10/16/2000 – Serious psychiatric disorders produced by Lariam

Warning: Serious psychiatric disorders produced by Lariam
(given for malaria)

Keith Epstein has written a wonderful article for the Washington
Post that exposes the dangers patients are reporting with this
new anti-malaria medication, Lariam.

How often have patients who took one of these new SSRI or
SNRI antidepressants made this same statement?

“I trusted what I’d been told by my government as an American
that this was the thing to do to protect me. I’d done my research!”
she said. “But the warnings are very minor.”

“They only said to be cautious if you have psychiatric problems. I
didn’t have any – until I took Lariam.”

Note that this is the CDC’s drug of choice for prevention of
malaria. Also note that the devastating effects of Lariam have
been ignored for about the same amount of time that the
devastating effects of SSRIs have been ignored. And Lariam’s
adverse effects have been continued to be ignored even though
some estimate that 25% of patients experience these effects. Yet
the manufacturer lists the adverse effects as “rare”.

No wonder the country is wondering what the CDC and the FDA
are doing while so many suffer. Obviously the foxes must be
busily guarding the hen house.

These are warnings coming from patients that most certainly
should not be ignored! These are serious, life threatening
reactions. Reactions so very similar to the serotonergic
antidepressants that it is chilling to read. How many of these
unsuspecting patients are ending up on antidepressants as
treatment for their Lariam-induced psychiatric disorders and find
themselves getting worse, then find it impossible to withdraw
from the antidepressant? Or they might even end up committed
to a psychiatric ward as so many SSRI users have been when
they had a similar psychotic reaction. As you will see one’s
vacation could become a tragic nightmare!

Ann Blake-Tracy, Executive Director,
International Coalition For Drug Awareness

The Lariam Files

By Keith Epstein
Special to The Washington Post
Tuesday, October 10, 2000

Michael J. Burch, a Washington consultant, had just returned
from a visit to his son, a Peace Corps volunteer working in
Ghana, and was having dinner at a Capitol Hill restaurant last
March. Burch had been feeling dizzy, his legs rubbery. He’d been
battling sleeplessness. Now, during dinner, a sudden surge
rose in his chest. He feared a heart attack. It was, he recalls, as
if “something were taking over my body.”

Elisa von Joeden-Forgey, an experienced traveler with no history
of psychiatric problems, had trouble sleeping within days of her
arrival in Cameroon, where she was to conduct postgraduate
research. She had vivid nightmares. She grew terrified that if she
dozed off she would disappear. Later, after she returned to the
United States, she was too frightened to leave the house. She
couldn’t concentrate or even carry on a conversation very well.
Her dissertation stalled. Her marriage faltered.

Not even Hope Trachtenberg-Fifer, a Virginia registered nurse
and marathon runner who teaches others to recognize
symptoms of medical conditions, had any idea what was going
on. While serving on a volunteer medical mission to Kenya in
1997, she dreaded the night, sensed doom and thought she’d
never see her family again. Though she’d never had mental
problems or trouble sleeping back home in Roanoke, she lay
balled up in bed, sobbing. She slept only for brief periods and
would wake up gasping and sweating. She wouldn’t eat or drink.
She wouldn’t leave her room. Her heart rate soared, her legs
wobbled. She was convinced she would die.

“I was a nut. I was psychotic,” she says. “And I was clueless..
There I was, a nurse and a health educator, and I had no idea
what was happening to me.”

All of these people say they were suffering side effects of
mefloquine, sold in the U.S. under the brand name Lariam. It is
the antimalaria medication recommended as the “drug of
choice” by the federal Centers for Disease Control and
Prevention (CDC) in 79 countries where malaria is resistant to
other drugs. Travel clinics and private physicians in the
Washington area, including those serving the State Department,
the Peace Corps and many public and private groups whose
personnel travel between here and Third World locations,
prescribe it routinely. American travelers headed for business or
pleasure to India, Thailand and Vietnam, on African safaris or on
tours of the Amazon basin typically are given prescriptions for

Mefloquine is used to prevent (and sometimes treat) malaria, a
devastating disease that kills more than 1 million people
worldwide each year, and is the second-most deadly
communicable disease in the world, after tuberculosis.
Mefloquine is over 90 percent effective when used in prevention,
and saves many thousands of lives annually. It is taken by 90
percent of Peace Corps volunteers in Africa and has reduced
their infections dramatically since it was introduced. Last year it
was prescribed at least half a million times. Most who take it for
prevention have only mild side effects or none at all.

But there is convincing evidence that the drug exposes a small
number of otherwise healthy travelers to traumatic and
sometimes bizarre neuropsychiatric reactions ˆ and that they are
often unaware of the risk of such reactions.. Reports of side
effects from mefloquine exposure include hallucinations,
sleeplessness, paranoia, psychotic episodes and suicide
attempts. Some users complain of effects persisting for weeks
or months, even years.

These reactions are documented in scientific studies, surveys
and in thousands of case reports in the files of Lariam’s
manufacturer, the Swiss firm Hoffmann-LaRoche, and the U.S.
Food and Drug Administration (FDA), the agency that regulates
pharmaceuticals. Adverse reactions were noticed by the
manufacturer and public health officials soon after the drug was
approved 11 years ago. The manufacturer twice agreed to revise
the label to list more, and more serious, side effects, including
psychiatric ones. Regulators in the United Kingdom had already
required explicit consumer warnings, and in 1997 the U..K.’s
Malaria Advisory Committee stopped recommending mefloquine
for travelers headed to malarial regions for two weeks or less.

Even so, U.S. travelers are often unaware of the potential for
disturbing effects. Because pharmacies are not required to
distribute the complete product label with most drugs, the
government-mandated warnings are not routinely circulated to
patients. And many physicians ˆ following the advice of the CDC
and drawing on their experience prescribing the drug to patients
with few serious problems ˆ either downplay or are unaware of
the symptoms a minority of people taking mefloquine report.
Despite the accumulating facts about side effects, the CDC has
continued to support mefloquine as the “drug of choice.”

As a consequence, many who take the drug and suffer side
effects are less likely to recognize them until considerable
mental anguish or physical injury has occurred. Many people
continue taking the medication because they do not realize that
the puzzling, even debilitating symptoms are associated with the
drug they are taking to prevent malaria. Patients often report
being treated by doctors who discount the possibility that their
problems are related to the drug.

People who have called the CDC to report or gather information
about the side effects of Lariam, including several people whose
cases were researched for this story, were told by agency staff
that their reactions were unlikely to be the result of the drug and
were advised to consider other causes, including stress.

While few agree on the number of people who suffer side effects
from mefloquine, there is little question that some of them do.

Andrea Meyerhoff, an FDA medical officer with responsibility for
drugs for tropical diseases and a travel medicine clinician at
Georgetown University, says that while cause and effect between
mefloquine and these symptoms may never be conclusively
proven, neuropsychiatric effects are clearly “associated” with the

Raymond Woosley, chairman of the pharmacology department
at Georgetown University and an authority on drug side effects,
says the reports on mefloquine are sufficiently widespread to
eliminate any doubt about the drug’s ability to produce these
effects at the preventive doses given travelers. “Mefloquine is
one of the more troublesome drugs people use, and causes a
lot of side effects,” he said. “Some of them are quite serious.”

Though Lariam can treat a deadly disease, he continued, its use
for prevention needs to be carefully considered. Unlike drugs
used to treat a patient who has already contracted a serious
disease, where even powerful side effects are tolerated in
service of the greater good of fighting a life-threatening condition,
Lariam is used to prevent a disease in otherwise healthy people
who are usually choosing to travel to infected areas.

Says University of Toronto professor Jay Keystone, a leading
authority on antimalarials who has served as a consultant to the
CDC and to the drug’s manufacturer: “I’m not questioning [the
CDC’s] intentions or integrity, and for most people the drug is
safe and effective. But they are trivializing very real and disabling
side effects.”

Officials at Hoffmann-LaRoche take the position that Lariam has
been proven safe and effective, and that labeling changes
approved by the FDA provide adequate notice of the side effects.

“Lariam has been used since 1985 by more than 12 million
people worldwide for prevention of malaria,” said Charles Alfaro,
a spokesman for Roche (as Hoffmann-LaRoche is widely
known). “The numbers [of side effects] are extremely low.
There’s a lot of data out there, but if you look at the experts
about Lariam, the causal association between mefloquine and
serious adverse health events is unlikely.”

“The pill is well-tolerated by most people, and the drug’s really a
good drug,” said Celia Maxwell, who as an FDA medical officer in
1987 recommended the drug’s approval, and who as a travel
medicine clinician now frequently prescribes it. Disabling side
effects are “very, very rare.”

But when they do occur, she adds, “it’s 100 percent real ˆ no
doubt about it.”

The precise odds of having a bad reaction to Lariam are the
subject of intense debate, at least partly due to disagreement
over what is meant by “bad.” Some scientists tally only the most
severe reactions requiring hospitalization, while others count
users who are unable to continue their daily activities. Others
include only those who stop taking the pill due to the side effects,
thus exposing themselves to the risk of malaria.

A Roche-sponsored study of 145,000 travelers in 1993
estimated the rate of “serious” side effects ˆ identified in this
study as those causing death or hospitalization ˆ at one in
10,000; this figure is often cited by the CDC and those who
support wide use of the drug. In a 1996 English survey of 2,395
users, one in 140 reported problems severe enough to stop
them from carrying out their daily activities.

The latest studies, presented last year at a tropical medicine
conference but not yet published, suggest that somewhere
between 10 and 20 percent of those who take mefloquine suffer
side effects ranging from mild to severe. One of these surveys,
conducted by the Scripps Travel Clinic of La Jolla, Calif.,
estimates the ratio of people suffering some side effects at one
in five.

Just who is likely to suffer these side effects? One-third of all
patients with problems have a history of hypersensitivity to
mefloquine or other quinine-related compounds; had been
taking beta blockers (a common class of drugs prescribed for
hypertension or heart problems); or had been prone to seizure

The other two-thirds of patients who experience neuropsychiatric
and other moderate to severe reactions? They have seemingly
solid mental and physical health histories. Medical experts say
there is no way of predicting who they will be, and virtually no
research is being done to find out.

Beyond the statistics from surveys and studies, there are reports
by patients and doctors to various government agencies.

In the United Kingdom, Lariam was suspected of causing 1,505
adverse reactions between 1990 and 1998, according to doctors’
reports compiled by health officials there. The government
subsequently expanded the drug’s warning label. The British
press has reported more on Lariam problems than the U.S.
press ˆ sometimes sensationally, adding to arguments that fear
itself contributes to reports of reactions. Letters to the British
Medical Journal have aired disagreements over the proper role
of Lariam. Just last week, the New England Journal of Medicine
published a similar exchange between doctors about the drug’s
side effect profile.

In the United States, more than 2,070 reports of adverse
reactions have been filed with the FDA in the last 11 years. More
than half of those reports ˆ 1,288 ˆ involved complaints of
“neurological events.” The Washington Post obtained 130 pages
of the reports, covering the period 1997 to 1999, under the
federal Freedom of Information Act.

Such data are anecdotally suggestive but statistically unreliable
unreliable because multiple reports may have been filed by a
doctor, patient and drug company for the same patient’s
experience, and because filing a report doesn’t prove reactions
were linked to mefloquine. In addition, nobody knows how many
other people may have experienced problems they did not report.
However, the data do illustrate what some practitioners and
patients believe to be happening.

The reports have few details and consist mostly of the date, the
source of the report (medical professional or patient), a tally of
symptoms, the outcome, a list of drugs reportedly taken and the
“primary suspect” of the reaction’s cause. Page after page, the
list of symptoms repeats: psychosis, anxiety, panic attack,
thoughts of suicide, hallucinations.

Report number 3057866-X, filed with the FDA on March 19, 1998,
lists the unidentified patient’s reactions: “Abnormal behavior,
chest pain, hallucinations, hyperventilation, insomnia, suicidal
ideation.” Outcome: “Required intervention to prevent permanent
impairment/damage.” Primary suspect: Lariam.

Report 330063-5, filed July 9, 1999. Reactions: “Anxiety, asthma,
chest tightness, cough, dehydration, nausea, panic attack.”
Outcome: Prolonged hospitalization. Primary suspect: Lariam.

Report 3413545-8, filed Dec. 3, 1999. Reactions: “Mental
disorder. Paranoia. Suicide attempt.” Primary suspect: Lariam.

Report 3074393-4, filed April 30, 1998. Reactions: “Aortic injury.
Facial bone fractures. Successful suicide.” Outcome: Death.
Primary suspect: Lariam.

During the Vietnam War, the number of malaria infections
among American military personnel sometimes exceeded
battlefield casualties, and U.S. officials knew something had to
be done. Chloroquine, then the drug of choice, wasn’t working as
well as it once had, and neither were two alternatives. The Walter
Reed Army Institute of Research screened a quarter of a million
compounds in a quest for a preventive drug.

Army researchers didn’t know how mefloquine worked, but it did.
Army experiments in the early 1970s on nearly 400 male
subjects, mostly hardy men, showed high effectiveness and few
symptoms besides dizziness, headaches and insomnia.
Hoffmann-LaRoche acquired the rights to develop the drug
commercially and submitted the results of the Army’s human
experiments to the FDA.

Medical officer Celia Maxwell of the FDA, one of many officials
involved with the approval process, predicted few adverse
reactions other than dizziness, vomiting and nausea. Mefloquine,
she concluded in 1987, “appears to be effective and safe.” In
1989 the FDA licensed the drug. A year later it was licensed by
the United Kingdom. It was immediately popular because
malaria was becoming resistant to chloroquine and air travel to
the Third World was growing fast.

Around the time the FDA approved Lariam, troubling reports
began to appear. In 1989, “serious neurological and psychiatric
adverse events attributed to the drug were brought to the
attention of the pharmaceutical company and of WHO,” the World
Health Organization stated in a 1991 report.

A notation on the report states that it was “not issued to the
general public” at the time; it was intended only to guide
discussions of scientists and policymakers. A copy was
obtained by The Washington Post.

“We knew” about adverse reactions, said Maxwell. “That’s why
we included some language about potential effects in the
[original] labeling.. But at that time, we just didn’t have the
numbers of reports” of ill effects that have emerged since.

The list grew. But Maxwell, now a professor of infectious
diseases at Howard University and a physician at the university’s
travel clinic, still favors Lariam, except for use by surgeons or
other people engaged in technical work overseas. (The drug’s
label suggests caution, due to side effects, by those who drive
vehicles, pilot planes and operate machinery. Some airlines,
hospitals and other companies employing travelers in sensitive,
high-risk jobs restrict use of the drug.) She says that, over 16
years of practicing medicine, only one patient reported to her a
neuropsychiatric side effect from the drug ˆ psychotic episodes
in which the woman heard voices and suspected a plot to
murder her.

Even so, the woman instrumental in approving Lariam for the
American public never uses it herself ˆ though, she says, not for
reasons unique to mefloquine. She opts for doxycycline.
Explains Maxwell: “I have a sensitivity to a lot of drugs.”

While the number of people who suffer serious side effects from
mefloquine is unclear ˆ and while it’s difficult to predict who
be affected ˆ it is clear that many people traveling to malarial
areas, particularly for the first time, are not well-informed about
possible risks.

At Washington-area CVS and Rite-Aid pharmacies, customers
do not routinely receive the drug’s FDA-approved and
twice-revised label ˆ a folded package insert of almost 50
paragraphs of small print that lay out the adverse reactions and
contraindications. Instead, customers receive a one-page
printout credited to an independent publisher listing milder
effects such as lightheadedness and insomnia, and advising
patients to “call your doctor if you develop unexplained anxiety,
mood changes, depression, restlessness or confusion.” It adds:
“If you notice other effects not listed above, contact your doctor or

To get the full package insert, customers must ask the
pharmacist or look up the drug in the Physicians’ Desk
Reference, which compiles information on drugs from all

A sampling in August of Washington-area travel clinics resulted
in echoes of assertions by CDC officials and the pharmaceutical
manufacturer that severe side effects are very rare. And some
clinical professionals in the area have little personal experience
with travelers’ problems with mefloquine.

Imtiaz Choudhary, director of Howard University’s travel clinic and
an infectious disease specialist, offered a common response
when asked what drug he prescribes for patients traveling to
most malarial regions.

“Mefloquine is the only one we have available,” he said. “I
strongly suggest people take this because its [side] effects are

Said Samuel Scott, senior clinical associate of Washington
Occupational Health Associates, which functions as a clinic for
business travelers and tourists: “[The CDC’s] drug of choice is
mefloquine, and so that’s generally what we use.” He added that
“I’ve not found it to be a problem. Bad dreams is the worst of it,
and so we warn them about that.”

Martin Wolfe, a veteran tropical medicine consultant who advises
the State Department, said a few federal employees have had
problems with mefloquine, but he continues to urge its use as
the primary defense against malaria. Ill effects are “not unheard
of” in his practice, but “we generally follow what the Public Health
Service [CDC] recommends.”

Meanwhile, other practitioners of travel medicine take a more
cautious approach.

“I don’t like using mefloquine [on patients] if I can avoid it. I’m
happy with the side effects,” said Robert Edelman, director of the
travelers’ health clinic at the University of Maryland Hospital in
Baltimore. He estimates as many as one in four of his patients
have a reaction ˆ insomnia, dizziness, feeling lightheaded or
nauseated, if not something worse.

“The patients are not happy ˆ and that’s bad, because they’re
going on these trips to get something accomplished or for a
good time. They’re on business and they need to be alert and
quick, and they have enough problems sleeping because of time
zones. People on vacation spend thousands of dollars on a trip
and suddenly find it ruined. They feel anxious and nervous and
have headaches.”

Edelman, who is also associate director of the University of
Maryland’s center for vaccine development, is critical of the
CDC’s Web site for failing to spell out percentages of patients
who have experienced specific categories of symptoms,
including the more moderate ones. The Web site says
neuropsychiatric events “very rarely” occur, and that statement is
deep in the product information. “If it’s one in four,” Edelman
said, “they should put it in there and let the patient decide
whether that’s too high or not. The problem is, most patients
aren’t even aware of these side effects unless you tell them.”

For those seeking protection from malaria, there are several
other options (see box, p. 15). In areas where malaria is not
resistant to it, chloroquine is the best choice. In areas where
malaria is resistant to chloroquine, the antibiotic doxycycline is
cheaper and has milder side effects; indeed, it’s the antimalarial
favored by President Clinton on foreign forays. (Asked why,
former presidential spokesman Joe Lockhart said, “the usual
reasons.” Lockhart also chose doxycycline, he said, because of
“the dreams.”)

Doxycycline must be taken daily, which is one argument against
it: Patients skipping a single dose can expose themselves to
malaria. It’s also not safe for pregnant women or children, and
creates acute sensitivity to the sun ˆ a tendency to burn faster,
considerable difficulty for many travelers. Like most antibiotics, it
can also cause yeast infections.

Malarone (See “Malarone: A New Alternative to Lariam,” Page 14)
was approved in July and so far shows effectiveness similar to
Lariam’s but with fewer side effects.

The CDC’s preference for Lariam, despite the availability of such
options and reports of problems for some users, puzzles some
patients and doctors. Hans Lobel, for years the CDC’s chief of
malaria surveillance, published many articles supporting the
drug’s use, dismissing reports of side effects as the result of
“travel-related stress” or underlying health problems. He
encouraged use of the drug for pregnant women and children,
despite the fact that the drug’s label says sufficient research has
not been done on those groups.

In an interview before he retired last fall, Lobel told The
Washington Post, “The scientific data showed us there are no
side effects that can be attributed to mefloquine. . .!=. The long
and the short of it is that scientific studies have not shown any
difference between mefloquine and a placebo.”

The CDC’s current Yellow Book, a biennial compilation of
information on diseases and treatments that is used by doctors,
travelers and the media, describes mefloquine as the “drug of
choice” and says it is “very rarely” associated with
neuropsychiatric reactions.

Jay Keystone, the Canadian authority on antimalarials who has
consulted to both the CDC and Roche, calls the language in the
Yellow Book “unacceptable and incomplete.” The information, he
says, should include a range of estimates for people who are
expected to experience symptoms such as anxiety, irritability,
nightmares and other disturbances that cause them to stop
taking the drug.

As this story was being reported, CDC officials repeated the
agency’s long-standing assertion that the best scientific
evidence shows no difference in tolerance between those taking
mefloquine and those taking a placebo. Officials also said
mefloquine will remain the agency’s “drug of choice.”

But late last week CDC officials indicated they may review new
data on Malarone and suggest its use in cases where
mefloquine or doxycycline cannot be used. Monica Parise, a
medical epidemiologist of the CDC’s infectious disease unit,
said it’s now possible that the next edition of the Yellow Book, to
be published in 2001, will acknowledge that patients and
doctors have three options for malaria prevention in
chloroquine-resistant areas ˆ creating not a single drug of
choice, but three choices.

In January 1999, Charles Perry ˆ a $160,000-a-year hospital
administrator with seven children ˆ had gone downstairs in his
Cincinnati home to retrieve a gallon of milk. Instead he got a
shotgun, angled the barrel against the base of his skull and
pulled the trigger.

He had told his wife, Linda, many times that that was where it
hurt the most.. The pain at the base of his cranium, the
nightmares and the hallucinations ˆ they all had started six
months earlier, during a safari trip to Zimbabwe to celebrate their
30th wedding anniversary.

Because of their public health backgrounds, both Perrys had
asked about Lariam’s safety ˆ at the pharmacy and at the local
health department. They were told it was fine ˆ in fact, the
“drug of

After a week canoeing the Zambezi River, Charles Perry began
imagining there were monkeys in their room.

“I was in bed and Chuck was sitting there just kind of enjoying
himself,” Linda Perry recalls, “and he jumps up out of the chair
and says, ‘Hey, there’s a monkey under the bed!’!=” Then he
chased “the monkey” into the bathroom.

Back home a few weeks later, he couldn’t sleep. He had vivid
dreams. He heard voices.

“Chuck went absolutely mad,” she says. “He couldn’t remember
anything. He couldn’t write his name. His eyes were just nuts.”
He called meetings at work, then forgot why he called them. One
night, he called 911 ˆ to report that his wife was going crazy.
Finally, he checked himself into the psychiatric ward.

Then Linda Perry remembered what an African guide had said
about how Lariam can make some people “crazy.” The guide
said that those who live in Africa know better than to take it.

“Oh God,” she remembers thinking. “It’s the Lariam.”

That may or may not be true ˆ doctors originally were unwilling
blame Lariam for Charles Perry’s mental problems, though one
physician wrote a letter doing so. And the timing of the suicide,
six months after exposure to the drug, is a complicating factor. In
many ways, the Perrys’ tale is a classic Lariam parable ˆ a
dramatic story of personal suffering and tragedy, but one that is
very hard to prove, either legally or scientifically, was caused by
the drug.

Like many people whose lives have been shattered by what they
believe are side effects of Lariam, Linda Perry has become an
activist for the cause. She filed a lawsuit in federal court in June
charging that the drug was responsible for her husband’s
suicide. In August, Roche filed a response, denying the
allegations, stating it had taken “reasonable care” in making and
distributing Lariam, and “any such injuries and/or damages
alleged by plaintiff were the result of superseding or intervening
causes . . . or caused by the negligence and/or fault of others.”
No trial date has been set.

A number of such lawsuits have been filed charging the
manufacturer with “failure to warn,” but none has been
successful. An attempt to gather plaintiffs in England for a class
action fell apart as legal bills mounted. Similar efforts have
stalled in Canada and the United States. One case in New
Jersey was settled out of court by Hoffmann-LaRoche, but the
case was sealed and the evidence and terms of the settlement
remain secret. An Indiana woman received a $10,000
out-of-court settlement from a pharmacy after suing for “failure to
warn” about Lariam’s dangers.

Perry is doing her best to provoke government action, so far with
only modest results. Ohio senators George Voinovich and
Michael DeWine have arranged a conference call for Perry and
her husband’s doctor with the FDA. The House Commerce
Committee is “actively engaged in conversations with the FDA
over concerns about the drug,” said committee spokesman Pete
Sheffield, and is exploring the possibility of holding hearings.

Meanwhile, individuals who believe they are victims of the drug’s
side effects hope their stories can help the public understand
the possible risks of taking the drug.

Michael Burch ˆ whose son contracted malaria while in the
Peace Corps and who appreciates the role mefloquine plays in
preventing and treating the disease ˆ says he wishes he had
known more before taking the pills.

“I wish I’d known what was happening to me” when he
experienced the cardiac and psychiatric symptoms in the
restaurant and thereafter. “I know we have the best medical
system in the world, and I still believe that.. But the system really
let me down.”

Hope Trachtenberg-Fifer, the nurse and health educator who
says she became “psychotic” after taking Lariam, feels “so used
and abused.” Before taking Lariam, she had consulted solid
information sources she often turned to for professional
decision-making: the Physicians’ Desk Reference and the
CDC’s Web site.

“I trusted what I’d been told by my government as an American
that this was the thing to do to protect me. I’d done my research!”
she said. “But the warnings are very minor.”

“They only said to be cautious if you have psychiatric problems. I
didn’t have any ˆ until I took Lariam.”

Keith Epstein, a former investigative reporter with the
Washington bureau of the Cleveland Plain Dealer, is a frequent
contributor to the Health and Travel sections of The Washington
Post. Dan Olmsted, a Falls Church writer and editor, contributed
reporting to this story.

© 2000 The Washington Post Company

Leave a Reply