Malaria?s Not So Magic Bullet

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?

There’s little doubt that Lariam may cause side effects. The
manufacturer, Hoffman-La Roche, warns against a litany of possible
reactions, from hypertension to hallucinations. What no one can
agree on is the risk. For severe psychotic reactions like Giannini
experienced, previous studies indicate the rate is an acceptable
one in 10,000. But a recent British survey pinned the figure at an
alarming one in 140. That and a growing pile of travelers-gone-loco
stories have convinced many people to question Lariam’s safety.

A leader of malaria surveillance for the Centers for Disease
Control and Prevention, Dr. Hans Lobel says simply, ‘Mefloquine is
a remarkable drug. It’s 95 percent effective, and study after study
shows it to be safe. Would you rather get malaria?’

It’s a question every traveler should take seriously. If you’re
‘lucky’ and contract one of the three nondeadly strains of malaria,
you can expect high fever, dizziness, chills, severe headaches,
nausea and fatigue. Less fortunate malaria contractors are infected
with the Plasmodium falciparum parasite, which produces
similar symptoms but can prove fatal without prompt treatment.
Worldwide, malaria infects up to 500 million people annually-and
kills nearly 3 million. Some 30,000 U.S. and European travelers are
infected each year.

In England, ground zero of the controversy, doctors have noted
an increase in malaria cases among returning British travelers.
Officials at London’s Hospital for Tropical Diseases lay some of
the blame on the British media’s sensational coverage of what’s
been dubbed ‘Lariam poisoning.’ Travelers are afraid to take their
medicine.

Beyond the popular press, medical experts have added fuel to the
fire. An assessment of Lariam studies published in the British
Medical Journal
in 1997 concluded: ‘The public are now
justifiably concerned about the safety of this drug, and the
absence of relevant research makes it difficult for doctors to
reassure or advise them in an informed and convincing way.Lobel,
however, stands by the research that supports Lariam’s safety. ‘At
least 12 million people have taken Lariam,’ he notes. ‘I’d be
surprised if no one got sick from it. Even aspirin causes side
effects in some people.’

Dr. Stephen Blythe, who runs a travel clinic in Florida and has
conducted his own survey, says, ‘The reality of life is that bad
news travels much faster than good. While it’s true that there are
obnoxious side effects, most people can take it without
problems.’

But to Lariam sufferers, the risk isn’t worth it. ‘It’s like I
lost a year of my life,’ says a slowly recovering Giannini. ‘I’d
rather take my chances with malaria.’

What does this mean for your next trip? Educate yourself on the
type and severity of the malaria threat in the region you plan to
visit. Chloroquine is still the recommended drug where resistance
has not been reported. If you take Lariam, start the dosage several
weeks before departure to test your reaction. An alternative drug,
doxycycline, which must be taken daily instead of weekly, is
available for travelers who cannot tolerate Lariam. If the risk of
malaria is low, you may be able to avoid drugs altogether and
simply take precautions against mosquitoes.

Visit ESCAPE Online’s Coconut Wireless to add your comments to
the Lariam issue.

Contact: CDC (877) 394-8747, www.cdc.gov; Lariam Action USA
(510) 663-5168.

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