Chris Harding

Date: 29 July 2013 Mefloquine Hydrochloride, Brain Damage: Military Service and Toxic Drugs
President Obama The White House 1600 Pennsylvania Avenue NW Washington, DC 20500 CC: US House Committee on Veterans Affairs; US Senate Committee on Veterans Affairs; US Senator Merkley; US Senator Wyden; and US Representative Defazio

To Whom It May Concern: Today, July 29, 2013, the Food and Drug Administration (FDA) issued a MedWatch alert about mefloquine hydrochloride.

Quote: "ISSUE: FDA is advising the public about strengthened and updated warnings regarding neurologic and
psychiatric side effects associated with the antimalarial drug mefloquine hydrochloride. A boxed warning, the most serious kind of warning about these potential problems, has been added to the drug label. FDA has revised the patient Medication Guide dispensed with each prescription and wallet card to include this information and the possibility that the neurologic side effects may persist or become permanent. The neurologic side effects can include dizziness, loss of balance, or ringing in the ears. The psychiatric side effects can include feeling anxious, mistrustful, depressed, or having hallucinations."[FDA; 1] As you know, our military service members are often prescribed this medication. Although precautions have been implemented to reduce prescriptions in environments when another anti-malaria drug is available, reports have indicated that the Department of Defense is not following the suggestions in all cases. In fact, Senator Dianne Feinstein sent the Department of Defense and US Veterans Affairs a letter on August 2, 2011. In that letter, Senator Feinstein states:

Year 2011 Quote: "However, in some instances mefloquine has been shown to have potentially serious neurological
side effects including irreversible brain stem and vestibular damage resulting in balance problems, vertigo, and psychotic behaviors."[Senator Feinstein; 2]

Year 2011 Quote: "In a September 2009 policy memorandum, the Department of Defense removed mefloquine as
the drug of choice for malaria prophylaxis. Per the memorandum, mefloquine was only to be prescribed in limited cases where the three preferred drugs were specifically contraindicated or unlikely to be effective. Additionally, the Federal Drug Administration requires that a pocket card describing the side effects and when to seek medical treatment be dispensed with each prescription. My office has been contacted recently by servicemembers who were prescribed mefloquine when one of the other medications would have been appropriate and were not given the FDA information card. These servicemembers are now suffering from the preventable neurological side effects described above." [Senator Feinstein; 2] As you can see, mefloquine hydrochloride can cause significant problems. In fact, a June 2013 Forensic Psychiatry journal article was released by several expert researchers on mefloquine hydrochloride toxicity. In that June 2013 Journal article, the authors state:

Year 2013 Quote: "Mefloquine (previously marketed in the United States as Lariam) is an antimalarial medication
with potent psychotropic potential. Severe psychiatric side effects due to mefloquine intoxication are well documented, including anxiety, panic attacks, paranoia, persecutory delusions, dissociative psychosis, and anterograde amnesia. Exposure to the drug has been associated with acts of violence and suicide. In this article, we discuss the history of mefloquine use and describe plausible mechanisms of its psychotropic action. Mefloquine

Mefloquine Hydrochloride, Brain Damage: Military Service and Toxic Drugs

1 of 3

Chris Harding intoxication has not yet been successfully advanced in legal proceedings as a defense or as a mitigating factor, but it appears likely that it eventually will be."[3] In fact, Dr. Ritchie, one journal article author and expert, has written a very informative Time article that discusses mefloquine hydrochloride toxicity and its potential impact with respect to past violent acts by military members[4]. In that article, Dr. Ritchie quotes the following:

Year 2013 Quote: "- Roche, manufacturer of the drug, now warns of long-lasting serious mental-health problems
and even irreversible neurological conditions linked to it. - Mefloquine has been found to be neurotoxic: like lead and mercury, it is capable of permanently damaging brain cells. - And we know that related quinoline drugs can be especially toxic to the limbic system, causing injury to the emotional and memory centers of the brain."[4] She then states "perhaps"[4] when considering "if" neuroanatomical changes could have caused the crime.

Year 2013 Quote: "Could permanent, but nearly undetectable brain damage from mefloquine, combined with a
traumatic brain injury, alcohol, and steroids, explain the crime?"[4] Although all drugs have risks, I believe the recent FDA boxed warning provides enough data to have a rational discussion about "if" a soldier should have to take mefloquine hydrochloride if ordered to do so. Would you want to take a medication that causes permanent changes? What would you do if you discovered that mefloquine hydrochloride has been implicated in brain damage[2]? At a minimum, the Veterans Affairs should be providing exposed veterans with compensation for permanent damage. I feel strongly about this because I am a 100% Total and Permanent disabled 1991 Gulf War veteran, and scientific research has shown that my population of veterans seem to be suffering from brain damage and nerve death as well[5;6]. Sadly, my 1991 Gulf War Illness claim was denied while my schizoaffective disorder claim was rated at 100% Total and Permanent[5;6]. Personally, I believe my schizoaffective disorder was caused by my 1991 Gulf War exposures[6]. I have been told by an eminent 1991 Gulf War researcher that epidemiologist are investigating the prevalence of schizophrenic and bipolar disorders in the 1991 Gulf War population. We were given pyridostigmine bromide, and it causes similar psychiatric problems when compared to mefloquine hydrochloride[6]. In fact, bromide salts have been connected to transitory schizophrenias[7]. The author of the latter journal article suggests that some might not recover[7]. War is hell but we need to minimize friendly fire. Please contact the Department of Defense on soldiers behalf and the Veterans Affairs on veterans behalf.

Mefloquine Hydrochloride, Brain Damage: Military Service and Toxic Drugs

2 of 3

Chris Harding

References: [1] US Food and Drug Administration. Mefloquine Hydrochloride: Drug Safety Communication - Label Changes Due to Risk of Serious Psychiatric and Nerve Side Effects, July 29, 2013. fda.gov[online]. 2013. Available from: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm362887.htm [2] US Senate. Senator Feinstein. Feinstein Calls for Review of Anti-malarial Drug, Aug. 18, 2011. feinstein.senate.gov[online]. 2013. Available from: http://www.feinstein.senate.gov/public/index.cfm/2011/8/feinstein-callsfor-review-of-anti-malarial-drug [3] Ritchie, Elspeth Cameron, MD, MPH; Block, Jerald, MD; Nevin, Remington Lee, MD, MPH. Psychiatric Side Effects of Mefloquine: Applications to Forensic Psychiatry, June 2013. j Am Acad Psychiatry Law[online]. vol. 41(2). pp. 224-235. Available from: http://www.jaapl.org/content/41/2/224.full [4] Ritchie, Elspeth Cameron. Sgt Scapegoat? The Latest on Lariam and the Sergeant, July 22, 2013. nation.time.com[online]. 2013. Available from: http://nation.time.com/2013/07/22/sgt-scapegoat-the-latest-on-lariam-and-thesergeant/ [5] Harding, Chris. 1991 Gulf War Environmental Exposures: Chemical Weapons, Experimental Mediication, etc, June 08, 2013. ireport.cnn.com[online]. 2013. Available from: http://ireport.cnn.com/docs/DOC-985240 [6] Harding, Chris. 1991 Gulf War Illness: Brain and Nerve Abnormalities, June 12, 2013. ireport.CNN.com[online]. 2013. Available from: http://ireport.cnn.com/docs/DOC-987496 [7] Golomb, Beatrice Alexandra. A Review of the Scientific Literature As It Pertains to Gulf War Illness. Volume 2: Pyridostigmine Bromide. gulflink.osd.mil[online]. 2012. Available from: http://www.gulflink.osd.mil/library/randrep/pb_paper/index.html [8] Levin, Max. Transitory Schizophrenias Produced by Bromide Intoxication. Am J Psychiatry[online]. Available from: http://ajp.psychiatryonline.org/article.aspx?Volume=103&page=229&journalID=13 Have a nice day! Chris Harding, 100% T&P Disabled 1991 Gulf War Veteran Email: harding.cb@gmail.com

Mefloquine Hydrochloride, Brain Damage: Military Service and Toxic Drugs

3 of 3