Patrick McClanahan (Mozambique 2010-12) Fights Mefloquine and the Peace Corps
Gerald, the studies do not mention whether there was informed consent, so I cannot answer your question until I find…
Patrick McClanahan (Mozambique 2010-12) joined the Peace Corps in September 2010, shortly after graduating from Penn State with a degree in physics. While in Mozambique, he taught 11th grade math in the village of Machanga along the banks of the Rio Save. His service was cut short by a reaction to the antimalarial medication mefloquine. The effects of this drug left him unable to work for months after returning to the US and they still affect him to this day.
When Patrick returned home, he quickly learned that his experience with mefloquine in the Peace Corps was not unique, nor even unusual — but it was preventable. There are safer options to the drug, and since returning it has been his goal to protect future Volunteers from the harm that he and countless others have experienced.
The following is a note that Patrick sent me. For Patrick it began last fall when he, as a member of the RPCV group, Health Justice for Peace Corps Volunteers went to Washington and met with Peace Corps Director Carrie Hessler-Radelet and others at HQ regarding the issue of antimalarial mefloquine. Here is Patrick’s statement:
In 1989, Peace Corps Volunteers were used as guinea pigs to test the safety and effectiveness of a new drug to prevent malaria — mefloquine (marketed by Roche as Lariam®). Mefloquine soon became Peace Corps’ go-to choice in regions where malaria had become resistant to the older, better-tolerated drug chloroquine.
Over the years, mefloquine became notorious for its devastating and sometimes permanent psychological side effects, including anxiety, depression, and psychosis. Peace Corps Volunteers were pressured or even forced to take the drug or go home, even though safer alternatives — doxycycline and, since 2000, Malarone — were available. Countless [Volunteers’] services were ruined and many returned Volunteers still suffer lingering effects of the poison.
In 2013, as reports of serious adverse reactions and studies demonstrating the drug’s neurotoxicity piled up, the FDA gave the drug a black-box warning, the agency’s strongest. Despite all of this, the Peace Corps still uses the drug, ignoring CDC guidelines, that mefloquine be started weeks before travel in order to detect early signs of a reaction and allow it to build up the blood levels high enough to prevent malaria.
In the beginning of 2015, Drs. Elspeth Ritchie and Remington Nevin — both former Army Doctors — familiar with mefloquine’s effects on military personel, wrote the following letter on behalf of returned Volunteers who were harmed by mefloquine. The letter recommends a policy consistent with CDC guidelines that would greatly reduce the danger posed by mefloquine for current and future Volunteers. It is hoped that the current leadership of the Peace Corps, which appears to take Volunteer well-being seriously, will implement the changes suggested in the letter.
This March 2015, the following letter was sent to the Peace Corps by Drs. E C Ritchie and R Nevin on behalf of Returned Peace Corps Volunteers harmed by the antimalarial mefloquine (Lariam). It asks the Peace Corps to adopt policy that would either discontinue the use of this drug or require that CDC guidelines be followed when using it. Doing so would dramatically decrease the risk posed by the drug to current and future Volunteers.
You can read the full letter at this link. It includes the names of all the RPCVs who have signed the letter to the Peace Corps Director.
http://www.remingtonnevin.com/rpcv20150305.pdf
Volunteers were used as guinea pigs to test the safety of a new drug? Without their informed consent? And the agency continued to use the drug despite the FDA’s black box warning. Outrageous.
And how slowly will the agency’s bureaucracy grind before it discontinues the use of the drug or follows CDC guidelines? And are new volunteers fully informed about the risks posed by the drug and given the option of refusing it. And are any of the volunteers who are still suffering “lingering effects of the poison,” planning to sue the agency?
More questions: Was Melfoquine used by other federal agencies whose employees were working in Malaria areas, i.e. the State Department? If not, why not? Did the Peace Corps procurement office get a particularly sweet deal from the drug company? Was the cost of the drug a factor in its continued use? What has Carrie Hessler-Radelet done about this situation since she met with Patrick last fall, or in response to the March, 2015 letter? I apologize for going on about this, but it’s disturbing on so many levels. We were all pumped full of drugs before we went overseas and I always believed our doctors would first, do no harm.
RPCVs did sign the letter that went to Peace Corps on March 5, 2015. That is the letter by Drs. Elspeth Ritchie and Remington Nevin. John has posted the link to that letter. Health Justice for Volunteers is a very active advocacy organization doing good work for Volunteers and RPCVs.
Gerald, the studies do not mention whether there was informed consent, so I cannot answer your question until I find someone who took part in those studies.
Military and State Dept. both used mefloquine widely and it seems to have enjoyed some sort of preferred status, but use has been all mostly curtailed. The military now considers mefloquine a “drug of last resort.”
Peace Corps’ response to the black box warning can be found here: http://passport.peacecorps.gov/2013/08/09/staying-safe-preventing-malaria/. When I served in 2010-11, the PCMOs systematically downplayed the dangers of mefloquine, explained away volunteer side effects, and made it difficult to switch to doxy.
I have heard that it is now easier to switch, current practice is to give volunteers doxycycline when they arrive (because mefloquine takes weeks to become effective), then, after individual consultation, put them on mefloquine, Malarone, or just continue doxy within the first week. With the confoundment of adjustment stress and two drugs at the same time, I have no idea what they would do in the event of an adverse reaction.