Army Instituting
Broad Inquiry at
Fort Bragg After 4 Killings
AP 24aug02
WASHINGTON, Aug. 23 — The Army will send medical experts to Fort Bragg, N.C., next week to study a wide variety of health-related issues that might explain a series of domestic killings.
Four Fort Bragg soldiers killed their wives this summer, investigators say.
The Army said in a statement today that, contrary to reports, the epidemiological team would not focus mainly on the possibility of a link between the killings and soldiers' use of an antimalaria medication.
"The team will consult with local medical and unit/installation leadership at Fort Bragg on a wide variety of possible contributing factors," including cultural and other issues, the statement said.
Consultants in psychology, social work and psychiatry will join Army epidemiologists and chaplains as well as officials from the federal Centers for Disease Control and Prevention. In addition to health issues, they will assess the Army's family education programs, practices and support services.
Three of four Fort Bragg soldiers who investigators say killed their wives this summer were Special Operations servicemen who had been deployed to Afghanistan, where the risk of malaria is high. Army officials would not say whether the men had taken the Army's preferred antimalaria drug, Lariam.
Two of the soldiers killed themselves after killing their wives.
Lariam has rare reported side effects, including agitation, depression and aggression.
Lariam (mefloquine) Info
source: http://www.indiana.edu/~primate/lariam.html
24aug02
Lariam is the trade name for the anti-malarial drug mefloquine, manufactured by Hoffman-LaRoche (approved by the FDA for use in the USA 2 May 1989). Mefloquine is also marketed under the trade name Mephaquine manufactured by Mepha.
There is increasing documentation, from medical case reports and anecdotally, that both the frequency and the seriousness of debilitating side-effects of this drug are under-estimated (specific references are listed on the lariam bibliography page).
A study published in the British Medical Journal (31 August 1996, 313:13) found that "About 0.7% (1 in 140) travellers taking mefloquine can expect to have a neuropsychiatric adverse event unpleasant enough to temporarily prevent them from carrying out their day to day activities, compared with 0.009% (1 in 1100) taking chloroquine and proguanil. [emphasis mine]" Previous investigation cited the rate of "serious" side-effects of lariam as only 1 in 10,000 (Steffen, et al., 1993 Lancet 341:1299-1303).
Anecdotally, many people have reported serious side-effects (e.g. panic attacks, "epileptic type" convulsions, headaches, visual and auditory hallucinations, etc.) that persist months after last dose, and are so debilitating that they can no longer continue their work or normal social interactions (see the many medical case reports and media references). "Lariam Action" support groups have been formed in the U.K., the U.S.A., New Zealand, Canada, Ireland, Denmark, and Switzerland. As of March 2001, lariam-related lawsuits have been filed in Ireland, Canada, Denmark, and the United States. (In 1996, class action lawsuit against the manufacturer was filed in the U.K. representing several hundred clients, but was withdrawn in 1999.) Legal action against Lariam's manufacturer was filed in the U.S. jointly by Stanley & Rose (Berkeley, CA) and Suggs & Kelly (Columbia, SC). For additional information, please read through the references and/or contact Stanley & Rose (contacts).
Please note: I am not a medical doctor. Information on this page should not be taken as medical advice. Rather, it should be considered information that your medical doctor may not be aware of. Malaria can be a life-threatening affliction, and one should exercise every precaution to avoid mosquito bites in malarial areas. In order to make the best decision regarding what anti-malarial to take, patient and doctor should take into consideration (1) the type of malaria most prevalent in your target area, (2) the level of resistance to the various anti-malarial medications in this area, (3) your current health status, lifestyle, and concurrent medications being taken, and then weigh the risks associated with the various medications to your particular situation. No medication guarantees that you will not contract malaria. And no medication is free of side-effects in all consumers.
Before choosing mefloquine, look at the medical research and media reports documenting the serious problems associated with this drug, and give this web site address to your physician, so that you can make an informed choice.
Acute paranoid hallucinatory psychosis following mefloquine prophylaxis (Lariam)
Psychiatr Prax 1999 Sep;26(5):252-4
[Article in German]
Kruger E, Grube M, Hartwich P.
Klinik fur Psychiatrie und Psychotherapie der Stadtischen Kliniken, Frankfurt a.M.
Mefloquine is a drug of choice for malaria prophylaxis in Africa because of the spread of chloroquine resistant plasmodium falciparum. On the other hand there are some reports about severe neuropsychiatric side effects associated with the intake of mefloquine medication. In our paper we present a case-report of a patient suffering for the first time from an acute paranoid psychosis induced by mefloquine prophylaxis.
Mefloquine-induced trigeminal sensory neuropathy.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001 Aug;92(2):163-5
Watt-Smith S, Mehta K, Scully C.
Department of Oral and Maxillofacial Surgery and Orthodontics, John Radcliffe Hospital and University College London, United Kingdom.
Trigeminal sensory neuropathy is an important finding, often indicative of trauma but sometimes related to neoplasia, infections, demyelinating conditions, connective tissue disorders, other disorders, or, occasionally, drugs. This paper reports on a patient with sudden-onset trigeminal sensory neuropathy of the lip that proved to be drug-induced, secondary to the antimalarial drug mefloquine. This appears to be the first report of sensory impairment in the orofacial region from exposure to mefloquine.
Unexpected frequency, duration and spectrum of adverse events after therapeutic dose of mefloquine in healthy adults.
Acta Trop 2002 Feb;81(2):167-73
Rendi-Wagner P, Noedl H, Wernsdorfer WH, Wiedermann G, Mikolasek A, Kollaritsch H.
Department of Specific Prophylaxis and Tropical Medicine, Institute of Pathophysiology, University of Vienna, Kinderspitalgasse 15, A-1095 Vienna, Austria. joy.pamela.wagner@univie.ac.at
The frequency and spectrum of adverse events associated with the antimalarial therapeutic regimen of mefloquine (MQ) (750 and 500 mg at an interval of 6 h) was assessed in 22 healthy volunteers who were monitored for 21 days following drug administration. An unexpected high frequency of side effects of any grade were reported by all 22 subjects. The most commonly reported symptoms were vertigo (96%), followed by nausea (82%) and headache (73%). Participants suffering from severe (grade 3) vertigo (73%) required bed rest and specific medication for 1 to 4 days. More females than males reported severe adverse reactions. The majority (77.3%) of the participants (f: 8/12, m: 9/10) showed symptom resolution within 3 weeks (510 h) after drug administration. Biochemical and haematological findings stayed within the normal range of values, but showed nevertheless a significant rise of Na, Cl, Ca, bilirubin, GGT and LDH. The unexpectedly high frequency and severity of adverse reactions after normal therapeutic dosage of MQ in healthy subjects may influence future recommendations regarding the use of MQ for stand-by treatment of suspected malaria in travellers.
Danger of malaria self-treatment. Acute neurologic toxicity of mefloquine and its combination with pyrimethamine-sulfadoxine
Presse Med 2001 Sep 29;30(27):1349-50
[Article in French]
Nicolas X, Granier H, Laborde JP, Martin J, Talarmin F.
Service de Medecine interne, Hopital d'Instruction des Armees Clermont-Tonnerre, Brest Naval. xfnicolas@hotmail.com
BACKGROUND: Mefloquine and pyrimethamine-sulfadoxine combination are recommended, as is quinine, for self-administered malaria prophylaxis. Patients should be carefully informed about appropriate use of this therapeutic scheme and advised on the importance of strict compliance to avoid overdose. CASE REPORT: We report the case of a patient who did not follow the prescribed dosage and who developed acute neurological disorders after overdosing. The patient developed seizures attributable to the sulfadoxine-pyrimethamine combination and mefloquine encephalopathy. DISCUSSION: Sulfadoxine-pyrimethamine-related seizures are exceptional and result from an overdose of pyrimethamine. The neurotoxicity of mefloquine is well-known and is particularly frequent at curative dosage. Toxic encephalopathy is a serious neurological manifestation which is slowly reversible depending on individual predisposition. Anti-malaria prophylaxis requires concerted efforts on the part of the traveler and the prescribing physician. Self-administration schemes can be both most useful and dangerous due to expected benefits and potential risks.
Neuropsychiatric symptoms in preventive antimalarial treatment with mefloquine: apropos of 2 cases
Encephale 2000 Jul-Aug;26(4):67-70
[Article in French]
Lebain P, Juliard C, Davy JP, Dollfus S.
Centre Esquirol, CHU de Caen.
Two observations of severe neuropsychiatric reactions occurring during chemoprophylaxis with mefloquine are reported. The first case regards a 43 years old woman who developed a severe depression with visual and auditive hallucinations and a paranoid delusion. She was treated by clomipramine and risperidone. The second case concerns a 55 years old man who developed an acute psychosis with confusion. He was treated with halopridol during a short time. He presented twice an acute psychosis during a chemoprophylaxis with mefloquine. Several cases of neuropsychiatric side effects with mefloquine chemoprophylaxis or treatment have been described. Authors estimate that one of 250 therapeutic users has severe neuropsychiatric reactions, compared with one of 10,000 to 15,000 in the prophylaxis users. Disorders could last from 15 minutes to several weeks. Women and patients with personal or familial antecedents of psychiatric disorders are more frequently concerned. Alcohol and the association with other antimalarial drugs (like quinine) are two other risk factors. Therefore, some advices may be suggested regarding the use of mefloquine for malaria prophylaxis and treatment.
Reported side effects to chloroquine, chloroquine plus proguanil, and mefloquine as chemoprophylaxis against malaria in Danish travelers.
J Travel Med 2000 Mar-Apr;7(2):79-84
Petersen E, Ronne T, Ronn A, Bygbjerg I, Larsen SO.
Laboratory of Parasitology, Statens Serum Institut, DK-2300 Copenhagen S., Denmark. ep@ssi.dk
BACKGROUND: The aim of the study was to provide data on the relative frequency of reported symptoms in travelers using chloroquine, chloroquine plus proguanil, and mefloquine. METHOD: The study was an open, nonrandomized study recording self-reported events in travelers recruited consecutively from two travel clinics in Copenhagen, Denmark. The main outcome measures were the relative proportion of travelers reporting particular symptoms in the three prophylaxis groups, compliance, hospitalization and premature termination of the travel. RESULTS: From May 1996 to April 1998 5, 446 travelers were included and 4,158 questionnaires (76.3%) returned. Compliance was significantly better in mefloquine users with 83.3% of short term travelers compared to 76.3% in chloroquine plus proguanil users. Also, 84.8%, 59.3% and 69.5% using chloroquine, chloroquine plus proguanil, and mefloquine respectively reported no symptoms and 0.6%, 1.1% and 2.8% reported "unacceptable" symptoms. Compared to chloroquine, mefloquine users had a significantly higher risk of reporting depression, RR 5.06 (95% CI 2.71 - 9.45), "strange thoughts," RR 6.36 (95% CI 2.52 - 16.05) and altered spatial perception, RR 3.00 (95% CI 1.41 - 6.41). CONCLUSION: Overall mefloquine is tolerated at least as well as chloroquine plus proguanil and shows better compliance, however, symptoms related to the central nervous system are more prevalent in mefloquine users and when symptoms develop, they are perceived as more severe.
Neuropsychiatric problems in 2,500 long-term young travelers to the tropics.
J Travel Med 2000 Jan;7(1):5-9
J Travel Med. 2000 Sep-Oct;7(5):225-6.
Potasman I, Beny A, Seligmann H.
Infectious Diseases Unit and Travel Clinic, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel.
BACKGROUND: The prevalence and features of travel associated neuropsychiatric problems (NPP) and their relation to previous psychological consultations, antimalarials and recreational drug use have not been adequately studied. METHODS: A two-phase postal and telephone survey has been conducted among 2,500 young travelers to tropical countries. We measured the rate and duration of NPP, characterized their features, and their association with previous psychological profiles, itinerary, type of travel, consumption of recreational drugs, and malaria prophylaxis. RESULTS: First phase: Out of 1,340 respondents, 151 (11.3%) indicated that they had NPP during travel, in contrast with 2.3% who needed psychological consultation before travel (p<.001). Second phase: 117 of 151 responded to the study questionnaire. The mean age of the respondents was 24.4 years, 54.7% were female, and the mean stay abroad was 5.3 months. The most common NPP were sleeping disturbances (52.1%), fatigue (48.7%) and dizziness (39.3%). Thirty-three travelers (2.5%) had severe symptoms, and 16 (1.2%) had symptoms lasting more than 2 months. Seven travelers had pure or mixed depressive symptoms. Consumption of recreational drugs was admitted by 22.2%. Mefloquine was used significantly more often by those who suffered NPP, than by the entire cohort (98.2% vs. 70.7%; p<.001). CONCLUSIONS: Long-term travel to the tropics was associated, in this cohort, with a considerable rate of neuropsychiatric symptoms. The majority of the responding travelers were females, used mefloquine as prophylaxis, and at least one fifth used recreational drugs.
Long-lasting neuropsychiatric side-effects following mefloquine prophylaxis. A case after six weeks of initiating and lasting six months
Ugeskr Laeger 1999 Mar 8;161(10):1422-3
[Article in Danish]
Bygbjerg IC, Ronn AM.
Kobenhavns Universitet, Panum Instituttet, Institut for Folkesundhedsvidenskab, afdelingen for international sundhed. I.Bygbjerg@pubhealth.ku.dk
Neuropsychiatric side-effects from mefloquine are well known. When used for prophylaxis, the side-effects have been claimed to be relatively rare, mild and transient, most often arising within two to three weeks, and in patients with a previous history of neuropsychiatric disorders. We here describe a case of severe neuropsychiatric side-effects arising six weeks after initiating mefloquine prophylaxis, requiring repeated hospitalization, and not resolving completely after six months, in a previously healthy 30 year-old female.
Death in the Ranks at Fort Bragg
T TRENT GEGAX & JOHN BARRY / Newsweek 5aug02
They valiantly fought for their country, but then some of them became coldblooded killers when they reached home. What set off four U.S. soldiers?
When 32-year-old Jennifer Wright went missing in late June, her husband, William, told neighbors he knew what had happened: she’d run off with a friend. An Army Special Forces master sergeant stationed at Fort Bragg, N.C., he’d recently returned from a tour of duty in Afghanistan, and his marriage was showing signs of strain.
WILLIAM WRIGHT CLAIMED it wasn’t the first time Jennifer had up and left, eventually to return. Jennifer Wright’s family was skeptical. She was a doting mother, and they didn’t believe she’d leave her three sons.
They were right. On July 19 Wright reportedly confessed to strangling Jennifer weeks before. He took police to a wooded area, where he’d allegedly buried her.
The murder was grisly, but in the tight-knit military community in and around Fort Bragg, it is becoming depressingly familiar. Jennifer Wright was just one of four Fort Bragg wives allegedly slain by their soldier husbands in the past six weeks. Inevitably, the murders raised uncomfortable questions about the stress of combat and the possible effects of extreme training. For years advocacy groups have complained that the Pentagon hasn’t done enough to help soldiers and their spouses deal with the enormous difficulties of military life—the long separations, fear of death, low pay and infidelities. Whatever the reason, the Army must now face a troublesome fact: a startling number of soldiers lauded as heroes for their service overseas are having a far harder time returning to life at home.
July 26 — Four wives of U.S. soldiers based in Fort Bragg have been murdered in the past six weeks, and in all cases, the husbands have been accused of the killings. NBC’s Don Teague reports.
The Bragg slayings are a gruesome case in point. On the night of June 11, two days after returning from Afghanistan, Sgt. 1/C Rigoberto Nieves got into an argument with his wife, Teresa, pulled a .40-caliber pistol, shot her and then turned the gun on himself. On July 9 Sgt. Cedric Ramon Griffin, of the 37th Engineer Battalion, allegedly stabbed his estranged wife, Marilyn, at least 50 times. On July 19 Sgt. 1/C Brandon Floyd, a member of the elite Delta Force who had also served in Afghanistan, fatally shot his wife and then himself.
CONFRONTING THE PROBLEM
Statistics show that domestic violence in the military occurs at twice the civilian rate. But the armed forces are overwhelmingly made up of young men, often from unstable, low-income families—the social group most likely to commit violent acts. Among comparable civilians, the rate of domestic abuse is close to that of soldiers. Even so, the number of violent crimes in the ranks is a problem the Army hasn’t fully confronted. Soldiers commit thousands of domestic assaults each year, and few are ever prosecuted in civilian courts.
Critics charge that the Army goes out of its way not to prosecute domestic abusers because under federal law those convicted would lose their right to carry a gun—and therefore become useless as soldiers. Some abused wives have quietly complained that base commanders pressured them not to bring charges. “The Fort Bragg murders may at last persuade people to wake up to the scale of the problem the military has,” says Christine Hansen of the Miles Foundation, which investigates military domestic abuse. “For the commanders, unit readiness is all. Which means they will do anything rather than lose a soldier.” One member of a Pentagon task force examining the issue told NEWSWEEK, “What’s needed is a determination right from the top to do something.”
At Fort Bragg, Special Forces soldiers and their wives told NEWSWEEK that the stresses of preserving a marriage and raising kids in the Army is just more than some people can handle. In most of the recent murders, the marriages were failing before the men went to Afghanistan. Special Forces soldiers are away from home as much as 10 months a year. The pay is scandalously low; a new Special Forces recruit—usually a soldier with five to seven years of experience—earns about $25,000 a year. “A young Green Beret who’s married with two kids qualifies for food stamps,” says one recruiter. Another sore spot: infidelity. “There are a lot of women who, when their husbands go, you see them out on the town running around,” says one military wife.
KEEPING TEMPERS AT BAY
Most learn to cope on their own. Yvonne Qualantone’s husband is nearing his 20-year mark. Mostly, she says, the stress has been financial. But over the years, she developed a drill to prepare for her husband’s homecoming. A few weeks before, she and the wives of her husband’s A-Team talk to their chaplain about keeping tempers at bay. She buys a new dress, and tells her five kids, “Make sure the bed’s made and your room’s clean.”
The Army says it is sensitive to these problems, and offers marriage counseling to any soldier or spouse who wants it. But privately, an official acknowledged to NEWSWEEK that a soldier “has to want to seek assistance,” something the men worry will make them look weak or hurt their chances for promotion. But in the aftermath of four brutal murders, the Army may have to start watching its men as closely at home as it does in the field.
With Julie Scelfo
Key Moments in Special Forces History
1980 - DESERT ONE
In November 1979, the Iranian Revolutionary Guard captured and held 52 Americans hostage at the U.S. Embassy in Tehran. The following April, U.S. Army Special Forces were dispatched to rescue the hostages by flying helicopters to Iran from Egypt. But the rescue was aborted when poor intelligence and a sandstorm caused two of the helicopters to crash in the desert, killing five Air Force personnel and three Marines.
1980 - OPERATION NIMROD
On April 30, six armed Iranians stormed the Iranian Embassy in London and took 26 hostages, demanding a separate homeland within Iran. The British Special Air Services stormed the building after one of the hostages had been killed. In the end, two hostages and five of the gunmen were killed. The operation was over within 15 minutes and declared a success.
1998 - OPERATION FAVIUS
In March, British intelligence got word that two members of the Irish Republican Army, Daniel McCann and George Savage, would be arriving in Gibraltar with a woman named Mairead Farrell, also an alleged terrorist. Operatives of the British Special Air Services believed the three were about to detonate a bomb, and McCann, Savage and Farrell were killed in a shootout. It was later discovered that they were unarmed.
In 1995, the European Court of Human Rights declared the killings unlawful.
1993 - SOMALIA
President Clinton decided to try to capture Somali warlord Moahmmed Farah Aideed after numerous attacks on U.S. soldiers conducting a humanitarian mission in Somalia.
On Oct. 3, U.S. Special Forces attempted a raid on Aideed’s compound but they were ambushed by his soldiers. In the battle that ensued, 18 U.S. soldiers were killed and 77 were wounded. An estimated 300 Somalis also were killed and another 700 were wounded, almost a third of them believed to be women and children. The mission’s failure was underscored by the withdrawal of all American troops by early 1995.
Bragg Investigation Put On Fast Track
CBS News 23aug02
RALEIGH, NC -- The army has suddenly put the Ft. Bragg murder investigations on the fast track. As CBS News Correspondent Cynthia Bowers reports, the military will now send an investigative team to North Carolina this weekend. Included in the investigation is whether the anti-malarial drug Larium was a factor.
The Army confirmed Friday that it will send a team of medical experts to Fort Bragg, N.C., to study a wide range of health-related issues that might explain a series of domestic killings.
However, a written statement said the epidemiological team's main focus will not be on the possibility of a link between the killings and soldiers' use of an anti-malaria medication.
"Contrary to news reports speculating that the team will focus primarily on anti-malaria prophylaxis/medications taken by soldiers, the team will consult with local medical and unit/installation leadership at Fort Bragg on a wide variety of possible contributing factors," the statement said.
The Army team will look into cultural and other issues not unique to Fort Bragg, the statement noted.
Four wives of soldiers at Fort Bragg were killed in a six-week span this summer. Each death is blamed on the husband. Three of the four men were Special Operations soldiers who had recently returned from Afghanistan.
Two of the soldiers killed themselves after killing their wives.
The Special Ops soldiers reportedly all took Lariam, a drug given to troops serving in places - like Afghanistan - where the deadly mosquito-borne disease malaria is prevalent.
Consultants in psychology, social work and psychiatry will join Army epidemiologists and chaplains as well as officials from the government's Centers for Disease Control. In addition to health issues, they will assess the Army's family education programs, practices and support services.
"Members will also look at specific data associated with recent cases looking for patterns, organizational dynamics and medical issues that may have contributing significance," the Army statement said.
William Wright, reports Bowers was one of three Ft. Bragg soldiers who reportedly took Lariam in Afghanistan and then came home and allegedly killed their wives.
Johnny Lown, a former Army Medic who served with Wright says, "Bill was not a guy that you'd suspect."
When Lowns heard about the murder he immediately wondered about Lariam. As a medic he dispensed the drug. It was in Haiti back in the mid 90's that he first noticed the problem with side effects.
"It was common knowledge with the nightsweats and the vivid dreams it also intensified a personality, if a guy was down he was gonna be more down if he was quiet he would be anxious."
Lown's wife Debbie knew enough to tiptoe around her husband when he was taking Lariam.
Debbie Lown says, "I was getting very concerned and as i talked to other team wives they said we're all experiencing the same thing some even worse then my husband.
The drug's manufacturer Hoffman LaRoche acknowleges side effects in rare cases saying no medicine is "completely free of adverse events. However, it is important to note that Lariam is not associated with violent, criminal conduct."
However, Roche Laboratories, acknowledges reports of suicide and suicidal thoughts attributed to Lariam, also known as mefloquine. But company spokesman Terence Hurley said they are extremely rare, "only a small percentage of the more than 25 million people that have successfully used Lariam."
Col. Robert of the U.S. Army says, "We have found for most soldiers this is the drug that they're able to handle very well and even the side effects they've had have been relatively minor."
But other nations feel differently. Australia for example doesn't give Lariam to its military anymore. The drugs critics here at home say any investigation is long overdue.
"There's no reason to believe right now that Larium affected the behavior of the individuals," Army spokeswoman Elaine Kanellis said Wednesday.
The Army says, simply put, Lariam saves soldiers serving in places like Somalia and Afghanistan and the benefits far outweigh the risks.
And it's not just soldiers and diplomats taking Lariam. It's one of three anti-malarial drugs recommended by the government and is prescribed to nearly 400,000 American travelers every year – many of whom may not be aware of the potential risks.
Malaria is a serious, sometimes fatal, disease caused by a parasite that infects humans through mosquito bites. The World Health Organization estimates that perhaps as many as 500 million cases of malaria occur each year and more than 1 million people die of the disease worldwide.
Lariam is the malaria remedy of choice for soldiers because it is taken once a week instead of daily.
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