Feinstein: "Service members continue to receive drug linked to permanent brain damage"

Originally posted at Firedoglake/The Dissenter

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.