Read and comment on this story from the Boston Globe about military investigators who are trying to determine whether a series of murders and suicides by soldiers was connected to an antimalarial drug, Lariam, developed by the Army. An Army spokesman says the Pentagon was not informed that the drug's manufacturer settled a lawsuit this year with a Cincinnati woman whose husband had taken his own life.
Lariam is the most effective anti-malarial drug known and has been used by thousands of Peace Corps Volunteers over the past ten years. However, the drug's potential side effects are rarely reported and include agitation, depression and aggression.
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Army studies medication link in killings
By Michael Kranish, Globe Staff, 8/31/2002
WASHINGTON - As military investigators try to determine whether a series of murders and suicides by soldiers was connected to an antimalarial drug developed by the Army, an Army spokesman says the Pentagon was not informed that the drug's manufacturer settled a lawsuit this year with a Cincinnati woman whose husband had taken his own life.
The spokesman also told the Globe the Army has concerns about a recent change in the drug's warning label, which has been reworded to note that rare cases of suicide have been reported. The firm, Hoffmann-La Roche, has acknowledged receiving reports of eight suicides by users around the world of its antimalarial drug Lariam, but the company maintains no link between the medicine and suicide has been established.
Army officials stressed they have reached no conclusions about the causes of two murder-suicides and two other homicides this summer at Fort Bragg in North Carolina. But the decision to investigate the possibility of a link to Lariam has shined attention on the drug's potential side effects, which include hallucination and paranoia.
The drug, which federal officials credit with saving many thousands of lives, is unusual because the Army developed it at the Walter Reed medical facility in Washington and then licensed the product to La Roche. Since the drug went on sale in 1989, 5 million people in the United States and millions more around the world have taken it, mostly without incident.
In May, La Roche agreed to make an undisclosed payment to settle a lawsuit involving the use of Lariam, the first time that such an agreement has become known publicly. The case grew out of the 1999 suicide of Charles Perry of Cincinnati.
The suit was filed by Linda Perry, a nurse whose husband started taking the drug in the summer of 1998 before the couple left on an African safari. After returning, Charles Perry lost 50 pounds, became severely depressed, and frequently hallucinated. His doctor diagnosed him with a brain disorder caused by Lariam. In January 1999, while Linda Perry was making hot chocolate for the couple, he shot himself through the neck.
''He was hallucinating, he was seeing things. It was absolute madness,'' Linda Perry said. ''I don't want this to happen to anybody else.'' Linda Perry said she, too, had some side effects but was not as seriously affected. She said that the drug remained in her husband's body for months longer than anticipated.
La Roche, in an e-mail response to questions submitted by the Globe, said the Perry suicide has been the only one reported by a Lariam user in the country. The company, whose headquarters is in Switzerland, said the confidential settlement reached in the case does not suggest the drug was at fault. La Roche also referred to the cost of litigation.
A Hoffmann-La Roche spokesman, asked whether the company informed the military about the settlement of the suicide suit, said it does not disclose such matters to ''third parties.''
An Army spokesman said the military was not aware ''of the out-of-court settlement you reference.'' Asked about label revisions that include reports of suicide, the spokesman said via e-mail, ''We are concerned with any changes in the package insert.''
An analysis of the Hoffmann-La Roche drug safety database presented at the International Society of Travel Medicine last year in Switzerland stated there were eight reported suicides by Lariam users between 1985 to 2000. Asked about this, the company spokesman said via e-mail: ''There has been no causal link established between the use of Lariam and neuropsychiatric events such as suicide and suicidal ideation,'' or the idea of committing suicide.
Representative Bart Stupak, Democrat of Michigan, alleged that both the Army and La Roche have an interest in declaring that Lariam has no connection to suicide, and said he worries that the military cannot conduct an unbiased investigation because it developed the drug. Stupak has long been critical of La Roche because he attributes the suicide of his 17-year-old son to another company product, the acne drug Accutane.
''Our military will say nothing is wrong with it because they developed it,'' he said. ''The hardest thing to do is to develop a drug and then admit you have a problem.'' Stupak called upon the Army and La Roche to fund an independent probe into Lariam.
In the Perry case, two doctors who treated Perry filed affidavits saying they found a link between Lariam and Perry's suicide. ''Mr. Perry's death is a direct and proximate result of the organic delusional disorder he suffered as a result of taking Lariam, and that Lariam therefore caused his suicide,'' according to the sworn statement of Dr. Melvin Gale, the director of psychiatry at Christ Hospital in Cincinnati. Gale did not return a phone call seeking comment.
There is little debate among public officials over the need for medication to prevent malaria, and federal officials said Lariam and other drugs have saved many thousands of lives. The question most recently has been whether Lariam is more dangerous than other antimalarials.
The mosquito-borne disease, common in tropical areas, causes an estimated 856,000 deaths worldwide each year. The Centers for Disease Control and Prevention says that in 1995, 591 cases of malaria were reported by US citizens, with 507 cases occurring in people who did not take drugs recommended by the CDC. There were six malarial deaths among US residents in that year.
A competing product, Malarone, is made by GlaxoSmithKline, which has been aggressive in suggesting that its drug is safer than Lariam. On Aug. 22, just as publicity about the Fort Bragg deaths was becoming widespread, the company issued a press release saying the Food and Drug Administration had determined that Malarone had ''fewer adverse events'' than Lariam.
As for the deaths in Fort Bragg, Army officials stressed that they are investigating the use of Lariam only as one of many possible links between the cases. Investigators from the Army's Office of the Surgeon General have spent this week at Fort Bragg interviewing people to determine who took the drug and whether soldiers understood the possible side effects. The four cases of deadly violence, all during June and July, were:
Green Beret Sergeant First Class Rigoberto Nieves, who fatally shot his wife and committed suicide two days after returning from Afghanistan.
Sergeant Cedric Ramon Griffin, accused of stabbing his wife and setting her body on fire.
Green Beret Master Sergeant William Wright, accused of strangling his wife.
Sergeant First Class Brandon Floyd, who killed his wife and committed suicide.
All of the men except Griffin served in Afghanistan.
Even if investigators determine that some of the soldiers took Lariam, it could be difficult to determine whether there is a link between the drug and the deaths.
At Fort Bragg, investigators were expected to ask whether soldiers were interviewed to determine whether they had mental problems before being given the drug. The company's Web site (www.lariam.com) says Lariam ''should be used with caution in patients with psychiatric disturbances.''
The Army said it provides written side-effect warnings ''to patients who request it,'' but contended that it had no record of how many soldiers, if any, refused to take the drug.
Michael Kranish can be reached at kranish@globe.com.
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