Army Reviews Controversial Drug After Afghan Massacre

Hugh Pickens writes "Time Magazine reports that after the massacre in which Staff Sgt. Robert Bales allegedly killed 17 civilians in Afghanistan, the Pentagon has ordered an urgent review of the use of the anti-malarial drug mefloquine, also known as Lariam, known to have severe psychiatric side effects including psychotic behavior, paranoia and hallucinations. 'One obvious question to consider is whether he was on mefloquine (Lariam), an anti-malarial medication,' writes Elspeth Cameron Ritchie in Time. 'This medication has been increasingly associated with neuropsychiatric side effects, including depression, psychosis, and suicidal ideation.' The drug has been implicated in numerous suicides and homicides, including deaths in the U.S. military. For years the military used the weekly pill to help prevent malaria among deployed troops, however in 2009 the U.S. Army nearly dropped use of mefloquine entirely because of the dangers, using it only in limited circumstances, including sometimes in Afghanistan. Army and Pentagon officials would not say whether Bales took the drug, citing privacy rules. Assistant Secretary of Defense for Health Affairs Jonathan Woodson has ordered a new, urgent review to make sure that troops were not getting the drug inappropriately. 'Some deployed service members may be prescribed mefloquine (PDF) for malaria prophylaxis without appropriate documentation in their medical records and without proper screening for contraindications,' the order says. It notes that this review must include troops at 'deployed locations.'"

Comments

The Administration's Sweating Profusely

[explosivejared]

Obviously it's pure speculation, but I have a hard time believing this would mitigate any punishment Bales receives. It would be a nightmare of the most extreme order for the military should Bales be exculpated, even in the most limited sense. The Afghans have been screaming for him to be tried under Afghan law. It would be hard enough to punishment short of the death penalty to the Afghan public, much less an outcome that ends with him in psychiatric care first. This is just one more massive headache in a case that can't be over for the Pentagon fast enough.

In the mean time, expect relations to continue to deteriorate between Afghan security forces and ISAF troops. There is real danger of this review fueling conspiracy theories and sparking further knife-in-the-back attacks on ISAF troops like we've already seen.

It increasingly seems that no one is winning from this war. Afghan civilians have had any sense that westerners provide safety shattered. Westerners trust their Afghan counterparts even less. And yet most of Afghan development depends on the industry that supports the international presence there, which a hasty pull-out would destroy. What's the least bad option here?

Re:The Administration's Sweating Profusely

[Anonymous Coward]

You're a fucking idiot.

Re:The Administration's Sweating Profusely

[buchner.johannes]

Obviously it's pure speculation, but I have a hard time believing this would mitigate any punishment Bales receives. It would be a nightmare of the most extreme order for the military should Bales be exculpated, even in the most limited sense. The Afghans have been screaming for him to be tried under Afghan law. It would be hard enough to punishment short of the death penalty to the Afghan public, much less an outcome that ends with him in psychiatric care first. This is just one more massive headache in a case that can't be over for the Pentagon fast enough.

That's what I think. They will search through all possible excuses and then declare him mentally ill -- I mean, who isn't mentally ill if they kill 17 people. It's like medication ads today ... look long enough you'll find something wrong. That's no punishment.

It would be interesting to know what Afghans think about the payment per injured/dead -- how does that relate in their culture?

It increasingly seems that no one is winning from this war.

Nobody ever wins in wars. It's about finding out who loses less.

Re:The Administration's Sweating Profusely

[tnk1]

best option: everyone commits suicide and let the Earth return to its natural state... humans are an aberration...

You go first. I'll be right behind you.

Re:The Administration's Sweating Profusely

[jythie]

'natural state' is meaningless, humans are part of nature.

Re:The Administration's Sweating Profusely

[jythie]

*nods* politically they have to punish him, though it would not be the first time the US has quietly let a citizen off the hook when a weak forign government screams bloody murder.

The bigger problem, if this medication played a role, is going to be the drug company. There have been numerous cases where a psychotic incident involving murder has been plausibly linked to a medication, but they have never survived court since drug companies do NOT want that kind of liability, so they fight tooth and nail.. and to be blunt, the medical industry is a lot stronger then the federal government. So it is very unlikely we will ever see a court approved link between this medication and a murder.

Re:The Administration's Sweating Profusely

[Hatta]

It increasingly seems that no one is winning from this war.

Increasingly? It was obvious from the start that this was a fool's errand. Afghanistan isn't called the graveyard of empires for no reason.

Just to put some perspective on this, Bales allegedly killed 17 civilians. NATO killed 410 civilians last year. If it took 10 such massacres to get us out of Afghanistan, we'd still be ahead by a factor of 2.

Bales is no worse than the war mongers keeping us in Afghanistan. At least he potentially has TBI and/or PTSD to blame. Obama has no one to blame but himself for civilian deaths in Afghanistan.

Re:The Administration's Sweating Profusely

[schlachter]

Until you've been through the altered psychological state that these and other drugs produce, it's hard to imagine the way in which it changes your thought patterns. It's not always possible to recognize your thought patterns as disturbed or to rationalize them away...or to surpress the urges associated with them.

Re:The Administration's Sweating Profusely

[Truekaiser]

No. they are looking for excuses other then the obvious reason. hopped up on nearly a decades worth of propaganda of these people being 'evil', and 'against our very way of life' etc him either alone or in a group. since many of the Afghanistan witnesses claim he was not alone. go out and slaughter a bunch of people for the fun of it. they want any reason to dismiss it from being pre-meditated.

as for why we are there and will continue to be there even in a less active role? we went in to chase out a certain group of people as the public reason. anyone who can read a map would see the country is valuable real estate if say the straight of Hormuz and the Pearson gulf is impassable for trade..

Re:The Administration's Sweating Profusely

[K. S. Kyosuke]

best option: everyone commits suicide and let the Earth return to its natural state... humans are an aberration...

The natural state of Earth includes having energy flows forming meta-stable localized regions of decreased entropy with complexity increasing over time, in one of their final forms usually called humans.

Re:The Administration's Sweating Profusely

[Hatta]

The power vacuum will be atrocious whether we leave now or if we leave in 10 years. This isn't a "you broke it, you bought it" situation. Afghanistan was broken when we got there, and it will be broken when we leave. The only question is how many lives we throw away before we realize that fact.

Re:The Administration's Sweating Profusely

[Americano]

I'm sorry, how is Afghanistan "valuable real estate for trade" if we can't use the strait of Hormuz and the Persian Gulf? A land-locked, mountainous country, with the sides closest to the Gulf being bordered by Iran on one side and Pakistan on the other, and miles and miles of mountains in between? Are we gonna build roads across all of that terrain, airlift in all our trade goods, and drive them to the borders of Pakistan and Iran, only to be turned around and sent back to our airbases?

Your argument would have made far more sense if you had suggested the government wants a military footprint between Pakistan and Iran - airbases, staging areas, etc. I could credit that that's something the DoD might be interested in. But trade? Please.

Re:The Administration's Sweating Profusely

[History's Coming To]

I took mefloquine for around three months while in Nepal. It does, without any doubt, have some strange psychological effects. In my case it took the form of strange "waking dreams", I could close my eyes and start dreaming without having to fall asleep. Add effects of this nature to a high-stress situation and you've got a person who probably shouldn't be allowed to wander around with a loaded rifle. Given the high praise that's been heaped on this soldier for his previous conduct and it wouldn't surprise me at all if mefloquine was an aggravating factor. Of course, there's no information on whether he was taking it or not, but if he was it's an urgent issue that needs to be dealt with ASAP.

Re:The Administration's Sweating Profusely

[shutdown -p now]

It would be irresponsible to 'just leave'.

Unless you have a coherent plan on how to fix it, it is even more irresponsible to stay - you waste money and lives without anything to go for it.

Re:The Administration's Sweating Profusely

[lgw]

Countries win wars all the time. War is the extension of a countries political will. In the abstract, war is about removing your opponent's ability to resist your political will - carthago delenda est. In practice war is about making it unacceptably costly for your opponent to resist your political will.

The Afghan war has always been a mystery to me. I understood a few months of knocking back Taliban camps, but since then? What exactly are we trying to force the Afghans to do? How exactly is this effort hurting our opponents there so much that they'll eventually have to concede to our will?

Iraq made perfect sense to me, but this one I just don't get.

Re:The Administration's Sweating Profusely

[lgw]

Realistically, if you ever want a cure for cancer, a pharma company needs to have some bar they can clear and say "this is enough testing, we can sell it now". Maybe your thinking of other cases where the liability of the company was more clear? When the military is involved it gets even more murky - sometime you knowingly do quite unsafe things in the military after all. Bomber pilots get stim pills that wouldn't be legal for most people (though pretty mild by illegal drug standards), but the danger of those pills is trivial compared to what they're doing while on them.

This is more a case of "what was the military thinking continuing any use of this drug" than "what was a pharma company thinking continuing to sell it to the military". Not every story needs a corporation as a mustache-twirling villain and a government agency as the shining hero, after all.

Re:The Administration's Sweating Profusely

[thomst]

explosivejared sighed:

It increasingly seems that no one is winning from this war.

prompting Hatta to respond:

Increasingly? It was obvious from the start that this was a fool's errand. Afghanistan isn't called the graveyard of empires for no reason.

Actually, it wasn't obvious at all. The U.S. invasion was welcomed by the majority of Afghans, who were pretty sick of the Taliban's reign of terror. The problem is that the Bush administration, instead of proceeding with the arduous and expensive task of nation-building that would have ensured the Taliban's permanent defeat, opted to turn its attention to invading Iraq. As a result, conditions for the average Afghan did not improve AT ALL under the American occupation, while Pakistan, our nominal ally in the "war on terror", sheltered, trained, equipped, and encouraged the Afghan Taliban to resume guerilla war against the American/NATO occupiers. As that conflict began generating more and more collateral damage, the tide of Afghan opinion turned more and more against the occupying troops, to the point that, today, our forces are nearly as hated as the Soviets were - and the Taliban are once again seen as saviors.

Obama inherited the Afghan quagmire from the Bush administration - which was responsible for causing it. Should he be persuaded immediately to withdraw all U.S. troops, not only would the Taliban instantly re-take control of Afghanistan, they would wreak horrific retribution against the most westernized sectors of Afghani society (i.e. - the most civilized and tolerant sectors), and plunge the country back into the 14th century hellhole it was before we invaded it in 2001.

And, not at all incidentally, make it once again a haven for international terrorism, a la September 2001.

It's a lousy, no-win situation to find ourselves stuck in, but the blame belongs with George W. Bush, not Barack Obama. As with the economy, Obama is merely the janitor, stuck with cleaning up after another one of the frat boy's "Wild Thing" parties.

Re:The Administration's Sweating Profusely

[SylvesterTheCat]

> What exactly are we trying to force the Afghans to do?

We are not trying to -force- the Afghans to do anything. Fundamentally, we are doing two things:

1. Security. We (US military + NATO / ISAF military + other militarys) are trying to help them create a credible security force (Afghan police forces + Afghan military) so that they can secure their borders against Talilban, Al Quada, & other external threats as well as against internal threats (criminal), Taliban et al.

2. Governance. We (US government + European governments + other governments) are trying to help them create a legitimate government,

Part of why this is hard is that the first requires the second.

I am familiar with all of this because I have been there twice. The first time, I worked with an Afghan Army in a training / mentoring role.

Re:The Administration's Sweating Profusely

[SylvesterTheCat]

The first time I was deployed there 2007-08, we were all issued Doxycycline for malaria prevention. The only significant side effects that I noticed was increased sensitivity to the sun, sometimes a mild upset stomach, and the slight annoyance of having to remember to take it every day. OK, not a big deal, unless you spend almost all of your day outside in a hot, cloudless environment. Rats... Even though the uniform does a good job of protecting against sunburn and, whenever possible, I wore the sun hat (a.k.a. "boonie" hat) vice the patrol cap or helmet, I did get some sun burn. Even today, I can look at my hands and see where my sleeves stopped on my hands.

We were told that mefloquine was an available alternative and that the advantages included only having to take it once per week and it didn't increase sensitivity to sunlight. So, after about 8 months in theater, I asked to switch. A few months later, when I was getting to the end of my deployment, I noticed that I was having auditory hallucinations. I'm not talking about "hearing voices," but rather it was like I was hearing sounds differently. I would hear normal sounds to my peripheral and there would be an added intensity to it that would get my attention. It is not an easy thing to describe and I know that I'm not doing it very well. At times, I would find myself on edge. Not the "draw my weapon and turn toward the threat"-type of reaction, but rather an always on edge, always guarded reaction. Considering that we were immersed with the Aghan soldiers (speaking a different language with a different culture and considerably less educated) almost daily, it was already a stressful situation. We also knew that there were informants to the Taliban amongst the Afghan Army junior enlisted ranks. Adding a pharmaceutical factor to the mix only made it slightly more intense.

What really scared the crap out of me about it was that the change had been so slow and subtle that it had crept up on me over a period of time without me noticing it.

I immediately switched back to Doxycycline and within a couple of months the side effects were gone.
The second time I was there (2010-2011), none of the medical professionals even mentioned mefloquine as an option. I took my Doxycycline and that was it.

I am not saying whether or not mefloquine was a factor in Bales actions. I am not a medical professional. I would say, based on my experience, that if he was taking mefloquine for an extended period of time, it could have been a factor.

Robert Bales is a fall boy

[Anonymous Coward]

Bales did nothing, and is getting blamed for what his platoon did. You cant shoot and burn 17 people and wake up with no memory of it, and multiple reports from witnesses say there were 15-20 men there.

Army coverup?

Army coverup.

Re:Robert Bales is a fall boy

[what2123]

I don't doubt it in the lease bit. Much of the talk from vets has been a harsh resistance staying abroad and wanting to come home. Then you get this little bit of fun: http://worldnews.msnbc.msn.com/_news/2012/03/29/10927844-child-witnesses-to-afghan-massacre-say-robert-bales-was-not-alone

Re:Robert Bales is a fall boy

[buglista]

Usually I'd say this was paranoia, but given what they did after Haditha, I've really got no trust left in justice meted out by the US army.

Re:Robert Bales is a fall boy

[ehiris]

You're giving the Army too much credit. It's a fuckup caused by ignorance.

Re:Robert Bales is a fall boy

[geekoid]

hahaha. You don't really know the area or the people, do you?

I don't trust any eye witness reports.
a) Anti American groups will suddenly have eye witness report of things that didn't happen,. or exaggerate claims
b) You CAN have psychotic episodes with no memory. Sometime they can go on for very lng periods of time.

Army cover up?

I don't know, and neither do you.

Re:I'm I in the wrong Blog?

[Anonymous Coward]

So I guess chemistry and biology aren't technologies anymore...

Re:I'm I in the wrong Blog?

[Kenja]

What's that? Drugged out solders killing civilians? Yawn. Wake me when there's news about how Apple or Microsoft is bad and Linux is good.

Nasty stuff

[Ion Berkley]

I can attest to this drugs potency, I've used it on two instances, and on one I suffered mightily the day and night after I took my weekly dose. Another of my friends was hospitalized after a psychotic episode on this drug. A girl I used to date used this drug for 2+ years during a posting to Sierra Leone in the military, apparently without any long term effect...but well beyond any duration it had been certified and tested for...however the flip side is that the initial brigade that was sent to Sierra Leone in a hurry were not on an anti-malarial and a large number came down with serious Malaria. Luckily there are much better alternatives in 2012, and I think it's somewhat weak to see this in the press...if it's being doled out to troops in this environment still then that is wrong and someone should get on it now, but this tabloid journalism and new culture of Mil/Gov leaks to the worthless press is ridiculous. Solve the friggin' problem, don't play some political game of buck passing in the headlines

Re:Nasty stuff

[Anne_Nonymous]

I used Lariam during an extended period of travel. My side effects consisted of extremely lucid and wonderful dreams. If the risks weren't so high, I'd recommend this as a recreational drug.

Re:Nasty stuff

[AnObfuscator]

I've also used it on a number of occasions (including some time in Sierra Leone), and I've only had mild side effects (some very, very strange dreams). However, I have seen others react very poorly, too. One of my friends contracted malaria and mono at the same time while in Guinea, and was dosed with massive quantities of lariam to treat it -- he had some serious psychological responses to it. Malaria really sucks, but so does this drug. BTW, when was your friend posted in Sierra Leone, and is he a Brit Para? I met a few of them when I was working for an NGO in Sierra Leone in 2001.

Re:Nasty stuff

[TheCarp]

The interesting things is that this story was on NPR the other day, except, they reported that it was incorrect to imply that the massacre triggered the review... the review was in the works before the massacre.

So to still be characterising it as such, several days after its come out that this association isn't true definitely is tabloid journalism.

Lariam? Really?

[jholyhead]

Having known someone who suffered from Lariam induced psychosis some years ago, I find it shocking beyond belief that they would give this stuff to men with guns.

Whether Bales was suffering from such psychosis at the time should be considered secondary - the US military was giving its soldiers a drug that can lead to violent psychotic episodes. The person who made that decision needs to be escorted to the cell adjoining Bales'.

Re:Scapegoat

[oodaloop]

No one is saying he isn't responsible for his actions. They're going to review the use of the drug as a whole, and it's about time. Everyone I know who's gone (I'm a defense contractor, and many of my coworkers have gone to AFG) have had bad reactions to the drug and stopped taking it. Typical stories include violent horrible dreams every night until they stop taking it. Do you think they SHOULDN'T review the use of the drug, given its known side effects?

Re:I'm I in the wrong Blog?

[JoeMerchant]

Since anyone with reasonably good karma can vote stories up to the front page now, /. content is going to start resembling Reddit more and more.

Re:Law and Order

[AuralityKev]

It was SVU - and I swear I thought this story was a parody recap of that. Right down to it being an anti-malaria drug.

Re:I'm I in the wrong Blog?

[jythie]

Everyone knows that if you can not use it to build a robot it isn't technology.

Re:Scapegoat

[supercrisp]

US folks, on our side of the Atlantic Paracetamol goes by "acetaminophen" (Tylenol is popular brand). Just FYI for the non-Googling types.

Useless, futile wars, ruined lives, for PROFIT!

[Paracelcus]

And they will give you poison that will drive you insane!

Yeah, like I would tell my grandson to join this mess!

Re:I'm I in the wrong Blog?

[metrometro]

Shorter parent: neurochemistry is BOOORING.

Re:Scapegoat

[TheBilgeRat]

Are YOU a doctor who can speak to the physiological effects of a drug that alters brain chemistry combined with lack of sleep, near constant terror, and easy access to firearms? If not, then perhaps relating to your field trip to Africa to combat in Afghanistan isn't such a great analogy.

Not so fast

[Anonymous Coward]

This project has raked billions through the business of government. At the top of the pyramid, the elite who make the decisions do not care where the money comes from or where it goes -- what matters is that it passes through their hands, giving them a chance to exploit that cash flow for personal gain.

In conclusion, this project has only increased the net worth of the business of government. At the top of the pyramid, that is the entire goal. We know this because the balance sheet doesn't lie, and neither does history.

You're not in the business of government, are you?

Re:I'm I in the wrong Blog?

[JustOK]

But there was an episode on M*A*S*H about that. Where Sgt Klingon went nuts on an away mission to Koreadia

Re:Scapegoat

[HornWumpus]

Dude you better check yourself in.

You've taken this drug, are on /. and believe you have wife. You even have conversations with this 'wife'.

Re:I'm I in the wrong Blog?

[Farmer Tim]

How are we supposed to be hunted down and killed by T-800s without chemistry and biology? Research into these fields is vital.

Oh, wait...

Re:Scapegoat

[geekoid]

Since they don't know if he was given the drug, aren't you being a little premature?

Also, 'side effects' happen with all drugs. You need to weigh the data about the side effects against the effects of not taking the drug.

I to methfloquine in Africa

[Adam Appel]

After about 6 weeks, I stopped taking it. The 2-3 days after my once a week pill (dose) I was out of my mind agressive and slightly disconnected with reality. I chose to risk malaria when traveling around east africa over the side effects of the drug. Others with me felt the same way though their side effects were a bit diffrent. When I returned to the states I did a litte research and found hallucinations were a rare side effect and a few people had compleat permanant mental breakdowns. I thought there was a class actin lawsuits and it was removed from the market (not that that always effect the military)

unfortunately Larium is cheap and effective

[trippytom]

This stuff is given to pretty much all Peace Corps Volunteers in malarial zones. Speaking from long term experience, it sucks ass. I made it about a year before I nearly lost the ability to sleep. I was then placed on Doxycyclene which worked ... never got malaria myself. The other option, Malerone, is like 10x as expensive. Neither Doxy or Mal is nearly as good ad malaria prevention, as have to be taken daily ISO weekly, so medical officers are hesitant to make a switch unless things have gotten pretty bad. I would say 50% of my fellow PCVs made it two years on Larium, and many blamed their psychological evacuations (wacky-vacs in Peace Corps lingo) at least in part on it. There is no way in hell anyone with access to firearms should be allowed within ten feet of this stuff.

Re:I'm I in the wrong Blog?

[shutdown -p now]

What's that? Drugged out solders killing civilians? Yawn. Wake me when there's news about how Apple or Microsoft is bad and Linux is good.

I have it on good authority that researchers in the labs that developed this drug were using Windows on some of their computers!

Caspian Sea Oil and Gas

[chrb]

Caspian Sea oil and gas unrecovered reserves are enormous, valued at over $10 trillion. Iran is currently a transit country for this, but the aim is to use Afghanistan instead. The Trans-Afghanistan Pipeline is a big part of this. Plans for an Afghan pipeline have been in the making for a long time, U.S. Congress testimony in 1998:

Mr. MARESCA. It's not going to be built until there is a single Afghan Government. That's the simple answer. We would not want to be in the situation where we became the target of the other faction. In any case, because of the financing situation, credits are not going to be available until there is a recognized government of Afghanistan.
Mr. BEREUTER. So you are not making any suggestions about the prospects of that or timing of that. It's just you are not going to move or it's not going to be moved from another source until that happens. That would be your judgment?
Mr. MARESCA. That's my judgment. We do of course follow very closely the negotiations which have been going on. We are hopeful that they will lead somewhere. All wars end. I think that's a universal rule. So one of these days this war too will end. Then I believe the pipeline will be secure.

That war (officially) ended thanks to the U.S. military, Afghanistan was (officially) unified under the Karzai government, and in 2002 Karzai signed the TAPI pipeline deal. Very fast given the complexity of such a deal. The U.S. has invested $0.5 trillion in the Afghan War so far, that's quite a lot just to bring bin Laden to justice. That $0.5 trillion didn't magically disappear - it was given to corporations which have profited handsomely from this war. Some stand to profit even more in the future from the ability to export Caspian Sea oil and gas through Afghanistan. And it also isolates Iran further.

Is it all a coincidence? It does seem awfully convenient...

Ratios matter

[erice]

Actually, my wife has just said to me that paracetamol has more documented cases of causing psychosis as a side effect than Lariam...

Other than pointing out that paracetamol also has potential for psychosis, what does this tell you? Paracetamol is vastly more widely used than Mefloquine. Even if the risk from paracetamol was only 1% of that from mefloquine, you could still see more documented cases of psychosis.

Anthrax shots

[CPTreese]

When I deployed to Iraq we were given the option of getting Anthrax vaccinations. As expected almost no one volunteered. About six months laterr we were "voluntold". I am now immunized against Anthrax if I touch it. If I breath Anthrax I'm still fucked. Totally worth the cancer I'm gonna get 15 years from now

Re:I'm I in the wrong Blog?

[cyberchondriac]

Worf did a cameo on M*A*S*H ? Oh wait, he was a Lieutenant.

Blame it on the drug

[abloylas]

Soldiers suffer from shell shock and go crazy doing what they do with or without drugs. It seems more convenient to blame "fuck ups" like these on a drug than on the simple fact that war causes horrible suffering and stress on both sides of a conflict and is expecially difficult to handle for soldiers who consciously or subconsciously feel they are occupying a country for dubious reasons. Blaming this one incident on a drug instead of on American foreign policy in general is easier for the party who is actually responsible for these atrosities.

If Macciavelli had known about drugs that "may" cause such behaviour, I'm sure he would have recommended the Prince give them to all soldiers, in case the shit hit the fan and you had to put the blame on something. Smart man - Macchiavelli.