Losing Control On A Legal Drug
by Paul McGoldrick
The idea of prescriptions for medications is that a qualified, trained, individual can assess a patient and decide whether a particular product is suitable based on medical history (personal and family), physical condition, etc. Doctors are also expected to decide whether a patient might misuse a product, or if there might be a problem of forgetfulness in taking the right dosage at the right time.
When you have to take a pill every day for over 20 years, at the same time of day, you do not forget it. I did this, taking antimalarials, for that kind of period of time. Even when I wasn't in the field I continued to take the pills because I would never have more than a few days notice about travel - indeed, for some time, I had a pre-packed bag in my office for travel now for when that situation arose.
I had all the other shots, of course, as they came up for renewal including one that always knocked me out for a day (every ten years, fortunately!) for yellow fever. I was even one of the last people to have a booster shot for smallpox before it was declared as eradicated (as hopefully will polio be so declared this year.) It is even envisioned that cruel diseases like leprosy are on the run, but there is no end in sight for malaria.
There are two broad versions of the malaria parasite with the nastiest being Plasmodium faciparum which blocks blood cells and, if you are really unlucky, causes cerebral malaria and kills you - sometimes within a day of any symptoms being noticed. The other parasite is Plasmodium vivax and it finds the liver, attacks red blood cells making the patient anemic, and causes flu-like symptoms of fever, nauseousness, and chills. And the chills are really something with most people. Every seven years, for most victims, the symptoms reappear. I lost an uncle to malaria - caught in a Japanese POW camp in the Philippines - when his seven year cycle came up while he was weakened from being treated for cancer.
So, I was always really keen to avoid the disease. I was prescribed chloroquine and never had any side effects from it - although the Red Cross decided early on that they no longer wanted my contributions to the blood bank.
By the 80s there was growing evidence that in some parts of the world malaria parasites had developed a resistance to chloroquine and my doctor recommended me to change to a new product from Hoffmann-La Roche called Lariam (generically mefloquine, and very often wrongly spelled as Larium) which worked, they thought, by making the haemin part of blood toxic to the parasites. Lariam had the additional advantage of only having to be taken once a week.
Very fortunately for me the side effects of the drug didn't hit me in Kenya, or Nigeria, or Burma, or some of the other interesting places I have been. But something went very wrong in a luxury hotel in Seoul, South Korea. I had arrived from Tokyo earlier that day and I remember that in the connection lounge at Narita I felt disoriented, and I fell fast asleep in the taxi from Kimpo to the hotel. I don't remember checking into the hotel but I do remember being found at the foot of a flight of stairs - which I had presumably fallen down - where I felt totally spaced out.
The doctor who was called to the hotel was, fortunately, clued up on what was happening. He just came straight out with, "Are you taking Lariam?" I very fortunately had taken only one pill, five days before the trip started: I have no idea how psychotic I might have become if I had taken the next one (due the next day.) And I was lucky that I was in a place that I could get out of quickly.
I am not a chemist, I am not a lawyer. But the link between Lariam and my reactions was a very straight line. And, since then, I have kept an eye on the symptoms that others have reported, many of them involving grand-mal seizures, major mood swings, aggression, and in some cases people have reported problems more than two years later.
Obviously there is a fine line between prescribing a drug that works, against a physician recognizing the possibility of a particular patient reacting badly to it, all weighed against the ghastliness of the disease. Certainly the time period before travelling on a new prescription should be extended from the recommended week to a period of three weeks, or so, to give the patient a chance to react badly near to facilities that know him or her.
Since the trials on Lariam (during the Vietnam War period) the military has been keen on the drug and it is still the antimalarial of choice for the services. Is the drug in any way related as to why four soldiers reportedly murdered their wives at Fort Bragg after returning from duty in Afghanistan? Certainly the malarial season in that country would have started in about May so, presumably, these men would have been taking the drug.
Being on the market more than a decade doesn't guarantee safety for a product and, I would presume, there is no such thing as a truly safe drug. I for one will never take the product again - I never want to revisit that total lack of control - but neither will I be one of those people who will jump on class action suits against Roche. There are four people in the legal drug chain: The manufacturer (who provides warnings and contraindications that people should read), the medical practitioner (who should check medical histories against the manufacturer's warnings, and should still warn the patient), the druggist (who should warn the patient, again, about possible side effects), and the patient himself (who needs to listen to the rest of the chain.)
Being legal doesn't make a drug good for everybody.