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On August 18, Senator Dianne Feinstein put out a press release indicating that the Department of Defense should consider taking the anti-malarial drug mefloquine, also known as Lariam, out of the DoD drug formulary as it is too dangerous.
Feinstein also indicated the drug has been administered to military personnel without the safeguards put in place by a 2009 Department of Defense protocol. Moreover, according to the press release, “These service members are now suffering from… preventable neurological side effects….” And what “preventable neurological side effects” were these?
According to Feinstein:
Mefloquine is known to cause serious side effects including gastrointestinal upset, dizziness, sleeplessness, vivid dreams, anxiety, paranoia, and hallucinations. In most patients, the side effects subside after discontinuing the medication. However, in some instances mefloquine has been shown to have potentially serious neurological side effects including irreversible brain stem and vestibular damage resulting in balance problems, vertigo, and psychotic behaviors.
Senator Feinstein did not mention a fact she certainly knows — that all in-coming prisoners at Guantanamo were administered large doses of this drug, beginning in January 2002.
In a series of articles by Jason Leopold and myself at Truthout last year (see here, here, and here), we documented the existence of a medical SOP that called for treatment doses of mefloquine to be administered to all detainees, whether they had malaria or not.
The controversy was subsequently taken up in a January 2011 article at the U.S. military-linked newspaper, Stars and Stripes.
This presumptive treatment of mefloquine on prisoners was unprecedented, and arguably caused a great deal of disorientation and nausea among shocked detainees first arriving at the Cuban prison. At worst, in some cases, it may have caused psychosis, or even neurological damage. Foreign workers hired by Kellogg, Brown and Root (a subsidiary of Halliburton) to build the prison’s new Camp Delta, who like some of the detainees, came from parts of the world where malaria was endemic, were not subject to the mefloquine SOP. Neither were U.S. military personnel.
Captain Albert Shimkus, the former Chief Surgeon for Joint Task Force 160 at Guantanamo, and commander of the Guantanamo hospital from 2002-2003, said that the Navy Environmental Health Center (NEHC) bore prime responsibility for the suggestion of the Guantanamo mefloquine SOP. He also said that he was told they were not to discuss the policy.
In addition, the Armed Forces Medical Intelligence Center at Fort Detrick, Maryland, part of the Defense Intelligence Agency; the Centers for Disease Control (CDC), and according to a different source, State Department officials, were all involved in the mefloquine decision. CDC wouldn’t comment. NEHC said they had to coordinate their response with other offices. But six months or so later, I still haven’t heard back.
Last February, LTC Thomas F. Veale at the DIA Public Affairs Office basically denied responsibility in the Gitmo mefloquine protocol, responding to my query, “The National Center for Medical Intelligence (formerly known as the Armed Forces Medical Intelligence Center) provides infectious disease risk assessments in support of US military and civilian force protection measures. NCMI’s function does not include prescribing treatment or making treatment policies.”
As the Truthout articles show, the Department of Defense, responding to reports of serious side effects associated with mefloquine, had determined as early as 2002 there were serious problems and called for more research. From the Dec. 1, 2010 Truthout article:
An April 16, 2002, meeting of the Interagency Working Group for Antimalarial Chemotherapy, which DoD, along with other federal government agencies, is a part of, was specifically dedicated to investigating mefloquine’s use and the drug’s side effects. The group concluded that study designs on mefloquine up to that point were flawed or biased and criticized DoD medical policy for disregarding scientific fact and basing itself more on “sensational or best marketed information.”
The Working Group called for additional research, and warned, “other treatment regimes should be carefully considered before mefloquine is used at the doses required for treatment.”
Meanwhile, in January 2005, Feinstein wrote to then-Secretary of Defense Donald Rumsfeld. It appears the DoD Lariam study had indeed been underway. It’s my contention that it is highly likely the dosing of the Guantanamo detainees was an illegal experiment on mefloquine for DoD, as well as possibly used to disorient incoming prisoners and ready them for interrogations — a fact I can’t prove, but should be investigated.
From Sen. Feinstein’s Jan. 2005 letter:
Dear Secretary Rumsfeld:
It has come to my attention that eighteen service members have been diagnosed with permanent brainstem and vestibular damage after having been on a regimen of the anti-malarial drug mefloquine (Lariam). This is of great concern to me and I am writing to reiterate my interest in the Department of Defense (DOD)’s investigation of the impact of mefloquine use by service members. I would like to ask you when you expect the investigation to be released.
In a 2009 policy change (PDF), DoD indicated that mefloquine should only be used on personnel who could not tolerate other anti-malarial drugs, and said it was “critically important that all DoD health care providers be familiar with the proper use, contraindications, warnings and precautions for prescribing mefloquine, especially with respect [sic] neurobehavioral effects” (emphasis in original).
According to Feinstein’s 2011 press release, “mefloquine was only to be prescribed in limited cases where the three preferred drugs were specifically contraindicated or unlikely to be effective. Additionally, the Federal Drug Administration requires that a pocket card describing the side effects and when to seek medical treatment be dispensed with each prescription. My office has been contacted recently by servicemembers who were prescribed mefloquine when one of the other medications would have been appropriate and were not given the FDA information card. These servicemembers are now suffering from the preventable neurological side effects described above.”
Because “contraindicated in patients with traumatic brain injuries, post traumatic stress disorder and other psychiatric illnesses,” Feinstein continued, telling Secretary Panetta, she now “question[ed] the need to maintain mefloquine on any Department of Defense or service specific formulary.”
The Department of Defense has not been open about its policy and usage of mefloquine, a drug it developed for antimalarial use during the Vietnam War, neither on how it is used on U.S. military personnel, nor on how it was used on detainees at Guantanamo. Congress should immediately implement open, public hearings on DoD and mefloquine, and release all documents related to mefloquine research and use by the Department of Defense, or intelligence agencies.
55 Comments
For more info and documentation, links and repostings, etc. on mefloquine/Lariam, see http://www.lariaminfo.org/
On what possible grounds, Jeff, do you imagine Congress may find “reason” to not open, immediately such hearings as you, very reasonably, suggest?
I ask as it is very likely, one may easily imagine, that such hearings will not be held, or, if they are, will amount to nothing but jingoistic white-wash.
This is a Congress which seems averse to holding the US Department of Defense to any varifiable standards whatsoever. And frankly, I can well imagine that the “activities” of all intelligence agencies are above and beyond accountability of any kind as regards the clear Constitutional responsibility of Congress of “oversight” of America’s too big and too secret intelligence “apparatus”.
Thank you, Jeff, for your continuing role in exposing so very many of this nation’s serious failures and deliberately inhuman actions.
How hard, do you imagine or have reason to consider, will Senator Feinstein “push” for investigation of and substantive “change” to these “programs”?
DW
In regards to your last question, the last time I queried Feinstein’s office on this issue, they had no comment, as far as I can remember. Perhaps they didn’t even get back to me, I’m not sure. In any case, they certainly had nothing to say. On the other hand, Feinstein has been on this for the sake of servicemen/women royally fucked up by the drug for some years now.
Congress shows little appetite to be more than the puppet for powers with purse-strings.
Puppets dancing on the long-ends of purse strings seems the perfect description, Jeff.
DW
“…years … on this …” aspect of the war-machine, especially if not hard nor rigourously pursued, safely pose no threat to Feinstein’s own endless war “interests” … or to be, exactly, precise … those of her husband …
DW
Yes, I agree. But she has helped us, inadvertently or not, by leaving a paper trail re U.S. actions and mefloquine.
Mefloquine, by the way, is a quinoline drug, and as we pointed out in our first article, I believe, this family of drugs was part of the MKULTRA research.
Also, I was the only researcher on this to catch that the original DoD human subject trials on mefloquine were conducted on prisoners who were deliberately inoculated with malaria… this being done maybe a year or so before such kinds of research on prisoners was outlawed. (It’s in one of the Truthout stories.)
I recall that Truthout story, Jeff, and as well the fact that you were the only researcher to catch and also, if memory serves, the first journalist (if you don’t mind me calling you that, as your expertise and abiding humanity places your work well beyond the level typical to what “passes” as journalism, these days) to bring to public awareness, certainly mine, this despicable truth with the depth and perception which it necessarily demanded and demands. In truth, this history is one of the many reasons why I hold you in such sincere regard and absolutely value your voice in our deeply shared concern for the for the present and future profession of psychology.
It is but little appreciation for the very crucially LARGE and critically important endeavors you daily engage.
Thus, I happily share with you a recognition much used on these FDL threads by our wise and equally compassionate, Southern Dragon:
Namaste
DiFi has profited, via her husband’s construction interests, from war.
It goes on. The military is hazardous to humans. Another substance, Agent Orange, has affected tens of thousands of vets, as well as Vietnamese but the Pentagon has fought helping these people for years.
from Salem-News.com
During the Vietnam War, between 1962 and 1971, the United States and its allies’ military sprayed 21,000,000 US gallons of chemical herbicides, manufactured by Monsanto and Dow Chemical, in Vietnam, eastern Laos and parts of Cambodia, as part of Operation Ranch Hand.
While in Vietnam, veterans and non-veterans were told not to worry, and were persuaded the chemicals was harmless. But in fact dioxin is one of the most poisonous substances known to humans. Vietnam estimates 800,000 deaths and more than 500,000 children born with birth defects due to AO’s toxicity.
The VA estimates that there may be as many as 250,000 US veterans who are suffering from Agent Orange-related illnesses.
The Japan Times
The Pentagon has once again denied allegations that the U.S. military buried the highly toxic defoliant Agent Orange in Okinawa, the Foreign Ministry said. The Japan Times ran a front-page story in which an unnamed U.S. veteran said he helped bury the Agent Orange at Hamby in the late 1960s. Other Vietnam veterans also said they handled the defoliant while stationed on Okinawa, according to the paper.
Don, did you see this, from last week?
Compensate the Victims! 50th Anniversary of Start of US Chemical Warfare Program in Vietnam
See also:
The “significant improvements” noted here is a reference to the 2009 change in DoD policy discussed (and linked) in my story. The journal article is by noted mefloquine researcher Major Remington L. Nevin MD, MPH.
All I can add is appreciation, Jeff.
Is Feinstein on any committee that could can hearings on mefloquine/Lariam? Does she have a hand-washes-hand (oops, not the best metaphor, perhaps) with a Senator on a committee that can?
It seems odd to me that a Senator with Feinstein’s clout, and with her clearly abiding interest in this reprehensible practice, has apparently yet failed to halt it.
Prolly just blackmail by DiFi to get Hoffman-LaRoche to give her bigger campaign contributions so she’ll STFU.
Assignments:
In what way are these side effects actually worse than contracting malaria? Sounds like it could be pretty much of a toss-up to me–troops might vote for chancing malaria given the facts.
Here’s the problem, Jeff. Do you know of a better anti-malarial drug?
The choice is between malaria, which is serious, and Lariam, which has serious risks for some people and long-term use.
I raise this only because when my daughter went for a semester study abroad in Ghana, we had to evaluate what anti-malarial drug she should take. My daughter and our family physician decided on Lariam, even with the risk.
This is not a clear decision. It is very difficult.
And I can understand why DoD does not want its people to get malaria.
You can argue when, where, and who should receive Lariam as normal preparation for what kinds of duty.
I think DiFi is grandstanding on this one. Unless there is an alternative effective anti-malarial.
All anti-malarial drugs are some variation on quinine. And all thus far have serious side-effects of one kind or another. And most likely all have neurological side-effects.
There have got to be other drugs to combat malaria.
That aside: if DiFi raises too much of a stink, the Obama people will surely take her to task. After all, we can’t have anybody criticizing the DoD. It might encourage whistleblowing.
I have experienced all of the ones I bolded but especially the gastrointestinal upset. I had the trots for over a decade after being administered that drug. To the point where the sphincter muscle has apparently been damaged causing ongoing leakage. All that in exchange for….nothing. Because after they experimented on me, the threw me out for being transsexual.
I used to travel to malaria-stricken regions a lot, and Lariam had such awful side effects I wouldn’t take it. I handed it out to people who lived in those areas instead. Great, now I’m a monster.
Here is the deeper problem, TD, our government forced human beings to take this drug, have required that others, who are not apparaised of its dangers, adequately, or at all. And, most damning “problem” of all, the fact that prisoners, captive beings with virtually no rights at all, were deliberately innoculated with malaria.
I understand what you have said, full well TD, and agree that such CHOICES must sometimes be made.
Do you fully understand the implications and reality attendant to what Jeff has brought to our collective attention?
One issue, the one you raise is medical, the ones Jeff raises are moral.
There are TWO clear sets of issues, and no honest conflation of the two is reasonable or usefully rational.
DW
TEDDY!
Thank you so much for that information! That woman is despicable!
She along with Rumsfeld need to be hauled to a town square. Any town USA will do! Oh yeah, and you can bring every other congress member that claims they are working on Oversight. Their oversight is a definition aside from what any normal sane person would describe it.
How many ways can a critter benefit and make money?
The sky is NO limit!
Not a monster, melvoid.
Did you convey to those to whom you provided the drug the information regarding side-effects?
As I said to TarheelDem, unless you withheld such vital information, it is a medical issue and not a moral one.
If you feel your actions rise to the moral issue, then you, and you alone, must decide where you stand.
When it comes to the behavior of government which does ALL things in our names, we have both a moral right and a legal obligation to judge, in good, and honest, conscience, what has been done.
DW
Yes, and then when soldiers come home with what they classify as PTSD they wish to ignore it.
Medical guinea pigs, we are.
The Government, which consists of Craven Democrats and Craven Republicans, Idealogues, Madmen, Whores, Panderers, and AIPAC loves Monsanto, Dupont, Dyncorp, Halliburton, ADM, Lilly, Phizer, Big Oil, PHRMA, AHIP.
For years, The Government has permitted Mergacorps to poison every living thing. And make us pay to clean some of it up (bury it) when they get caught.
Take GMO crops (and animals) for example. Consider Neonicatoids which are banned in Europe.
Feinstein’s (Frankenstein) behavior here is most accurately described by ECahn at comment 12.
No single member of congress should be allowed to hold that much sway on so many committees.
When is she up for re-election. We have to put that one out to pasture along with the rest of them.
Military construction was also once “of great concern” to DiFi.
North Bay Bohemian, January 24, 2007
Title: “Senator Feinstein’s Iraq Conflict”
Author: Peter Byrne
(excerpts follow)
Dianne Feinstein — the ninth wealthiest member of congress—has been beset by monumental ethical conflicts of interest. As a member of the Military Construction Appropriations Subcommittee (MILCON) from 2001 to the end of 2005, Senator Feinstein voted for appropriations worth billions of dollars to her husband’s firms (including Perini Corp.).
Shortly before my expose of Senator Dianne Feinstein’s conflict of interest was published in January 2007, Feinstein, who had declined to substantively comment upon serious allegations of ethical misconduct as reported in the story, resigned from the Military Construction Subcommittee.
The back story to that encounter is that, in October, vanden Heuvel (The Nation) had abruptly killed the Feinstein story, which had been scheduled to run as a cover feature before the November 2006 election in which Feinstein was up for reelection.
I then sold the story to Salon.com, who abruptly killed it right before publication, too. So I sold the tale to the North Bay Bohemian, which, along with its sister papers in San Jose and Santa Cruz ran it on the cover—complete with follow-ups.
Before I left for Desert Storm they gave me chloroquine to take. I woke up the next morning with lumps on around my groin area and was told I had an allergic reaction to the drug.
When I got over there I was itching bad and my skin began peeling in thick layers. They took me off the medication completely(I’m not sure how large a threat malaria was in the desert anyway)and they gave me some lotion. I had very thick peeling for at least a month.
After I got home I developed a rash on my feet and hands at burned. My feet felt like they had glass in them and it was difficult to walk. Eventually I had a rash on my trunk and my doctor could not determine the cause. I went to a rheumatologist and at first they thought I had lupus because my blood work was really high on ANA but I didn’t. They didn’t know so I went to a veteran’s hospital and they couldn’t figure it out either.
They classified it as something like “unknown cause” which is how they classified “Gulf War Syndrome” stuff and tried prednisone. Things got worse. I was removed from that and after about a year it cleared up. They had put me on about 10 percent disability but I was removed from that when everything went away. They never figured out what it was.
But I always wonder about that and the other drugs they gave me.
I’m almost 50 now and every time different things come up it crosses my mind that I may have damaged myself with some of the medicines I was given.
I’ll never really know.
There’s enough real scandal out there — in general, in relation to Gitmo in particular, and in relation to military medicine and Gitmo in even more particular — that you don’t have to invent fake scandals. Puffing up fake scandal just hurts the credibility you need to rely on when publicizing real scandal.
Every medicine is also a poison. We don’t restrict remedies to medical use only, prescription control, unless they have poisonous effects that require a careful balancing of the risks posed by these effects against the potential benefits, the risks posed by the disease the medication/poison is being used to treat or prevent.
Yes, mefloquine is nasty stuff. So are all of our anti-malarials. But malaria is even nastier. As a result, the standard medical advice for people going into malarious areas is to use one of our nasty medical poisons as a preventive. Depending on the particular species profile and resistance profile in the area being entered, one or another of our malaria-prevention poisons may be recommended. Mefloquine often gets the nod, whether for soldiers or detainees, or tourists, or Peace Corps workers. That’s been true for decades. Mefloquine is absolutely a very routine and recognized choice for malaria prophylaxis, and has been for decades.
Where’s the scandal in giving detainees in a malarious area the same medication that non-military doctors would recommend in many cases for civilian travellers to a malarious area? Is Gitmo not a malartious area? Are the military people there not given malaria preventives? Is that prevention mefloquine? Perhaps there is some scandal lurking in negative answers, if any, to those last three questions. But if so, that’s what you need to articulate, not the utterly non-scandalous fact that the US gives detainess sent to a malarious area a recognized and widely used malaria preventive. It would be scandalous not to give detainees such protection in that situation.
The idea that the mefloquine was used for its potential psychotropic effects doesn’t make much sense. We already know that the military used — and most shockingly to me as a military physician, used with the cooperation of military medical personnel — used noise, forced sleep deprivation and solitary confinement to break detainees psychologically. They kept their victims awake directly, by not letting them sleep. We know that already. What possible sense would there be to giving them a medication that would give only some of them an often fairly mild sleep difficulty? You can make anyone psychotic just by not letting them sleep. We know the military did just that at Gitmo in many cases. So where’s the point in giving the detainees a medication that will render just a very few, a random and unpredictable few, of them psychotic?
This fake scandal relies on the notion that mefloquine was part of some elaborate, secret, Rube Goldberg device to mistreat detainees. The real scandal is that the military, actively aided by military medicine, did the mistreatment directly and overtly.
I had Lariam when I traveled in south east Asia in 1993, and it was so awful I stopped taking it. I was very careful about mosquito bites – I covered up before dusk (long sleeves, long pants, elastic at cuffs, and turtle neck) and kept it on until after dawn, and used bug spray. It was a hot climate, but I figured this was better than the Lariam. That stuff is awful.
I disagree that this is a “fake scandal”. For starters, these guys were in prison, and they would not be exposed to mosquitoes inside. There should be screens on the windows and doors, and bug nets if that is not possible.
And even bug spray would be better than those drugs.
Furthermore, the prisoners were not informed about what they were forced to take.
The question of what drug to use to combat malaria is a complex one. For one thing, what kind of malaria is one trying to combat. The two most prevanlant types, P. falciparum and P. vivax, are the ones most commonly found, with P. falciparum the more deadly. (“P.” stands for Plasmodium.) Some drugs work better than one than the other.
To make matters worse, thanks to natural selection, after awhile, the malaria organism becomes tolerant of the drug that formally worked against it. Mefloquine itself was developed in part because so many mosquitoes were carrying resistant forms of malaria that previously had been controlled by chloroquine. Now mefloquine, too, has precipitated mefloquine-resistant strains.
If that all isn’t complicated enough, there are other issues, such as how long it takes to develop a “loading dose” that will protect the individual. And then there’s the important fact that the malaria organism goes through a number of different changes during its life cycle, and no drug, mefloquine included, actually kills the organism in all stages. It is because of a dormant stage where the organism sits mainly in the liver, without symptoms to the host, that full protection cannot be achieved without giving the person the drug primaquine… except not everyone can tolerate primaquine.
Oh, Tarheel Dem. Believe me, I’ve looked at this issue a great deal.
There are a number of other drugs that can be used, but often the mediating role of what drug is chosen is played by two non-disease factors: financial and ease of use.
Mefloquine is unique in that it can be taken only one time per week, versus daily for the other medications. Secondly, it is cheaper than some of the other meds. A very effective substitute, with far lesser side effects, is Malarone, a combination drug made with Proguanil and Atovaquone. While not too effective for actual malarial infection (unlike mefloquine), it makes an excellent prophylactic drug, which is what we’re talking about here, preventing malaria.
There are a number of other drugs, including the Chinese herb widely used, Artemisinin. In addition, there are the old stand-bys, quinine and Chloroquine.
Just as important as drugs, maybe more so, is education in anti-mosquito behaviors, e.g., treating one’s clothing with anti-mosquito agents, using netting, and wearing proper clothing. In fact, these latter behaviors do as much or more to combat the spread of malaria than drugs. See, for instance:
While I have great and lasting problems with Dianne Feinstein, she is not “grandstanding” on this problem. From her standpoint, mefloquine undermines the morale of the military, and reluctance to use the drug also undermines the very protection from malaria that the government seeks. Such reluctance and/or poor education on malarial drug use and protection behaviors have been noted in studies looking at malarial outbreaks among troops.
As for Guantanamo, the entire project was bogus, as dancewater @29 points out. The evidence for that is in our previous articles. I have more evidence on that which I will be posting as part of an article soon.
You write:
If you went back and read all three Truthout articles, Dr. Tomkins, then you wouldn’t have to ask these questions. Let’s take them one at a time:
1) “Where’s the scandal in giving detainees in a malarious area the same medication that non-military doctors would recommend in many cases for civilian travellers to a malarious area? Is Gitmo not a malartious area? ” — Cuba is a “malarious area,” but so is the American South. The question is not whether malaria-carrying mosquitoes live in the area, but how endemic the disease is. How does one stop malaria from spreading, say, in the American South, or on or around military bases in the South? Well, it is not by giving everyone mefloquine, is it? Or other antimalarial prophylactic drugs. It is by practicing malaria prevention procedures and mosquito control. And guess what? That’s what they did in Cuba years ago, and such procedures were also practices at the Guantanamo camp. At a meeting of the Armed Forces Epidemiological Board in Feb. 2002, officials were specifically told that malaria was not an issue at Guantanamo (which, btw, is very dry and not a congenial environment for the mosquitoes). Read all this and more in the Truthout series.
2) “Are the military people there not given malaria preventives? Is that prevention mefloquine?” — The answer to that is no, the military people there are not given malaria preventatives, so that means they don’t have to take mefloquine either. Even more, when thousands of Haitians were brought to Guantanamo in the 1990s, leaving a malaria-endemic area, they were not given prophylactically large presumptive treatment-levels of any drug, much less mefloquine. The Haitians were tested for malaria and treated symptomatically. The Guantanamo detainees, too, were tested for malaria, but only after they were already “treated.” Again, it’s all in the Truthout series. Why don’t you read it?
Dr. Tomkins, you do a disservice to use your medical authority on matters for which you have not evidently researched the topic. I have spoken to epidemiologists, who we quote in our article, and medical experts. Some have disagreed in regards to the dangers of mefloquine. But none have defended — NONE — the presumptive treatment of the Guantanamo detainees with 1250 mg of mefloquine upon arrival (the prophylactic dose, for those who don’t know, is 250mg per week ).
Taking mefloquine off the DoD’s formulary would be a dangerous overreaction. I would urge FDL members not to support such nonsense.
Chloroquine resistant strains of malaria are becoming the rule in many parts of the world, most notably in South East Asia (i.e. Afghanistan / Pakistan). In these areas, there simply is no better drug for the majority of travelers. The alternative malaria prophylaxis drugs, in areas of known cloroquine resistance are Primaquine, Atovaquone-proguanil, and doxycycline. These are not realistic alternatives.
Firstly, all of those drugs are absolutely contraindicated in some very large groups of patients. None of them can be given to pregnant women because of serious, permanent birth defects. Primaquine cannot be given to patients with Glucose-6-phosphate dehydrogenase (G6PD) deficiency because of a potentially fatal reaction. G6PD deficiency, by the way, is estimated to affect approximately 1 in 10 African American men and approximately 400 million people worldwide. Atovaquone-proguanil, similarly, is not effective in many patients of Asian or African descent because they do not metabolize the drug into its active form.
Then, there are the side effects and dosage regimens. As bad as the adverse effects to mefloquine are, all of the alternatives are just as bad, if not worse. Doxycycline, which must be taken multiple times per day, every day, notoriously causes severe sensitivity to sunlight, which is obviously a problem for men and women in tropical/desert climates. All the other alternative drugs must also be taken daily, as opposed to the once-weekly regimen of mefloquine.
In summary, mefloquine is the closest thing modern medicine has to an ideal anti-malarial prophylaxis drug. Removing it from the DoD formulary would be a foolish overreaction.
If the concern is that mefloquine was being used to abuse Guantanamo detainees, then that should be the focus. Proving those allegations would not be difficult given the fact that the dose for malarial prophylaxis is much lower than the high doses given for treatment. All one would have to do is look at the diagnoses and mefloquine doses the detainees were given. If an asymptomatic detainee was consistently given a more than a prophylactic dose of mefloquine (one 250 mg pill per week), then that would constitute medical malpractice and/or abuse.
And by the way, all malarial drugs are not a variation on quinine. If someone told you that, they are ignorant. Doxycycline, which is widely used now in the military as a malaria prophylactic, is a tetracycline. Artemisinin, which I noted above, is actually the Chinese herb qinghaosu, but it is used for treatment, not prophylaxis, I believe. Another antimalarial, the Sulfonamides, are analogs of PABA.
Grym, I’m not medically competent to say whether or not mefloquine should be on the formulary. I’ve said there should be an investigation into its use and any experiments done in secret on the drug. — I’m reporting the issue primarily because it shows governmental concern with the effects of the drug in the context of its indiscrimate use on prisoners.
You write, ” If an asymptomatic detainee was consistently given a more than a prophylactic dose of mefloquine (one 250 mg pill per week), then that would constitute medical malpractice and/or abuse.”
It’s not “if”, Grym, as we reported, it was written inproceesing orders/SOP at Guantanamo (see pg. 7 of this PDF for the actual document) to give a treatment dose of mefloquine (divided into doses of 700mg, then 550mg 12 hours later) to all detainee upon arrival at Guantanamo, symptomatic or not, prior to testing for malaria, i.e., a dosage five times that of the weekly prophylactic dose, which is what carries the side effects Feinstein is talking about.
And for all those reading this article who can’t let their animus for Feinstein go for a second to see the bigger picture, then you are missing the point of this article, which is not to promote Dianne Feinstein, but to raise an issue totally ignored, i.e., the deliberate drugging of the Guantanamo detainees in a very questionable way, and the need for an investigation into that, not to mention other forms of drugging or ongoing abuse at that and other military/CIA/JSOC prison facilities. In addition, it seems that use of mefloquine has been too long cavalierly used on U.S. troops without proper research on the drug (which never had Stage III trials, for instance), or without proper oversight for a serious, dangerous, if albeit sometimes helpful drug. (See the conclusion of the Interagency Working Group, which included DoD, quoted in the article.)
The entire government is rife with corruption, and Feinstein is truly among the worst. But the story here is not about governmental corruption.
The real story in your comment concerns the corruption of the supposedly liberal press, in this case, the Nation and Salon.com, for killing anti-Feinstein stories out of deference to Democratic election politics. But also, in this case, not really relevant here… unless we consider how the drugging of detainees — and mefloquine wasn’t the only such drug — is not reported by the mainstream press, nor frankly a concern of most progressive bloggers.
Any post like this must contain the names of the makers of the drug and look at how much the makers spent on lobbying for this and other drugs, who in congress got the money and who the CEO the board of directors etc has political, military or food and drug administration connections.
As usual Jeff, thanks for the detailed response. And for this:
Not taking medication would provide no protection. Widespread opposition to taking it would indeed affect morale.
Wow… That document, if legitimate, is pretty damning. Giving mefloquine at that dosage to all patients, regardless of history or symptoms, is medical malpractice. Period. I think you’ll be hard-pressed to find a U.S. physician who will say otherwise…
If it was done with the intention to disorient, manipulate, or cause discomfort to detainees, then, in my mind, that would qualify as mistreatment and possibly torture. That is very concerning, and I’m glad people such as yourself are pursing this issue and making it public.
That being said, I think demonizing mefloquine is a big mistake. Doing so undermines your efforts and distracts from your strongest claims. You also risk alienating the medical community who would otherwise be on your side. Furthermore, by questioning the use of mefloquine at all you do yourself a disservice by turning the argument into a technical/scientific debate in which you admit you are are unqualified to participate… There is no good reason to do that. You have the moral and legal high-ground if you simply stick to the misuse of mefloquine and the abuse of detainees.
Alienate the medical community? Far be that from my intention, though I do not fear doing that. I have too long seen the pernicious use of psychiatric meds, for instance, and witnessed first-hand the cover-up of such things, to care one whit about alienating the medical community, which has, btw, been silent on the medical malpractice and collaboration with torture by both doctors, psychologists, and many medical personnel in the U.S. military and CIA.
However, you say “That document, if legitimate…” — Grym, the link is to a DoD site. It’s legit. Okay. If that’s not enough, I spoke directly more than once to the man who signed off on the protocol, Captain Albert Shimkus (a nurse, btw, not a doctor, but yet was also at the time Chief Surgeon at Gitmo), and he confirmed the SOP.
So the question for you is this: which is worse, my so-called demonization of mefloquine, or DoD massive malpractice and torture? You’ve spent some time writing here about this article, what are you going to do when faced with direct evidence of governmental abuse and torture? Hm?
There is nothing I despise more than a person who decides to throw in their two cents, claims to speak authoritatively about an issue and accuses the authors of stories of creating a “fake scandal” without even taking the time to read about the very issue they are opining about. That these comments were offered by a “Dr.” and done so publicly is, in my opinion, a scandal in and of itself.
By the way, good Dr., the world’s foremost expert on tropical diseases and the treatment of the diseases disagrees with you as does other experts who have actually taken the time to review the evidence we presented in our investigative stories before weighing in with an opinion.
Six years this BS has been going on?
Democratic voters have mistakenly believed that Democrats want what they want. The DLC-controlled Democratic Party gives lip service to all populist issues (like living wages, civil rights protections, restoring habeas corpus, ending the wars, public healthcare, Wall Street reform, environmental and energy issues, etc.).
If the Bush years taught us anything, it’s that anyone can sell anything and anyone to Americans, if you’re stolid and relentless in your sales pitch and tactics. It’s not that Bush and Rove were geniuses and knew something that nobody else knew; Bush & Rove were just more ruthless, obvious, artless, in doing what politicians and the parties had gone to great lengths to hide from Americans — If you keep at it, escalate your attacks, don’t take ‘no’ for an answer and never back away, you will wear the opposition down.
Obama didn’t get to be the first black president, vanquish the Clinton machine (to get the nomination ) and the oldest, most experience d politicians in US history (including the Rove machine) by not having mastered these skills. Nor do Democratic politicians (more incumbents than ever, in office longer) not know how to do it. How do you think Democrats managed to keep impeaching Bush and Cheney off the table, have us still reelecting them and not marching on Washington with torches and pitchforks?
Democrats know how to do it — They just don’t want to do it.
The trick for them has been to keep the many different populist groups believing that they really do support our issues, but they’re merely inept. And to get us to keep voting for them despite their failure to achieve our alleged shared objectives.
Getting Democratic voters (and Obama’s ‘most ardent supporters’) to understand that Democratic politicians have been taking us all for suckers and patsies is the most immediate problem and the challenge.
Four soldiers murdered their wives during a six week period in the summer of 2002 at Ft. Bragg. Two of the soldiers later committed suicide. There is speculation these events many have been triggered by side-effects of mefloquine ( Lariam), manufactured by the Swiss drug maker Hoffman – La Rouche. Most of the generic mefloquine comes from China.
http://www.cbsnews.com/stories/2003/01/27/60II/main538144.shtml
http://www.alibaba.com/showroom/mefloquine.html
I apologize if I was unclear: I SUPPORT you and your efforts to expose this scandal. I’m glad that somebody is.
Societal reform requires people such as yourself who expose injustice, build a consensus, and ultimately create the broad coalition of factions which mandates change. In that regard, I was merely trying to provide some helpful advice. Speaking as someone inside the medical community, I can tell you that efforts to totally ban or limit the prescription of mefloquine will at the very least evoke a turf-war, bunker mentality. Worse yet, because the use of mefloquine is so highly supported by medical literature, it may be misinterpreted as an attack from an anti-scientific kook. (Which, by the way, might explain some of the skepticism expressed by some of the other posters.)
Maybe you don’t want support from the medical community. That’s fine and understandable to some extent. If that’s the case, then, by all means, feel free to ignore what I wrote–I was only trying to help.
but -
and -
Feinstein, Inc.is not really credible as a reform agent.
While I appreciate hearing you support me on this, what beyond stating this in a comment have you done?
Actually, there are plenty of medical doctors and researchers who have problems with mefloquine. Did DoD issue its limiting 2009 policy change on mefloquine because of “crackpots”?
As a group, doctors have been silent on the mass empiric treatment of the Guantanamo detainees. And when it comes to torture, not one U.S. doctor has been censured, lost his/her license, or been brought up on ethics charges by the either the AMA or the American Psychiatric Association, in relation to torture by the United States. This is even when we have documented proof, for instance, of the participation of doctors and other medical personnel in the torture, e.g., the CIA’s Office of Medical Services, etc.
AMA and APA have put out nice policies on paper, but they haven’t implemented them, and APA (American Psychiatric Association, not American Psychological Association) has indicated the policy is not enforceable anyway.
Yeah, support. You’re glad “someone” is doing something about this. I suppose your support here is something, but the support of an anonymous doctor (assuming you are a doctor from what you say) in a comment on a blog, that and fifty cents won’t even buy you a cup of coffee anymore.
What’s with the straw man argument, really? Who proposed Feinstein as a “reform agent”?
The military investigated this and determined that Lariam was not a factor. Take that what for what it is, and consider the source.
Thanks for the update.
“consider the source” Good advice. These days I would trust a military investigation over that of CBS, but not by much.
The “farce” is in full force here. Mefloquine is not the enemy, misinformation and lies are the enemy. Several months ago I chimed in on Jason Leopold’s stolen (from the Seton Hall farce) story about mefloquine at Gitmo and completely blew his hypothesis away with documentation that detainees at Gitmo refused to take the mefloquine and most other medications that were prescribed for them. I sent Jason copies of my January 2002 journal notes and a draft medical SOP from Gitmo, which I helped write, where I was the ranking U.S. Medical Department officer with the Joint Detainee Operations Group for Joint Task Force 160, U.S. Naval Station Guantanamo Bay, Cuba, from February to June 2002. Jason ignored this evidence against his lies and never mentioned it to his few readers. He then went on a terror campaign to try and discredit me, even stooping to calling me to threaten a bad story about me without regard to the truth in order to shut me up. He’s known for inventing “facts,” is a convicted felon, and “sniff,” former admitted coke head. The U.S. military medical personnel at Gitmo while I served there were some of the most competent, caring, and intelligent individuals anyone would be privileged to know. To suggest nefarious intent is irrational, erroneous, and unproductive in civilized conversation. Shame on you, Jason and Jeff. Now, you want to make some more illegal phone calls to me pretending to be from an FBI number in Washington, D.C. Go right ahead, I have a few Federal friends who would LOVE to re-intorduce you to the criminal justice system.
Oh good Lord. Montgomery Granger, the opportunist rears his ugly head. And Monty, perhaps you need a lesson in reading comprehension. Our story was not “stolen,” a defamatory statement on your part, rather it was done separately from Seton Hal, which they noted in their press release.
The role of Mr. Granger here appears to be to throw out lies and accusations to muddy the waters around the story. I certainly hope readers see through such blatant abuse of the public discourse.
We certainly were not unaware that some detainees tried to refuse medications at times, including possibly mefloquine. I even personally asked Capt. Shimkus, the chief surgeon for Task Force 160 and Commander of the Naval Hospital, Guantanamo at the time the mefloquine SOP was implemented what the instructions were when detainees either refused medication, or threw up the medication soon after due to nausea. He said he was never notified of any problems in that regard.
The attacks on Jason Leopold is character assassination of the worst sort, and meant to wound via ad hominem attack, the better to torpedo the story. Jason wrote all about his life in the critically acclaimed memoir, News Junkie. Anyone can read about it there.
The implication there were “illegal phone calls pretending to be from an FBI number” not only makes no sense, it is absurd, and probably libelous. It smacks of Cointelpro tactics, meant to smear myself and Jason as some kind of lunatic crazies.
For those interested, Mr. Granger was at Guantanamo for five months in the first half of 2002. Despite what he says about writing up a draft medical SOP, he had no input in the writing of the In-processing medical SOP for detainees that called for the empiric treatment dosing of mefloquine. He remains an unashamed apologist for treatment of detainees at Guantanamo. He wrote a book, Saving Grace at Guantanamo, about his experiences.
I can’t know Mr. Granger’s motivations, but I think he has been upset ever since we used a portion of his book in our first article on mefloquine at Guantanamo, where we used his own observations from Guantanamo to buttress our case. For instance, he wrote about increases in psychosis among the detainees. He also wrote that a Navy entomologist was present at Guantanamo in January and February 2002 and during that time only identified insects that were nuisances and did not identify any insects that were carriers of a disease, such as malaria.
I believe Mr. Granger in that he thinks he is noble. He is so unaware of the reality of the Guantanamo situation, in his attempt to ennoble it, that on the cover of his book, he has a photo of the detainees in orange jump suits, with earmuffs and goggles, bent over and bowed, except one, who is being given water in a cup by a faceless guard, who with a gloved hand holds a cup to a detainees mouth and with the other hand holds the back of the detainee’s head. It is a fascist’s idea of sympathy for the Untermenschen. — You can see the picture I’m talking about at the Amazon page for his book. I forfend giving the link, however, as I can’t bring myself to promote his book in any way, but only give info on it here as necessary for the public’s understanding.
Yes I’m cynical but I suspect the worst of Feinstein. When does the patent run out on this drug that the DoD is paying thru the nose for? If the patent is gonna expire soon, she wants the pharma company to be ‘forced’ to switch to another drug still under patent and thus can charge outrageous amounts per dose for another 17 years.
Always look for the money behind every political act — especially Feinstein.
Now you know why doctors trained in the military must retrain if they want civilian credentials.
Instead of making some vacuous threats akin to the type preteens whining little biatches make on MySpace, why don’t you go ahead and call your “friends” you rear echelon motherfucker?