Tesla_WTC_Solution
16th March 2014, 04:57
Isn't that what was done with Mefloquine pills at Gitmo?
They drugged the detainees to alter their perceptions...
holy crap.
http://www.truth-out.org/news/item/253:exclusive-controversial-drug-given-to-all-guantanamo-detainees-akin-to-pharmacologic-waterboarding
EXCLUSIVE: Controversial Drug Given to All Guantanamo Detainees Akin to "Pharmacologic Waterboarding"
Wednesday, 01 December 2010 12:29
By Jason Leopold and Jeffrey Kaye, Truthout | Investigative Report
The Defense Department forced all "war on terror" detainees at the Guantanamo Bay prison to take a high dosage of a controversial antimalarial drug, mefloquine, an act that an Army public health physician called "pharmacologic waterboarding."
The US military administered the drug despite Pentagon knowledge that mefloquine caused severe neuropsychiatric side effects, including suicidal thoughts, hallucinations and anxiety. The drug was used on the prisoners whether they had malaria or not.
Interviews conducted over the past two months with tropical disease experts and a review of Defense Department documents and peer-reviewed journals show there were no preexisting cases where mefloquine was ever prescribed for mass presumptive treatment of malaria.
The revelation, which has not been previously reported, was buried in documents publicly released by the Defense Department (DoD) two years ago as part of the government's investigation into the June 2006 deaths of three Guantanamo detainees.
Army Staff Sgt. Joe Hickman, who was stationed at Guantanamo at the time of the suicides in 2006, and has presented evidence that demonstrates the three detainees could not have died by hanging themselves, noticed in the detainees' medical files that they were given mefloquine. Hickman has been investigating the circumstances behind the detainees' deaths for nearly four years.
All detainees arriving at Guantanamo in January 2002 were first given a treatment dosage of 1,250 mg of mefloquine, before laboratory tests were conducted to determine if they actually had the disease, according to a section of the DoD documents entitled "Standard Inprocessing Orders For Detainees." The 1,250 mg dosage is what would be given if the detainees actually had malaria. That dosage is five times higher than the prophylactic dose given to individuals to prevent the disease.
Maj. Remington Nevin, an Army public health physician, who formerly worked at the Armed Forces Health Surveillance Center and has written extensively about mefloquine, said in an interview the use of mefloquine "in this manner ... is, at best, an egregious malpractice."
The government has exposed detainees "to unacceptably high risks of potentially severe neuropsychiatric side effects, including seizures, intense vertigo, hallucinations, paranoid delusions, aggression, panic, anxiety, severe insomnia, and thoughts of suicide," said Nevin, who was not speaking in an official capacity, but offering opinions as a board-certified, preventive medicine physician. "These side effects could be as severe as those intended through the application of 'enhanced interrogation techniques.'"
Mefloquine is also known by its brand name Lariam. It was researched by the US Army in the 1970s and licensed by the Food and Drug Administration in 1989. Since its introduction, it has been directly linked to serious adverse effects, including depression, anxiety, panic attacks, confusion, hallucinations, bizarre dreams, nausea, vomiting, sores and homicidal and suicidal thoughts. It belongs to a class of drugs known as quinolines, which were part of a 1956 human experiment study to investigate "toxic cerebral states," as part of the CIA's MKULTRA mind-control program.
The Army tapped the Walter Reed Army Institute of Research (WRAIR) to develop mefloquine and it was later licensed to the Swiss pharmaceutical company F. Hoffman-La Roche. The first human trials of mefloquine were conducted in the mid-1970s on prisoners, who were deliberately inoculated with malaria at Stateville Correctional prison near Joliet, Illinois, the site of controversial antimalarial experimentation in the early 1940s.
The drug was administered to Guantanamo detainees without regard for their medical or psychological history, despite its considerable risk of exacerbating pre-existing conditions. Mefloquine is also known to have serious side effects among individuals under treatment for depression or other serious mental health disorders, which numerous detainees were said to have been treated for, according to their attorneys and published reports.
In 2002, when the prison was established and mefloquine first administered, there were dozens of suicide attempts at Guantanamo. That same year, the DoD stopped reporting attempted suicides.
By February 2002, there were at least 459 detainees imprisoned at Guantanamo. In March of that year, according to the book "Saving Grace at Guantanamo Bay: A Memoir of a Citizen Warrior" by Montgomery Granger, "the situation" at the prison began "deteriorating rapidly."
"There is more and more psychosis becoming evident in detainees ...," wrote Granger, an Army Reserve major and medic who was stationed at Guantanamo in 2002. "We already have probably a dozen or so detainees who are psychiatric cases. The number is growing."
"Presumptively Treating" Malaria
Though malaria is nonexistent in Cuba, DoD spokeswoman Maj. Tanya Bradsher told Truthout that the US government was concerned that the disease would be reintroduced into the country as detainees were transferred to the prison facility in January 2002.
A "decision was made," Bradsher said in an email, to "presumptively treat each arriving Guantanamo detainee for malaria to prevent the possibility of having mosquito-borne [sic] spread from an infected individual to uninfected individuals in the Guantanamo population, the guard force, the population at the Naval base or the broader Cuban population."
But Granger wrote in his book that a Navy entomologist was present at Guantanamo in January and February 2002 and during that time only identified insects that were nuisances and did not identify any insects that were carriers of a disease, such as malaria.
Nevertheless, Bradsher said the "mefloquine dosage [given to detainees] was entirely for public health purposes ... and not for any other purpose" and "is completely appropriate."
"The risks and benefits to the health of the detainees were central considerations," she added.
A September 13, 2002, DoD memo governing the operational use of mefloquine said, "Malaria is not a threat in Guantanamo Bay." Indeed, there have only been two to three reported cases of malaria at Guantanamo.
The DoD memo, signed by Assistant Secretary of Defense for Health Affairs William Winkenwerder, was sent to then-Rep. John McHugh, the Republican chairman of the House Veterans Affairs Subcommittee on Military Personnel. McHugh is now Secretary of the Army.
A Senate staff member told Truthout the Senate Armed Services Committee was never briefed about malaria concerns at Guantanamo nor was the committee made aware of "any issue related to the use of mefloquine or any other anti-malarial drug" related to "the treatment of detainees."
When questions were raised at a February 19, 2002 meeting of the Armed Forces Epidemiological Board (AFEB) about what measures the military was taking to address malaria concerns at Guantanamo, Navy Capt. Alan J. Yund, the liaison officer to the AFEB, did not disclose that mefloquine was being administered to detainees as a form of presumptive treatment and indicated that infected detainees who may have had the disease would be treated on a case-by-case basis.
Yund also said detainees were given a different anti-malarial drug known as primaquine and noted that "informed consent" was "absolutely practiced" prior to administering drugs, an assertion that contradicts claims made by numerous detainees who said they were forced to take drugs even if they protested. Yund did not return calls for comment.
Bradsher declined to respond to a follow-up question about who made the decision to presumptively treat detainees with mefloquine.
An April 16, 2002, meeting of the Interagency Working Group for Antimalarial Chemotherapy, which DoD, along with other federal government agencies, is a part of, was specifically dedicated to investigating mefloquine's use and the drug's side effects. The group concluded that study designs on mefloquine up to that point were flawed or biased and criticized DoD medical policy for disregarding scientific fact and basing itself more on "sensational or best marketed information."
The Working Group called for additional research, and warned, "other treatment regimes should be carefully considered before mefloquine is used at the doses required for treatment."
Still, despite the red flags that pointed to mefloquine as a high-risk drug, the DoD's mefloquine program proceeded.
In fact, a June 2004 set of guidelines issued by the Centers for Disease Control and Prevention (CDC) says mefloquine should only be used when other standard drugs were not available, as it "is associated with a higher rate of severe neuropsychiatric reactions when used at treatment doses."
According to the CDC, "'presumptive treatment' without the benefit of laboratory confirmation should be reserved for extreme circumstances (strong clinical suspicion, severe disease, impossibility of obtaining prompt laboratory confirmation)."
A CDC spokesman refused to comment about the "presumptive treatment" of malaria at Guantanamo and referred questions to the DoD.
Nevin said, if "mass presumptive treatment has been given consistently, many dozens of detainees, possibly hundreds, would almost certainly have suffered such disabling adverse events."
"It appears that for years, senior Defense health leaders have condoned the medically indefensible practice of using high doses of mefloquine ostensibly for mass presumptive treatment of malaria among detainees from the Middle East and Asia lacking any evidence of disease," Nevin said. "This is a use for which there is no precedent in the medical literature and which is specifically discouraged among refugees by malaria experts at the Centers for Disease Control."
Even proponents of limited mefloquine usage are seriously questioning the logic behind the DoD's actions. Professor James McCarthy, chair of the Infectious Diseases Division of the Queensland Institute of Medicine in Australia, who is an advocate of the safe use of mefloquine under proper safeguards, and takes it himself when traveling, told Truthout he was unaware of the use of mefloquine for mass presumptive treatment as described by the DoD, but could imagine it under certain circumstances.
However, when informed that lab tests were available and the detainees were screened for the blood product G6PD, used to determine the suitability of certain antimalarial drugs, McCarthy found the DoD's use of mefloquine at Guantanamo difficult to understand and "hard to support on pure clinical grounds as an antimalarial."
Treatment, Torture or an Experiment?
Another striking point about the DoD's decision to presumptively treat mostly Muslim detainees with mefloquine beginning in 2002 is that it is the exact opposite of how the DoD responded to malaria concerns among the Haitian refugees who were held at Guantanamo a decade earlier.
Between 1991 and 1992, more than 14,000 Haitian refugees were held in temporary camps set up at Guantanamo. A large number of Haitian refugees - 235 during a four-month period - were diagnosed with malaria. But instead of presumptively treating the refugee population at Guantanamo, the DoD conducted laboratory tests first and only the individuals who were found to be malaria carriers were administered chloroquine.
Another example of how the DoD approached malaria treatment differently for other subjects is in the case of Army Rangers who returned from malarial areas of Afghanistan between June and September 2002 and were infected with the disease at an attack rate of 52.4 cases per 1,000 soldiers.
However, the Rangers did not receive mass presumptive treatment of mefloquine. They were given other standard drugs after laboratory tests, according to documents obtained by Truthout.
Nevin said the DoD's treatment of Haitian refugees represented "a situation that arguably presented a much higher risk of disease and secondary transmission, but one which US medical experts stated at the time could be safely managed through more conservative and focused measures."
Why did the government use the "conservative and focused" approach in treating Haitian refugees and the Army rangers, but then revert to presumptive mefloquine treatment in the case of the Guantanamo detainees, who - a month after the prison facility opened in January 2002 - were stripped of their protections under the Geneva Conventions?
According to Sean Camoni, a Seton Hall University law school research fellow, "there is no legitimate medical purpose for treating malaria in this way" and the drug's severe side effects may actually have been the DoD's intended impact in calling for the drug's usage.
Camoni and several other Seton Hall law school students have been working on a report about mefloquine use on Guantanamo detainees. Their work was conducted independently of Truthout's investigation into the issue.
A draft copy of the Seton Hall report Canoni provided to Truthout, "Drug Abuse? An Exploration of the Government's Use of Mefloquine at Guantanamo," says mefloquine's extreme side effects may have violated a provision in the antitorture statute related to the use of "mind altering substances or other procedures" that "profoundly disrupts the senses or the personality."
Legal memos prepared in August 2002 by former DoD attorneys Jay Bybee and John Yoo for the CIA's torture program permitted the use of drugs for interrogations. The authority was also contained in a legal memo Yoo prepared for the DoD less than a year later after Secretary of Defense Donald Rumsfeld convened a working group to address "policy considerations with respect to the choice of interrogation techniques."
In September, Truthout reported that the DoD's inspector general (IG) conducted an investigation into allegations that detainees in custody of the US military were drugged. The IG's report, which remains classified, was completed a year ago and was shared with the Senate Armed Services Committee.
Kathleen Long, a spokeswoman for the Armed Services Committee, told Truthout at the time that the IG report did not substantiate allegations of drugging of prisoners for the "purposes of interrogation."
The medical files for detainee 693 released in 2008 shows that, two weeks after he first started taking mefloquine in June 2002, he was interviewed by Guantanamo medical personnel and reported he was suffering from nightmares, hallucinations, anxiety auditory and visual hallucinations, anxiety, sleep loss and suicidal thoughts.
The detainee said he had previously been treated for anxiety and had a family history of mental illness. He was diagnosed with adjustment disorder, according to the DoD documents. Guantanamo medical staff who interviewed the detainee did not state that he may have been experiencing mefloquine-related side effects in an evaluation of his condition.
Mark Denbeaux, the director of the Seton Hall Law Center for Policy and Research, who looked into the 2006 deaths of the three Guantanamo detainees, said in an interview "almost every remaining question here would be solved if the [detainees'] full medical records were released."
The government has refused to release Guantanamo detainees' medical records, citing privacy concerns in some cases, and assertions that they are "protected" or "classified" in other instances. The few medical records that have been released have been heavily redacted.
"A crucial issue is dosage" Denbeaux said. "Giving detainees toxic doses of mefloquine has mind-altering consequences that may be permanent. Without access to medical records, which the government refuses to release, the use of mefloquine in this manner appears to be grotesque malpractice at best, if not human experimentation or 'enhanced interrogation.' The question is where are the doctors who approved this practice and where are the medical records?"
Bradsher did not respond to questions about whether the government kept data about the adverse effects mefloquine had on detainees.
An absolute prohibition against experiments on prisoners of war is contained in the Geneva Conventions, but President George W. Bush stripped war on terror detainees of those protections. Some of the "enhanced interrogation techniques" also had an experimental quality.
At the same time detainees were given high doses of mefloquine, Deputy Secretary of Defense Paul Wolfowitz issued a directive changing the rules on human subject protections for DoD experiments, allowing for a waiver of informed consent when necessary for developing a "medical product" for the armed services. Bush also granted unprecedented authority to the secretary of Health and Human Services to classify information as secret.
Briefings on Side Effects
As the DoD was administering mefloquine to Guantanamo prisoners, senior Pentagon officials were being briefed about the drug's dangerous side effects. During one such briefing, questions arose about what steps the military was taking to address malaria concerns among detainees sent to Guantanamo.
Internal documents from Roche, obtained by UPI in 2002, indicated that the pharmaceutical company had been tracking suicidal reactions to Lariam going back to the early 1990s.
In September 2002, Roche sent a letter to physicians and pharmacists stating that the company changed its warning labels for mefloquine.
Roche further said in one of two new warning paragraphs that some of the symptoms associated with mefloquine use included suicidal thoughts and suicide and also "may cause psychiatric symptoms in a number of patients, ranging from anxiety, paranoia, and depression to hallucination and psychotic behavior," which "have been reported to continue long after mefloquine has been stopped."
Military Struggles
Cmdr. William Manofsky, who is retired from the US Navy and currently on disability due to post-traumatic stress disorder and side effects from mefloquine, said those are some of the symptoms he initially suffered from after taking the drug for several months beginning in November 2002 after he was deployed to the Middle East to work on two Naval projects.
In March 2003, "I became violently ill during a night live-fire exercise with the [Navy] SEALS," Manofsky said. "I felt like I was air sick. All the flashing lights from the tracers and rockets ... targeting device made me really sick. I threw up for an hour straight before being medevac'd back to the Special Forces compound where I had my first ever panic attack."
For three years, Manofsky said he had to walk with a cane due to a loss of equilibrium. Numerous other accounts like Manofsky's can be found on the web site lariaminfo.org.
In 2008, Dr. Nevin published a study detailing a high prevalence of mental health contraindications to the safe use of mefloquine in soldiers deployed to Afghanistan. Responding in part to concerns raised by the mefloquine-associated suicide of Army Spc. Juan Torres, internal Army presentations confirmed that the drug had been widely misprescribed to soldiers with contraindications, including to many on antidepressants.
A formal policy memo in February 2009 from Army Surgeon General Eric Schoomaker removed mefloquine as a "first-line" agent, and changed the policy so that mefloquine would not be prescribed to Army personnel unless they had contraindications to the preferred drug, the antibiotic doxycycline. Nor could mefloquine be prescribed to any personnel with a history of traumatic brain injury or mental illness.
By September 2009, the policy was extended throughout the DoD.
New prisoners are no longer arriving at Guantanamo and the prison population has been in decline in recent years as detainees are released or transferred to other countries. Currently, the detainee population at Guantanamo is a reported 174.
But Nevin said the justification the Pentagon offered for using mefloquine to presumptively treat detainees transferred to the prison beginning in 2002 "betrays a profound ignorance of basic principals of tropical medicine and suggests extremely poor, and arguably incompetent, medical oversight that demands further investigation."
http://www.wired.com/wiredscience/2013/08/mefloquine-robert-bales/all/
A Gruesome War Crime Renews Concerns About a Malaria Drug’s Psychiatric Side Effects
BY GREG MILLER08.15.139:30 AM
Early in the morning of March 11, 2012, Army staff sergeant Robert Bales left his remote outpost in an impoverished region of Kandahar Province, Afghanistan and killed 16 people in two nearby villages. His victims, mostly women and children, were sleeping at the time. Bales shot or stabbed them to death before dragging some of their bodies into a pile and lighting them on fire.
His crime is as baffling as it is gruesome. In June, he pleaded guilty to the murders in a military court, telling the presiding judge: “There’s not a good reason in this world for why I did the horrible things I did.”
In the weeks since his guilty plea, there’s been growing speculation that a drug meant to prevent malaria may have played a role in the murders. In certain circles, including the military, the Peace Corps, and other organizations that send people into malarial zones for long periods of time, the drug – known as mefloquine — has long had a bad reputation for setting nerves on edge and causing nightmares.
In some cases, mefloquine can mess with the mind in more serious ways, causing confusion, hallucinations, and paranoia. On July 29, the FDA added a black box — its strongest warning — to the label of the drug, citing neurological and psychiatric side effects that can last months or years after someone stops taking it.
“I like to say this drug is like a horror show in a pill,” said Remington Nevin, a former Army physician who’s now an epidemiologist at Johns Hopkins University. In a recent paper, Nevin argues that the drug’s effects on the brain and behavior make it likely to become increasingly important in forensic psychiatry.
Although mefloquine has been eyed as a possible contributing factor in previous killings, so far apparently no one has argued successfully in court that the drug made someone less culpable for a crime.
Bales’s defense team did not raise the issue during his trial, but they still could do so at his sentencing hearing on August 19. “If it’s seen as mitigating in the Bales case, I could certainly see this coming up in a lot of cases where people might say ‘mefloquine made me do it,’” said Elspeth Cameron Ritchie, a former Army psychiatrist and a coauthor with Nevin on the recent paper.
A Troubled Past
Mefloquine is a puzzling drug with an unusual history.
It was discovered by the U.S. Army during the Vietnam war. The military realized that in many parts of the world, the malaria parasite was evolving resistance to a drug called chloroquine, which was the standard antimalaria drug of the time.
Mefloquine was identified from a pool of more than 250,000 compounds screened for their ability to stop these chloroquine-resistant malaria strains, according to a 2007 paper by British physician Ashley Croft. The drug had the added advantage of requiring just one dose a week instead of one a day. The Army handed off the compound to F. Hofmann-La Roche, which gained FDA approval for the drug in 1989 and marketed it under the trade name Lariam. “The underpinning safety and pharmacokinetic studies which should have been performed prior to the licensing of Lariam … were never carried out,” Croft wrote.
When the first careful clinical trials to assess how well the drug is tolerated by healthy people were finally reported 12 years later, they turned up evidence of common neuropsychiatric side effects, including strange or vivid dreams, insomnia, dizziness, and anxiety. Croft speculates that the FDA would not have approved the drug if the results of those trials had been available before 1989.
In the intervening years, anecdotal evidence that the drug can have devastating consequences has piled up.
A smattering of case reports have linked the drug to suicide. In one particularly horrible example, a 27-year-old man with no prior history of mental illness committed suicide by stabbing himself in the head and torso with a knife. A recent investigative report by the Irish broadcaster RTÉ implicated mefloquine in a cluster of suicides among Irish Defense Forces deployed on peacekeeping missions.
Perhaps most famously, the drug was investigated as a contributing factor in the murder-suicides at Fort Bragg in 2002, when four soldiers, three of whom had recently returned from Afghanistan, killed their wives, and two of them killed themselves. (A military panel concluded that mefloquine was an unlikely factor in the killings, instead placing the blame on marital problems and the stress of deployment.)
Nevin and Ritchie both say they saw the drug’s effects during their time in the military. Ritchie served in Somalia. “I think it was my first day there, a young man was evacuated out of there screaming and yelling, and it was found that he’d taken five mefloquine tablets,” she said. “He was supposed to be taking them once a week and he took them once a day.”
In Afghanistan, Nevin says the drug took a toll on his unit in more subtle ways. “Even though everyone may not become clinically ill, the bell curve for anxiety, irritability, and restless sleep is going to shift, and that can have dramatic effects on a unit,” Nevin said. “We were being affected by the drug.”
Perhaps more disturbingly, mefloquine was sometimes given out indiscriminately.
Nevin says that before he deployed to Afghanistan in early 2007, he saw medics at Fort Bragg distributing the drug from plastic trash bags. “We were told to reach into a garbage bag and find our prescription, but if we couldn’t find it, to just take someone else’s,” he said. That would have violated the military’s policy at the time, which required screening for psychiatric problems and previous traumatic brain injuries — and excluding soldiers who tested positive from getting mefloquine.
A study Nevin published in 2008 found that nearly 10 percent of 11,725 active-duty personnel in Afghanistan had either a pre-existing condition or were on other medication that should have barred them from taking mefloquine. A follow-up study found that 14 percent of those who should not have taken mefloquine received a prescription for it.
In recent years, the U.S. military has significantly called back its use of the drug. A recent set of recommendations, issued in April, advise the use of mefloquine only in patients who are unable to tolerate two other antimalarial drugs and have no recent history of TBI or psychiatric problems.
Mysterious Biology
Photo: Kim Pierro/Flickr
What mefloquine does to the brain is poorly understood.
The drug’s chemistry predisposes it to build up in fatty tissues like the brain at much higher concentrations than it does in the bloodstream, where the malaria parasite hangs out. “Mefloquine is a psychotropic drug with incidental anti-malarial properties,” Nevin said.
One thing mefloquine does in the brain is block tiny molecular pores called gap junctions. Gap junctions help neurons synchronize their electrical activity by allowing ions to flow freely between them. One hypothesis, Nevin says, is that mefloquine desynchronizes neurons that normally put a brake on the limbic system, an evolutionarily ancient network of brain regions important for memory and emotion.
Cutting the brakes on the limbic system, he says, could be how the drug produces symptoms like anxiety, paranoia, and hallucinations.
It’s a plausible scenario, says neuroscientist Michael Fanselow of UCLA. “Gap junctions regulate activity in two very key limbic structures, the hippocampus and amygdala,” Fanselow said. The hippocampus is involved in memory and navigation, and disrupting these functions could result in disorientation and hallucinations. Disrupting the amygdala, meanwhile, could produce anxiety or alter emotional reactions, Fanselow says.
Nevin thinks it’s also possible that mefloquine, or perhaps some byproduct produced as the drug gets broken down in the brain, is directly toxic to neurons. Doses comparable to those given to people disrupted the sleep and balance of rats and killed neurons in the animals’ brain stems, according to a 2006 study.
Problems with sleep and balance are among the most common long-term neurological side effects reported for mefloquine. However, the kind of damage seen in the rats could only be seen in humans by doing an autopsy and looking at brain tissue under a microscope. That’s never been done, Nevin says.
“If this sort of damage were apparent on MRI [scans] we would have figured this out a long time ago,” he said.
Defensive Maneuvers
Could mefloquine really cause someone to commit an atrocious act like the murders Bales committed?
Probably not on its own. After all, thousands of travelers have taken mefloquine and experienced little more than bad dreams and a touch of jumpiness. But the drug’s effects might be amplified in soldiers living with the daily stress of combat, or who’ve experienced traumatic brain injuries from explosive blasts — the signature health hazards of the recent conflicts in Iraq and Afghanistan.
‘I think mefloquine is more like the straw that breaks the camel’s back when there’s other things going on.’
“I think mefloquine is more like the straw that breaks the camel’s back when there’s other things going on,” Ritchie said.
Robert Bales definitely had other things going on. He admitted to the court that he’d been taking anabolic steroids, and fellow soldiers testified during his trial that they’d been drinking alcohol against regulations on the night of the murders.
Whether he was also taking mefloquine at the time is not clear.
In July, Bales’s defense attorney, John Henry Browne, told the Seattle Times that Bales took mefloquine in Iraq, where he did three previous tours of duty (and also where he also reportedly suffered a TBI, which should have disqualified him from receiving any more of the drug).
A document Nevin obtained via a Freedom of Information Act request hints at the possibility Bales took the drug during his fateful final tour in Afghanistan as well. The document, an “adverse event record” sent to Roche, does not name Bales but involves a soldier who took mefloquine and killed 17 Afghan civilians, the same erroneous number listed in Bales’s original charging documents.
However, Nevin has not been able to determine who filed the adverse event report. It’s possible that whoever filed it had no direct knowledge of Bales’s case. Browne, the defense attorney, told the Seattle Times that he does not know whether Bales took mefloquine in Afghanistan because his medical records are incomplete.
The new black box warning. Image: FDA
The drug is detectable in the blood for up to a month, but the Army has not said whether Bales was tested.
If evidence comes to light that Bales was on mefloquine at the time of the murders, that could be viewed as mitigating evidence at his sentencing hearing, says Christopher Slobogin, a professor of criminal law and psychiatry at Vanderbilt University. The relevant legal principle is called involuntary intoxication. That doesn’t mean someone had a good buzz going, Slobogin explains, it means that they took a drug – either unknowingly or unaware of the possible side effects – that caused a serious cognitive impairment.
“The classic example is someone slipping LSD in your coffee,” Slobogin said. “It implies an inability to appreciate what one is doing or to appreciate the wrongness of what one is doing.”
The recent FDA announcement, which cites psychiatric side effects lasting months or years, could aid the defense as well, especially if it only has evidence that he took mefloquine during his previous tours in Iraq and can’t prove he was taking it at the time of the crime. “That’s obviously helpful to the defense,” Slobogin said.
“The accused is given considerable leeway during the sentencing phase to present evidence of extenuation and mitigation,” said William Woodruff, a law professor at Campbell University in Raleigh, N.C., and former colonel in the U.S. Army Judge Advocate General’s Corps. It seems likely that the court would admit evidence about mefloquine at the sentencing hearing, Woodruff says, but how much weight they would give it is difficult to predict.
On August 19, a military jury will convene to decide Bales’s fate. His guilty plea takes the death penalty off the table. The question is whether his life sentence will include any possibility of parole.
No matter what the jury decides, we will probably never know exactly what role, if any, mefloquine played in this horrific crime. And as long as the drug is in use, it’s unlikely to be the last time we’re left to wonder.
http://seattletimes.com/html/nationworld/2017944964_drugsofwar10.html
Originally published April 9, 2012 at 5:31 PM | Page modified April 10, 2012 at 4:23 PM
Soldiers at war in fog of psychotropic drugs
In a small but growing number of cases across the nation, lawyers are blaming the U.S. military's heavy use of psychotropic drugs for their clients' aberrant behavior and related health problems. Such defenses have rarely gained traction in military or civilian courtrooms, but Air Force pilot Patrick Burke's case provides the first important indication that military psychiatrists and court-martial judges are not blind to what can happen when troops go to work medicated.
By Kim Murphy
Los Angeles Times
U.S. Air Force pilot Patrick Burke's day started in the cockpit of a B-1 bomber near the Persian Gulf and proceeded across nine time zones as he ferried the aircraft home to South Dakota.
Every four hours during the 19-hour flight, Burke swallowed a tablet of Dexedrine, the prescribed amphetamine known as "go pills." After landing, he went out for dinner and drinks with a fellow crewman. They were driving back to Ellsworth Air Force Base when Burke began striking his friend in the head.
"Jack Bauer told me this was going to happen — you guys are trying to kidnap me!" he yelled, as if he were a character in the TV show "24."
When the woman giving them a lift pulled the car over, Burke leapt on her and wrestled her to the ground. "Me and my platoon are looking for terrorists," he told her before grabbing her keys, driving away and crashing into a guardrail.
Burke was charged with auto theft, drunken driving and two counts of assault. But in October, a court-martial judge found the young lieutenant not guilty "by reason of lack of mental responsibility" — the almost unprecedented equivalent, at least in modern-day military courts, of an insanity acquittal.
Four military psychiatrists concluded that Burke suffered from "polysubstance-induced delirium" brought on by alcohol, lack of sleep and the 40 milligrams of Dexedrine he was issued by the Air Force.
In a small but growing number of cases across the nation, lawyers are blaming the U.S. military's heavy use of psychotropic drugs for their clients' aberrant behavior and related health problems. Such defenses have rarely gained traction in military or civilian courtrooms, but Burke's case provides the first important indication that military psychiatrists and court-martial judges are not blind to what can happen when troops go to work medicated.
After two long-running wars with escalating levels of combat stress, more than 110,000 active-duty Army troops last year were taking prescribed antidepressants, narcotics, sedatives, antipsychotics and anti-anxiety drugs, according to figures recently disclosed to the Los Angeles Times by the U.S. Army surgeon general. Nearly eight percent of the active-duty Army is now on sedatives and more than 6 percent is on antidepressants — an eightfold increase since 2005.
"We have never medicated our troops to the extent we are doing now. ... And I don't believe the current increase in suicides and homicides in the military is a coincidence," said Bart Billings, a former military psychologist who hosts an annual conference at Camp Pendleton, in Southern California, on combat stress.
The pharmacy consultant for the Army surgeon general says the military's use of the drugs is comparable to that in the civilian world. "It's not that we're using them more frequently or any differently," said Col. Carol Labadie.
But the military environment makes regulating the use of prescription drugs a challenge compared with the civilian world, some psychologists say.
Follow-up appointments in the battlefield are often few and far between. Soldiers are sent out on deployment typically with 180 days' worth of medications, allowing them to trade with friends or grab an entire fistful of pills at the end of an anxious day. And soldiers with injuries can easily become dependent on narcotic painkillers.
"The big difference is these are people who have access to loaded weapons, or have responsibility for protecting other individuals who are in harm's way," said Grace Jackson, a former Navy staff psychiatrist who resigned her commission in 2002, in part out of concerns that military psychiatrists even then were handing out too many pills.
For the Army and the Marines, using the drugs has become a wager that whatever problems occur will be isolated and containable, said James Culp, a former Army paratrooper and now a high-profile military defense lawyer. He recently defended an Army private accused of murder, arguing that his mental illness was exacerbated by the antidepressant Zoloft.
"What do you do when 30-80 percent of the people that you have in the military have gone on three or more deployments, and they are mentally worn out? What do you do when they can't sleep? You make a calculated risk in prescribing these medications," Culp said.
The potential effect on military personnel has special resonance in the wake of several high-profile cases, most notably the one involving Staff Sgt. Robert Bales, accused of killing 17 civilians in Afghanistan. His attorneys have asked for a list of all medicines the 38-year-old soldier was taking.
"We don't know whether he was or was not on any medicines, which is why (his attorney) has asked to be provided the list of medications," said Richard Adler, a Seattle psychiatrist who is consulting on Bales' defense.
While there was some early, ad hoc use of psychotropic drugs in the Vietnam War, the modern Army psychiatrist's deployment kit is likely to include nine kinds of antidepressants, benzodiazepines for anxiety, four antipsychotics, two kinds of sleep aids, and drugs for attention-deficit hyperactivity disorder, according to a 2007 review in the journal Military Medicine.
Some troops in Afghanistan are prescribed mefloquine, an antimalarial drug that has been increasingly associated with paranoia, suicidal thoughts and violent anger spells that soldiers describe as "mefloquine rage."
"Prior to the Iraq war, soldiers could not go into combat on psychiatric drugs, period. Not very long ago, going back maybe 10 or 12 years, you couldn't even go into the armed services if you used any of these drugs, in particular stimulants," said Peter Breggin, a New York psychiatrist who has written widely about psychiatric drugs and violence.
"But they've changed that. ... I'm getting a new kind of call right now, and that's people saying the psychiatrist won't approve their deployment unless they take psychiatric drugs."
Military doctors say most drugs' safety and efficacy is so well-established that it would be a mistake to send battalions into combat without the help of medications that can prevent suicides, help soldiers rest and calm shattered nerves.
Fueling much of the controversy in recent years, though, are reports of a possible link between the popular class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) — drugs such as Prozac, Paxil and Zoloft, which boost serotonin levels in the brain — and an elevated risk of suicide among young people. The drugs carry a warning label for those up to 24 — the very age of most young military recruits.
Last year, Culp's client, Army Pfc. David Lawrence, pleaded guilty at Fort Carson, Colo., to the murder of a Taliban commander in Afghanistan. He was sentenced to only 12 ½ years, later reduced to 10 years, after it was shown that he suffered from schizophrenic episodes that escalated after the death of a good friend, an Army chaplain.
Deeply depressed and hearing a voice he would later describe as "female-sounding and never nice," Lawrence had reportedly feared he would be thrown out of the Army if he told anyone he was hearing voices — a classic symptom of schizophrenia. Instead, he'd merely told doctors he was depressed and thinking of suicide. He was prescribed Zoloft, for depression, and trazodone, often used as a sleeping aid.
The voices got worse, and Lawrence began seeing hallucinations of the chaplain, minus his head. Eventually, Lawrence walked into the Taliban commander's jail cell and shot him in the face.
"They give him this, and they send him out with a gun," said his father, Brett Lawrence.
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