Feb. 13, 2005 12:00 AM
SAN DIEGO - As a volunteer firefighter, Georg-Andreas Pogany had seen disfigured bodies pulled from wrecked cars, but something different happened when the Army interrogator saw the mangled remains of an Iraqi soldier.
He became panicked, disoriented and that night reached for his loaded pistol and rifle as he thought he saw the enemy bursting into his room. Pogany asked superiors for help; the Army packed him home to face charges of cowardice, the first such case since Vietnam.
None of it made sense to Pogany until he learned more about the white pills the Army gave him each week to prevent malaria. The drug's manufacturer warned of rare but severe side effects including paranoia and hallucinations.
Pogany is among the current or former troops sent to Iraq who claim that Lariam, the commercial name for the anti-malarial drug mefloquine, provoked disturbing and dangerous behavior. The families of some troops blame the drug for the suicides of their loved ones.
The evidence is largely anecdotal, but stories have raised alarm in Congress, and the Pentagon has stopped giving out a pill it probably never needed to give to tens of thousands of troops in the first place.
"What are we doing giving drugs that cause hallucinations, confusion, psychotic behavior to people that carry weapons and hold secret clearances?" asked Pogany, 33, who is seeking a medical discharge. "It doesn't pass the common-sense test."
The U.S. military, which developed the drug after the Vietnam War, maintains that Lariam is safe and effective, though the military tells its pilots not to take Lariam.
In written guidance about the drug last year, the military urged commanders to send for a medical evaluation anyone who showed behavioral changes after taking the drug, "especially . . . if they carry a weapon."
That description fits nearly all U.S. troops in Iraq.
Lariam is among the drugs recommended by the U.S. Centers for Disease Control and Prevention for treatment and prevention of malaria, which kills 1 million or more people worldwide each year.
The drug's New Jersey-based manufacturer, Roche Pharmaceuticals, points out that 30 million people worldwide have used Lariam during the past 20 years.
"There is no reliable scientific evidence that Lariam is associated with violent acts or criminal conduct," Roche spokesman Terence Hurley responded to e-mailed questions.
Further blurring the issue, the side effects associated with Lariam closely mirror symptoms of stress disorders related to combat, making diagnosis difficult.
Still, the pill has dedicated critics who believe it's causing problems that are just beginning to be understood. A review by the Department of Veterans Affairs found 34 articles in medical journals about patients who took Lariam and became psychotic.
Doctors at the Naval Medical Center in San Diego have diagnosed a disorder in the region of the brain that controls balance in 18 service members who took Lariam.
Pentagon records show the number of Lariam prescriptions issued to active-duty personnel nearly doubled, from 18,704 in 2002 to 36,451 the next year, said Lt. Col. Stephen Phillips, a program director for deployment medicine. Prescriptions issued at remote locations aren't counted, so actual numbers may be higher.
FEWER SIDE EFFECTS
Shortly after the March 2003 invasion, military doctors determined another malaria drug would do the job with fewer side effects. Around the same time, the U.S. Food and Drug Administration announced that doctors should give patients revised information, underscoring that some Lariam users say they often think about killing themselves.
Military officials now concede Lariam wasn't needed in Iraq.
Troops sent to Kuwait in 1991 for Operation Desert Storm were given another anti-malarial, chloroquine. Before the Iraq invasion, the Armed Forces Medical Intelligence Center in Fort Detrick, Md., which is charged with evaluating medical risks, was concerned that a deadly malaria strain may have become resistant to chloroquine.
In March 2003, U.S. Central Command recommended the use of Lariam or another drug, doxycycline, in high-risk areas in Iraq.
Some commanders chose Lariam because it could be taken once a week rather than daily like doxycycline, whose side effects included sensitivity to sunlight. By July 2003, the military had determined the resistant strain wasn't in Iraq. Chloroquine then became the drug of choice.
Former Army Spc. Don Dills and his wife say he grew anxious, paranoid and depressed after taking Lariam for seven months in Iraq. Dills, 22, says he "went crazy" on a family visit to Mississippi last year and wound up jailed for robbery. When Dills' wife called her husband's first sergeant about the arrest, he told her: Look into Lariam.
"The bottom line is they know what's going on," said Elicia Dills, 25, of Pueblo, Colo. "They just don't know how to deal with the can of worms they opened."
Posted, The Arizona Republic: