- The Washington Times - Monday, August 5, 2002

Scores of Peace Corps volunteers say that over the past 12 years they have suffered crippling paranoia, anxiety, hallucinations, memory loss, suicidal behavior and physical ailments from seizures to vision difficulty because of the drug handed out by government doctors to prevent malaria.
Many of those affected were medically evacuated and some were hospitalized because of problems volunteers said were caused by Lariam, also called mefloquine. Others risked contracting malaria when they secretly violated Peace Corps rules and quit taking the drug because side effects bothered them. Some say that debilitating problems that began when they started taking the drug have continued for years after they stopped.
"This has been the big story among Peace Corps volunteers for 12 years," said Allen Hoppes, a volunteer in Mali, West Africa, in 1992. That was three years after the Peace Corps began using Lariam, which continues to be the organization's drug of choice.
"The Peace Corps told us if we did not want to take Lariam, we did not want to be Peace Corps volunteers," he said.
Mr. Hoppes secretly took only half a pill each week. He said Lariam caused paranoia and hallucinations, and he tried to kill a giant imaginary python prowling his floors and confronted a nonexistent intruder in his house one night.
"I thought he wanted to kill me," he said. "I think Lariam has too many side effects to be considered safe."
Lariam is a product of Hoffmann-La Roche, a giant Swiss pharmaceutical company with U.S. headquarters in Nutley, N.J. In addition to Peace Corps volunteers, U.S. soldiers including troops currently in Afghanistan State Department employees and civilian vacationers receive the drug, which has been prescribed to 22 million people worldwide since 1985. It was cleared for use in the United States in 1989.
In a recent two-month investigation of Lariam, United Press International reporters found evidence that the drug can cause mental problems so severe that in a small percentage of cases it has triggered suicide. Thousands of pages of internal Roche safety documents obtained by UPI showed the company tracking suicides and suicidal behavior and acknowledging that depression, which it said can lead to suicide, is a known side effect of Lariam.
The Food and Drug Administration (FDA) told UPI that no action was required because a link with suicide had not been proved, a position maintained by the drug company as well. The FDA also cited the effectiveness of the drug, which has cut cases of deadly cerebral malaria among Peace Corps volunteers by 71 percent since 1989. Lariam is used to prevent and treat malaria, which the FDA says kills 850,000 people a year, mostly children in Africa.
Former Peace Corps volunteers said the organization had denied Lariam could cause their health problems. UPI reporters interviewed 33 former volunteers and reviewed 83 e-mail messages from others. Nearly half of the Peace Corps' 7,000 volunteers face malaria risk and more than 83 percent are given Lariam to prevent the disease, according to Peace Corps medical data obtained by UPI. Many report no troublesome side effects from Lariam.
President George W. Bush has proposed doubling the size of the Peace Corps to some 14,000 volunteers.
Informed of UPI's findings, Sen. Christopher J. Dodd, Connecticut Democrat, chairman the subcommittee that oversees the Peace Corps and a former volunteer, said: "The potential side effects of Lariam that this investigation has uncovered are worrisome and should be looked into by independent medical experts to ensure that the health of Peace Corps volunteers is being adequately safeguarded."
Volunteers said they usually received their first pill during orientation in Philadelphia or Washington, just one day prior to departure to their posts. That startled a handful of the volunteers who had done their own research and learned that the manufacturer recommended taking the first dose one week before exposure to malaria.
Volunteers also said they were warned only that the pills could provoke vivid dreams. They said the Peace Corps downplayed possible side effects.
Volunteers with a history of mental problems, considered risky candidates for Lariam according to the drug label from Roche, were told to take their pills just like other volunteers.
The Peace Corps says it offers the antibiotic doxycycline as an alternative drug for volunteers who are not able to take Lariam. Some volunteers said the Peace Corps allowed them to switch. But many said they were not provided alternatives or were discouraged, cajoled or threatened into staying on mefloquine even as their side effects worsened.
Volunteers said that Peace Corps medical officials in the field dismissed complaints about the drug. They said doctors hired by the Peace Corps in the United States to treat volunteers who required emergency psychiatric evacuations would not discuss Lariam as a possible cause.
Russell Gerber, the chief of epidemiology at the Peace Corps, said there is no evidence that mental problems among volunteers are caused by Lariam. "We do get people who develop schizophrenia in the Peace Corps, but it is not associated with mefloquine," he said.
Steve Weinberg, associate director for volunteer support, noted that the Centers for Disease Control and Prevention (CDC) advises the Peace Corps on malaria prevention. He said the CDC "has been behind mefloquine pretty much 100 percent. They just love it. They are the leading expert, and we rely heavily on them."
After interviewing volunteers who said they had Lariam problems, UPI in May scheduled follow-up interviews with both Mr. Gerber and Mr. Weinberg, but Peace Corps spokeswoman Ellen Field canceled them.
Field and Peace Corps Director Gaddi Vasquez did not answer written questions from UPI or agree to interviews. "I want to get the Peace Corps out of this story," Ms. Field told UPI.
The Walter Army Institute of Research invented the drug, along with Roche. After it was approved, key studies of Lariam's safety and effectiveness were conducted on Peace Corps volunteers by the CDC, which reported that no serious side effects were observed and that psychiatric reactions were most likely due to travel stress or mental illness.
But among the more than 100 volunteers who contacted UPI with similar symptoms, several said their particular experiences show that travel stress and mental illness did not cause their problems.
Staci Bolton had been a volunteer for a year and a half in the Caribbean island of St. Lucia, where there is no malaria risk, when the Peace Corps gave her Lariam in the winter of 1998 for a two-week vacation to Venezuela.
She said the Peace Corps handed her the pills in a white envelope with no warnings, but that soon after she returned to St. Lucia she was hospitalized with vomiting, chills, sudden bouts of crying and weakness so bad she could not walk. She said she suffered intense anxiety and unexplained chest pain.
"I was convinced I was going to die," Ms. Bolton said.
She also said she nearly threw herself out a third-story window of the Peace Corps headquarters in St. Lucia while waiting to be evacuated to Washington.
"I remember thinking, 'I should jump off that balcony.' I saw huge, human-sized butterflies. I wasn't afraid of them. I don't know if I was thinking I should go after those butterflies or I don't know what I was thinking."
The Peace Corps sent Ms. Bolton to the Virginian Suites hotel just outside Washington, where the organization rents a block of rooms for volunteers who do not require immediate hospitalization. The Peace Corps also maintains a contract with the Psychiatric Institute of Washington to handle volunteers who do require immediate hospitalization for mental problems.
Ms. Bolton said that the doctor in the hospital in St. Lucia determined that Lariam might have caused her problems, but that the doctors the Peace Corps provided in Washington would not discuss the drug. Ms. Bolton said her medical chart from Washington says the cause of her problems was undetermined.
She said her symptoms cleared up soon after stopping Lariam, and she was able to return to service.
Another Peace Corps volunteer served in Lithuania in the early 1990s but said the considerable stress of his assignment caused no serious mental problems. The volunteer, who requested anonymity, later took Lariam on his own during a vacation to Zimbabwe two years ago and tried to commit suicide by overdosing on Xanax after taking his sixth pill of Lariam. He said he believes his suicide attempt "absolutely" was connected to Lariam.
Kevin Lee Croft, who served in Togo, West Africa, in 1992, also ruled out stress and said Lariam made him hallucinate plate-sized butterflies coming out of the walls of his house, and when he looked in the mirror, his face had no eyes. He says he suffered severe paranoia and still has troubling anxiety he thinks is left over from taking the drug.
Other volunteers said they believe Lariam caused their bizarre hallucinations and other harrowing reactions because symptoms would reappear when they started taking the drug again after a break.
The Peace Corps evacuated Leah Rabin from Burkina Faso, West Africa, in August 2001, after she hallucinated "man-sized spiders" on her bed at night and suffered depression she said was severe and triggered by Lariam. Ms. Rabin first had to stop taking Lariam in June 2000 after her third pill but the Peace Corps put her back on Lariam following a bout with malaria in November 2000.
Scientists consider the reappearance of symptoms once a drug has been restarted a strong indication of causality. The technical term is "re-challenge."
Two studies on Peace Corps volunteers by the CDC in the 1990s showed no problems from the drug.
Peace Corps volunteers said the CDC's findings were wrong, mostly because people lied and did not take the drug or tinkered with the dosage.
Mark Ames, who served in Benin, West Africa, from 1992 to 1995 when one CDC study was ongoing, said he heard at the time he was part of a study.
"If there was one, then it is absolutely useless. Nobody was taking it the way they were supposed to," he said, noting that 30 percent to 40 percent of volunteers cut the pill in half, quit taking it or otherwise secretly adjusted the prescribed dose. "Everybody had their own modification of it."

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