Background: As I started to research mefloquine in early 2019, the first name that came up in my online search was Chris Stiles. To the Lost.
Name: Chris Stiles (rank: NCO, 1 RAR, Australian Army)
Deceased: 3rd August 2016 (aged: TBC). Townsville, Queensland, Australia.
NOK: Lisa Alward (Sister).
Exposure to Anti-Quinolines: Confirmed participant of the controversial Tafenoquine & Mefloquine drug trials during his deployment to East Timor (INTERFET) in 1999-2000. Townsville Bulletin suggests he was prescribed mefloquine. Possible exposure to Mefloquine during his 1990s service (i.e. the Tully Jungle Warfare Centre utilised ‘what ever was on the shelf’). Discharged 2006.
Conditions witnessed/documented that relate to Quinism: Mental health issues linked to quinoline exposure. Suicide.
Confounding Factors: Possible PTSD.
Cause of Death: Suicide.
OPINION: Dr Remington Nevin wrote the definitive piece on mefloquine and suicide in 2013. Via the Huffington Post. Mefloquine: The Military’s Suicide Pill. Excerpt:
In late July, 2013, the FDA issued a powerful “black box” safety warning for a drug which has been taken by hundreds of thousands of troops to prevent malaria. The drug is called mefloquine, and it was previously sold in the U.S. by F. Hoffman-La Roche under the trade name Lariam. Since being developed by the U.S. military over four decades ago, mefloquine has been widely used by troops on deployments in Africa, Iraq and Afghanistan.
We now recognize, decades too late, that mefloquine is neurotoxic and can cause lasting injury to the brainstem and emotional centers in the limbic system. As a result of its toxic effects, the drug is quickly becoming the “Agent Orange” of this generation, linked to a growing list of lasting neurological and psychiatric problems including suicide.
The public had its first glimpse of the mefloquine suicide problem over a decade ago in 2002, when a cluster of murder-suicides occurred among Ft. Bragg soldiers returning home from deployment. All three soldiers had been taking mefloquine, yet an official Army investigation later concluded mefloquine was “unlikely to be the cause of this clustering.” The Army Surgeon General even testified to Congress there was “absolutely no statistical correlation between Lariam use and those murder suicides.” The next year, in 2003, a spike in suicides in the early months of the Iraq war was linked in media reports to widespread use of mefloquine; in response, the U.S. Army promised a study “to dispel Lariam suicide myths.” Yet when mefloquine use was halted in Iraq in 2004, the active duty Army suicide rate fell precipitously.
Lisa Alward reported that Chris had been exposed to traumatic events including the death of a ‘mate’ who was killed in a grenade incident (as I write that sentence I have also triggered a new memory). Quinism is commonly misdiagnosed as PTSD or Depression. Evidence given at the 2018 at the Foreign Affairs, Defence and Trade References Committee inquiry into anti-quinoline use raises concerns about misdiagnosis. Excerpt from Page 9:
1.26 On 25 July 2018 the House of Commons Defence Committee presented a report on Mental Health and the Armed Forces, Part One: The scale of mental health issues. The report notes there is a lack of research into the mental health effects of physical exposure to factors such as neurotoxicity or mild traumatic brain injury:
An example is the antimalarial drug Lariam, or Mefloquine, where our predecessor Committee found that a minority of those who used it suffered serious mental health issues. Such side effects were known to occur, yet the Ministry of Defence did not take the appropriate steps to minimise the risks to those whom it prescribed the drug. A number of witnesses have suggested that other drugs being prescribed by the Armed Forces may be having similar effects but that the current lack of research and data over neurotoxicity and its potential mental health effects may be resulting in cases being missed or being misdiagnosed, for example as PTSD.
Special Note: A failure of the Townsville Bulletin to fact check their story. Given it involved the death of a veteran you would have thought they might have done some rudimentary journalism.
Lisa Alwards’ story published 21.08.2016 via The Daily Telegraph. Veteran suicides: ‘Let my brother be the last’. Excerpt with key point highlighted:
THE grieving sister of the 41st veteran known to have died by suicide this year has made an emotional plea to Australia: “Please, let my brother be the last”.
By the time East Timor veteran Chris Stiles took his own life, on August 3, he had lost his job, his family and his home. His Canberra-based sister, Lisa Alward, said a warning to the Australian Defence Force in March that her brother was at high risk of self-harm went unheeded.
“He should have been on their radar. But they did not help him,” Mrs Alward said. “I pleaded with the authorities to step up to this challenge, listen to this message that our veterans are suffering and need help and make my brother the last one.”
A tone deaf Air Vice Marshall Tracy Smart published almost a month later (17.09.2016) via the Townsville Bulletin. Australian Defence Force’s top-ranking medical officer Tracy Smart speaks candidly about controversial antimalarial drug trials. Excerpt with key point highlighted:
Christopher Stiles, a veteran of East Timor who the Bulletin understands was prescribed mefloquine in the drug trials, died in Townsville in August after taking his own life.
The Bulletin understands Defence records show he did not report any adverse effects during the study, nor did he present with any psychological concerns during service, and at the time of discharge in 2006, he was considered fully fit for service.
But Mr Stiles told of his struggle to seek adequate medical help after leaving the Army at the forum and his death has since been linked to his participation in the trial.
AVM Smart said she was aware Mr Stiles has attended the event but that he didn’t “specifically reach out for help”.
“Whenever any of us hear about the suicide of any Defence member it is a blow,” she said. “In terms of the forum, I understand he was there, obviously there were a lot of people there. “He certainly didn’t come up personally and ask me for help and in fact he didn’t contact us after the forum.”
His Sister reached out in March. The ADF should have reported Lisa’s concerns to the Department of Veterans Affairs’ for follow-up. This should have been known by the AVM. The AVM chose to blame the victim instead.
Medical/MH Note: My opinion is not based on a medical nor mental health background. Just a lived experience former Digger trying to raise awareness on Quinism. Remember, PTSD wasn’t a thing until it was.
Australian Broadcasting Corporation. Defence force admits soldier shouldn’t have been included in East Timor anti-malaria drug trial. Published 22.08.2016. https://www.abc.net.au/news/2016-08-22/adf-admits-soldier-should-have-been-excluded-anti-malaria-test/7772322
Huffington Post. Mefloquine: The Military’s Suicide Pill. Published 25.09.2013. https://www.huffpost.com/entry/mefloquine-the-militarys_b_3989034
Foreign Affairs, Defence and Trade References Committee, Australian Senate. Use of the Quinoline anti-malarial drugs Mefloquine and Tafenoquine in the Australian Defence Force. Published December 2019.
Marriott, A. (2022). If you wake at midnight. London, UK. Austin, Macauley.
Repatriation Medical Authority, Australian Government. SOPs matching factor Mefloquine. Last modified 2023. http://www.rma.gov.au/sops/search?Number=&Year=&Condition=&Factor=Mefloquine
The Daily Telegraph. Veteran suicides: ‘Let my brother be the last’. Published 21.08.2016. https://www.dailytelegraph.com.au/news/nsw/veteran-suicides-let-my-brother-be-the-last/news-story/2c172fda684d925e977cd250b37b14b3
Townsville Bulletin. Losing battle for help with mental illness. Published 16.08.2016. https://www.townsvillebulletin.com.au/news/losing-battle-for-help-with-mental-illness/news-story/be1927503f2568fad54d5807fa6d8724
Townsville Bulletin. Australian Defence Force’s top-ranking medical officer Tracy Smart speaks candidly about controversial antimalarial drug trials. Published 17.09.2016. https://www.townsvillebulletin.com.au/news/australian-defence-forces-topranking-medical-officer-tracy-smart-speaks-candidly-about-controversial-antimalarial-drug-trials/news-story/f0c8dd8fa54fac8556b0b9fd62e32950