"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