Malaria?s Not So Magic Bullet

From Peace Corps to psychiatric hospital, Lariam's untold story

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Like most Peace Corps volunteers, Martin Giannini embarked on his mission full of high hopes and enthusiasm. His assignment in Togo promised to be the adventure of a lifetime. It certainly was-but not the kind he expected. Giannini's African adventure ended in a padded room in a Chicago psych ward. 'I was totally loony,' admits Giannini. 'It felt like I was in some 'X-Files' episode with instructions being planted in my brain. I tried to escape, but couldn't get past the four guards.' What led Giannini, a healthy young man with no history of mental illness, to take on a battalion of guards in a psychiatric hospital? A drug, say his doctors. An antimalaria drug the Peace Corps recommended.

Mefloquine, known commonly under the brand name Lariam, is the most prescribed malaria prophylaxis in the world. It's clearly the most effective. And controversial.

Like Giannini, an increasing number of Lariam users have reported hallucinations, paranoia, depression, nightmares and other psychotic effects after taking the drug. It has been implicated in suicide attempts and numerous aborted trips. In the last two years alone, the alleged side effects have led to British and U.S. lawsuits against Lariam's manufacturer (unresolved), a storm of media coverage (ongoing) and a Canadian government investigation into the military's use of Lariam in Somalia (pending). Tap into the global travelers' wire, and the word is clear: Take this drug at your peril.

Just ten years ago, Lariam was greeted by doctors as a chemical miracle. Strains of malaria in Africa and Asia had developed resistance to chloroquine-the drug of choice since World War II. The result was skyrocketing rates of infection. By the late 1980s, the Peace Corps considered abandoning its African operations altogether because half its volunteers were contracting malaria. Then came Lariam. Infection rates dropped overnight. Experts pronounced the drug a godsend.

How did Lariam go from wonder drug to dreaded drug in a few years? Is it an unsafe medication unleashed without adequate testing, as some argue-or is it the victim of a rumor mill run amok, as others contend?

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