Random Analytica

Random thoughts, charts, infographics & analysis. Not in that order

Tag: Tafenoquine

Random Analytica: A ‘Soldiers-Five’ [trans. Basic Reading Guide] on Mefloquine

An old ‘soldiers-five’ on Mefloquine. When I first thought I was given Mefloquine I wasn’t sure where to look first. I initially got some good and some bad information. I’m not the tree of knowledge on Mefloquine but here is a suggested reading list and resource guide concerning Mefloquine. I’ve focused on veterans because that is my lived experience. Remember, this is a guide only. Consult your doctor.

Last updated 7th October 2019

World Health Organisation

8th August 1989: World Health Organisation. The original warning from WHO way back in 1989.

Consumer Medicine Information

9th October 2017: The Consumer Medicine Information guide for Lariam (linked here: 171009_ConsumerMedicineInformation_Roche_Lariam). A veteran mate has underlined the important health warnings.

Mefloquine Articles (non-specific)

27th April 1996: New Scientist.  Malaria pill stands accused – Lariam fends off malaria more effectively than any other drug, but growing evidence of disturbing side effects may soon land its manufacturer in court (via 960427_Article_NewScientist_Mefloquine). Thanks to the veteran mate who sent this through. He was given Lariam in 1994 and 1999 without the serious side-effects.

Mefloquine Articles for Veterans

27th January 2003: CBS News. The Dark Side Of Lariam. How Dangerous Is It? One of the first ‘deep-dives’ into mefloquine by a news outlet. Discusses the Fort Bragg suicide cluster where mefloquine was a factor.

19th September 2013: CBS News. Elite Army units to stop taking anti-malarial drug. The US Army’s Special Forces banned from using mefloquine in 2013.

25th September 2013: Huffpost. Mefloquine: The Military’s Suicide Pill. Dr Remington Nevin writes about mefloquine including the 2013 FDA’s ‘black-box’ warning. The world is waking up to the dangers of mefloquine. Dr Nevin is one of the leading experts in the field.

12th October 2014: Army Technology. Mefloquine – the military’s deadly malaria treatment. Dr Remington Nevin discusses the downside to mefloquine including his own personal deployment experience with the drug.

11th August 2016: Military Times. Malaria drug causes brain damage that mimics PTSD: case study. A different take on mefloquine exposure from the USA.

22nd August 2016: Australian Broadcasting Corporation. Defence force admits soldier shouldn’t have been included in East Timor anti-malaria drug trial. One of the first articles I read. Also includes a link to a 2016 7.30 Report about the Australian mefloquine/tafenoquine trials.

30th August 2018: The Irish Times. Vivid nightmares and suicidal thoughts – ex-soldiers blame drug for destroyed lives. An Irish perspective. With a standing Army of approximately 10,000 they have still administered Lariam to approx. 5,500 – 6,000 over the years.

Podcasts

12th June 2019: The Medical Republic. TMR podcast: Can this anti-malarial drug really cause “brain damage”? Thanks to my GP, Dr Mary Lamond for sending this to me. Along with other subjects the podcast covers mefloquine/tafenoquine exposure and its risks in simple language.

Books

23rd January 2014: ‘The Answer to the Riddle Is Me’ by David Stuart MacLean. The Washington Post book review can be found here.

Official Mefloquine Sites (Information & Policy)

Last accessed 7th October 2019: Department of Defence (Australia). Mefloquine. An excellent resource. One of the first sites I visited. Mefloquine Loading Doses are also explained.

Experts

Dr Remington Nevin (USA). Possibly the leading expert in the field of Quinism in 2019 when I suspected my exposure. US Army (Major – Retired). A Vermont-based physician epidemiologist and expert consultant in the adverse effects of antimalarial drugs, particularly mefloquine and tafenoquine.

 

If you or someone you know needs help, please phone Lifeline on 131 114, Kids Helpline on 1800 55 1800, Beyond Blue on 1300 224 636 or Open Arms on 1800 011 046.

Random Analytica: Mefloquine Use by the Australian Defence Force (1990s)

I’m ready to heal yet I still need to count the cost. Others have made the attempt and fallen short. It might be my most important piece of epidemiology to date. It might pan out to be nothing. At least now I can do it systemically and at a slower pace.

It’s personal for me.

191112_MefloquineUseByADF90s (UPD)

The chart above is still a work in progress. I’m starting to get some good feedback from other veterans… If you want to add to this chart please reach out.

Last updated 12th November 2019

Notes:

191112_MefloquineNotes (UPD)

 

990910_Photo_JMolan_OpSpitfire

10th September 1999. Brigadier Jim Molan & Ian Martin directing the evacuation of Dili, East Timor. Source: Twitter (John L. Gould)

 

If you or someone you know needs help, please phone Lifeline on 131 114, Kids Helpline on 1800 55 1800, Beyond Blue on 1300 224 636 or Open Arms on 1800 011 046.

4. Mefloquine Dispatches: Harley Quinn, 1997

I’m told by my GP that PTSD is just like shrapnel. Only this year did I learn that I had shrapnel in my arm back in the 90s. I don’t believe in PTSD. Now I’m trying to remove it from my head.

Not all memories are awful. Some are wonderful.

It’s late 1997. I’m doing my Secret Squirrel course in Melbourne. I’m seeing three different women in Townsville, which is unusual for me. I am operating on muscle memory and I’m certainly not looking for love.

We meet in the gym. I feel underweight for Special Forces. I’m eating seven meals a day. I work out morning and night. I still don’t feel right.

She is with two friends from other postings. I know her friends well enough to walk over and start a conversation. One of the girls is a great rugby player who also happens to be gay. She doesn’t make a big deal about it because homosexuality is still banned by the Army. The other girl has a beautiful face and a kind smile for anyone. A decade later I hear (third-hand) that she got ‘schrapped’ in the Sands on patrol with the Boys. Her face is now damaged.

I feel so sorry for everyone who carries scars now.

It’s late 1997 again. I start to chat to Harley Quinn. I know her but not well. Like most people in the peace-time Army everyone knows everyone after a few years, especially in your own Corps. I think we last caught up in Darwin in 95 but I can’t quite remember. I take a break from my work-out. We start to talk. She gets a constant stream of interruptions. She is not classically beautiful but she has a natural attractiveness that draws admirers. She knows everyone. She talks easily with those who deserve it. Dismisses time-wasters. She commands attention. She is in the prime of her youth. I get a lift from our conversation. By her presence. We all agree to meet at the mess for dinner.

A fortnight later we are in a trinity of nightclubs. It’s just Harley Quinn and me. Our friends cannot keep up. We move from one nightclub to the next and then back again. We dance for hours. We laugh with absolute joy.

We leave the building with our friends. We are both spent. The sun is out. The light surprises us both. I think we have both fallen hard. We hold hands. We really hold hands. It’s a special moment. The future looks bright.

Tears stream down my face as I have this memory yesterday. I use movement to guide the memories. I remember back to 1997. As I dance away I still don’t know anything about mefloquine. I certainly don’t know I was given it six-months previously. My face hasn’t turned red yet. That doesn’t happen for another decade and a half. I’m slowly turning into The Joker but I think I’m fine.

I get more memories of my Harley Quinn. We break up in 1999. It’s a hard break-up. A horror story for another day. She has been deployed to Bougainville on Operation BEL-ISI. The Australian Defence Force is testing a new anti-malarial drug on the troops. The Generals are excited about its potential. It’s called Tafenoquine.

It has a nickname too. Mefloquine 2.0

191021_Image_HarleyQuinn

Image: Warner Bros. Pictures

 

If you or someone you know needs help, please phone Lifeline on 131 114, Kids Helpline on 1800 55 1800, Beyond Blue on 1300 224 636 or Open Arms on 1800 011 046.

Mefloquine and Tafenoquine use by the Australian Defence Force 1990 – 2017

Mefloquine and Tafenoquine are two different types of anti-malarial drugs that have been in use potentially as far back as 1990 but trialled extensively by the Australian Defence Force at the turn of the century. From 2016 via the Australian Broadcasting Corporation. Defence force admits soldier shouldn’t have been included in East Timor anti-malaria drug trial. Excerpt:

The Australian Defence Force has acknowledged it accidentally exposed one of its soldiers to controversial anti-malarial drugs during trials in East Timor, despite the soldier having a medical history of mental illness which should have precluded his involvement.

The soldier, Chris Salter, developed chronic depression and psychosis after inclusion in the Timor trials of psychoactive drugs mefloquine and tafenoquine.His illness has led to repeated suicide attempts and more than a dozen stays in psychiatric hospitals. He is unable to work or care for his family.

Since the trials, which included thousands of Australian soldiers between 2001 and 2003, a small group of veterans have developed severe mental illnesses. They believe the ADF erred by giving them the drugs even though there was a significant body of research which pointed to the drugs’ side effects, which in some cases are permanent.

I just wanted to get a chart posted which highlighted the use of Mefloquine and Tafenoquine in Australian soldiers over the past 30-years. Currently most of the documentation concentrates on the trials conducted between 1998 – 2002, however there is some evidence that groups of soldiers were subjected to trials of mefloquine as far back as 1992 during Operation SOLACE (Somalia). I’ll update the chart as new information comes to hand.

Mefloquine~TafenoquineUsebyADF1990-2017

Explanatory Notes:

1992-93: Somalia – Awaiting more information
1993: Cambodia – Awaiting more information
1994-96: Rwanda – One confirmed mefloquine dosage. Awaiting more info
1997: PNG – One confirmed mefloquine dosage. Awaiting more info
1998: Bougainville – Peace Monitoring Group – 201 troops given Tafenoquine (note: Stuart McCarthy’s notes state 374 troops were given Tafenoquine).
2000: East Timor – 639 troops given Tafenoquine during trials.
2000: East Timor – 162 troops given Mefloquine during the Double-Blind trial
2000: East Timor – 492 troops given Tafenoquine during the Double-Blind trial
2001: Australia – 31 troops given Tafenoquine to test for Relapse Prevention
2001: East Timor – 1,157 troops given Mefloquine during the last major trial of the drug

An excellent resource for understanding the trial intensity of both anti-malarial drugs is Stuart McCarthy’s Summary of ADF Mefloquine and Tafenoquine Clinical Trials 1998 – 2002. See attached:

150724_Summary_SMcCarthy_ClinicalTrials

Data Sources

  1. Mefloquine http://www.defence.gov.au/Health/HealthPortal/Malaria/Anti-malarial_medications/Mefloquine/default.asp
  2. Randomized, double-blind study of the safety, tolerability, and efficacy of tafenoquine versus mefloquine for malaria prophylaxis in nonimmune subjects https://www.ncbi.nlm.nih.gov/pubmed/19995933
  3. Summary of ADF Mefloquine and Tafenoquine Clinical Trials 1998 – 2002 https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Foreign_Affairs_Defence_and_Trade/Mefloquine/Submissions
  4. TGA Approvals for Australian Defence Force Use of Mefloquine in Townsville (Queensland) and Somalia, 1992-93 https://www.righttoknow.org.au/request/tga_approvals_for_australian_def