Did an anti-malaria drug cause the Afghan massacre?

The U.S. soldier who went mad and killed 16 civilians has been identified: He is Robert Bales of Ohio. Those who grew up with him remember him as a sweet kid, kind-hearted and well-liked. Not a drinker. Not given to rage or extremist views.

Journalist Robert Fisk, whom I admire, argues that Bales was not the proverbial "lone nut," but an average soldier who got caught up in the bloody narrative of war: Death and vengeance, atrocity and counter-atrocity. The war itself has transformed good men into beasts, says Fisk, and their leaders can barely contain them.

Well...maybe. But this piece offers a theory worthy of further investigation.

Few remember the grisly summer of 2002 when four Fort Bragg soldiers’ wives were murdered within six weeks of each other and the malaria drug, Lariam, widely prescribed to troops deploying to Afghanistan and Iraq, was suspected as a factor.

Few also probably remember the case of Andrew Pogany, a staff sergeant who volunteered to serve in Iraq in 2003, but was sent back to Fort Carson after experiencing PTSD-like panic symptoms and hallucinations related to violence in theater. He and his attorney were later able to prove his reaction was a probable effect of Lariam. Pogany went on to help other soldiers who have experienced extreme PTSD and/or drug responses.

Troops who have used Lariam blame the drug for nightmares, depression, paranoia, auditory hallucinations and other psychiatric symptoms including complete mental breakdowns, says the Associated Press. Family members have blamed for their loved ones’ suicides. The effects of Lariam can last for “weeks, months, and even years,” after it’s stopped, warns the VA. The drug “should not be given to anyone with symptoms of a brain injury, depression or anxiety disorder,” reported Army Times, which describes “many troops who have deployed to Iraq or Afghanistan.”

This 2009 piece by CBS News offers more details. Here's a description of how Lariam affected a tourist in Africa...

"She just became completely psychotic in the van," says Bob. "(She) started taking her clothes off and she had called people back from the dead. And they had a doctor at this lodge that came into the van. And she looked at Jane and she said, 'Did she take Lariam?' She said she had seen this in many Americans."

But could Lariam lead to something worse? That was the question raised last summer when Master Sgt. William Wright and three other Ft. Bragg soldiers were accused of killing their wives, all within a period of just under six weeks. Wright and another soldier were given Lariam, and Wright is considering using that as part of his defense. One of his fellow Green Berets thinks Lariam did play a role. John Lown, now an ordained minister, visits Wright in jail every week.

At first, Lown says, Wright was "very confused, he was very paranoid, and I was like 'Wow this is not the Bill that I knew.'… About the fifth week after that, he was, he was coherent. He was fine. He even said, 'Well, I'm thinking a lot better now.'"

What does Lown think caused his change? "I think it was the medication. It took about two months for the stuff to clear out of your system."

Lown and his unit had names for the days they took Lariam: "Everybody would call it manic Mondays or wild Wednesdays."

Roche, the drug company, claims that Lariam causes serious psychiatric side effects in only one in 10,000 people. But Dr. Paul Clarke, an infectious disease specialist and the medical director of a large network of travel clinics in Great Britain, organized his own study, after he and other British doctors saw problems with much greater frequency.

Even if we go with the one in 10,000 figure, we should keep in mind that there are nearly 110,000 American troops in Afghanistan. By Roche's own estimate, 11 of those soldiers are going to have serious problems.

But we have good reason to suspect that Roche may be understating the issue.

Overbosch and colleagues (2001) reported adverse events attributed to mefloquine in 42% of 486 people studied. Neuropsychiatric adverse events were found in 29% of the subjects, with 19% being considered "moderate or severe".

Many people have reported serious side-effects (e.g. panic attacks, "epileptic type" convulsions, headaches, visual and auditory hallucinations, etc.) that persist months after last dose, and are so debilitating that they can no longer continue their work or normal social interactions...

As of March 2001, lariam-related lawsuits have been filed in Ireland, Canada, Denmark, and the United States. (In 1996, class action lawsuit against the manufacturer was filed in the U.K. representing several hundred clients, but was withdrawn in 1999.) Legal action against Lariam's manufacturer has been filed in the U.S. by several firms.

Roche stands to lose a lot of money. Previous class action suits against the company have not met with success. If, however, Bales' condition can be linked to Lariam, those suits may well succeed -- and Roche might not be able to weather the storm.

Can we expect this administration, or any other, to conduct an impartial investigation of the "Lariam" theory? This past year, Roche has donated roughly $330,000 to political candidates; the money has been evenly split between Republicans and Democrats.