate suicides did not look into whether the drug may have caused deaths. "The mental health advisory team did not look at pharmaceutical use," Army surgeon general's office spokeswoman Lyn Kukral said. "Assessing the impact of any medications, including mefloquine, on suicides rates was beyond the team's capability."

UPI began raising questions with the surgeon general's office in April after finding more apparent suicides in units that took mefloquine than the Army had acknowledged. In one case, the office told UPI that the 3rd Armored Cavalry Regiment based at Fort Carson, Colo., had taken the antibiotic doxycycline, not Lariam, to prevent malaria in Iraq. But soldiers in that unit -- where at least one suicide occurred -- insisted they had taken mefloquine. A number described serious mental problems they said seemed to be caused by the drug.

It is not clear how many soldiers in Iraq last year took mefloquine. Pentagon pharmacists filled about 45,000 prescriptions for mefloquine for the armed services, worldwide, in the year ending last October.

Soldiers claim medical records are notoriously inaccurate for recording the use of Lariam.

Late last year, the Army said there was no need to resume mefloquine or doxycycline in Iraq this spring because the risk for malaria was so low. The military also appears to have quietly switched from Lariam to doxycycline as its preferred anti-malaria medicine in Afghanistan, according to Pentagon documents reviewed by UPI.

So far this year, there have been eight suicides in Iraq -- an annual rate of 8.4 per 100,000 troops, the Army said. That is less than half last year's rate of 18 per 100,000. The Army said no other deaths are under investigation as potential suicides.

"We're not going to offer speculation on why it's down so much," Army spokeswoman Martha Rudd told UPI, but she noted that the Army has implemented most of the recommendations from the mental health team that visited Iraq last year as concern mounted over the suicides. She said the Army's overall suicide rate this year is currently 7.7 per 100,000, the lowest rate since statistics have been kept.

The Army cautioned against making any connection between Lariam and suicide.

"Suicide is a very complex issue," the Army said in its statement to UPI, "especially when the extraordinary physical and mental stresses of combat and deployment profoundly impact soldiers' emotional well-being.

"Attributing the cause of a suicide to a single factor when there is little real evidence of its causation does a great disservice to our soldiers and to the general public. In the case of mefloquine, we are convinced that the overall risk of life-threatening malaria infection ... requires that we use the best medications available - including mefloquine - to protect troops against it."

Steve Robinson, executive director of the National Gulf War Resource Center and a former Army Ranger, said the change in suicide rates may show something about Lariam.

"I find it extremely interesting that suicide rates would fall immediately after DOD stops the use of Lariam in theater. It's counter-intuitive to see the suicide rate drop at all while the rate of combat has increased and soldiers were asked to stay longer in Iraq," Robinson said.

"If the drop in suicide rates are somehow connected to stopping the use of Lariam then it would provide a significant link in understanding the deleterious effects of the drug."

Based on a three-month investigation, UPI reported in May 2002 that mounting evidence suggests Lariam caused such severe mental problems that in a number of cases it has led to suicide. That summer, three Special Forces soldiers who had served in Afghanistan killed their wives and then themselves after returning to Fort Bragg. They had taken mefloquine, UPI's reporting found, but the Army called it an "unlikely" factor in the deaths.