Malaria, Mefloquine, and Peace Corps: What Price Protection? Part Two

The literature contains many articles about concerns with the use of mefloquine published in the more than twenty years between the time mefloquine became Peace Corps’s anti-malaria medication of choice and the FDA’s Black Box warning.  In reviewing these articles, it is helpful to keep in mind the Peace Corps’ timeline:

1. 1961 – 1990  Chloroquine was the anti-medication of choice
2. 1990 – 1992  Peace Corps participates in research of mefloquine, in response to                               development  of chloroquine resistant malaria
3. 1992 –            Mefloquine becomes the anti-malaria medication of choice
4. 1995 –            Dr. Lobel reviews medical literature for Peace Corps Medical Officers                         in  newsletter
5. 2004              FDA issues a medication guide to be given to all patients who are                                   taking mefloquine. (Information on how Peace Corps complied is not                           yet available).
6. 2013             FDA issues a BLACK BOX warning about dangers of mefloquine and                            Peace  Corps  revised  its policy accordingly.
7. 2015   Dr. Nevin writes to Peace Corps and recommends changes to this new policy to better protect Volunteers.

Here is a sampling of the articles.

Peace Corps Online, published by RPCV Hugh Pickens, has an excellent collection of articles on Lariam. (Mefloquine) To find the list, here is the text to link to:http://peacecorpsonline.org/messages/messages/2629/2027702.html

Among them is this paper written, in 2001, by RPCV Rebecca Brodsky about the Neurological Side Effects of Mefloquine. Neurological Side Effects of Mefloquine: A Trans-Atlantic Debate*RPCVs commented on the article, describing their experiences with mefloquine, both positive and negative.  Here is the text to link to: http://peacecorpsonline.org/messages/messages/2629/1008120.html

In this copyrighted UPI story. UPI Investigates: Lariam and the Peace Corps, by Dan Olmsted and Mark Benjamin, UPI, July 30, 2002, during the time when Gaddi Valdez was Peace Corps Director, the UPI spoke with Peace Corps staff and volunteers about the use of mefloquine. Volunteers recounted difficulties with the mefloquine. The Peace Corps staff appeared to be dismissive of the concerns. The article is good to read.  Here is the text to link to: http://lariaminfo.org/pdfs/UPI/UPI20020730Lariam_and_the_Peace_Corps_Main_UPI_Story.pdf

In this 2007 article from The Journal of the Royal Society of Medicine., A lesson learnt: the rise and fall of Lariam and Halfan the development of Lariam and the role of the United States Department of Defense and military-industrial complex is reviewed.  Here is the text to link to:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1847738/

The United States military also was adjusting its policy on the use of mefloquine. Read this article in the Army Times by linking to the text:http://archive.armytimes.com/article/20090324/NEWS/903240308/Army-scales-back-use-anti-malaria-drug

From that article:

“The Army has dropped Lariam – the drug linked to side effects including suicidal tendencies, anxiety, aggression and paranoia – as its preferred protection against malaria because doctors had inadvertently prescribed it to people who should not take it”

Dr. Remington Nevin  lists on his website a number of  his publications about the potential of adverse reactions to mefloquine.  He has also testified before Congress.  Here is his website:  http://www.remingtonnevin.com/site/home.html

In this context, it is understandable that Dr. Remington has written a letter to Peace Corps Director Carrie Hessler-Radelet urging that Peace Corps change its policy on the use of mefloquine.  Read the letter:  http://www.remingtonnevin.com/rpcv20150305.pdf