Become a fan of Slashdot on Facebook


Forgot your password?
The Military Medicine United States Technology

Army Reviews Controversial Drug After Afghan Massacre 195

Hugh Pickens writes "Time Magazine reports that after the massacre in which Staff Sgt. Robert Bales allegedly killed 17 civilians in Afghanistan, the Pentagon has ordered an urgent review of the use of the anti-malarial drug mefloquine, also known as Lariam, known to have severe psychiatric side effects including psychotic behavior, paranoia and hallucinations. 'One obvious question to consider is whether he was on mefloquine (Lariam), an anti-malarial medication,' writes Elspeth Cameron Ritchie in Time. 'This medication has been increasingly associated with neuropsychiatric side effects, including depression, psychosis, and suicidal ideation.' The drug has been implicated in numerous suicides and homicides, including deaths in the U.S. military. For years the military used the weekly pill to help prevent malaria among deployed troops, however in 2009 the U.S. Army nearly dropped use of mefloquine entirely because of the dangers, using it only in limited circumstances, including sometimes in Afghanistan. Army and Pentagon officials would not say whether Bales took the drug, citing privacy rules. Assistant Secretary of Defense for Health Affairs Jonathan Woodson has ordered a new, urgent review to make sure that troops were not getting the drug inappropriately. 'Some deployed service members may be prescribed mefloquine (PDF) for malaria prophylaxis without appropriate documentation in their medical records and without proper screening for contraindications,' the order says. It notes that this review must include troops at 'deployed locations.'"
This discussion has been archived. No new comments can be posted.

Army Reviews Controversial Drug After Afghan Massacre

Comments Filter:
  • Obviously it's pure speculation, but I have a hard time believing this would mitigate any punishment Bales receives. It would be a nightmare of the most extreme order for the military should Bales be exculpated, even in the most limited sense. The Afghans have been screaming for him to be tried under Afghan law. It would be hard enough to punishment short of the death penalty to the Afghan public, much less an outcome that ends with him in psychiatric care first. This is just one more massive headache in a case that can't be over for the Pentagon fast enough.

    In the mean time, expect relations to continue to deteriorate between Afghan security forces and ISAF troops. There is real danger of this review fueling conspiracy theories and sparking further knife-in-the-back attacks on ISAF troops like we've already seen.

    It increasingly seems that no one is winning from this war. Afghan civilians have had any sense that westerners provide safety shattered. Westerners trust their Afghan counterparts even less. And yet most of Afghan development depends on the industry that supports the international presence there, which a hasty pull-out would destroy. What's the least bad option here?
    • Obviously it's pure speculation, but I have a hard time believing this would mitigate any punishment Bales receives. It would be a nightmare of the most extreme order for the military should Bales be exculpated, even in the most limited sense. The Afghans have been screaming for him to be tried under Afghan law. It would be hard enough to punishment short of the death penalty to the Afghan public, much less an outcome that ends with him in psychiatric care first. This is just one more massive headache in a case that can't be over for the Pentagon fast enough.

      That's what I think. They will search through all possible excuses and then declare him mentally ill -- I mean, who isn't mentally ill if they kill 17 people. It's like medication ads today ... look long enough you'll find something wrong. That's no punishment.

      It would be interesting to know what Afghans think about the payment per injured/dead -- how does that relate in their culture?

      It increasingly seems that no one is winning from this war.

      Nobody ever wins in wars. It's about finding out who loses less.

      • by lgw ( 121541 )

        Countries win wars all the time. War is the extension of a countries political will. In the abstract, war is about removing your opponent's ability to resist your political will - carthago delenda est. In practice war is about making it unacceptably costly for your opponent to resist your political will.

        The Afghan war has always been a mystery to me. I understood a few months of knocking back Taliban camps, but since then? What exactly are we trying to force the Afghans to do? How exactly is this effo

        • Sounds like Clausewitz' conception of war

          Also, to refer to "It's about finding out who loses less" in buchner.johannes' post and "making it unacceptably costly for your opponent to resist your political will" in yours - make it more costly for them than for you.

      • Nobody ever wins in wars. It's about finding out who loses less.

        The people with the least to lose, obviously.

      • He joined the US army, of course he was mentally ill. Never volunteer for anything, as my Staff Sergeant used to remind me.
    • by jythie ( 914043 ) on Friday March 30, 2012 @11:27AM (#39523191)
      *nods* politically they have to punish him, though it would not be the first time the US has quietly let a citizen off the hook when a weak forign government screams bloody murder.

      The bigger problem, if this medication played a role, is going to be the drug company. There have been numerous cases where a psychotic incident involving murder has been plausibly linked to a medication, but they have never survived court since drug companies do NOT want that kind of liability, so they fight tooth and nail.. and to be blunt, the medical industry is a lot stronger then the federal government. So it is very unlikely we will ever see a court approved link between this medication and a murder.
      • by lgw ( 121541 ) on Friday March 30, 2012 @02:18PM (#39525521) Journal

        Realistically, if you ever want a cure for cancer, a pharma company needs to have some bar they can clear and say "this is enough testing, we can sell it now". Maybe your thinking of other cases where the liability of the company was more clear? When the military is involved it gets even more murky - sometime you knowingly do quite unsafe things in the military after all. Bomber pilots get stim pills that wouldn't be legal for most people (though pretty mild by illegal drug standards), but the danger of those pills is trivial compared to what they're doing while on them.

        This is more a case of "what was the military thinking continuing any use of this drug" than "what was a pharma company thinking continuing to sell it to the military". Not every story needs a corporation as a mustache-twirling villain and a government agency as the shining hero, after all.

    • by Hatta ( 162192 ) on Friday March 30, 2012 @11:33AM (#39523257) Journal

      It increasingly seems that no one is winning from this war.

      Increasingly? It was obvious from the start that this was a fool's errand. Afghanistan isn't called the graveyard of empires for no reason.

      Just to put some perspective on this, Bales allegedly killed 17 civilians. NATO killed 410 civilians last year. If it took 10 such massacres to get us out of Afghanistan, we'd still be ahead by a factor of 2.

      Bales is no worse than the war mongers keeping us in Afghanistan. At least he potentially has TBI and/or PTSD to blame. Obama has no one to blame but himself for civilian deaths in Afghanistan.

      • Not so fast (Score:2, Insightful)

        by Anonymous Coward

        This project has raked billions through the business of government. At the top of the pyramid, the elite who make the decisions do not care where the money comes from or where it goes -- what matters is that it passes through their hands, giving them a chance to exploit that cash flow for personal gain.

        In conclusion, this project has only increased the net worth of the business of government. At the top of the pyramid, that is the entire goal. We know this because the balance sheet doesn't lie, and neither

      • by geekoid ( 135745 )

        How did this become Obama's fault? Bush got us stuck in that quagmire. It would be irresponsible to 'just leave'.
        The power vacuum would be horrendous. We will leave, and afghan locals are more and more taking control of patrols and routine security measures.

      • Re: (Score:3, Insightful)

        by thomst ( 1640045 )

        explosivejared sighed:

        It increasingly seems that no one is winning from this war.

        prompting Hatta to respond:

        Increasingly? It was obvious from the start that this was a fool's errand. Afghanistan isn't called the graveyard of empires for no reason.

        Actually, it wasn't obvious at all. The U.S. invasion was welcomed by the majority of Afghans, who were pretty sick of the Taliban's reign of terror. The problem is that the Bush administration, instead of proceeding with the arduous and expensive task of nation-building that would have ensured the Taliban's permanent defeat, opted to turn its attention to invading Iraq. As a result, conditions for the average Afghan did not improve AT ALL under the American occupation, while Paki

        • by Hatta ( 162192 )

          Actually, it wasn't obvious at all.

          I called it in 2001.

          Should he be persuaded immediately to withdraw all U.S. troops, not only would the Taliban instantly re-take control of Afghanistan, they would wreak horrific retribution against the most westernized sectors of Afghani society (i.e. - the most civilized and tolerant sectors), and plunge the country back into the 14th century hellhole it was before we invaded it in 2001.

          Which will happen whether we leave today, or whether we leave in 2112. The longer we

    • Until you've been through the altered psychological state that these and other drugs produce, it's hard to imagine the way in which it changes your thought patterns. It's not always possible to recognize your thought patterns as disturbed or to rationalize them away...or to surpress the urges associated with them.

    • by Truekaiser ( 724672 ) on Friday March 30, 2012 @12:05PM (#39523619)

      No. they are looking for excuses other then the obvious reason. hopped up on nearly a decades worth of propaganda of these people being 'evil', and 'against our very way of life' etc him either alone or in a group. since many of the Afghanistan witnesses claim he was not alone. go out and slaughter a bunch of people for the fun of it. they want any reason to dismiss it from being pre-meditated.

      as for why we are there and will continue to be there even in a less active role? we went in to chase out a certain group of people as the public reason. anyone who can read a map would see the country is valuable real estate if say the straight of Hormuz and the Pearson gulf is impassable for trade..

      • I'm sorry, how is Afghanistan "valuable real estate for trade" if we can't use the strait of Hormuz and the Persian Gulf? A land-locked, mountainous country, with the sides closest to the Gulf being bordered by Iran on one side and Pakistan on the other, and miles and miles of mountains in between? Are we gonna build roads across all of that terrain, airlift in all our trade goods, and drive them to the borders of Pakistan and Iran, only to be turned around and sent back to our airbases?

        Your argument woul

        • by chrb ( 1083577 ) on Friday March 30, 2012 @02:34PM (#39525723)

          Caspian Sea oil and gas [] unrecovered reserves are enormous, valued at over $10 trillion. Iran is currently a transit country for this, but the aim is to use Afghanistan instead. The Trans-Afghanistan Pipeline [] is a big part of this. Plans for an Afghan pipeline have been in the making for a long time, U.S. Congress testimony in 1998: []

          Mr. MARESCA. It's not going to be built until there is a single Afghan Government. That's the simple answer. We would not want to be in the situation where we became the target of the other faction. In any case, because of the financing situation, credits are not going to be available until there is a recognized government of Afghanistan.
          Mr. BEREUTER. So you are not making any suggestions about the prospects of that or timing of that. It's just you are not going to move or it's not going to be moved from another source until that happens. That would be your judgment?
          Mr. MARESCA. That's my judgment. We do of course follow very closely the negotiations which have been going on. We are hopeful that they will lead somewhere. All wars end. I think that's a universal rule. So one of these days this war too will end. Then I believe the pipeline will be secure.

          That war (officially) ended thanks to the U.S. military, Afghanistan was (officially) unified under the Karzai government, and in 2002 Karzai signed the TAPI pipeline deal. Very fast given the complexity of such a deal. The U.S. has invested $0.5 trillion in the Afghan War so far, that's quite a lot just to bring bin Laden to justice. That $0.5 trillion didn't magically disappear - it was given to corporations which have profited handsomely from this war. Some stand to profit even more in the future from the ability to export Caspian Sea oil and gas through Afghanistan. And it also isolates Iran further.

          Is it all a coincidence? It does seem awfully convenient...

    • by History's Coming To ( 1059484 ) on Friday March 30, 2012 @12:53PM (#39524267) Journal
      I took mefloquine for around three months while in Nepal. It does, without any doubt, have some strange psychological effects. In my case it took the form of strange "waking dreams", I could close my eyes and start dreaming without having to fall asleep. Add effects of this nature to a high-stress situation and you've got a person who probably shouldn't be allowed to wander around with a loaded rifle. Given the high praise that's been heaped on this soldier for his previous conduct and it wouldn't surprise me at all if mefloquine was an aggravating factor. Of course, there's no information on whether he was taking it or not, but if he was it's an urgent issue that needs to be dealt with ASAP.
      • Not to discount the possible influence of medication, but isn't it also plausible that he got sick and tired of a populous that did nothing to help or inform them as they walked and drove over IEDs day in and day out? Of watching his buddies lose their limbs and lives while villagers look surprised and say "How did that get there?!?" That he wanted to teach them a lesson (even though that meant becoming just like the so-called enemy he was fighting)? I'm not saying it's right to kill civilians caught i

    • by chrb ( 1083577 )

      When a U.S. soldiers goes on a rampage shooting civilians, he is labelled as an unwitting victim of psychotropic drugs.

      When a Norwegian militant goes on a rampage shooting civilians, he is labelled as an unwitting victim of mental illness.

      What do you think would happen if either of these men were Muslim? These defenses would never be accepted.

      Different rules for different folk...

      • What do you think would happen if either of these men were Muslim? These defenses would never be accepted.

        They'd be applauded for their heroic actions against the infidels on Al-Jazeera?

        The difference between a terrorist/insurgent and a patriot/freedom fighter quite often depends on who's telling the story...

    • by Jonner ( 189691 )

      The longest our forces stay there, the more of them will be killed, the more Afghans they'll kill and the more enemies they'll make. Both the Afghan and Pakistani governments are completely ineffective against the Taliban. There is no good option for the US. Therefore, there's no point in trying any more and we should get out as quickly as we can.

  • Sounds like a scapegoat to me. Shouldn't the medical personnel responsible for his presumed prescription then be prosecuted?

    • Re:Scapegoat (Score:5, Informative)

      by oodaloop ( 1229816 ) on Friday March 30, 2012 @11:11AM (#39522987)
      No one is saying he isn't responsible for his actions. They're going to review the use of the drug as a whole, and it's about time. Everyone I know who's gone (I'm a defense contractor, and many of my coworkers have gone to AFG) have had bad reactions to the drug and stopped taking it. Typical stories include violent horrible dreams every night until they stop taking it. Do you think they SHOULDN'T review the use of the drug, given its known side effects?
      • Of course, I think the review should go through. Of course, I realize there is little chance this will exculpate Bales. I said as much. I was commenting on the politics of the situation. As evidenced by numerous posts in this very thread, it's very easy to read about this drug's role and immediately jump to conclusions about a conspiracy to allow these murders to go unpunished. If such a jump is so easy on slashdot, imagine what what conspiracies might spread in a more febrile environment like Afghanistan a
      • If you read the descriptions of side effects for the drug it rapidly becomes apparent that the way Larium prevents malaria is by giving you all the symptoms of malaria.

        I took Larium and had no bad side effects. Granted I wasn't in a warzone, but on vacation. I'm sure that has some added psychological protection to it.

      • by geekoid ( 135745 )

        AH, well anecdote. So yes, lets based how we go forward on that, cause science is so mainstream.

      • by sjames ( 1099 )

        If he had a psychotic reaction to a prescribed drug (either alone or in combination with a brain injury or psychiatric injury from his service), then he truly ISN'T responsible.

        There are several drugs that have been linked to psychotic reactions. This is apparently one of them. They do need serious review.

      • by Ihmhi ( 1206036 )

        No one is saying he isn't responsible for his actions.

        Gonna go a bit "Bill Clinton" here, but it depends on your definition of responsible.

        If by "responsible" you mean that he killed 17 people, well, that is very likely. In that sense, he is responsible.

        If by "responsible" you mean that he made a conscious choice to start shooting civilians, that is very much in doubt. The effects of this drug and/or PTSD and/or other unknown factors could have factored in. Motivation kinda matters in things like this.

    • by geekoid ( 135745 )

      Since they don't know if he was given the drug, aren't you being a little premature?

      Also, 'side effects' happen with all drugs. You need to weigh the data about the side effects against the effects of not taking the drug.

  • Scapegoat (Score:2, Insightful)

    by Atheose ( 932144 )
    This sounds like it will be a easy scapegoat for the entire massacre, rather than the fact that the individual was responsible, or the military in general.
  • by Anonymous Coward on Friday March 30, 2012 @10:57AM (#39522831)
    Bales did nothing, and is getting blamed for what his platoon did. You cant shoot and burn 17 people and wake up with no memory of it, and multiple reports from witnesses say there were 15-20 men there.

    Army coverup?

    Army coverup.

    • Re: (Score:2, Insightful)

      by Moheeheeko ( 1682914 )
      Agreed. Also, how does somone shoot 1 person without the rest of the village getting the fuck out of Dodge? Something in the "Official" story doesnt add up.
      • I don't does one women get attacked multiple times, stabbed, raped, all while her calls for help are heard (and ignored by) multiple people?

        It's not so far fetched.

        One thing you have to understand is Afghans don't live in houses like you or I. They live in big mud walled compounds, with a central courtyard containing smaller structures. They also aren't packed quite as tightly as your typical American city. This is out in the country, in a desert area. There might be hundreds of yards between you

      • No, Afghanistan has a strong culture of private property. People live behind walls and iron gates, where their women can walk around without risk of being seen. People in these types of homes do not evacuate when there is a crisis, they lock their doors. Which may not be enough, if they are under military attack, but it the first natural reaction. It is the same in the US.

    • by what2123 ( 1116571 ) on Friday March 30, 2012 @11:15AM (#39523047)
      I don't doubt it in the lease bit. Much of the talk from vets has been a harsh resistance staying abroad and wanting to come home. Then you get this little bit of fun: []
    • Usually I'd say this was paranoia, but given what they did after Haditha, I've really got no trust left in justice meted out by the US army.
      • by geekoid ( 135745 )

        The military didn't rule a way I think they should with my limited exposure to any of the evidence, clearly they cant be trusted.

        You're thinking can't be trusted.

    • Citation needed.

    • by ehiris ( 214677 )

      You're giving the Army too much credit. It's a fuckup caused by ignorance.

    • by geekoid ( 135745 ) <> on Friday March 30, 2012 @12:19PM (#39523799) Homepage Journal

      hahaha. You don't really know the area or the people, do you?

      I don't trust any eye witness reports.
      a) Anti American groups will suddenly have eye witness report of things that didn't happen,. or exaggerate claims
      b) You CAN have psychotic episodes with no memory. Sometime they can go on for very lng periods of time.

      Army cover up?

      I don't know, and neither do you.

    • The BBC had early eye witness reports of "one or two" attackers. They then had third-party claims of witness reports claiming a larger attack, but they were not able to find these witnesses and interview them. It was speculated that they might have been witnessing the early US investigation, which did include a large number of troops and helicopters.

      • One of the witnesses claimed to have survived because his wives draped themselves over him in a big pile, and two of them were killed, but he survived. But he also lost a daughter.

  • Nasty stuff (Score:5, Insightful)

    by Ion Berkley ( 35404 ) on Friday March 30, 2012 @11:06AM (#39522931)

    I can attest to this drugs potency, I've used it on two instances, and on one I suffered mightily the day and night after I took my weekly dose. Another of my friends was hospitalized after a psychotic episode on this drug. A girl I used to date used this drug for 2+ years during a posting to Sierra Leone in the military, apparently without any long term effect...but well beyond any duration it had been certified and tested for...however the flip side is that the initial brigade that was sent to Sierra Leone in a hurry were not on an anti-malarial and a large number came down with serious Malaria. Luckily there are much better alternatives in 2012, and I think it's somewhat weak to see this in the press...if it's being doled out to troops in this environment still then that is wrong and someone should get on it now, but this tabloid journalism and new culture of Mil/Gov leaks to the worthless press is ridiculous. Solve the friggin' problem, don't play some political game of buck passing in the headlines

    • I used Lariam during an extended period of travel. My side effects consisted of extremely lucid and wonderful dreams. If the risks weren't so high, I'd recommend this as a recreational drug.

    • Had a classmate who was an Army veteran, it's only what he told me, but he said after taking the drug he became enraged and broke windows in his house, tore siding off, punched holes in walls for a good 3 hours. I figured there were probably others that reacted similarly to him on the drug, or who reacted poorly to it in some other way.

      • by geekoid ( 135745 )

        After drinking milk, I was rear ended at a stop sigh; clearly I need to stop drinking milk.

        • by sjames ( 1099 )

          If you can establish a credible cause and effect that matches observation, such as horrible intestinal cramps caused you to stand on the brake and then you got rear-ended, then perhaps you SHOULD stop drinking milk.

    • I've also used it on a number of occasions (including some time in Sierra Leone), and I've only had mild side effects (some very, very strange dreams). However, I have seen others react very poorly, too. One of my friends contracted malaria and mono at the same time while in Guinea, and was dosed with massive quantities of lariam to treat it -- he had some serious psychological responses to it. Malaria really sucks, but so does this drug. BTW, when was your friend posted in Sierra Leone, and is he a Brit P
    • by kbob88 ( 951258 )

      Yeah, I've used it for a few trips, and it does make you have really weird, bizarre dreams. Crazy stuff. I'm not sure I would go back on it. I didn't go psychotic or anything, but I'm a pretty even-keeled person. Anything that affects your brain that much could definitely have bigger consequences for someone who's a bit unstable to begin with.

    • Re:Nasty stuff (Score:5, Informative)

      by TheCarp ( 96830 ) <[ten.tenaprac] [ta] [cjs]> on Friday March 30, 2012 @11:49AM (#39523433) Homepage

      The interesting things is that this story was on NPR the other day, except, they reported that it was incorrect to imply that the massacre triggered the review... the review was in the works before the massacre.

      So to still be characterising it as such, several days after its come out that this association isn't true definitely is tabloid journalism.

      • It's also true that the squeaky wheel gets the grease. The project may have been in the works for some time, but it's possible that now that it's deemed important, it's getting hurried.

    • I've used mefloquine before in India & Nepal. It gave me surreal nightmares on the night I would take the pill (once a week), and made things ever so slightly lucid, but that's it. On the warning note it says that it should only be taken by people who are mentally stable & secure and it can give you nightmares among other mental issues, but if you're a mentally strong person you should be fine.

      Personally I wouldn't take it again even though I believe I am well in control of my mind & emotions,

    • There is no reason I know of for anyone to be using lariam anymore, except possibly for cost. Malarone(=atovaquone=proguanil) is much safer.

  • Lariam? Really? (Score:5, Interesting)

    by jholyhead ( 2505574 ) on Friday March 30, 2012 @11:06AM (#39522941)
    Having known someone who suffered from Lariam induced psychosis some years ago, I find it shocking beyond belief that they would give this stuff to men with guns.

    Whether Bales was suffering from such psychosis at the time should be considered secondary - the US military was giving its soldiers a drug that can lead to violent psychotic episodes. The person who made that decision needs to be escorted to the cell adjoining Bales'.
    • This stuff is given to pretty much all Peace Corps Volunteers in malarial zones. Speaking from long term experience, it sucks ass. I made it about a year before I nearly lost the ability to sleep. I was then placed on Doxycyclene which worked ... never got malaria myself. The other option, Malerone, is like 10x as expensive. Neither Doxy or Mal is nearly as good ad malaria prevention, as have to be taken daily ISO weekly, so medical officers are hesitant to make a switch unless things have gotten prett
  • The radio series "This American Life" did a story about a guy who traveled to India and lost his marbles on Mefloquine. Look for "Contents Unknown".
    • by geekoid ( 135745 )

      No. it's story about a guy who lost his marbles, but ALSO happened to be on Mefloquine.

      Not to be confused with Melfoquine; which will turn you blue~

  • That we review the controversial word 'controversial'. It is horribly overused and misused.

    Mefloquine isn't 'controversial'. It has well-known psychiatric side effects and well-known efficacy as an antimalarial prophylactic.
  • And they will give you poison that will drive you insane!

    Yeah, like I would tell my grandson to join this mess!

  • The article is wrong. This study was ordered prior to the incident and is part of their regular reviews of all medical treatments.

  • After about 6 weeks, I stopped taking it. The 2-3 days after my once a week pill (dose) I was out of my mind agressive and slightly disconnected with reality. I chose to risk malaria when traveling around east africa over the side effects of the drug. Others with me felt the same way though their side effects were a bit diffrent. When I returned to the states I did a litte research and found hallucinations were a rare side effect and a few people had compleat permanant mental breakdowns. I thought there was
  • Did it occur to anybody besides me that violent behavior is something that *should* be encouraged in a soldier? I'm not seeing how a drug with these observed effects gets anybody off the hook for that Afghan massacre -- not Bales, not his squad mates, nor his commanders. The massacre was the result of failure to manage Bales, period. He's a trained killer, and one with a history of deceiving people for monetary gain [] predating his enlistment in the military. It also looks like the military ignored so

    • Did it occur to anybody besides me that violent behavior is something that *should* be encouraged in a soldier?

      You've got some derp on your chin.

  • Wasn't this a Law & Order episode?
  • When I deployed to Iraq we were given the option of getting Anthrax vaccinations. As expected almost no one volunteered. About six months laterr we were "voluntold". I am now immunized against Anthrax if I touch it. If I breath Anthrax I'm still fucked. Totally worth the cancer I'm gonna get 15 years from now

  • Soldiers suffer from shell shock and go crazy doing what they do with or without drugs. It seems more convenient to blame "fuck ups" like these on a drug than on the simple fact that war causes horrible suffering and stress on both sides of a conflict and is expecially difficult to handle for soldiers who consciously or subconsciously feel they are occupying a country for dubious reasons. Blaming this one incident on a drug instead of on American foreign policy in general is easier for the party who is actu

"Nuclear war can ruin your whole compile." -- Karl Lehenbauer