In Harm’s Way

“I believe we should be doing everything we can to protect the health of service members and veterans,” Sen. Dianne Feinstein (D-Calif.) wrote in a January 21 letter to Defense Secretary Donald Rumsfeld. “I know you share my concern for the health and well-being of our nation’s military personnel.”

The cause of Feinstein’s concern wasn’t inadequate body or truck armor, depleted uranium or the anthrax vaccine. Instead, she was calling on Rumsfeld to expedite a study on the rare but occasionally severe side effects of the anti-malaria drug Lariam, which has been given to troops serving in Iraq and Afghanistan. While the Pentagon terminated the use of Lariam in Iraq in March 2004, after pressure from the House Armed Services Committee, it seems to be dragging its heels in researching the drug’s effects.

Lariam (generic mefloquine) is a commonly used anti-malaria drug invented by the Army in the 1970s to replace chloroquine, which was found to be unsuccessful against certain strains of the disease in Southeast Asia. Introduced onto the U.S. market in 1989, it is highly effective in both preventing and treating malaria, as well as many otherwise resistant strains of the life-threatening mosquito-borne parasite.

Protection, however, can come at a nasty price, particularly for soldiers already overwhelmed by stressful situations. Among the myriad side effects for Lariam—according to the Food and Drug Administration (FDA) and anecdotal accounts of patients given the drug—are anxiety, paranoia, depression, vertigo, hallucinations, nightmares, psychotic behavior, brain damage, vestibular (inner ear) damage and suicidal thoughts.

The FDA also notes that “caution should be exercised with regard to activities requiring alertness and fine motor coordination such as driving, piloting aircraft, operating machinery … These effects may occur after therapy is discontinued due to the long half-life of the drug.”

According to the Centers for Disease Control (CDC), there are other malaria treatments available, including chloroquine, doxycycline and Malarone (combination atovaquone and proguanil HCL). The CDC recommends chloroquine for use in Iraq because it is less toxic than Lariam, and there is no known resistance to it in Iraq.

At least 18 soldiers have been diagnosed with brain or vestibular damage from Lariam toxicity since the invasions of Iraq and Afghanistan, according to Feinstein’s office. One of the afflicted soldiers, Georg-Andreas Pogany, an Army special-forces soldier, was also charged with “cowardice”—a crime punishable by death—after he suffered a panic attack when he saw the mangled body of a dead Iraqi, according to reports from United Press International. (The charges against Pogany were later dropped.) There were also a slew of spousal murders at Fort Bragg in the summer of 2002, after which each soldier committed suicide. Each of the soldiers involved had taken Lariam. The Army blamed the crimes on marital problems, and denied any relationship between the suicides and use of the drug.

The FDA requires that a warning be issued to any patient prescribed the drug, but, according to Steve Robinson, executive director of the National Gulf War Resource Center, many soldiers taking it were never informed of the potential side effects.

Feinstein and the House Armed Services Committee have been driving the push for a study of the drug’s side effects in Congress. In June 2004, Feinstein began her calls for a study with letters to both Rumsfeld and outgoing Secretary of Veterans’ Affairs Anthony Principi. The Pentagon responded to Feinstein’s request with a promise to conduct the study, but said that it would take years to complete.

But according to Robinson, the Pentagon’s study is different from the one requested by Feinstein. Instead of surveying current troops, they have chosen to perform a retroactive study on Lariam’s effects on soldiers during the ’80s and ’90s. Robinson believes the reason for the change is that the Pentagon hasn’t kept proper records on soldiers’ prescriptions, making it impossible to track any correlation between side effects and use of the drug.

Ever since the outbreak of Gulf War Syndrome—and the difficulties that those conducting a survey of affected soldiers encountered in tracking down medical records—the Pentagon has been required by law to keep track of any medication given to service members.

“If you don’t have anything accurate to base the study on, then how can you make conclusions?” says Jeanne Lese, co-director of Lariam Action USA, a Lariam awareness advocacy group.

Malaria is a serious concern, and Iraq and Afghanistan both have particularly high rates of incidence, but, as Robinson says: “We just want the [Department of Defense] to do their job in protecting our troops. If you don’t look, you won’t find.”