EPISODE 11
“If you wake at midnight: The Lariam wonderdrug scandal” with Andrew Marriott
In this episode, Heather and Lee talk with author Andrew Marriott about his firsthand experience in the British military and the drug that soldiers were ordered to take that would change their lives forever.
TRANSCRIPT
Heather: Our next two episodes will address the harms of drugs given to military members under the guise of protection from chemical warfare in the case of Gulf War illness and antimalarials for those soldiers deployed to regions known for malaria. In both cases, these drugs were dispensed without informed consent, and with a knowledge of the potential harms they might cause to military personnel, including long-term health effects.
For most of the last century, drugs such as quinine, chloroquine and mefloquine (or Lariam) have been used as a method of controlling malaria. In prior episodes we have discussed the dangers of fluoroquinolones — Levaquin, Cipro, and aloflax. These anti-malaria drugs exhibit similar toxicity patterns to the fluoroquinolones. In fact, the phamacore of the fluoroquinolones and chloroquine are very similar, and the origins of the quinolone class are from the use of chloroquine as an antimalarial. Today we will focus on the antimalaria drug Mefloquine, or Lariam, a drug known to have long-lasting and horrific adverse effects. Since the Food and Drug Administration approved Lariam in 1989, more than 20 million people have received it, according to its maker, Roche Pharmaceuticals.
Numerous military members from around the world ordered to take the Lariam —and I stress “ordered,” with no informed consent and no information regarding the risks associated with the drug — have experienced and continue to suffer from a host of toxic effects, including neuropsychiatric adverse effects such as psychosis, suicidal thoughts, insomnia, depression, hallucinations, and unusual behavior. These effects are very similar to our prior guests’ toxic reactions to fluoroquinolones. These adverse effects have been connected to various acts of violence towards others and suicidal ideation for soldiers ordered to take them.
Recently we had an opportunity to sit down with Andrew Marriott, the author of a shocking book documenting his and his fellow soldiers’ experience with Lariam while in the British Army, and his efforts over the last decade to seek answers and acknowledgment for those harmed by the drug, only to uncover a history of institutional denial, deception, and greed. I encourage all of our listens to read Andrew’s book, If you wake at Midnight. We’ll put a link up on the website.
Lee: Awareness is power.
Heather: And it can save your life.
Lee: Welcome to our podcast, “Know Risks.”
Heather: I’m Heather.
Lee: And I’m Lee. We’re two moms, a lawyer and a nurse, who were brought together by a misfortune. Both our children were harmed by adverse drug reactions.
Heather: The purpose of this podcast is to educate people on the risk of any health treatments you put in or on your body.
Lee: We feel if we’d been properly informed and been our own experts, our children would not have been harmed.
Heather: In today’s world, with medicines being incentivized for profits, you need to educate yourself. Know the risk of health treatments and it can protect yourself and your loved ones from being harmed.
Before we start our interview today, I just want to share a little bit more about our guest, Andrew Marriott.
Andrew was an infantry soldier in the British Army for over 30 years, with service in Northern Ireland, Bosnia, the former Soviet Republic of Georgia, the Middle East, and West Africa. He was awarded a commendation for devotion to duty as a platoon commander and was later made a Member of The Order of The British Empire. While serving in Sierra Leone, he was required to take the anti-malaria drug Lariam, a drug now largely abandoned because of its disturbing and dangerous side-effect profile. The drug caused him a range of injuries, the most chronic being a condition diagnosed as nightmare disorder.
In 2015 and 2016, he made major contributions to a British Parliamentary inquiry into the Ministry of the Defence's use of Lariam. That inquiry caused the Ministry of Defence to be condemned for its failure in its duty of care to its personnel and veterans. It also called for Lariam to be relegated to a drug of last resort.
Andrew has since gained a doctorate in archaeology. The only student to have been awarded the departmental prize at the University of York for dissertations at degree and masters level, his research has been published in several academic journals and the national media. He spends the rest of his time as an advocate for British veterans and their next of kin whose lives have been devasted by Lariam. In that cause he has appeared on multiple broadcasts on the BBC TV and radio and other national news programs, while also contributing to articles carried by Britain's leading newspapers.
His 2022 book, If You Wake at Midnight: The Lariam wonder drug scandal, chronicles the development and marketing of Lariam against the background of people who courageously share how this psychotropic drug changed their lives forever.
He is married, with two adult daughters, and lives in the North of England.
Heather: Well, we have a wonderful podcast today. I am so excited to have our guest on today, Mr. Andrew Marriott. He’s the author of a book, just an exceptional book, If You Wake At Midnight, and it discusses the drug Lariam that is — I believe in some cases; we’ll let Mr. Marriott speak to this — still being used throughout the world to address malaria. We’re just really happy to have him here with us today and to kind of unfold this discussion. Lots of points in this book come up and really hit Lee and I in regards to the toxic effect of this drug and some of the adverse effects our children went through with fluoroquinolones.
So I want to say good morning to Andrew. Thank you for being with us this morning. And I think it would be best — I mean, this is just an incredible, incredible book, incredible advocacy, disturbing — it really touched me watching my son, what he went through, and your discussion of the widows and the soldiers that were affected by this drug. So I just want to give you kind of an opportunity to give us an overview of the book and just what made you want to put this down, you know, pen and paper, and what made you really pursue this issue of Lariam?
Andrew: Well, thank you very much for that very kind introduction and also for the opportunity to be able to speak today.
I guess it’s worth saying from the start that I come from a military background. I spent 35 years in the British army, and it was while I was serving in West Africa that I was required to take the antimalarial drug Lariam. It’s a very controversial drug. It was the default drug for the British armed forces serving in malarial areas such as West Africa, Afghanistan, and other tropical parts of the world. There were other safer alternatives. One of the problems with the drug, which I think probably spreads over into other medications, is that it has a range of neuropsychiatric side effects and these are particularly marked in Lariam compared with the much safer alternatives for other antimalarial drugs that are freely available on the market.
I took the drug for almost a year while I was in Sierra Leone, so I consumed probably the better part of 50 pills on a weekly basis, and I suffered a number of side effects. These initially ranged from disturbed sleep to nightmares to physiological problems such as balance and vision, other things such as restlessness and confusion, anger management, and problems with my sleep that manifested themselves in a number of ways. And I quickly realized that a lot of other members of the force that I was serving with in Sierra Leone were suffering similar side effects. In fact, a large number of the personnel were throwing away the pills rather than comply with the regulation that you had to take the antimalarials. That actually put me in a slightly difficult moral position because I was leading a small team of officers and warrant officers from the U.K., Canada, and the United States, and as the team leader, of course, I had a responsibility for their health, and you have to take issues like malaria very seriously in those parts of the world, and the strain of malaria there is a particularly nasty one. So the chain of command required that as you would take other protections, such as sleeping under a mosquito net, covering up bare skin during the day to avoid being bitten, wearing creams and using insect repellent, so we were required to comply with the weekly drug regimen. It was quite a surprise to me to see the range of side effects that were appearing among my peers and the soldiers that we were leading. We had been warned that there would be some side effects, but these would pass, they would not be permanent, and that the more serious of them would only manifest in about one in 25,000 personnel. So those odds seemed quite good. In fact, they were all far from the truth. What I discovered at the end of my tour was that there were safer alternatives available that did not cause these range of side effects. And there was no need for us to have been using this drug. That had put me in the position whereby, as a leader, I was requiring my soldiers, in the same way that I wanted to make sure that they were safe, that their vehicles were properly maintained, that they were drinking clean water and so on, that they were complying with all of the health requirements. So as a commander I would be checking to make sure that they had taken their antimalarial medication. What I didn’t realize was that I was complicit, if you like, in a much wider scheme of enforcing one drug when there are safer alternatives.
One of the things that probably ultimately motivated me to write the book was that senior medical officers that I approached early on during my tour in Sierra Leone told me that the drug was safe and they told me that there was no alternative for the strain of malaria that we were faced with. That was manifestly untrue. We didn’t have the opportunity back then, in the early 2000s, to easily go on to Google and check all of these things, so I rather took the word of senior medical officers that this was the most appropriate drug for the theater of operations. And I was told that there had been a risk assessment conducted by the surgeon general of the British armed forces — so, you know, that is the top of the tree in the medical profession inside the army, the air force, and the navy — and that he had determined that that was the drug that we should take. There’s another difficulty that arises with this because when you determine that you’re only going to use one drug, you’re denying all of those who in the first place might be contraindicated to that drug and therefore it shouldn’t be suitable for them in the first place. If they’re also presenting with difficult side effects, you ought to be giving them an alternative antimalarial prophylaxis. Well, that didn’t happen. The regime was forced. So there was a moral issue and there was a serious medical issue.
And when I returned home I knew that there was something wrong with me. I had had a number of individual events during that year. For example, I explain in the book I was driving home on a period of leave one day when I pulled over at a service station for a break, rested for 10 minutes, fell asleep, woke up. I had absolutely no idea who I was or where I was or what I was doing in that car. That passed quite quickly, but again, as I say in the book, if it was only 60 seconds, that’s a long time. Just count slowly to 10 and even that sort of period, when you’ve got no idea who you are, you have effectively a memory wipe, but thankfully, in my case, my memory came back quite quickly. There have been other instances, particularly amongst American citizens, where this has been a long-term legacy for people. And again, I refer to other cases in the book.
And then, shortly after I returned from Sierra Leone — again, as I explain in the book, I had probably just finished my last pill — because you have to take the antimalarials for a number of weeks after you leave the theater. I was on another duty in Kyrgyzstan, I just booked into a hotel, I had a room on one of the upper stories, and I stepped out onto the veranda and I had this — well, it wasn’t overwhelming because I’m still here, but this almost overwhelming desire to throw myself off the balcony with coherent thoughts going through my brain as to why not do it? It won’t hurt when you hit the bottom. It will be over in a flash. And I stepped back, closed the veranda windows, then, if you like, came back to my senses, and because I was a serving relatively senior officer in the army, I suppressed all public memory, if you like, of that event because to have admitted that sort of behavior would have lost me my job, effectively. And over the coming years, I began to see the scale of the problem. I thought that it would be addressed by the senior echelons in the British armed forces, both on the medical side and on the command side, because quite clearly what I had discovered was that this was a drug that was dangerous, quite clearly incompatible with military use. Even at the lower spectrum of the side effects, we don’t want soldiers going into combat who are confused, who are restless, who have problems with anger management, problems with their vision, balance, and so on, never mind the ultimate of the side effects, which lead into acts of violence or self-harm and ultimately suicide.
And I had rather naively, I suppose, with hindsight, supposed that the Ministry of Defense, when this matter was brought to their attention, would say we need to speak to you, come and tell us there’s a problem. But as the years passed, and I left the army with my condition not pursued to any proper diagnosis, effectively what was going on was that there was a cover-up, and of course the cover-up may have been because of malpractice or it may have been because of incompetence. Who knows? But it’s not the state of affairs that you need inside a professional army, air force, or navy. And I discovered that for very good reasons the drug was actually not being given to aircrew, either in the army or in the air force, because of the risks presented to people in charge of aircraft, be they helicopters or fast-attack aircraft. So why is it deemed sensible that a soldier with an assault rifle, somebody with a piece of artillery, or even in the navy, the commander of a nuclear-armed submarine could be exposed to these sorts of drugs that we knew was too dangerous to give to the air force?
So a few years after those events, I decided to leave the army. I did get one piece of advice before I left from a military doctor in a corridor who said, make sure you get as much of this onto your army records as possible, so I did. And as I explained in the book, I did have a range of visits to medical specialists who were thankfully, on the one hand, able to determine that I was not suffering from depression or any form of mental illness, but eventually, when all of the pieces came together from the various consultants, most of them being civilian, was that I was suffering from the long-term side effects of Lariam. And in my instance, probably the most enduring aspect is that since I took my first Lariam pill in 2002, I have not had an undisturbed night of sleep, and that’s quite tricky.
On the one hand, I suppose if you wanted to be flippant about it, I’m sort of a Jekyll and Hyde, or perhaps even a vampire sort of character, and as much as I hope appear normal and sane during the day, but I go to bed at night knowing that what unfolds during the night is going to be unpleasant. I’ve eventually come to terms with it but hence the title for the book, If You Wake At Midnight. I usually don’t try to go to sleep before midnight because it’s not worth it. I will wake hour after hour. But the other bit about the title, If You Wake At Midnight, you’re probably familiar with the term “them that ask no questions isn’t told a lie,” and it’s from an old Rudyard Kipling poem and that’s what’s at the heart of this: them that asks no questions don’t ask questions about Lariam because we don’t want to find out the answers. And as I retired and then I took up another career as an archeologist, I started to encounter more people, both civilians and veterans and their families, who had been as badly affected by this or, as you will see in the book, even more so. And probably the beating heart of the book — and that’s a difficult phrase to use since we’re talking about a suicide, but the beating heart of the book is Jane Quinn’s story of that awful night in Scotland when, with their young family in the house, her husband, Cameron, who had recently left the army and had taken the drug, committed suicide. And it was the courage of Jane and her willingness to join a group that we made in the United Kingdom that then also had contacts across the rest of the world; it was her story and the others and a remarkable series of very brave women whose stories are exposed in the book and others, like a retired warrant officer, David Remington, who tells his own story of a suicide. I give the chapter the title “Anatomy of a Suicide.” Their courage but also the way in which they had been abandoned by the institutions that should have looked after them — and that’s what caused me eventually to write the book is although we’d managed to get Parliament interested and our Defence Select Committee, which is a little bit like a congressional inquiry in the United States, the defense committee, which is independent of government and party politics, decided that they would have an investigation into this. And what we uncovered during that process and what they uncovered show a very unhealthy state of affairs. And I was rather hoping that given that the Select Committee had said that the drug was too dangerous to use and said that the MOD [U.K. Ministry of Defence] should only ever use it as a last resort — and I will accept that in some cases it might be the only drug that is appropriate for one in 50,000, or it might be necessary to use that particular drug as therapy as opposed to prophylaxis. So you can’t rule it out altogether. But it should have become a drug of last resort.
What we also found during that process were a series of — well, I will use the word deceits that were put up by ministers and others involved in this story in order to close it down. And having hoped that perhaps the outcome would have been a proper public inquiry, perhaps with evidence given on oath by all of those concerned, that should have been the next step, but it was perfectly clear that the government, the Ministry of Defence, the Department of Health, and our drug regulators wanted to close this down. “We don’t want any further investigation.”
I think one of their incentives in trying to close this down was in order to suppress the story — over here, if you want to take action against an institution or an individual for medical negligence, there is a serious restriction arising from our statute of limitations, which means that you can only bring a case for negligence within three years of the act of negligence or the first point at which you would have been aware of that. And so the Ministry of Defence clearly has a vested interest in closing this down because there are hundreds, probably thousands, who have been dreadfully affected by this drug, some who have committed suicide, some who have been involved in acts of self-harm, and others whose careers have simply fallen apart, marriages that have been destroyed. And I know that this has happened also in the United States. I think it was around about 2002 you had a series of unexplained murders at Fort Bragg, of which Lariam seemed to be the common denominator, and I believe it is still also thought entirely plausible, if not highly likely, that Staff Sergeant Bales, who in Afghanistan, I think in 2012, went on that awful killing spree when 16 Afghan civilians were killed.
So those were the — if you like, the inspirations for writing the book. We needed to get the full story out and although, in a few cases, such as mine, and to a certain extent Dave Remington, who is the man who very courageously explained his own attempt at suicide, the full stories have come out but they haven’t really been properly investigated. And until such time as we expose the full nature of this, people like Dave and others are now suffering in what we’re calling over here trauma sanctuary. You have to tell a doctor what is wrong with you. The doctors are all encouraged — and certainly within the Ministry of Defence almost forced — to tell sufferers that this is not an illness or an injury from a neurotoxic drug; they are suffering from posttraumatic stress disorder. Or worse — and I think you’ve experienced this as well — the doctors will often, particularly military doctors, will often try to ascribe the illness to an earlier childhood event, so you have invented sleep disorders that they claim that the child was suffering long before they enlisted in the armed forces, and mothers who know best say, this is entirely untrue.
So until such time as syndromes are recognized for the injuries that they are, these people can’t get proper treatment. And in fact, in many instances, the treatment is going to be counterproductive. That happened with a general. He was one of the most decorated officers of his generation. He had suffered a traumatic brain injury while serving in the Balkans. He should have been contraindicated to Lariam, but he’s required to take it. And he was suffering complex injuries but also Lariam injuries. But those would not be acknowledged, and he and many others are being put on entirely inappropriate treatment regimes and, in some cases, they are making them worse and potentially leading to deterioration and death. And that’s another rationale for putting the book out in public domain.
It is difficult reading in parts. And in fact, I find when I have been proofreading or when I return to it there are two or three chapters — and you’ll know which ones I’m referring to — where I have to stop and take a breath or go for a walk, and that’s been the response of many of my colleagues who have read the book. Some have said, wow, you didn’t take any prisoners there. But actually I have been kind to quite a few people. But those who I have named I have named for very good reason. But this is a book that has moved some very hardened war veterans, whether they be infantry soldiers, aircrew in fast-attack aircraft, and each one of them, although they have been aware of the Lariam problem, have said, my god, I never realized it was that bad.
Lee: I just want to sort of — as you’re talking and I’m thinking and as I read your book — you know, I’d heard about this and read about it, but I don’t even think that the magnitude of it is even known because you mentioned how, when you’re in the army and the fear of losing your job — so imagine that you have, you know, suicidal thoughts or you’re feeling, you know, these weird dreams and you’re feeling aggressive, that’s — like you mentioned, you don’t want to point those things out to your superiors because that could put you in a position of being, you know, let go or out. So there’s that. And then you’re giving these people this medication that’s causing all these horrific side effects, but until I read your book, it didn’t dawn on me: We’re also putting them in harm’s way because they’re expected to be in a very dangerous environment, to be in a calm state of mind, to react calmly — and, you know, I’m not a military person, but, you know — to defend themselves and others, and if you mention your 60 seconds of not even knowing where you were in the car, imagine that happening out in the field for these. Like, we have no idea how many soldiers have lost their lives out there as a result of not being 100 percent from these side effects.
Andrew Marriott: Yeah. I think you’re absolutely correct, and one of the other reasons that institutions in the United States, Canada, and the United Kingdom do not want to have a look at this is that a lot of misdemeanors and acts, ranging up to atrocities, are potentially going to be attributable to Lariam. And I’m sure you’ll be aware that in Canada, there is an awful lot of controversy as to just exactly what it was that stimulated the events in Somalia that caused the airborne regiment to be disbanded. It may have been multifaceted, but to rule out, without any form of examination, the likely — certainly highly plausible contributory nature of Lariam, a psychotropic drug, to those behaviors — even more so since General Roméo Dallaire, who commanded the U.N. forces in Rwanda, has personally described his problems with the drug, and yet we’re not prepared to examine what has been going on. I would think that a number of our military problems that we have experienced in Afghanistan, Iraq, in Africa, and possibly non-malarial areas, because of the lingering and persistent nature of the drug, will be because of that. And you’re absolutely right: They’ll be tens of thousands of people who have been suffering from this and no one is going to be the first — or very rarely will anyone say I have some problems; I’m having nightmares; I thought of throwing myself off a balcony. I know exactly what the response would have been had I gone to my bosses and said, those are the sorts of thoughts that are going through my mind. So that was why I went through a medical system that was as close as possible to the civilian one, so all of the various consultants that I saw were giving me coherent, thoughtful, considered opinions, as opposed to those that were colored either by the services’ medical personnel or the chain of command.
Heather: And from your book I could see that there was — I remember, from reading it, it was just very good advice that was given to you, I believe by a physician in the military, to make sure that you really document this as you go through the process of just noting what effects this drug had on you. I just — while I was reading it, though, I just couldn’t help — this kind of playbook that’s used by, you know, institutions and industry, when there are very obvious — I mean, I think it was as clear to you as other soldiers began to experience this from this drug. I remember parts of your book when, you know, other soldiers are warning, or I believe there was a French soldier who said, I’d never take that; you know, I would take this other substitute; you shouldn’t take that. So there was this — and, you know, we’ve talked about it in one of the podcasts — this hunch that it was this drug that was doing it, but just this idea that, you know, aside from all the other hurdles in making the connection that you’re having an effect from the drug and then sharing this, especially when there’s thoughts of suicide or thoughts of violence, you know, this just real demonization of the victim, you know, that it’s an underlying illness. You know, going back in their medical history, it just becomes a real deterrent to having cohesion among those who were harmed, because it’s very difficult; it takes a very strong person. I just commend everyone you’ve wrote about, especially Jane that you mentioned in your book, to pursue this and push forward.
And it seemed to me clear — and I just — there’s so much to unpack here, but this whole issue that seems to be one of the adverse effects of, like, the memory wipe with this drug, and in some cases, in reading the book — I know yours was brief but there appear to be other victims that their memories did not come back, that they lost parts of their lives due to this. I was just fascinated because it appeared very clear to me the way that various institutions from your discussion about Guantanamo Bay studies that were done in the military, studies that were done in prisons by, you know, what appears to be government — this is just your opinion, but do you think that was the interest in this drug in giving it to, you know, military or prisoners or whatever? Do you think it was that memory issue that they were looking at? Or, I mean, what was the fascination of this drug — (laughs) — you know, with these groups?
Andrew Marriott: Yeah. That’s a question that is unresolved. You very rightly point out the rather idiosyncratic nature in which this drug was developed in a period that we were told had ended, but in the mid to the later part of the 20th century, when there were extraordinary breaches of medical research ethics in order to develop antimalarials and the culture that was developed in the 1940s where antimalarials were developed and tested on cohorts of prisoners in state penitentiaries who were quite clearly unable to give informed consent. But also — and I’d never heard of this until I started doing the closer research — programs such as the U.S. MKUltra, the activities in the ’50s and ’60s when the U.S. Army Chemical Corps and the CIA and the Walter Reed Research Institute appeared to have a sort of Venn diagram encompassing each of those institutions on various pathways of research, and it appears quite clear that there was an attempt to develop some form of psychotropic drug which would be used either individually, in interrogations perhaps, or collectively in chemical warfare munitions to disorient an enemy, but it was quite clear that there were these researchers going on and it would appear that Lariam popped out of one of these research programs. You know, it’s given that Walter Reed serial number, and as one of our doctors over here said, it is — Lariam, or mefloquine at the time, was a progeny of one of these researchers. So it would appear that a drug that was potentially — or a compound that was potentially being examined for its hallucinogenic properties was found to have antimalarial properties. And as we know, all of the intellectual property — because the Department of Defense can’t go into marketing in the public — in order to bring this into production and sales that could be purchased by the U.S. Department of Defense, it would appear that all the intellectual property and research papers were passed at no cost to Roche Pharmaceuticals. So we don’t know why the drug was originally developed, but we got some very strong clues.
But we were also assured during the — I think during the Carter presidency when there was a congressional investigation into MKUltra and the other activities that were going on — that the director of the CIA said, this is all in the past; these experiments no longer occur. Well, what is going on, has gone in Guantanamo Bay appears to give the lie to that because to give inmates on arrival five times the normal prophylactic dose within 24 hours cannot be to treat malaria and the only plausible options are that this is a continuation of those programs of research on a literally captive cohort to observe their behaviors, or possibly as a form of chemical waterboarding. And that is not the sort of drug that we should be giving to the general public, or even the armed forces.
So one of the lessons that I hope that will come out for people who do read the book is that we need to be a lot more interested in the origins of our drugs, and if a regulator — CDC, FDA, the MHRA over here — if they are not satisfied that they know how the drug has been developed and what its characteristics are they should not license it and that this drug came to the market, both in the United States and then in the United Kingdom, having avoided the normal phase three safety trials, is a national scandal. And I don’t know how many other instances of drug sales this would apply to. It would —
Lee Ford: One of our podcasts — and I’m not sure if we’ve actually released that one but we do talk about the randomized control trials and how they’re farmed out and, you know, you think when you’re taking a medication that’s approved by the FDA that they’ve done all those safety checks, but in reality, they’re not specifically looking at all the side effects; there’s only — it’s farmed out and they don’t even actually see all the raw data. So I think that it’s a problem that’s still continuing now, you know, and people are getting these medications that aren’t safe, and then that takes us back to something that we’ve also talked about, which is informed consent. And, you know, these people that were given this Lariam, like, how do they give informed consent when the whole gamut of side effects have not truly been studied? Surely they weren’t told that — like you mentioned, maybe they were told that it was rare, which is a word that they like to use a lot. (Laughs.) But they weren’t given proper informed consent because I think a lot of them would have chosen potentially, like you said, the other, less-risk medication, or potentially, like, is it not even an option to just treat when you’re sick? Like, is it absolutely necessary to have a prophylactic treatment instead of just treating those that actually get sick? Do you know?
Andrew Marriott: Well, that’s a very interesting ethical and legal matter. I think that what the British army has done in a number of instances, by forcing the drug on individuals, they’re not so much guilty of medical negligence; it’s actually a form of assault that, over here, is legally termed as battery. If you make someone take a drug against their will or without informed consent, they are exposed to the charge of battery, and this is another vulnerability that will exist within the MOD and I’m sure that the MOD lawyers have been advising ministers that where it can be shown that soldiers have forcibly been given this drug or denied an alternative, there is a legal exposure that goes beyond simple medical negligence. And there should be a right to say I do not want to take this drug, and de facto that was what was happening because so many, as we found out now, were sensibly throwing away their pills rather than taking them. Had they been found out, they probably would have been subjected to internal military disciplinary procedures, whether those were formal, whether they would have been records on their service which said that this individual is not appropriate for promotion, or whether they would have been unofficial — and for “unofficial,” read illegal punishments. We found that in Sierra Leone in 2003 there was a battalion medical officer who was enforcing Lariam at the direction of the surgeon general, so he was doing the surgeon general’s bidding but as a doctor he has an ethical responsibility to his patients, and he should not have been part of the system that was forming up companies of soldiers 120-strong with a company sergeant major in front of them watching them while they took their pills and then, if anyone refused to take it, having what he called a “name and shame” board where people were publicly exposed as allegedly putting unit cohesion at risk when they’re looking after their own safety.
Lee: Well, I would imagine too that there was some fear, you know, if you’re — you’re not told the real risks of the malaria versus the risks of the medication. There’s the potential that you’re coerced into even believing that you need it because of the fear of what would happen, not that if you get malaria there’s actually a treatment, you just would be sick and you would take this treatment right away. But the thing that happened, I think, to me with my daughter — and she didn’t have the Lariam in this instance; it was a fluoroquinolone — but I was not informed of the side effects and what to watch for. Had I been informed of those side effects, I would have stopped it immediately, which is the proper response. So if they’re not properly informed, if you have any nightmares, if you have any suicidal thoughts, like, if they’re not given all that information to stop, then they wouldn’t even know when to stop.
Heather: Yeah, but I think in this particular instance — and I think Andrew writes about that in his book — well, first of all, you’re not having informed consent in this context. I would argue even in our cases — I mean, even when it’s not a military order, just for the general person, you know, being prescribed meds, there is a lot — not to the degree that you would have in the military, but there is a lot of ridicule if you have questions or want to know more about that drug, so much so that that type of, you know, antagonism to any type of information becomes a real obstacle because generally, you know, you’re having issues when you’re seeing a doctor and you’re hoping that whatever they can provide you will assist you, and either preventing those issues or — you know, you don’t think that the treatment — (laughs) — is going to be the thing that really becomes the cause of your demise, and in many cases, it is.
So it’s just amazing to me with this too — and this really hit me in, you know, going through something similar with a family member — is that when you really look at the labeling — and Andrew, you talk about this in your book — I mean, if these indications — nightmares, anxiety, the host of potential adverse effects — if they’re present, the drug should be stopped. And it appears to me that these — that was never even discussed, and they continued to receive that drug, it sounds like, for weeks and months and however long it was necessary to keep taking Lariam.
And you talk about that a lot in your book because I believe in the manufacturer’s labeling, that was there initially, that if these indications occur to stop its use, but they were never followed, and it didn’t appear that any of the powers that be or the physicians followed that protocol.
Andrew Marriott: Yeah. You’re touching on a really interesting thread regarding the responsibilities of the manufacturers. What I discovered was that companies like Roche produce different warning labels and different patient information leaflets, it appears, dependent on the legal jurisdiction within which they’re selling the drug, so the warnings in the United States were different to those offered to the United Kingdom, and a key aspect of the side effects of Lariam is that many of these side effects are what we call prodromal. A prodome, as you probably know, is a warning of a much more serious event, and if you suffer from one of these prodromal side effects, you have to stop taking the drug immediately because it could be the only warning that something much more serious may happen.
Now, in the U.K. Roche withdrew that prodromal warning, and while I was taking the drug, prodromal had been removed from both the patient information leaflet and the summary of product characteristics that the doctors would have been referring to, and it was only reinstated in about 2013 after we started to bring this to attention in the British media. So pharmaceutical companies appear to be able to produce warnings that are different, more related to their legal vulnerability in different jurisdictions around the world, rather than the patients that they should be protecting. So I had a team of Americans, British, and Canadians in West Africa; we were all taking the same drug, but apparently for the Canadians and the Americans, some of these symptoms were prodromal, but not for us. Of course, that’s an unsustainable position, and years later it was reinstated, probably partly because of what we were putting into the press and the television at that time, but also I noticed that there had been an audit of Roche’s (PILs and SPCs ?) at around that time and they had found to be deficient in a number of cases, so I suspect there was probably a lot of hasty housekeeping going on at Roche Pharmaceuticals in order to bring these up to date.
And with these big, major companies, it is extraordinary that they are allowed to get away with it, and particularly in the case of Roche U.K. because when Roche was applying for a change to its license and ordered that the pill could be prescribed on a weekly basis as opposed to a fortnightly basis, they gave an assurance to our regulators that all of the drug warnings would be harmonized worldwide. Not only that, the center for harmonizing was actually the Roche U.K. outfit just north of London, and yet we seem to be the last to put back in the prodromal warnings. And I wonder how casual other pharmaceutical companies may be with their own products, and also when you’re talking about quinolines or fluoroquinolones, whether there is a uniformity across the different manufacturers of the drugs because I guess that there will be a number of institutions, both within North America and worldwide, who are creating similar, almost identical drugs but potentially with completely different warnings, and discretion left to the drug manufacturer as to whether there should be a boxed warning, until the likes of us and you draw it to people’s attention, usually after there has been an awful, tragic event, and then they bring their papers up to date.
Lee: Well, it seemed to us, just going on the fluoroquinolones that we have knowledge of from our cases, but the black box warning came so many years later and it really was a lot of people that had to go forward, but they estimate that it’s only 1 percent, you know, a very low percentage of cases of adverse drug reactions that actually get reported and documented in order to make those changes. It seemed in the U.S. the labeling, from my understanding — and Heather would know more — if the drug company labels a side effect, then they can’t be liable as long as they have it, so there, it seemed to me, like, every time something comes up new, they do add it but it’s just buried in a pile of stuff that the patient would never see and some doctors would never read (is the ?) problem.
Heather: Yeah, and I think in our cases, like when you look at the fluoroquinolones in the lawsuits and kind of — you know, this has been going on for so long; the fact that it took till 2015, ’16 to get some labeling that addresses the issue, and the permanency of the issue of taking these drugs has — you know, there’s still a belief by — or a misconception, even when you talk to physicians, that if you quit taking the drug, these adverse effects don’t continue, you know, that there’s this relationship that they don’t extend after you start taking the drug, which we know is certainly not accurate.
But I think Lee — you know, in our situation with that, I just — it’s a hard one to unpack with these drugs because you just can’t help but think that — I mean, a lot of these issues are if you kind of follow the money. (Laughs.) You know, I hate to say it that way but it’s — you know, when you really look at this, shortly after the hearings we had in the States for the fluoroquinolones, shortly after that, the drug our children took, Levaquin, the drug company quit making it, and then it goes generic. And of course, if it’s a generic drug, you’re really in trouble because there’s no cause of action then against the drug maker at that point. So there’s all kinds of kind of ways that I think industry’s able to navigate this, but the fact that it takes so, so very long — and that really brings it back, too, in terms of, you know, the effects. I’m just really curious because I know that, Andrew, you’re in contact with a lot of soldiers, those who took this drug, in supporting them and just being an advocate for them, and a lot of this — you know, in reading your book, that really made sense too. It’s labeled as PTSD. Regardless of what the drugs are, children took and Lariam — you know, how they have in common, it is very clear: When you’re dealing with neuropsychiatric or what a layperson would call mental health issues, there’s always this default that that is some underlying illness, and I think that’s why the kind of scapegoat for all of this is PTSD. And how could anyone argue that a military person, especially someone in combat, didn’t experience that type of stress? And I think legally that’s what really dilutes the situation and scares — I know in the States, you know — is this an underlying illness? Is this from the drug? But what I’m really curious about is I know a lot of these are just attributed to post-traumatic stress syndrome. Conveniently for that, the industry has a lot of other drugs to treat that condition. I’m just curious, in your experience in working with soldiers who have gone through this — I just know from my son, being given more drugs for “treatment” of this so-called underlying illness were really — just hasten the pathway to his demise, because once you’ve had, you know, a toxic reaction to a drug, the last thing you need is to pile on a bunch of additional psychotropic drugs or mood stabilizers or anti-anxiety drugs to treat it. That’s not what they need.
I’m just curious if you could talk a little bit — I mean, how have these soldiers fared? I mean, how have they moved forward? Are they receiving that type of treatment or, you know, how do they move forward?
Andrew Marriott: Unfortunately, generally speaking, no is the answer, and that is the tragedy. Whenever a veteran presents to his civilian doctor, the civilian doctors — many of them will never have heard of Lariam because they now largely no longer prescribe it. But they are all encouraged — when I say “they”: the medical professionals are all encouraged to guide people down the PTSD route. It’s simple; it’s also, coming back to the phrase that you used a few minutes ago, it is also following the money because that is where all of the research is. I don’t wish to be dismissive of people who are doing good research into a psychiatric disorder that needs treatment, but it cannot be the be all and end all. It is very much in vogue at the moment. It is also what attracts all, practically all of the research funding in this field, particularly research funding that comes from the Ministry of Defence. So if you are a researcher in psychiatry on mental illnesses or whatever in institutions such as King’s College, you can submit a research proposal that will try to advance our understanding of PTSD and you will attract funding from all sorts of sources. If you were to suggest that you might want to do some research to look at the impact of neuropsychiatric and neurotoxic drugs on the behaviors of people, you will attract none, and there is an institutional close-down on this. Some of it is cultural but some of it is deliberate.
So, for example, at the height of the problem that we were bringing into the public a few years ago, the then-secretary of state for health in the British government, who had been at the top of the medical tree on the civilian side of this and in the governance side, left government one day and the following day he took up an appointment with Roche Pharmaceuticals. Now, as long as we have this sort of merry-go-round between the pharmaceutical industry and politicians and then those who are in the legislature and in the executive, we won’t have proper ethical investigations. And very sadly, that then goes down into the area where a lot of veterans would seek help, which are our military charities, or you’ll have your equivalents.
Heather: The VA.
Andrew Marriott: We have Royal British Legion here, Help For Heroes, all sorts of organizations that do sterling work, but you will not find a single entry on their websites related to Lariam or neurotoxicity. And they are encouraged, either financially or culturally or because of the entrées that they will get or the psychiatrists who are leading these debates, to simply go down the PTSD route, and that’s the tragedy and that’s why people like Dave Remington, who still needs help but, my goodness, he’s doing some superb work. I can’t imagine the number of people that Dave Remington has pulled back from the edge from a Facebook or a Twitter engagement or going and putting an old sergeant-majorly arm around the shoulder and saving the man. So there are going to be hundreds of people who have ended up in institutions such as prisons, who are sleeping rough or whatever who don’t have PTSD; they are suffering from an illness, an injury that is attributable to a drug that was given to them by the Ministry of Defence. And until such time as we break the logjam open — and perhaps my book will appear on the desks of ministers who can read it. I’m going back to where we started. What was the motivation for the book? It’s to tell the story in all of its aspects and all of its cold facts and show what has happened, and if they believe that I’m not telling the truth, well, get in contact with me; let’s have the discussion. The book has now been out for two and a half months. I haven’t heard anything from any minister, any senior officer in the surgeon general’s department or in the command. Not surprising. I think you may recall when (Bee Coldwell ?), one of the other women who shares her story — she says that she was at an event, a social event, and she happened to meet the then-chief of the defense staff and they got to talking about Lariam, and he said, I’m afraid this is something I can’t do anything about until I retire. Why would that be? Of course, he has now long since retired and we haven’t heard a thing from him. But until we break that logjam, we won’t have the recognition of the illness, and people like Dave Remington — yeah —
Lee: Well, hopefully your book is going to create — you know, hopefully lots of people will read it and you’ll get more awareness and with that comes more people and hopefully more voices, and that may be. And I wouldn’t be surprised that the more people that talk about and read your book, the more people that will — it will resonate with them, “that’s exactly what happened to me.” I know that’s been the case with us. We’ll mention something and somebody’s like, I have all those symptoms; I think I took that medication too, you know? So you’ll probably — more people, it will come. And I mean, I just loved reading your book, incredibly sad story but a story that needs to be told and hopefully will bring volumes and make change. So yeah, it’s just been wonderful to talk to you.
Heather: And also, Andrew, I mean, as an archeologist I’m sure you’re aware of this, but you’ve left your mark. I mean, I know on days when I get really discouraged with all this, having lost a son, to what I have uncovered as indifference, corruption, just a total disregard of human dignity. And just in reading this book — these are people, good people who wanted to serve their country. You know, this is not the way they should have been treated. You know, it’s unreal that this would not be addressed, but when you look at the close relationship between, you know, industry and our governmental institutions, you mentioned just the recycling in the states we have, you know — head of the FDA one year and the next year they’re the head of a major drug company. You know, what is that telling us about, you know, the mission of those agencies, which is to protect us and to ensure our safety? It’s disheartening. But you writing this book, you know, Lee and I trying to kind of speak out, trying — I know you referenced in your book you tried to use the court system — very difficult to find attorneys willing to put the work in to bring these cases, and very difficult procedural requirements that — you know, whether it’s a statute of limitations — here in the States we only have two years, you know, is our statute of limitations. So there’s definitely — (laughs) — a rationale for those, you know, time limitations to really ensure that a lot of, you know, these cases and people’s stories never make it to the surface and really make sure that there can be no justice to be had in these circumstances.
So I just really want to commend you because I think what we can do — and that’s the purpose of what Lee and I, you know, are trying to do to get people’s stories out — is they have to be told and they have to be documented, you know? We’ll do whatever we can. We were fortunate, and I think in my case it was because it was my own son, in regards to bringing lawsuits, you know? You have to be relentless, you know, because there is so much intimidation and so much personal attack on those who try to bring these cases. And I’m sure that you have felt that type of attack — (laughs) — in pursuing, getting, you know, these stories out. So I just, yeah, I just really want to commend you. The book is exceptional. I would encourage everyone to read it. It’s certainly disturbing, but it’s a story that needs to be told. And it’s still going on.
I mean, correct me if I’m wrong, Andrew, but, I mean, people are still receiving Lariam; is that correct?
Andrew Marriott: They are. The Ministry of Defence gives it to a small number. They are required to present to Parliament a six-monthly review. I think they’re probably backsliding on that a bit. The numbers are (right done ?), but it almost seems like a perverse intention just to ensure that a few people get it because they can. As a drug of last resort, it should hardly be on the radar at all. It’s largely discontinued and of course Roche have abandoned it, but Mefloquine, the generic, the MOD I think still wants to show that they are giving it, partly, as I say, because I think they can and it’s a sort of perverse desire just to continue doing it to show that they had some sort of justification for issuing it in the first place. So, you know, rather like a child’s behavior, when it’s admonished, you know, the child will then just continue to push a little bit and just do a few more naughty things to validate their actions. We need something a little bit more grown-up from our major institutions.
I guess sort of finally is I mentioned the motto of our military academy, which is “serve to lead.” That’s where there have been so many failures. Our officers are meant, during their service, having been trained at the academy at Sandhurst, to lead, and that’s what our service is about. And as I left the army, I realized that I was still a part of, if you like, the officer institution and there would be veterans and their families out there saying, why don’t they do something? Well, I’m still a part of the “they”; I’m still part of the institution; I still feel a responsibility. And that should not be abandoned, and I rather hope that a few consciences will be pricked by what I have said and we never do this again, either with Lariam, with any of the drugs that you’re dealing, or, God forbid, the next-generation antimalarial Tafenoquine, which is a compound equally as bad.
Heather: Yeah, that was disheartening to read that in your book. I think it was — was it Jane who had a quote regarding that in your book,
Andrew Marriott: Yeah.
Heather: — regarding just what lies ahead and fearing the future more?
Well, Andrew, I just want to thank you for joining us. Such an honor to meet you and really gives — I know I can say personally for myself, you give me the motivation to keep going with this, you know, because I think we all know, whether this issue has touched us individually or our family members, our loved ones, it’s not an easy path, you know? It’s not an easy path. And it’s just, like I said, a real pleasure. Gave me the momentum to push a little harder. (Laughs.)
Andrew Marriott: I’m very grateful to both of you for the opportunity and the invitation to speak. And it is one of the positives out of these dreadful excursions that we have to do is that along the way you meet some really inspirational people, and you are two that I will add to the group that I’ve been privileged to work with in the Lariam story, and I find your work equally inspirational. And thank you for what you’re doing.
Lee: That’s very kind. And thank you so much.
So we will have the link to your book on our website. So we will hopefully help you attract more people for your cause.
Andrew Marriott: Thank you.
Heather: Get the book. I have it right here. (Laughs.)