Nyt fra USA
Voice of America News bragte den
6. april 2001 en opsigtsvækkende historie, hvori beskadigelse
af hjernen pga lariam bliver omtalt og dokumenteret :
by Carolyn Weaver
INTRODUCTION: April seventh marks World Health Day
a day the World Health Organization selects to highlight a
public health issue. We're going to take this opportunity
to highlight a highly dangerous infection--malaria--which
still threatens the health of millions. But, ironically, some
say the cures may be as devastating as the disease itself.U.S.
health officials say the drug "Lariam" has prevented
millions of infections, especially in countries where malaria
is resistant to other drugs. But in some people, the drug
causes severe neuro-psychiatric side effects. VOA's (Voice
of America) Carolyn Weaver reports on a life-saving medicine
that may also be a prescription for "unintended damage."
NARRATOR Kristi Anderson was a federal criminal investigator
when she traveled to South Africa on vacation in 1991. To
protect her against malaria -- a potentially fatal disease
carried by mosquitoes -- Ms. Anderson's doctor prescribed
a drug called mefloquine, sold in the United States under
the brand name Lariam. After the third pill, she began having
constant dizziness, nausea, and panic attacks.
KRISTI ANDERSON "I would sweat, I would have chills,
I'd shake. Almost, always, there was nausea, but sometimes
it was a wave of dizziness or vertigo, and then I would start
having this feeling of impending doom. I wanted to get out
of where I was, I just wanted to get back home or someplace
where I felt safe because I was afraid something terrible
NARRATOR Nauseated and losing weight -- and tormented
by anxiety and phobias -- Kristi Anderson quit her job and
moved back home to California for a year and a half, until
she was well enough to go back to work. But in 1996, she returned
to South Africa - and again took Lariam - and again became
violently ill. Only then did she begin to suspect the drug
was the cause.
KRISTI ANDERSON "He said the damage was in my
NARRATOR Neurological tests at Stanford University's
California Ear Institute, confirmed Kristi's suspicion finding
damage to a part of the brain, the vestibular system, that
KRISTI ANDERSON "He told me, from the Lariam patients
he had seen and what his tests showed, he believed that Lariam
was the cause of my vestibular problems and he thought it
was the cause of the earlier problems as well."
NARRATOR A spokesman for the Roche pharmaceutical company,
which makes Lariam, declined VOA's requests for an interview,
saying the company saw no advantage to participating. In the
12 years since Lariam was approved for use in the United States,
Roche has twice added new warnings of possible adverse effects
in the package insert given to doctors. It's a long list,
including, among other things, nausea, vomiting, dizziness,
convulsions, depression, hallucinations, psychotic or paranoid
reactions, and anxiety. But few patients ever see the package
insert. And many tropical health and travel doctors, like
former State Department consultant Martin Wolfe, prescribe
Lariam routinely. They're acting on the guidance of the Centers
for Disease Control and Prevention, which recommends Lariam
as one of the most effective drugs for preventing malaria.
It's a disease endemic in many parts of Africa and Asia, where
it kills more than one million people, most of them children,
MARTIN WOLFE "We do prescribe it very frequently
because it only has to be taken once a week, and we believe
the compliance is better with a drug taken once a week than
one taken daily. And since we are protecting against a potentially
life threatening illness, we want to do the very best we can
to encourage people to take their medication."
NARRATOR It's impossible to pin down the incidence,
but some experts say the rate of severe reactions is far higher
than the one in ten-thousand cited in early research by Roche.
A study presented at an infectious disease conference last
fall reported mild to serious neuropsychiatric adverse effects
in 29% of travelers on Lariam.
RAYMOND WOOSLEY "There are some very serious reactions
that appear to be happening more commonly."
NARRATOR Dr. Raymond Woosley is the head of pharmacology
at Georgetown University in Washington, D.C.
RAYMOND WOOSLEY "You look in the package insert,
they're listed there. So they are real, there is no doubt
about that. But the true incidence is something we don't understand,
and it really doesn't matter, because they're such severe
reactions that patients need to be warned about this."
NARRATOR Colonel Wilbur Milhous was among the military
scientists who first developed Lariam at the Walter Reed Army
Institute for Medical Research -- and then gave the rights
to make and sell the drug to the Roche company. But as reports
of severe reactions to Lariam began to emerge -- and as lawsuits
were filed over illness and violence allegedly linked to the
drug -- he says the government feared that Roche would pull
the drug off the market.
WILBUR MILHOUS "There was clearly an unmet medical
need which the drug fulfilled. We were frightened from a U.S.
perspective, in terms of national contingencies, what would
happen if it were withdrawn?"
NARRATOR So, Colonel Milhous says, top government health
officials promised Roche they would continue to back Lariam,
despite the growing reports of adverse effects. Officials
at the Centers for Disease Control and the Food and Drug Administration,
which approved the Lariam, declined VOA's request for an interview.
But earlier this year, the CDC updated its malaria protection
guidelines, offering alternative drugs, including doxycycline
and Malarone, for those who do not wish to take Lariam.
WILBUR MILHOUS "This is essentially the type of
laboratory where this all started."
NARRATOR Colonel Wilbur Milhous says American health
officials now are looking ahead, to the next generation of
drugs --largely because of growing resistance to Lariam in
some strains of malaria. But there is little doubt that Lariam
will continue to be prescribed for months
and years to
come, to Peace Corps volunteers, soldiers, and ordinary travelers.
Despite bouts of dizziness, Kristi Anderson has resumed her
career, and tends her California flower farm on weekends.
She says she's felt more at peace since she came upon a newspaper
article about Lariam that explained her mental symptoms.
KRISTI ANDERSON"Reading that article released
me from this shame of 'Kristi, you're some kind of weak person
and you better watch out because you're going to have a nervous
breakdown again sometime, you just better be careful. I realized,
that's what made me sick -- that's what happened to me
that's why I became a different person."
NARRATORCarolyn Weaver, VOA-TV.
Fra Lariam Action i USA
Dear friends of Lariam Action, In the past two weeks we
have sent out 80 press kits to major newspapers in the
US, news services, tv and radio stations, and selected
personal contacts. The kits contained :
1) a press release (below),
2) Escape magazine article, July 1999
3) copy of a message posted to the Peace Corps bulletin
board about the Escape article,
4) our Lariam Action brochure, "Facts about malaria
and anti-malaria drugs."
Thought you would be interested in this information. Thanks!
* * * *
June 15, 1999 For Immediate Release Contact Jeanne Lese,
Information Blackout about Lariam's
Side Effects Outrageous
OAKLAND, CAThe U.S. media have been silent for too
long about the damaging side effects of Lariam® (mefloquine,
Roche Pharmaceuticals), asserts Lariam Action USA. And
the drug manufacturer's failure to fully disclose in the
U.S. information about Lariam's side effects makes the
information blackout blacker. Charmian Cohen, director
of the organization and a Lariam victim herself, wants
to shine some light on this dark situation.
Lariam is the most widely prescribed antimalaria drug in
the world. According to Hans Lobel, MD, of the Centers for
Disease Control (CDC), at least 12 million people have taken
Lariam, which was introduced in the U.S. in 1989. Although
no one knows exactly how many people have suffered serious
adverse effects from this drug, London's Malaria Advisory
Services to Travellers Abroad (MASTA) estimates conservatively
that more than 60,000 people could be affected with temporarily
disabling neuropsychiatric side effects from Lariam.(1)
Lariam can cause a wide range of dramatic, long-lasting physical
and mental side effects. Its physical side effects may include
transient to persistent dizziness, insomnia, gastrointestinal
problems, severe headache, muscle problems, weakness, and
overwhelming fatigue. Lariam's neuropsychiatric side effects
may include panic attacks, suicidal ideas, hallucinations,
terrifying nightmares, lingering psychoses, and severe, sustained
depression. Most side effects occur after the ingestion of
1 to 4 tablets. Even one pill can cause immediate and long-term
damage. There is no way to predict who will react to Lariam.
And because of the lack of awareness about Lariam in this
country, many people who suffer from its side effects are
Lariam Action USA's new website supplies much of the missing
information American doctors need. Physicians in other countries
are better informed about Lariam and are much more cautious
about its use. Cohen states, "We provide the U.K.s
patient product information because the U.S. version is badly
out of date. We have direct links to the U.K.'s 'Guidelines
for the Prevention of Malaria,' the MASTA study, other independent
medical studies, articles, websites, and other important Lariam
Over the past two years, Lariam Action USA has heard from
nearly 500 people reporting significant Lariam side effects.
Cohen observes, "Lariam is given to healthy people who
want to avoid getting malaria. We are told how effective Lariam
is at preventing the disease, but we hear nothing about its
dark side. After you've suffered a severe toxic Lariam reaction
firsthand, and compared horror stories with others with similar
experiences, you develop a sense of outrage. Enough is enough.
No one else should have to endure this suffering."
Despite mounting reports of serious Lariam reactions and
litigation against the manufacturer, the media in America
have ignored the Lariam story. Two notable exceptions are
"Malaria's Not So Magic Bullet" in ESCAPE magazine,
July 1999, and "Some Find Malaria Drug Worse Than the
Disease," San Francisco Examiner, May 17, 1998 (both
online). In other countries however there is no Lariam blackout.
Ireland and Denmark have had extensive media coverage about
Lariam in 1999. Lariam documentaries were aired in the U.K.
in199697 and in Canada in 1997. MP John Cummins' investigation
of the use of Lariam by Canadian troops in Somalia has been
widely reported in the Canadian press. Many attribute the
soldiers uncharacteristic violence in that war to psychotic
side effects of Lariam.
Det australske TV program Insight er udsendt nationalt
samt genudsendt dagen efter. Sheldon Johnston er fra
den australske patientforening. Han har fået SÅ
mange henvendelser efter udsendelsen, at han er ved at drukne,
henvendelser både fra lariam-ofre og fra læger
- og fra Roche.
Her er hele udsendelsesteksten:
Lariam - A Bad Trip
Insight, Thursday February 17th, 2000
Reporter: Alan Sunderland
EACH YEAR AT LEAST THREE MILLION AUSTRALIANS HEAD OFF OVERSEAS...ON
BUSINESS, ON HOLIDAYS, OR TO VISIT FRIENDS AND RELATIVES.
ALMOST ONE IN THREE OF THESE TRAVELLERS FLY TO EXOTIC AND
DANGEROUS DESTINATIONS... THE BACKBLOCKS OF ASIA, THE JUNGLES
traveller: "Have you got your passport? Where are
you flying to? Harare? Okay, have you got your passport and
ticket there please. Yes I do"
BUT WHAT MANY DON'T REALISE IS THAT ONE THE BIGGEST DANGERS
THEY COULD FACE IS FROM SOMETHING THEY'RE CARRYING WITH THEM.
A DRUG, DESIGNED FOR THEIR PROTECTION, THAT'S DRIVING SOME
PEOPLE INTO DEEP DEPRESSION, HALLUCINATIONS, THOUGHTS OF SUICIDE,
EVEN SELF-MUTILATION...ALMOST FIVE YEARS AGO, SHELDON JOHNSTON
WAS ONE OF THOSE AUSTRALIANS OFF TO SEE THE WORLD. A FIT,
ADVENTUROUS YOUNG MAN AND A SEASONED TRAVELLER, HE WAS ABOUT
TO EMBARK ON A SEVEN MONTH ADVENTURE IN AFRICA...
Sheldon Johnston: "I was on an overland truck
trip going through Africa., I started in London..."
BEFORE HE LEFT LONDON, SHELDON WAS CAREFUL TO GET ALL THE
ROUTINE MEDICAL PROTECTION HE NEEDED, INCLUDING ANTI-MALARIALS...
Sheldon Johnston:"I didn't really even see a doctor,
I just saw a practice nurse whose job it was to jab me with
a needle and send me on my way with a prescription."
THAT PRESCRIPTION WAS ABOUT TO TAKE SHELDON JOHNSTON ON A
JOURNEY INTO HELL....
Sheldon Johnston: "I thought my body was just
adjusting and I'd gotten through it after a week, but one
little illness after another, what I mistakenly thought was
a cold, dehydration sickness, what was misdiagnosed as malaria
and typhoid, all along the way I visited five hospitals in
Nigeria and Cameroon."
EVENTUALLY, SHELDON SUFFERED A SEIZURE IN THE WILDS OF CAMEROON,
AND FINISHED UP, EMACIATED AND EXHAUSTED, IN YET ANOTHER TINY
Sheldon Johnston: "So I was on a drip overnight
in this small village hospital, and I would say that I was
gravely ill at that stage. I think a few of my travel companions
in hindsight were actually afraid that I was going to die..."
WE MOVE FORWARD A YEAR NOW, TO 1996. ANOTHER YOUNG AUSTRALIAN
ON ANOTHER DREAM HOLIDAY IN AFRICA....
Lesley Gidding: "I just wanted to backpack around
East Africa, and so I landed in Zimbabwe and worked my way
up to, through Malawi, Tanzania, Kenya and Uganda, and I worked
in Tanzania and then headed off to Kenya and Uganda"
LESLEY GIDDING ALSO GOT ALL HER VACCINATIONS AND HER ANTI-MALARIALS.
AND, LIKE SHELDON, HER TRIP WAS ABOUT TO TURN INTO A NIGHTMARE...
Lesley Gidding: "I remember, actually I was reading
my journal last night to remind me of how I was feeling at
that time, and I was writing that my head was spinning, and
that I was in this haze, and I didn't quite under stand where
I was or what was happening to me and I was really scared"
Lesley reading: "16th March 1997. I'm tired, numb
and hazy headed. I'll probably maybe if I can write again
when things become clearer." "I don't feel anything.
Nothing. Absolutely nothing feels real to me at the moment,
and hasn't done for a long long time."
A VIDEO SHOT BY LESLEY'S FRIENDS AT THE TIME SHOW HER PUTTING
A BRAVE FACE ON HER AFRICAN HOLIDAY, BUT BEHIND THE SCENES
THINGS WERE VERY DIFFERENT...LESLEY HAD BOUTS OF FEVER, FLU-LIKE
SYMPTOMS AND VOMITING. BUT THAT WAS NOTHING COMPARED TO WHAT
HER MIND WAS GOING THROUGH..
Lesley Gidding: "I went into this really weird,
I won't call it a depression, but it was more like anxiety
and paranoia. I really thought that people were following
me, I really thought that people were going to hurt me."
MONTHS EARLIER, IN A DIFFERENT PART OF AFRICA, SHELDON JOHNSTON
HAD BEEN EXPERIENCING THE SAME MENTAL SYMPTOMS ALONG WITH
HIS PHYSICAL SUFFERING...
Sheldon Johnston: "It was like there was a fog
over my brain, and wading through glug just trying to keep
my eyes open.""I was also very depressed for no
reason, but, to the point where I realised it was madness,
there was just no reason behind it, I was almost so, of, errrr,
shake my head and think, no I'm not really that sad about
being here on holiday and having a good time, you know."
EVENTUALLY, SHELDON BECAME SO SICK HE WAS FLOWN TO LONDON.
AT THE HOSPITAL FOR TROPICAL DISEASES IN KINGS CROSS, THE
CAUSE OF HIS ILLNESS WAS FINALLY DISCOVERED...
Sheldon Johnston: "After waiting, I was seen by
a doctor, after about fifteen minutes of consultation, he
was very quick to deduce that I'd probably had mefloquine
MEFLOQUINE... MARKETED AROUND THE WORLD UNDER THE BRAND NAME
LARIAM. IT'S A HIGHLY EFFECTIVE PREVENTION AND TREATMENT FOR
MALARIA. BUT THERE'S A CATCH.WHEN SHELDON ARRIVED BACK IN
SYDNEY, AN EMACIATED AND SICK MAN, HE'D DISCOVERED FROM BITTER
EXPERIENCE THAT LARIAM CAN CAUSE SEVERE NEURO-PSYCHIATRIC
SIDE EFFECTS IN SOME USERS....AS HE BEGAN THE SLOW RECOVERY
FROM HIS BOUTS OF DEPRESSION AND SICKNESS, SHELDON DECIDED
TO RECORD HIS EXPERIENCE FOR OTHERS, AND RESEARCH THE PROBLEMS
Sheldon Johnston: "I started typing out the details
of what happened, and that developed into what became a web-site,
it wasn't really intended that way.""I very naively
put my e-mail address on there, hoping that someone might
come back to me and just share their experience."
IT WAS LIKE OPENING THE FLOODGATES. DOZENS OF PEOPLE SENT
IN MESSAGES. THOSE DOZENS TURNED INTO HUNDREDS...
Sheldon Johnston: "When that response came back,
my in-box was just inundated. I had to take my e-mail address
LESLEY GIDDING HAD RETURNED FROM AFRICA UNAWARE OF THE REASON
FOR HER MENTAL AND EMOTIONAL PROBLEMS. SHE WAS STILL BATTLING
DEEP DEPRESSION AND ANXIETY ATTACKS...
Lesley Gidding: "I described it as my really dark
place and I didn't know how to get out. I was just, life was
way too bad."'I was thinking life is too much, I'd really
like, you know, I'm not saying that I had suicidal tendencies
but I thought about it."
AFTER NEARLY TWO YEARS SUFFERING IN IGNORANCE, LESLEY LOOKED
UP MALARIA ON THE INTERNET ONE DAY, AND FOUND SHELDON'S SITE...
Lesley Gidding: "And I started reading these things
and this was in the middle of this depression and I was seeing
a therapist, and I just started crying when I was reading
what other people had said on Sheldon's page, because for
the first time in all these years, I thought, these people
are going through exactly what I went through, and it was
amazing it was just this, like a light came on...""I'm
not bent, I'm not twisted, its lariam."
SO, IF IT'S THE LARIAM, IF TAKING A COMMONLY PRESCRIBED DRUG
CAN CAUSE THAT MANY HEALTH PROBLEMS, THE OBVIOUS QUESTION
IS WHY IS IT STILL BEING PRESCRIBED? WHY IS IT STILL BEING
TAKEN BY THOUSANDS OF AUSTRALIANS EVERY YEAR?THE FIRST POINT
TO MAKE IS THAT MALARIA IS A VERY SERIOUS HEALTH PROBLEM.
TWO AND A HALF MILLION PEOPLE, HALF OF THEM CHILDREN UNDER
FIVE, DIE FROM THE DISEASE EVERY YEAR, AND THE RATE IS RISING.
ANY DRUG THAT CAN OFFER PROTECTION TO TRAVELLERS IS WELCOMED
WITH OPEN ARMS BY THE MEDICAL ESTABLISHMENT...THE ARMY MALARIA
INSTITUTE IN QUEENSLAND IS ONE OF AUSTRALIA'S LEADING CENTRES
FOR MALARIA RESEARCH...
Army researcher : "We've collected some mosquitoes
from overseas, and what we have to do, we have to dissect
the mosquitoes, remove the salivary glands, and also the head."
THE MALARIA PARASITE BECOMES RESISTANT TO MORE AND MORE DRUGS
ALL THE TIME. LARIAM EMERGED ABOUT TEN YEARS AGO AS A NEW
AND QUITE EFFECTIVE WEAPON AGAINST MALARIA, PARTICULARLY IN
DRUG RESISTANT REGIONS....
Col. Mike Epstein: "Yes, it is a good drug, there
is no doubt about that, and it has been responsible for saving
many many lives."
FOR THAT REASON, LARIAM IS ONE OF THE TWO DRUGS MOST COMMONLY
PRESCRIBED FOR AUSTRALIANS TRAVELLING TO MALARIA PRONE AREAS...
Doctor & patient: "Christine this looks like
a fantastic trip you're about to do, you've got a nice long
trip, too...""We have a choice between two medicines,
medications. The first one is an antibiotic called doxycycline,
and the second one is not an antibiotic called mefloquine,
trade name lariam.""You have problems with antibiotics?
Okay, that says to me that probably we should be focussing
on the issue of lariam."
Dr Tony Gherardin: "Mefloquine is one of our mainstays
as you are aware for malaria prophylaxis against chloroquine
resistant malaria, so it is a very useful tool and one of
the two major choices for the high risk areas."
BUT WHAT ABOUT THE WORRYING SIDE-EFFECTS? THE SORT OF MENTAL
AND PHYSICAL HEALTH PROBLEMS EXPERIENCED BY PEOPLE LIKE SHELDON
AND LESLEY. WELL, FOR A LONG TIME, THE ARGUMENT HAS BEEN THAT
THOSE SERIOUS SIDE EFFECTS ARE EXTREMELY RARE...
Dr Tony Gherardin: "The number of people who need
to withdraw from mefloquine is not that high."Col, Mike
Epstein: "Now these side effects are relatively rare,
it occurs in about one in ten thousand cases."
HOFFMAN LA ROCHE, THE COMPANY THAT MAKES LARIAM, HAS ALWAYS
ACKNOWLEDGED THAT THE DRUG CAN HAVE NASTY SIDE EFFECTS.IN
THE FIRST FEW YEARS OF ITS USE, THE COMPANY'S OWN MONITORING
OF THOSE EFFECTS INCLUDED REPORTS OF CONVULSIONS, SEVERE DEPRESSION,
ATTEMPTED SUICIDE, HALLUCINATIONS AND PSYCHOTIC EPISODES.THE
CONCLUSION, HOWEVER, WAS THAT THEY WERE EXTREMELY RARE, PERHAPS
ONE IN TEN THOUSAND. BUT SINCE THEN, THINGS HAVE CHANGED...AS
EARLY AS 1993, QUESTIONS WERE BEING ASKED ABOUT THE BEHAVIOUR
OF CANADIAN SOLDIERS IN SOMALIA, AFTER AN OUTBREAK OF AGGRESSIVE
BEHAVIOUR, AND THE KILLING OF TWO SOMALI TEENAGERS.THE TROOPS
WERE TAKING LARIAM, BUT NO CONCLUSIVE LINK WAS EVER ESTABLISHED.SINCE
THEN, HOWEVER, A GROWING BODY OF OVERSEAS RESEARCH HAS POINTED
TO A MUCH HIGHER RATE OF SIDE EFFECTS WITH LARIAM THAN ANYONE
IMAGINED.MOST IMPORTANTLY, THIS STUDY PUBLISHED IN THE BRITISH
MEDICAL JOURNAL MORE THAN TWO YEARS AGO SURVEYED TRAVELLERS
TAKING LARIAM.IT FOUND THAT ONE IN EVERY 140 TRAVELLERS WILL
EXPERIENCE A NEURO-PSYCHIATRIC SIDE EFFECT BAD ENOUGH TO INTERRUPT
THEIR DAY TO DAY ACTIVITIES. ONE IN SIX HUNDRED WILL FINISH
UP IN HOSPITAL.
WE TRIED TO TALK TO HOFFMAN LA ROCHE ABOUT THESE NEW STUDIES,
AND ABOUT HOW SAFE THEY CONSIDERED LARIAM TO BE. BUT THE COMPANY'S
AUSTRALIAN PRESIDENT SAYS THEY CAN'T COMMENT, BECAUSE THEY'RE
INVOLVED IN LEGAL ACTION OVERSEAS IN RELATION TO THE DRUG.
INSIGHT HAS LEARNED THAT HUNDREDS OF PEOPLE IN THE UNITED
STATES AND BRITAIN ARE TAKING LEGAL ACTION OVER THE SIDE-EFFECTS
OF USING LARIAM.IN THE MEANTIME, TRAVELLERS ARE STILL HEADING
OVERSEAS, AND THEY'RE STILL BEING PRESCRIBED LARIAM. THERE
HAVE BEEN REGULAR CALLS FOR MORE DETAILED STUDIES TO CONFIRM
EXACTLY WHAT'S GOING ON, BUT THAT RESEARCH HAS NEVER BEEN
Dr. Bernie Hudson: "It's very difficult. The answer
as far as adverse reactions and the rates is probably somewhere
between one in 140 and one in 10,000.""I think the
article from the UK probably didn't get as much exposure to
doctors here in Australia."
Dr Tony Gherardin: "I believe mefloquine is a
drug that does have a rate of nuisance and perhaps even more
than nuisance side effects. That rate is poorly defined, there
is no doubt. You would be aware the studies are not helpful
in this area."
AS AN EXPERT IN TRAVEL MEDICINE, TONY GHERARDIN IS AT LEAST
ABLE TO PROPERLY WARN PEOPLE OF SOME OF THE MORE SEVERE SIDE
EFFECTS, AND WATCH FOR ANY PROBLEMS...
Doctor & patient: "So, there's the tablet,
and there's the instructions, you read up on those, and I
want you to take one a week for the three doses, and then
we'll talk about how you got on with those."
BUT WITHOUT DEFINITIVE EVIDENCE, AND WITHOUT A PUBLIC DEBATE
IN AUSTRALIA TO MATCH THE ONE OVERSEAS,AUSTRALIAN DOCTORS
GENERALLY ACCEPT THAT MOST OF THE SIDE EFFECTS FROM LARIAM
ARE MILD AND MANAGEABLE...
Doctor & patient: "It does have a relatively
high rate of some minor side effects. Which ones? Dizziness
can occur, and that's quite common, sometimes weird dreams
or vivid dreams, now some people say that's tremendous, but
it can be a little off-putting if you first take it, and also
sometimes there can be the issues of mood swings, and some
people do, particularly young women, can feel a bit depressed
BUT THE PEOPLE WE'VE SPOKEN TO SAY THE SYMPTOMS THEY SUFFERED
WEREN'T MINOR, THEY WEREN'T MERELY OFF-PUTTING, AND THEY WERE
MUCH, MUCH MORE THAN A "NUISANCE"...
Lesley Gidding: "I remember waking up every now
and then and having a shower because I was dripping wet, and
then going back to bed and it was awful, it was probably the
worst thing I've ever been through physically."
Sheldon Johnston: "I wouldn't say that I've ever
been the same person since. I guess anybody who's been through
that sort of experience wouldn't come out the same person."
DR ANDREW FULLER AT MELBOURNE'S ALFRED HOSPITAL KNOWS JUST
HOW SERIOUS THE REACTION TO LARIAM CAN BE...
Dr. Fuller: "Well, how are you getting on David,
what sort of symptoms have you had in the last couple of weeks?"
"David": "Oh, I'm pretty down, I'm not
as bad as I was before Christmas, all the spate of attacks
I had from October onwards I was fairly suicidal again, but
I'm not as bad as I was then, but I'm still always on that
morbid thought level."
DAVID HAS SUFFERED BOUTS OF DEPRESSION, ANXIETY AND NERVOUS
TREMORS FOR TEN YEARS AFTER BEING GIVEN LARIAM...
Dr. Fuller: " He describes the classic, what I
think are the classic symptoms of waves of symptoms every
three or four weeks."
DAVID IS AN EXTREME CASE, BUT ANDREW FULLER HAS NOW SEEN NINE
PATIENTS WHO'VE SUFFERED DEPRESSION FOR UP TO THREE YEARS
AFTER TAKING LARIAM...
Dr. Fuller: "Mefloquine is a tissue drug. It penetrates
into fatty tissues like the brain, the liver and so forth,
which I think explains why it takes such a long time for these
patients to get better."
SHEREE YEOMANS IS ANOTHER OF DR FULLER'S PATIENTS. SHE WAS
GIVEN LARIAM ON A TRIP TO AFRICA, AND SPENT YEARS RECOVERING
FROM THE EFFECTS...
Sheree Yeomans: "I was just, yeah, severely depressed,
very angry and aggressive. Obviously angry, number one, because
of how I felt, but secondly that this drug can be given so
easily and just disrupt my life when I was in such a happy
period of my life."
THE ANTI-DEPRESSANTS SHEREE HAD TO TAKE MEANT HER PLANS TO
START A FAMILY HAD TO WAIT THREE YEARS UNTIL SHE RECOVERED.
HER HUSBAND SAYS THE DRUG CHANGED HER COMPLETELY...
Trevor Dove: "You know it was just scary, just
the difference it made, you know her attitude and aggression
and then the next minute she'd be totally within herself,
withdrawn and the weirdest thing I've ever seen."
SHEREE AND MARK ARE BY NO MEANS THE WORST CASES ANDREW FULLER
Dr. Fuller: "I've had a patient, for instance,
who thought he was Jesus Christ, and got up on a table in
a foreign country, in Vietnam in fact, and really did think
he was Jesus Christ and needed some haloperidol to calm him
MANY OF THE DOCTORS WHO KNOW AND UNDERSTAND THE PROBLEMS OF
LARIAM SUGGEST THAT THESE WORRYING SIDE EFFECTS ARE BEING
UNDER-REPORTED , BECAUSE THEY'RE MENTAL AND PSYCHOLOGICAL,
RATHER THAN PHYSICAL...
Dr. Hudson: "Modern medicine often doesn't have
very good tools for objectively evaluating some of those adverse
events. So the person that says I don't know what it was,
doc, but I just don't feel right might pass with flying colours
on all the tests that are done, but they'll just say I'm never
going to take that drug again, because I know that I just
didn't feel well."Dr. Fuller: "When you prescribe
mefloquine, I think you should say if you get any, when you
have the first dose, before you leave Australia, when you
have the first dose, if you have any dizziness or any funny
feelings in the head, or anything odd in the head, please
stop, do not take any more and consult your doctor."
DESPITE ALL OF THAT, THERE ARE STILL THOSE WHO BELIEVE THAT
THE SIDE-EFFECTS FROM LARIAM USE ARE TOO RARE TO WORRY ABOUT,
BUT THE AUSTRALIAN ARMY IS NOT AMONG THEM.THE DRUG IS NOT
RECOMMENDED FOR USE BY AUSTRALIAN TROOPS OVERSEAS. OUR
SOLDIERS IN EAST TIMOR ARE, WHEREVER POSSIBLE, USING AN ALTERNATIVE
DRUG, DOXYCYCLINE.AND THE VERY SAME ARMY MALARIA INSTITUTE
THAT CALLS LARIAM A GOOD DRUG THAT CAN SAVE LIVES ALSO SAYS
IT DOESN'T WANT SOLDIERS USING IT...
Col. Epstein: "We are concerned with the severe
cases that have been associated with the use of mefloquine
from a side-effect point of view.""Depression, anxiety,
vivid dreams, they ARE serious, and we would prefer our soldiers
and all ADF personnel not to come up against those type of
IN OTHER WORDS, ITS TOO DANGEROUS TO GIVE TO TRAINED SOLDIERS
HEADING OVERSEAS ON ASSIGNMENT, BUT SAFE ENOUGH TO GIVE TO
TOURISTS.AND THE ARMY ISN'T THE ONLY PROFESSIONAL ORGANISATION
A LITTLE CONCERNED ABOUT LARIAM...
Medicin Sans Frontiers workers talking together: "I
think she has gone for a year in Yemen, and now its 1,2,3,4,5,6,7,
Australian people in East Timor"
MEDICIN SANS FRONTIERS IS ONE OF THE WORLD'S LEADING HUMANITARIAN
AID ORGANISATIONS. IT SENDS THOUSANDS OF DOCTORS, NURSES AND
OTHER MEDICAL STAFF AROUND THE WORLD EVERY YEAR. AMONG ITS
MANY REGULAR HEALTH PROGRAMS IS A RANGE OF PROJECTS TO FIGHT
MALARIA IN DEVELOPING COUNTRIES...
Jean-Yves De Lemps: "A child dies every thirty
seconds of malaria, so its first, one of the first priorities
of MSF just a big battle against malaria."
BUT EVEN MEDICIN SANS FRONTIERS , WITH ITS FOCUS ON FIGHTING
MALARIA, HAS EXPERIENCED FIRST HAND THE SERIOUS PROBLEMS ASSOCIATED
Jean Yves de Lemps: "Yes, I guess we very commonly
get some reports about people who have some problems, side
effects about mefloquine in the field, so we send more than
two thousand people a year and we get a lot of reports that
people can be feeling very uncomfortable with mefloquine."
SO COMMON IS THE EXPERIENCE, THAT THE AUSTRALIAN BRANCH OF
MEDICIN SANS FRONTIERS HAS HAD TO SEND TWO PEOPLE BACK FROM
THE FIELD IN THE LAST COUPLE OF MONTHS. THE FIRST WAS AN AUSTRALIAN
MIDWIFE SENT TO MALAWI..
.Jean Yves de Lemps: "After a week she started
to feel a lot of anxiety and she had some panic attacks and
she was not able to work properly, and she got completely
lost. She didn't know what she had to do and why she was here,
and after twelve or thirteen days she was really depressed
and she start to speak about suicide, and we had an obligation
to send her back home."
THE SECOND CASE WAS A FIFTY YEAR OLD SURGEON FROM EUROPE,
SENT TO EAST TIMOR. HE SUFFERED FROM SIMILAR SYMPTOMS....
Jean Yves de Lemps: "We sent him back with a nurse
with him, and he has been welcomed by a psychiatrist in Europe
when he went back. And he has been working for more than thirty
years as a surgeon in Europe and he never had any problem
THE ORGANISATION NOW ADVISES ITS VOLUNTEERS TO THINK VERY
CAREFULLY ABOUT WHAT MALARIA PROTECTION THEY CHOOSE, AND IF
ITS LARIAM, TO MONITOR THEIR REACTION VERY CAREFULLY. BUT
JEAN-YVES HIMSELF, WHO HAS SPENT FIFTEEN YEARS TRAVELLING
FOR MEDICIN SANS FRONTIERS, HAS DRAWN HIS OWN CONCLUSIONS...
Jean-Yves de Lemps: "I never took any mefloquine
because I knew there was some bad side effects with mefloquine."
THE MEDICIN SANS FRONTIER EXPERIENCE UNDERLINES A PARTICULARLY
WORRYING TREND WHEN IT COMES TO LARIAM. THE PEOPLE WHO KNOW
A LOT ABOUT IT TEND TO AVOID IT. BUT IN AUSTRALIA, TOO
FEW PEOPLE SEEM TO KNOW A LOT ABOUT IT.MOST OF THE EXPERTS
INSIGHT SPOKE TO DIDN'T USE IT AS A FIRST CHOICE DRUG...
Dr. Andrew Fuller: "I still have prescribed lariam,
mefloquine, in recent times, although I must admit I probably
prefer to prescribe doxycycline or cholorquine and proguanil
because of my experience."
Dr. Tony Gherardin: "I personally have a preference
to steer towards doxycycline."
BUT FOR EVERY DOCTOR WHO KNOWS AND UNDERSTANDS THE RISKS OF
LARIAM USE, THERE ARE MANY MORE WHO DON'T...
Dr. Bernie Hudson: "There's probably pockets of
doctors out there and members of the public who are very well
aware of the adverse reaction to lariam and the caution that
should be used, and others who maybe aren't as aware."
GEORGINA COLE SAYS SHE DEFINITELY WASN'T AS AWARE AS SHE SHOULD
HAVE BEEN. SHE WAS OVERSEAS WHEN WE STARTED RESEARCHING THIS
STORY, AND ARRIVED HOME JUST A COUPLE OF WEEKS AGO...
Georgina Cole: "I went to South America, Ecuador,
Bolivia, Peru, Chile and Argentina, 24 of us altogether and
three of us were taking lariam."
SO WHAT ADVICE WAS SHE GIVEN BEFORE SHE LEFT?
Georgina Cole: "None. No information whatsoever,
they just simply asked had we taken it before, did you have
any problems, and that was it."
DEEP IN THE JUNGLES OF ECUADOR, AND ALONG THE TRIBUTARIES
OF THE AMAZON, GEORGINA EXPEREIENCED THE FAMILIAR SIDE EFFECTS
Georgina Cole: "Lack of sleep, a few hours a night
sleep, mood swings, depression, hallucination, and I personally
developed a real fear of heights, I was very paranoid and
I had never experienced that before."
HER FRIENDS WERE MORE BADLY AFFECTED. ONE BEGAN CRYING UNCONTROLLABLY,
THE OTHER HAD DREAMS AND HALLUCINATIONS..
.Georgina Cole: "She was staying in a room that
had a cross with Jesus on it, and she woke up in the middle
of the night quite scared that Jesus had jumped off this cross
and was madly attacking her, and was quite petrified."
FORTUNATELY, THE LOCAL TOUR GUIDES HAD SEEN IT ALL BEFORE,
AND WERE QUICK TO ADVISE THEM TO STOP TAKING THE DRUG...
Georgina Cole: "There was three crew on the trip,
none of them actually took any anti-malarial drugs at all,
and when we first arrived at the trip, we were asked hands
up who's taking lariam, and they had experienced strange things
with passengers before."
REMEMBER, THAT WAS JUST WEEKS AGO. IT SUGGESTS THAT TOO MANY
AUSTRALIANS ARE STILL BEING PRESCRIBED LARIAM AND HEADING
OVERSEAS WITH INSUFFICIENT INFORMATION AND ADVICE.ONE OF THE
WORST CASES INSIGHT HAS HEARD HAPPENED LATE LAST YEAR. AN
AUSTRALIAN MAN TRAVELLING OVERSEAS ON HOLIDAY WAS PRESCRIBED
LARIAM. AFTER TAKING THE DRUG, HE HAD A SEVERE PSYCHOTIC REACTION
AND ATTACKED HIMSELF WITH A KNIFE , SUSTAINING LIFE-THREATENING
INJURIES. HE IS STILL RECOVERING...
Dr. Fuller: "If you're in a foreign country and
you get sick, you're going to be in trouble, and if you're
paranoid and you think you're Jesus Christ you're in huge
Sheree Yeomans: "I don't feel enough information
was given. As well as something in writing, something verbally
should have been said as well, and certainly stating the effects
a lot more widely, occur a lot more widely than stated in
the leaflets as well."
Lesley Gidding: "I wasn't told enough. I thought
that I researched it enough, I sat down with my doctor and
we talked long and hard and he was really dismissive of it.""I
was told, if you don't get it in the first two weeks, you're
fine. I wasn't warned that it was something that could effect
you years later."
RECENT RESEARCH SUGGESTS THAT WE SHOULDN'T BE SURPRISED BY
THIS AT ALL. A SURVEY CARRIED OUT AT MONASH UNIVERSITY MORE
THAN A YEAR AGO TESTED THE PRE-TRAVEL HEALTH ADVICE PROVIDED
BY GENERAL PRACTITIONERS. IT FOUND THAT TEN PER CENT DIDN'T
RECOMMEND APPROPRIATE ANTI-MALARIA DRUGS. 20% RECOMMENDED
DRUGS WHEN THEY WEREN'T NECESSARY, AND 80% DIDN'T RECOMMEND
APPROPRIATE IMMUNISATIONS.THE CONCLUSIONS? DOCTORS' TRAVEL
ADVICE WAS INCONSISTENT, AND MUCH COULD BE CONSIDERED INADEQUATE...
Dr. Gherardin: "It is not a simple drug to be
prescribing, and I think the onus is very much on doctors
to be informed about the issues of mefloquine, and often our
travellers are better informed than many of the GP's."
SO WHAT'S THE LONG-TERM SOLUTION TO THE PROBLEM OF LARIAM
SIDE-EFFECTS? WELL, RESEARCHERS SAY NEW DRUGS ARE BEING INVESTIGATED
ALL THE TIME, AND IT MAY NOT BE LONG BEFORE SOMETHING SAFER
Dr. Gherardin: "I think what you're highlighting
is the need for better drugs, maybe safer drugs, but more
effective drugs, to fight what is in fact an increasing disease."
BUT UNTIL THAT HAPPENS, IT SEEMS THAT TOO MANY AUSTRALIANS
WILL BE RELYING ON WORD OF MOUTH AND ON BITTER EXPERIENCE,
TO ALERT THEM TO A SIGNIFICANT HEALTH RISK...
Sheldon Johnston: "To take an unknown drug was
just like a bungee jump, you know, just to think what the
hell, throw yourself to the elements and you'll come out alive
at the end, you'll be right, you know."
Georgina Cole: "I think that its still the best
anti-malarial drug to take, but I would rather not take it."
Lesley Gidding: "And I don't remember when I came
out of that dark period, but I did, and I'm out of it, and
I'm not going back."
"Good Health Debate:
Should this safari drug be banned?"
London Daily Mail,
Tuesday, July 25th, 2000.
"Yes" says Andrew Bryce, founder and chairman
of Mefloquine Action Ireland.
"When people think of side-effects, they imagine something
that occurs while you are taking a drug. But, with mefloquine, or
Lariam, symptoms can last for weeks, months and years afterwards.
It is up to the medical profession and drugmakers to decide whether
Lariam should be withdrawn. But we believe people who are considering
taking it should be fully informed of the risks and made aware that
it can ruin your life.
My view is that it should be used only for a very restricted number
of people. If you have malaria, mefloquine is very powerful and
effective, and when you have the disease the risk-benefit odds are
very different from when you are perfectly healthy.
It is appalling that people are being given a drug than can damage
their health and lives when they are fit and simply going on holiday.
Alternatives are available.
There are probably some cases where the doctor and patients may
feel it is the best option. For example, if the person is working
in the bush, miles from a hospital. But it should be used extremely
sparingly. It is also vital that every patient is counselled about
Many say other anti-malarial drugs have unpleasant side-effects.
However, those are usually stomach upsets, not the frightening,
neuro-psychiatric ones you can get with mefloquine.
An additional problem with mefloquine is that a significant number
of people stop taking it because of the reactions they suffer while
on holiday. This means they immediately become at risk of contracting
Lariam has ruined my life. I used to have a very good job as a
civil engineer, and active social life, and I was heavily involved
in sport. Now I can do nothing at all.
In September 1996, I went on honeymoon to Kenya and was given mefloquine.
As a result I was in bed for three months. Even after that, although
I could walk down the stairs, my wife had to help me back up again.
The effects were absolutely brutal, including vertigo, massive
head spinning sensations, dizziness, anxiety, restlessness. There
was also anxiety. If you have never suffered with anxiety before--and
I hadn't--it is very difficult to recognise it and know what is
wrong with you or understand what is happening. In my job, at that
time, I was used to standing up and giving presentations to 200
or more people. I was never stressed. Then, after taking mefloquine,
I was having strange, uncomfortable sensations when faced with such
I was also extremely fatigued. I carried on working for a time,
but every day when I came home I was so tired I fell asleep as soon
as I came through the door.
But I had to give up my job. In the previous eight years I 'd had
a total of less than ten days' sick leave. Then, suddenly I was
unable to work because of all the terrible symptoms.
Many others have been affected in the same way. Mefloquine completely
shattered my life. It now bears no resemblance to what it was before."
* * *
"No" says Prof. David Bradley, Professor at London
School of Hygiene and Tropical Medicine and co-director of malaria
"Should you travel to a tropical or subtropical country, there
may be a
risk of malaria. What you do about it will depend on how big a risk
is and whether the malaria parasites there are resistant to common
medicines for the prevention of the disease.
There are many places in the world where there is a risk of getting
malaria, but this varies enormously. The drug that gives the best
protection and is licensed is mefloquine. It will give you more
than 90 pc
A comparable level of protection is given by doxycycline, which
is not yet
formally licensed for malaria prevention--although it is used for
of other things, including acne.
Meflqouine gives good protection. The drawbacks are that some people
don't feel well on it. A small proportion--about 0.5 pc we believe
Their minds don't work well while they are taking the drug. And
it is long-lasting--you have to take it only once a week--becomes
disadvantage if you suffer with side-effects because they will last
It is the recommended drug because it gives such good protection
(remember people die of malaria). We need to ensure that people
who have any form of psychiatric trouble or depression do not take
it, nor should those who have ever had fits.
If Lariam were not available, more people would have died of malaria.
Doxycycline is now probably as effective, but it has to be taken
daily and you are in deep trouble if you miss a day.
Lariam does not deserve some of the Press it has had. As with any
has its limitations and side-effects. When the side-effects involve
mind, people understandably get more upset than from a stomach upset.
A third option, chloroquine and paludrine together, is much less
even though it is safe in other ways.
The bottom line is that individuals have to decide what they are
take in consultation with medical advice, Half of my colleagues
by Lariam and the other half choose doxycycline.
You can reduce the risk further by using mosquito repellents in
evenings and sleeping under an insecticide-treated net or in a screened,
air-conditioned room in addition to taking the tablets.
But, above all, remember that nothing can give 100 pc protection
and if you
get a fever or 'flu' within three months of returning from overseas,
It is an easy disease to treat if caught early, but, if not, you
survive to tell the tale."
* * *
Neil Levene, 31, an exhibitions organiser from London, suffered
such serious side-effects while taking Lariam he refuses to take
the drug ever again--despite having caught malaria. He says:
"In November 1997, my GP prescribed Lariam because I was going
to Kenya for my sister's wedding. I was told to take one tablet
a week and I wasn't warned about side-effects.
I took my first tablet a week before I was due to travel. But that
night I suffered from a terrible nightmare. I woke up soaked in
The whole of the next day I was disturbed. I felt something was
weighing down on me, affecting my mood. I also felt ropey, so I
thought it must have been something I had eaten.
The following week, when I was in Africa, I took a second tablet
and again I suffered from frightening nightmares. It was emotionally
draining, and made me feel unhappy.
In the third week, when a lot of us went to the coast where my
sister was spending her honeymoon, I took another tablet and felt
spaced out. I then realised they were making me feel so awful, so
I stopped taking them.
A year later, I went to Africa again but I decided I wasn't going
to take Lariam at all. Instead I was prescribed two older anti-malaria
drugs, paludrine and quinine. I took lots of precautions, such as
wearing long trousers, sleeping under a mosquito net, and using
an anti-mosquito spray.
But one evening, after I'd had one drink too many, I fell asleep
on top of the mosquito net. I must have got bitten, as four days
after I got back from holiday I started suffering similar symptoms
to those Id experienced on Lariam. I got worse and worse and
I had to be rushed to the nearest hospital, where I stayed on a
drip for five days.
Fortunately, I hadnt got a serious strain of malaria, so
it doesn't recur. Even though I've had malaria, I still wouldn't
take Lariam because the disease didn't make me feel as emotionally
unsettled as the drug. I felt so down that I'd never take it again."
TAKE ANTI-MALARIA DRUGS, BUT GET ALL OF
THE FACTS FIRST
Sunday, June 4, 2000
Travelers to malaria-ridden parts of our world face a dilemma.
It's not a matter of taking a drug or not taking a drug, but
deciding which drug to take. Only the foolhardy would journey
to places like India, the Solomon Islands, sub-Sahara Africa
and most of Southeast Asia without protecting themselves against
malaria, a serious, sometimes fatal disease transmitted by
the bite of a
The problem is this: In the U.S., there are three drugs
commonly used to prevent malaria -- chloroquine, doxycycline
and mefloquine. Chloroquine (sold as Aralen and taken orally
once a week) is ineffective in severe malaria areas, but is
often used for travel to Central America, Haiti and certain
parts of the Mediterranean. Doxycycline, effective in severe
malaria areas, must be taken orally every day. And the third
drug, mefloquine, sold as Lariam, effective in the worst malaria
areas and taken orally once a week, is a bit controversial.
Because Lariam has to be taken only once a week, it generally
is the drug of choice. But Lariam, like most drugs, has side
effects ranging from mild nausea, dizziness and vivid dreams
to rarer hallucinations and severe anxiety attacks.
It is the more severe side effects that have brought notoriety
to Lariam, although several studies conclude that only about
20 percent of the takers experience any side effects at all.
What appears to be a side issue of Lariam is that doctors
often prescribe Lariam as the drug of choice without adequately
explaining the side effects and offering travelers a choice
between Lariam and doxycycline, which has its own set of side
Lariam, produced by Hoffman-La Roche, a Swiss firm, was
first introduced in Europe in 1984 but was not approved by
the U.S. until 1989. Its product information sheet was updated
in 1994, and then vastly expanded last year, greatly elaborating
the section on side effects.
A case in point came from a physician in Michigan, who requested
not to be identified further. In January 1999, the doctor
traveled to India to visit his daughter, who was attending
school there. He gave me this account in a phone interview:
"I went to a travel nurse consultant for a large family
practice medical group. She took a history, updated my shots
and prescribed a malarial prophylaxis. To the best of my recollection,
only one drug was mentioned, Lariam. I didn't make a big deal
of it. I got my prescription filled at a local pharmacy and
was given five individually packaged pills. There was no package
information sheet, just instructions to take one pill a week
before leaving, one a week there and the remainder upon returning.
"I started taking the pills. I thought I was OK. When
I was in India, I never slept at night. I didn't make too
much of it. I've always had a difficult time sleeping, but
not to the point where I couldn't get to sleep. I might drift
off at 3 or 4 o'clock and wake up at 6. I also remember being
a little edgy while I was there. "But things really didn't
get bad until I got home. It culminated one night when I was
alone at home and my wife was out of town. I had such depression,
paranoia, an inability to act and function. I almost got to
the point where I couldn't decide whether to stand up or sit
The doctor's "incredible, profound anxiety" caused
him to take leave of his practice because he couldn't function.
He said he could hardly drive his car and had his wife drive
them to Detroit to see a specialist about a very fine tremor
he had (unrelated to the Lariam reaction). "While in
the doctor's office, my wife looked up Lariam in the `Physicians'
Desk Reference' and found the drug could produce neurotoxic
symptoms in less than 1 in 1,000 cases," the Michigan
On the advice of an infectious disease specialist, the doctor
finished off his anti-malarial treatment with doxycycline,
but the Lariam remained in his system because the drug has
a 21-day half life, which means that every 21 days, half of
what is left in the system dissipates.
The doctor said he's fine now, but it wasn't until the end
of the fourth month "that I started feeling whole again."
If you search the Internet, you'll find other Lariam horror
stories What you won't find are comments from 80 percent of
the takers (myself included) who had no problem with the drug.
The important thing for travelers heading for malaria areas
is to make an informed choice.
"The first thing I would tell travelers is to go to
the Centers for Disease Control Website (www.cdc.gov),"
said Dr. John MacArthur, a family practice and preventive
medicine specialist at the CDC in Atlanta. "Find the
country you're traveling to and then see what the situation
is with malaria as well as what vaccines or drugs are recommended.
It's a good way for lay persons to educate themselves prior
to seeing a primary-care physician."
MacArthur added: "What I usually tell a person who
talks to me about not liking the side effects of either one
of those drugs, I tell them the CDC gets anywhere from 1,000
to 1,500 cases of malaria reported annually from travelers
importing the disease into this country. And certainly the
disease is much worse than some of the side effects they're
going to be experiencing."
But, MacArthur warned, nothing is 100 percent effective.
When addressing the malaria issue, he said people have got
to think about other things such as sleeping in a well-screened
room or under a mosquito net, using a repellent that contains
between 20 and 30 percent DEET and wearing long sleeve shirts
and trousers, especially at dusk or evening time. "It's
really from dusk to dawn that mosquitoes transmit malaria,"
said MacArthur. "It's not just popping a few pills and
off we go. People have got to think about a number of different
ways to keep healthy."
At Northwestern Memorial Hospital's Travel Immunization
Center in Chicago, the first thing patients do is complete
a medical history. "We always go over the medical history
first," said Valerie Gongaware, a staff nurse at the
center. "So we know ahead of time whether there are going
to be reasons travelers can't take certain drugs. We review
the patient's itinerary to decide whether there is a malaria
risk. If there is a malaria risk, we go over the types of
drugs that are available for that area of the world that they
can take, and the possible side effects. If there is a choice
we explain the differences in the drugs and how to take them.
Based on their health history and travel plans, we help them
decide which might be the better drug for them."
But, stressed Gongaware, "It's important for people
to be truthful about their medical history. Why risk it. When
you start talking about potential side effects, then people
start fessing up -- `Oh, yes, I'm being treated for clinical
depression,' which then would preclude them from taking Lariam."
Northwestern's Travel Immunization Center also provides
each patient with a booklet that provides information on immunization
vaccines, medications needed for travel and tips on disease
prevention. Bonnie Ward, who runs the San Diego International
Traveler's Medical Clinic, also stressed the need to screen
patients to make certain there's no health history that would
indicate a predisposition to having a reaction to medication.
"Throughout our education process,
if a person feels a little uneasy with what we've stated,
then we will go ahead and look at other options."
The bottom line: You have to take malaria seriously.
Tribune, TRAVEL HOME section
Column: VOICE OF THE TRAVELER Letters
Sunday, June 25, 2000
WESTFIELD, N.Y. -- As one who has had his life nearly wrecked
by Lariam, I can tell you the degree and extent of the pain
caused by Lariam is much more extensive than hinted at in
Alfred Borcover's column ["Traveler's Dilemma";
June 4]. I wish he had contacted Lariam Action USA to learn
the gravity of Lariam prior to writing this column.
-- John Ellison
Lariam Action USA was one of the sources Borcover used in
researching his column. For more information: Lariam Action
USA, PMB 248, 1563 Solano Ave., Berkeley, CA 94707; 510-663-5168;
IOWA CITY -- I graduated from Dartmouth College in 1992 and
then went to Zimbabwe to play professional soccer later that
year. I took Lariam for over three months and the drug built
up toxic levels in my system. To make a very long story short,
I became very sick from the drug and it ended my soccer career.
I could not work or do much of anything for nine months. I
went from being a professional athlete to not even being able
to walk down the block. The problems continued for years,
and some of the symptoms remain to this day, even eight years
later. And the side effects I experienced were very serious.
I experienced the side effects that you mentioned but I had
many more as well, the most serious were problems with my
heart -- murmurs, abnormal rhythms, tachycardia and an atrial
-- Jesse Bradley
MISSOURI CITY, Texas -- No wonder the physician [who suffered
serious side effects from Lariam] requested not to be identified.
I cannot believe that a health-care provider did not research
his choices for anti-malaria drugs prior to visiting another
health-care provider. Research is critical prior to any intervention!
-- Barbara J. Blue