Former troops who say they were sickened by the malaria drug Lariam, or mefloquine, and their advocates urged members of a scientific panel on Jan. 28 to talk to veterans and examine their medical records when considering the potential chronic health effects of malaria medications.
A National Academies of Sciences, Engineering and Medicine committee has started an 18-month review of all available scientific research on malaria drugs used to prevent the debilitating disease. Committee members are looking to see what role, if any, the medications have played in causing neurological and mental health symptoms, such as dizziness, vertigo, seizures, anxiety and psychosis, in some patients.
The panel said it is looking particularly at mefloquine and a related new drug, tafenoquine, but will review all malaria medications to distinguish any relationship between the drugs and long-term health effects in adults.
At the panel's opening meeting in Washington, D.C., several veterans urged it to "look at this very, very closely."
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Retired Col. Timothy Dunn described himself as a hard-charging, motivated Marine in perfect health before he took mefloquine in September 2006.
But the first time he took it, he experienced nightmares and anxiety, he said, and the symptoms got worse with each subsequent dose. He stopped taking the medication after he returned home, but the symptoms still persist, 12 years later, including tinnitus, dizziness, anxiety and depression.
"Ladies and gentlemen ... there probably are many veterans out there who think they are losing their minds or thought they were depressed and have never related it to this awful mefloquine drug," Dunn said.
Retired Navy Cmdr. Bill Manofsky, the first veteran diagnosed by the Department of Veterans Affairs as having symptoms directly related to taking mefloquine, told the panel he has referred 280 veterans for medical care, including about 100 to the VA's War Related Illness and Injury Study Center for possible mefloquine poisoning. He asked the panel to look at all available information.
"The medical records are not going to show up in the literature," Manofsky said.
In most National Academies reviews, panelists interview subject-matter experts and review all available documentation on an issue, including federal government documents, academic reviews and previous studies.
In earlier studies of military-related environmental exposures, National Academies panelists often were unable to draw any conclusions because the research or data on a topic simply doesn't exist.
Dr. Remington Nevin, a former Army preventive medicine specialist who now serves as executive director of The Quinism Foundation, a non-profit organized to support research into the effects of mefloquine and tafenoquine, expressed concern that the VA requested the National Academies review knowing the panel's findings would prove inconclusive.
"Your work of the next 18 months is premature ... certain powerful and entrenched interests would love nothing more than for the National Academies to conclude after 18 months that there is insufficient evidence for the existence of [mefloquine-related illnesses], or insufficient evidence to justify VA acting," Nevin said.
An unknown number of U.S. troops, Peace Corps volunteers and some State Department employees have said they are permanently disabled from taking mefloquine, a once-a-week medication prescribed for personnel stationed in places such as Afghanistan, Iraq and parts of Africa.
The Defense Department began phasing out its use in 2009 out of concern for possible neurological side effects.
In 2013, the Food and Drug Administration placed a "black box" warning on mefloquine, saying the drug can cause ongoing or permanent neurological and psychiatric conditions, including dizziness, loss of balance, ringing in the ears, anxiety, depression, paranoia and hallucinations, even after discontinuing use.
At their inaugural meeting, the National Academies members also heard from federal officials who set policy on medications and monitor their effects, including the Office of the Assistant Secretary of Defense for Health Affairs, the FDA, and the Centers for Disease Control and Prevention.
During his presentation, Dr. Loren Erickson, a retired Army infectious disease specialist who now serves as the VA's chief consultant for post-deployment health, said the VA is "excited to [have] the academy review the issue," as it's one that has been a topic of consideration by the VA for years. "We all have an interest in seeking the truth."
The VA contracted with the National Academies to conduct the review. Panel members noted that the final report will include observational findings but will not make any recommendations to the VA on how to handle disability claims or health benefits related to malaria drug exposure.
-- Patricia Kime can be reached at firstname.lastname@example.org. Follow her on Twitter @patriciakime.