[Vision2020] Crazy Pills

[Art Deco]

  [image: The New York Times] <http://www.nytimes.com/>

------------------------------
August 7, 2013
Crazy Pills By DAVID STUART MacLEAN

CHICAGO — ON Oct. 16, 2002, at 4 p.m., I walked out of my apartment in
Secunderabad, India, leaving the door wide open, the lights on and my
laptop humming. I don’t remember doing this. I know I did it because the
building’s night watchman saw me leave. I woke up the next day in a train
station four miles away, with no idea who I was or why I was in India. A
policeman found me, and I ended up strapped down, hallucinating in a mental
hospital for three days.

The cause of this incident was drugs. And these drugs had been recommended
to me by the Centers for Disease Control and Prevention.

I had been prescribed mefloquine hydrochloride, brand name Lariam, to
protect myself from
malaria<http://health.nytimes.com/health/guides/disease/malaria/overview.html?inline=nyt-classifier>while
I was in India on a Fulbright fellowship.

Since Lariam was approved in 1989, it has been clear that a small number of
people who take it develop psychiatric symptoms like
amnesia<http://health.nytimes.com/health/guides/symptoms/memory-loss/overview.html?inline=nyt-classifier>,
hallucinations<http://health.nytimes.com/health/guides/symptoms/hallucinations/overview.html?inline=nyt-classifier>,
aggression and paranoia, or neurological problems like the loss of
balance<http://health.nytimes.com/health/guides/symptoms/dizziness/overview.html?inline=nyt-classifier>,
dizziness or ringing in the
ears<http://health.nytimes.com/health/guides/symptoms/tinnitus/overview.html?inline=nyt-classifier>.
F. Hoffmann LaRoche, the pharmaceutical company that marketed the drug,
said only about 1 in 10,000 people were estimated to experience the worst
side effects. But in 2001, a randomized double-blind study done in the
Netherlands was published, showing that 67 percent of people who took the
drug experienced one or more adverse effects, and 6 percent had side
effects so severe they required medical attention.

Last week, the Food and Drug
Administration<http://topics.nytimes.com/top/reference/timestopics/organizations/f/food_and_drug_administration/index.html?inline=nyt-org>finally
acknowledged the severity of the neurological and psychiatric side
effects and required that mefloquine’s label carry a “black box” warning of
them. But this is too little, too late.

There are countless horror stories about the drug’s effects. One example:
in 1999, an Ohio man, back from a safari in Zimbabwe, went down to the
basement for a gallon of milk and instead put a shotgun to his head and
pulled the trigger. Another: in Somalia in 1993, a Canadian soldier beat a
Somali prisoner to death and then attempted suicide. “Psycho Tuesday” was
the name his regiment had given to the day of the week they took their
Lariam.

Lariam is no longer sold under its brand name in the United States, and our
military finally caved in to pressure and stopped prescribing it to the
majority of its soldiers in 2009. But some are still getting it; lawyers
for Staff Sgt. Robert Bales, who has pleaded guilty to killing 16 Afghan
civilians in 2012, said he had taken the drug. And the generic version is
still the third most prescribed anti-malaria drug here, with about 120,000
prescriptions written in the first half of this year.

Make no mistake: mefloquine does a good job protecting against malaria (and
unlike some other anti-malaria drugs, it can be used during
pregnancy<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/pregnancy/index.html?inline=nyt-classifier>and
has to be taken only weekly). It just works at a significant risk, the
full extent of which we’re still discovering.

The new F.D.A. warning advises people taking mefloquine to call their
doctor’s office if they experience side effects. Fine advice, except that
by the time most people — business travelers, Peace Corps volunteers,
students studying abroad — start to notice the side effects, they are
thousands of miles away, frequently out of cellphone service.

Most worrying of all, the announcement notes that the drug’s neurological
side effects — dizziness, loss of balance or ringing in the ears — may last
for years, or even become permanent. I suspect that it’s only a matter of
time before that black box tells us that the psychiatric effects may become
permanent too.

More than a decade has passed since my last dose of Lariam, and I still
experience depression<http://health.nytimes.com/health/guides/symptoms/depression/overview.html?inline=nyt-classifier>,
panic attacks<http://health.nytimes.com/health/guides/disease/panic-disorder/overview.html?inline=nyt-classifier>,
insomnia<http://health.nytimes.com/health/guides/specialtopic/insomnia-concerns/overview.html?inline=nyt-classifier>and
anxiety that were never a part of my life before.

We have a generation of soldiers and travelers with this drug ticking away
in their systems. In June of last year, Remington Nevin, a former Army
preventive
medicine<http://health.nytimes.com/health/guides/specialtopic/preventive-health-care/overview.html?inline=nyt-classifier>officer
and epidemiologist, testified in front of a Senate subcommittee
that he was afraid that Lariam “may become the ‘Agent Orange’ of our
generation, a toxic legacy that affects our troops and our veterans.”

Science is a journey, but commerce turns it into a destination. Science
works by making mistakes and building off those mistakes to make new
mistakes and new discoveries. Commerce hates mistakes; mistakes involve
liability. A new miracle drug is found and heralded and defended until it
destroys enough lives to make it economically inconvenient to those who
created it.

Lariam is a drug whose side effects impair the user’s ability to report
those side effects (being able to accurately identify feelings of confusion
means that you probably aren’t that confused). The side effects leave no
visible scars, no objective damage. But if Lariam were a car, if
psychological or neurological side effects were as visible as broken bones,
it would have been pulled from the market years ago.

It’s a prescription I wish I had left unfilled.

David Stuart MacLean <http://davidstuartmaclean.com/> is the author of the
forthcoming memoir “The Answer to the Riddle is Me.”


-- 
Art Deco (Wayne A. Fox)
art.deco.studios at gmail.com
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