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<a href="http://www.nytimes.com/"><img src="http://graphics8.nytimes.com/images/misc/nytlogo153x23.gif" alt="The New York Times" align="left" border="0" hspace="0" vspace="0"></a>
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<div class="">August 7, 2013</div>
<h1>Crazy Pills</h1>
<h6 class="">By
<span><span>DAVID STUART MacLEAN</span></span></h6>
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<p>
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. </p>
<p>
The cause of this incident was drugs. And these drugs had been
recommended to me by the Centers for Disease Control and Prevention.
</p>
<p>
I had been prescribed mefloquine hydrochloride, brand name Lariam, to protect myself from <a href="http://health.nytimes.com/health/guides/disease/malaria/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Malaria." class="">malaria</a> while I was in India on a Fulbright fellowship. </p>
<p>
Since Lariam was approved in 1989, it has been clear that a small number
of people who take it develop psychiatric symptoms like <a href="http://health.nytimes.com/health/guides/symptoms/memory-loss/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Memory loss." class="">amnesia</a>, <a href="http://health.nytimes.com/health/guides/symptoms/hallucinations/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Hallucinations." class="">hallucinations</a>, aggression and paranoia, or neurological problems like the <a href="http://health.nytimes.com/health/guides/symptoms/dizziness/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Dizziness." class="">loss of balance</a>, dizziness or <a href="http://health.nytimes.com/health/guides/symptoms/tinnitus/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Tinnitus." class="">ringing in the ears</a>.
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. </p>
<p>
Last week, the <a href="http://topics.nytimes.com/top/reference/timestopics/organizations/f/food_and_drug_administration/index.html?inline=nyt-org" title="More articles about the U.S. Food And Drug Administration." class="">Food and Drug Administration</a>
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. </p>
<p>
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. </p>
<p>
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.
</p>
<p>
Make no mistake: mefloquine does a good job protecting against malaria
(and unlike some other anti-malaria drugs, it can be used during <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/pregnancy/index.html?inline=nyt-classifier" title="Recent and archival health news about pregnancy." class="">pregnancy</a>
and has to be taken only weekly). It just works at a significant risk,
the full extent of which we’re still discovering. </p>
<p>
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.
</p>
<p>
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. </p>
<p>
More than a decade has passed since my last dose of Lariam, and I still experience <a href="http://health.nytimes.com/health/guides/symptoms/depression/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Depression (Mental)." class="">depression</a>, <a href="http://health.nytimes.com/health/guides/disease/panic-disorder/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Panic disorder." class="">panic attacks</a>, <a href="http://health.nytimes.com/health/guides/specialtopic/insomnia-concerns/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Insomnia concerns." class="">insomnia</a> and anxiety that were never a part of my life before. </p>
<p>
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 <a href="http://health.nytimes.com/health/guides/specialtopic/preventive-health-care/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Preventive health care." class="">preventive medicine</a>
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.”
</p>
<p>
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. </p>
<p>
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.
</p>
<p>
It’s a prescription I wish I had left unfilled. </p>
<div class="">
<p> <a href="http://davidstuartmaclean.com/">David Stuart MacLean</a> is the author of the forthcoming memoir “The Answer to the Riddle is Me.” </p> </div>
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<br clear="all"><br>-- <br>Art Deco (Wayne A. Fox)<br><a href="mailto:art.deco.studios@gmail.com" target="_blank">art.deco.studios@gmail.com</a><br><br><img src="http://users.moscow.com/waf/WP%20Fox%2001.jpg"><br>
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