At the opening of the Global War On Tourism, DOD medical personnel were very concerned about malaria. The protozoan-infectious disease is a killer; some estimates attribute two million deaths a year to it. It’s of little concern in the United States, where swamp drainage has eliminated it. (It once was endemic to the entire populated area of the nation, and was a major killer of 17th and 18th-century colonists). But in many nations it has never been beaten. It is spread by mosquitos; mosquito eradication, something developed by the US Army to support the construction of the Panama Canal, is the key public-health tool to fighting it. Quinine based drugs are used for treatment and prevention, and the one the military preferred, in part because it is effective against strains resistant to other drugs, is mefloquin (made by Roche under the name Lariam). It attacks multiple stages of the Plasmodium parasite life cycle.
Mefloquine is a relatively cheap drug, because the $5 tablet needs to be taken only weekly. But it has always had dreadful side effects.
To consider whether deploying troops would be exposed to malaria, Army doctors looked at World Health Organization statistics, via the CDC — at the country level. Much of Afghanistan, for example, is too high and arid to support mosquitoes. And in Iraq, there was then, and is now, no malaria at all. But if there’s one thing the DOD likes more than saving money, it’s stupid uniformity, so everyone took mefloquine.
(Since 2001, the WHO and CDC have revised guidance for Afghanistan and Pakistan, admitting you’re safe above 2,500m altitude. In India, the mosquitos can only climb to 2,000m, apparently). They have also cautioned against long-term Mefloquine use because of these side effects, and outside the military is it rarely if ever prescribed for over six months at a time. (We took it for 18 months).
Recipients have somewhat different reactions. Our own was horrible dreams and hallucinations, which continued for approximately six months after discontinuing the drug.
Now DOD says… oops… turns out this was a bad drug all along! Sorry about that. But we figured this out from 12 years of field reports of side effects that we initially denied and dismissed.
By Cheryl Pellerin | Headquarters Marine Corps | September 26, 2013
The Defense Department’s policy on the antimalarial drug mefloquine, which has been in use for decades, is consistent with a stronger, updated warning about the drug from the Food and Drug Administration, senior DOD officials said.
On July 29, the FDA posted on its website a public advisory about neurologic and psychiatric side effects associated with mefloquine hydrochloride, a drug used to prevent and treat the deadly mosquito-borne disease.
The regulatory agency added a boxed warning — the most serious kind — to modify the drug’s label and revise the patient medication guide and wallet-information card given with each prescription to include the possibility that the neurologic side effects could persist or become permanent if the drug is used.
The FDA uses a boxed warning when an adverse reaction is so serious in proportion to the drug’s potential benefit that prescribers should consider this when evaluating the drug’s risks and benefits. The warning also is used to alert prescribers that they can prevent or reduce a serious adverse reaction in patients by using the drug appropriately.
Neurologic side effects can include dizziness, loss of balance or ringing in the ears. Psychiatric side effects can include anxiety, mistrust, depression, or hallucinations.
At the Defense Department, mefloquine was designated as the antimalarial drug of last resort in April, according to a DOD policy letter issued that month by Dr. Jonathan Woodson, assistant secretary of defense for health affairs.
via DOD Mefloquine Policy mirrors FDA update on malaria drug > Headquarters Marine Corps > News Article Display.
Interesting thing: even at the beginning of the war, when everyone was eating one of the 50-cent-piece sized pilled every Mefloquine Monday, there was one group of service members that was exempt: aviators. See, the services knew all along that the drug was psychoactive and damaging, but the aviators have their own medical specialists.
They took Doxycycline, and none of the aviators got malaria… or hallucinations, or vivid dreams about axe murderers. Because nobody wants a guy driving a $10 million dollar helicopter or an even more expensive jet to be flipping out. A guy driving a $1000 rifle and a rucksack made by Unicor Federal Prison Industries? To hell with him.