Malaria drug links elite soldier suicides

By MARK BENJAMIN and DAN OLMSTED WASHINGTON, Sept. 7 (UPI) -- A startling pattern of violence and suicide by America's most elite soldiers has followed their use of a controversial anti-malaria drug, an investigation by United Press International and CNN has found.

The government already warns that the drug, called Lariam, might cause long-term mental problems -- including aggression and suicide.

Six Special Forces soldiers who took their lives are all believed to have taken the drug, according to the UPI-CNN investigation. The cable news network broadcast a segment on the joint investigation Tuesday.

Sen. Dianne Feinstein voiced concern about Lariam and the Special Forces suicides. The California Democrat had previously written key government officials seeking an urgent review of Lariam use.

"I have long been concerned about the use of the drug Lariam for service members and other U.S. government employees deployed abroad," Feinstein told UPI. "Now, there is an indication that Lariam may have contributed to the suicides of some of our nation's elite troops.

"The Department of Defense, and all other government agencies that give this drug to their employees, should immediately reassess their decision to use Lariam and look for alternatives that can protect our troops without causing dangerous side effects."

The Pentagon announced in February that it is investigating whether there is a link between the drug and any soldier suicides. But it defends Lariam, known generically as mefloquine, as both highly effective and safe for soldiers to take. Army medical officials declined requests for an interview but said in a written statement, "We have no data that indicate that Lariam was a factor in any Army suicides in Operation Iraqi Freedom and Operation Enduring Freedom (Afghanistan)."

Instead, the Army said, the deaths were linked to "failed personal relationships, financial crises, legal difficulties and mental problems like depression and psychosis" -- the same factors that trigger suicide in the general public, magnified by ready access to guns.

The psychotic behavior and suicides are particularly jarring because Special Forces soldiers are highly trained and psychologically vetted. An Army study in 2000 showed Special Forces soldiers produce more of a chemical in the brain that helps them cope with and recover from extreme duress.

"It's just antithetical to their whole practice of their craft to suddenly lose control, become depressed, paranoid, hallucinate and become suicidal," said Dr. Paul Ragan, associate professor of psychiatry at Vanderbilt University and a former military psychiatrist. "You have to look for some exogenous factor, some outside factor, something new in the mix that will change how they've otherwise been able to operate."

Those deaths then raise concerns about the tens of thousands of soldiers who have taken Lariam during the war on terrorism -- and about dozens of suicides and a handful of murders among troops while overseas or after returning home.

The pattern also suggests that the Army might have missed the cause of three murder-suicides involving Special Forces soldiers at Fort Bragg, N.C., in the summer of 2002. A report by the Army surgeon general's office blamed marital problems for all the deaths and called Lariam an unlikely factor. But the report did not consider physical or mental problems among the three Special Forces soldiers, described by family and friends, that fit side effects from Lariam.

The UPI/CNN investigation found three more suicides by Special Forces soldiers -- all of them Green Berets believed to have taken Lariam. None appears to have had acute marital problems, combat stress or other personal issues that would help explain their sudden plunge into violence.

- A 43-year-old Special Forces weapons sergeant killed himself in 1997 in Ecuador, where he was helping train Ecuadorian Special Forces. Engaged to be married, he smilingly picked up a gun and shot himself in the head in front of two fellow soldiers.

- A Special Forces sergeant killed himself in July 2003 in the Washington suburb of Alexandria, Va. Happily married and expecting his first child, Tyler Whiffen, 32, went to the woods behind his condominium and shot himself in the head. "He wasn't depressed at all," said Karla Whiffen, his widow and mother of his 6-month-old son. "In fact, I have never known anyone to enjoy life so much. For him to take his life was so out of the blue. Nothing has surfaced that would make this anything but this drug." Whiffen took Lariam in Afghanistan.

- The most recent case involved Special Forces Chief Warrant Officer William Howell, 36, who served in Iraq and killed himself after returning to Fort Carson, Colo. His wife, Laura, also reported no marital problems. He killed himself in March after stalking her around their yard with a gun and pointing it in her face. He shot himself when police arrived.

"I knew my husband, I knew who he was. I know what he was," said Laura Howell. "The only difference was one pill. A little white pill that he took. There was nothing else in his life that was different, in his job, nothing. And there was no accumulative effect of anything in his life that would lead to suicide."

The suicides since Sept. 11, 2001, identified by the UPI-CNN investigation are the only Special Forces suicides during that period, according to the Army. It could provide no data on Special Forces suicides before then or on the number of Special Forces soldiers who have taken the drug.

Lariam has physical and mental side effects. A cluster of physical symptoms also appeared in the pattern of Special Forces soldiers who committed suicide, matching those noted by the Food and Drug Administration, including diarrhea, rash, headaches, trembling and night sweats.

For example, after taking Lariam in Iraq, Bill Howell specifically complained of ringing in the ears, panic attacks, headaches, diarrhea, vomiting, skin rash and tingling and numbness in his hands and feet. All are listed under adverse reactions on Lariam's official product label.

The Department of Veterans Affairs recently alerted every doctor in the VA healthcare system to be on the lookout for soldiers suffering mental or physical problems from taking Lariam, even if the service members had not taken the drug for a long time.

This summer, a Navy doctor at a Pentagon treatment facility in San Diego has begun to diagnose service members with permanent brain-stem damage and fingered Lariam as the apparent culprit. One Special Forces soldier diagnosed with that permanent damage said Lariam has given him homicidal and suicidal urges.

"I can tell you from my own personal experience that it goes from zero to 100 very quickly," said this active-duty soldier, who asked not to be identified for fear of retribution. "You're ready to take that plunge into hurting someone or hurting and killing yourself, and it comes on unbelievably quickly. It's just a sudden thought it's the right thing to do. You'll get a mental picture, and it's in full color."

He said that after taking the drug he attacked his wife and considered suicide for the first time.

The 1997 apparent suicide of a Special Forces soldier uncovered in the UPI-CNN investigation involved a Green Beret weapons sergeant who was in a room with two other soldiers at a base near Quito, Ecuador.

"He had picked up the team sergeant's weapon. He looked at the team sergeant and asked if it was loaded. Then he looked at my other friend, smiled, and pulled the trigger," said Justin Schuman, a former Army staff sergeant who retired in June. Schuman was not in the room during the shooting but was present when the medical helicopter arrived. He said the two soldiers who were in the room at the time immediately described what happened.

"We were at a loss. We really had no idea what possessed him to do that," Schuman said. "We knew there were some stressors in his life. He was about to get remarried, but there was nothing in particular. Nobody mentioned Lariam."

Schuman said he and the two soldiers who were present decided to portray the incident as an accident.

"We told Army investigators that it was an accidental discharge because (we feared) they would have denied his family all his benefits. Because he never said anything about suicide, we just played it off as if he was playing suicide."

But it could not have been an accident, he said. "There really is no more trained person in the world than a trained (Special Forces) weapons sergeant. I can't tell you that it was the Lariam, but he was on Lariam at the time and he committed suicide right in front of us in a very bizarre way."

Last year, the FDA ordered that all patients given Lariam be told in writing about rare reports of suicide, along with psychiatric side effects that have been reported to last "long after" someone stops taking it. The FDA says it does not know if Lariam caused any of the reported suicides.

While malaria can be deadly, there are other drugs that prevent it. A recent study showed that 29 percent of people taking Lariam had some kind of mental problem -- twice the rate of a similar malaria drug.

The violent behavior that accompanied all but one of the Special Forces suicides raises troubling issues because experts say that a drug that could trigger homicide should not be prescribed to anyone. Karla Whiffen said her husband shoved her on two separate occasions -- once knocking her to the ground -- after returning from Afghanistan, something he had never done before.

Laura Howell said her husband punched her "four or five times in the head" before he went to get the gun he ultimately used to kill himself. He had struck her once before, when he was taking steroids to bulk up. "He was very sensitive to chemicals. Anything that had a side effect to it, he would get it," she said.

At Fort Bragg, none of the three Special Forces soldiers involved in the murder-suicides in 2002 had any known history of domestic violence, according to family, friends and police. Experts said it is rare for a domestic homicide not to be preceded by an escalating pattern of violent abuse.

Lariam's manufacturer, Swiss pharmaceutical giant Hoffmann-La Roche, said in a statement by spokesman Terence Hurley that there is "no credible scientific evidence" linking Lariam to suicide, suicidal thinking or violent criminal conduct. The rate of serious mental and neurological side effects is "very low," he said, adding that "data from well-designed studies show Lariam to be safe and well-tolerated."

Hurley added: "The label has advised for many years that Lariam should be used with caution in patients with psychiatric disturbances and has disclosed, clearly, that depression and other neuropsychiatric events have been reported among patients who have used Lariam."

He also noted the Army developed the drug and said, "The Army has its own extensive knowledge base and experience with Lariam. As with all decisions regarding prescription medications, the decision about whether Lariam is appropriate for any individual patient -- whether soldier or civilian -- is a matter for the independent medical judgment of the prescribing physician."

Based on a three-month investigation, UPI reported in May 2002 that mounting evidence suggests Lariam has caused such severe mental problems that in a number of cases it has led to suicide

The soldier in Lebanon was a long time ago -- 1983. He was not from Ft Bragg but from 10th SFG(A) which was in those days at Ft. Devens.

The guy with the marital problems was not either of the ones you mention (or should I say all three? As there are two Bills) but actually came home early to try to straighten out the marital difficulties. He took the wrong approach. Although I believe that one of the names you listed also maps to long-time marital stress.

Now, there is another case that gets tossed in with these and definitely shouldn't be. There was a 10th Group soldier that capped himself after returning from Iraq -- shortly after being arrested for trying to set up a tryst with a 13 year old. In that case, suicide was probably the best thing for that sick soul. That man was not either of the ones you have named (and I don't believe he was an SF soldier, rather a support guy... who are no better than the average run of support guys and occasionally you get a bummer. In 10th in 1979 we had two guys murder one of 'em's wife and we had "Green Beret Killer" headlines for three years... they were a cook and a truck driver, IIRC).

If you really want to know who had an Air Jordans problem, freepmail me. This stuff is tragic enough without washing it out in public.

And finally: to anyone who reads this --- if it's that bad, divorce her (or him!). You'll be able to laugh about it soon enough. Suicide is pleasing only to Allah, I mean Satan (I'm always getting those two confused. Must be the mefloquine!)

d.o.l.

Criminal Number 18F

"I have to say, I have my doubts about this. Thousands of us took Mefloquine (Lariam), once a week, for months on end, and while there were some side effects -- most of the guys had extremely vivid nightmares -- "

Vivid nightmares are an indication that a drug IS having an effect on the brain, mild though it may be. From what I understand, those guys who had the severe reactions to Larium subsequently had tests that showed brain stem damage. Specifically, they had SPECT scans and, I believe, evoked nystagmus tests. You only flunk both those tests if you have something bad going on in your brain. You certainly don't exhibit nystagmus, especially persistent upbeating nystagmus, or have an abnormal SPECT from garden variety psychological issues. It's organic in nature. And the psych problems are secondary to the organic problem, not the other way around. Also, there's no way to predict who'll get those particular side effects from Larium. In other words, the guys who are a little 'off' aren't necessarily the ones who'll have problems. It seems to be completely random. I'm sure Larium helps zillions more than it hurts, but woe to the one in a thousand. I, for one, am glad that the potential side effects are getting publicized, however rare they may be. Forewarned is forearmed.

Thanks for this information, MM.

I presume that the SPECT scan and nystagmus test were prescribed by a physician concerned about some other behavioural issue or complaint? (I'd ask my doc lady but she is not up on the net at present).

Here are a few facts, points, and thoughts not previously mentioned:

At the time of this initial cluster of suicides/homicides at Bragg, there were also two, one a wife killing by a soldier who had not deployed and had not taken malaria prophylaxis of any kind, and one bizarre case where a mother/daughter tag team killed their husband/father on his return from overseas. These could not have been caused by mefloquine, but sometimes they get lumped in to news stories.
There is enough evidence for an advocate (think John Edwards!) to build a case that could convince a lay jury, but there is not enough to get an attribution of cause through a scientific peer review.
The military has a tendency to give everyone Lariam whether they need it or not. This simplifies administration of the drug, but we had guys taking it at 13,000 feet MSL in Afghanistan in February. Let's just say the mosquito threat is not so great at that place and time. :) So one good thing I am taking away from this discussion and the reading it has made me do is a set of instructions for my unit's docs which I will discuss with our surgeon and get implemented, so only people who will be in malarial areas take malaria prophylaxis.
There is apparently a problem with discontinuing one drug and taking another. That means that we can't just take a guy who has
As you point out, existence of some side effects doesn't seem to be a marker for the serious side effects. "You don't know who's going nuts till he's all gone," basically.
The scientific research into the etiology and prevalance of mefloquine psychosis is inconclusive but definitely shows that more research along these lines is indicated.
We have a long way to go before anyone can say with any kind of scientific certainty that the homicides and suicides we have seen were caused or partly caused by mefloquine. We also can't say they are not. What we can say is, "it is possible," which immediately should raise the question of, "how do we determine that for sure?" Which is a question of theory and experimental design at this point, and one hopes qualified individuals will apply themselves here.
Brain stem damage may exist in some cases of presumed mefloquine psychosis but it is a post hoc ergo propter hoc logical fallacy to assume causation here. There may be other factors at play, and we can't shout 'Eureka!' yet.
We also run into the spinal surgeon's fallacy here: for decades doctors operated on certain discs that were irregular-looking on x-rays, trying to relieve back pain, with results that were just about random. Until someone got the bright idea to make a set of control x-rays of people who were not having back pain, where they found that quite a few of them had the same deformed looking discs as the ones experiencing pain. The point? Clinical observations are useful, but each one is only one data point and there are unintended consequences in reading too much into them.

The bottom line of this is that the whole thing will take quite a bit longer to understand, and longer still to know what action to take. In the meantime, the message from the statistics is to take your Lariam.

d.o.l.

Criminal Number 18F

"I presume that the SPECT scan and nystagmus test were prescribed by a physician concerned about some other behavioural issue or complaint?"

Actually, they'd probably never order those tests for a behavioral issue in the absence of concomitant physical problems. PET or CAT scans are usually ordered before a diagnosis of schizophrenia to rule out tumors, but not those. The nystagmus tests would be done to nail down the cause of balance issues and maybe problems with holding eye position, and are often done in conjunction with positional vertigo tests. The SPECT scan is a fancy CAT scan that's quite expensive and not available everywhere and is used to study blood flow in the brain. So it studies function as opposed to just things like white matter disease. They often do them on folks with MS, CFS, neurological lyme, brain trauma, long-term meth abuse, etc. I assume they were ordered on the Larium guys due to cognitive disfunction of some kind - short-term memory issues, dizziness, disorientation, etc.

I'm not a doctor, btw, so keep that in mind.

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