Outside magazine, September 1997
S M A R T T R A V E L E R
Peace Corps volunteer Mike Hayes was having a rotten night. After months in Ghana he'd lost his voice. Then, as he sat in his hotel room, vivid, disconnected, irrational thoughts began racing through his head. Then he heard the cobra. The hissing, he was certain, was coming from the foot of his bed. (The noise actually was a woman sweeping, he'd learn later.) "The adrenaline was rushing through me," Hayes says. Running out of the hotel, he tried to hail a cab — no easy task when you're voiceless. Frustrated, he began to strip and rush, half-clad, into and out of the hotel. Several bystanders finally tackled him and drove him him to a hospital, where he was forcibly injected with round after round of tranquilizers. Hayes had no prior history of psychosis. He had, however, begun taking Lariam just before arriving in Ghana.
Lariam, the most widely prescribed malaria prophylaxis in the world, has recently become the most controversial. Standard treatment for travelers heading to areas where malaria is resistant to other drugs — which means most of Africa and the Far East — Lariam, known generically as mefloquine, has proven to be highly effective. "It's an almost ideal drug," says Dr. Hans O. Lobel, senior malariologist at the U.S. Centers for Disease Control and Prevention and the man who sets malaria-treatment policies for American physicians.
But a growing chorus of voices begs to differ. This year in Britain, hundreds of Lariam users filed a class-action lawsuit against Hoffman-La Roche, the drug's manufacturer, charging that Lariam's testing and side-effect warnings were dangerously inadequate. The suit cited a survey by British doctors showing that one in 140 Lariam users suffered severe reactions — a number vastly higher than Roche's own figure of one in 10,000. (Twelve million people worldwide have taken the drug since its introduction in 1985.) Though disputing the survey, Roche has made changes to Lariam's product information in Britain, including sobering warnings about hypertension and convulsions.
But psychosis remains the most worrisome of Lariam's side effects. John Ellison of Westfield, New York, for example, was flying to Ghana as a Fulbright professor in 1991 when he began having violent, recurrent hallucinations of a plane exploding with his wife and daughter aboard. The visions plague him to this day. "I compare it to Agent Orange," says Chris Geary, a 51-year-old curator of photography at the National Museum of African Art in Washington, D.C., who blames Lariam for a prolonged suicidal depression in 1995. "You have a situation that's totally murky," she says, "you don't have a lot of hard data, and there are interest groups involved."
Several suits are being readied in the United States against Roche. Some users are even calling for the FDA or the CDC to re-examine the drug. But Lobel says that he believes Lariam has been tested sufficiently and, like Roche, feels many of the mental disturbances among Lariam users are caused by the stress of Third World travel.
What does all of this mean for anyone planning to travel in a malaria-ridden part of the world? Educate yourself, those on both sides of the debate say. Begin by contacting Lariam Action USA, a group convened by unhappy users. Its E-mail address: LariamUSA@aol.com. You can also consult the less partisan CDC Web site (http://www.cdc.gov/), which includes extensive information about malaria — including a listing of areas where travelers needn't consider Lariam at all. In North Africa, the Caribbean, and most of Central America, the disease isn't yet resistant to chloroquine, an older antimalarial drug. Even in resistant areas, travelers can gain some protection by taking chloroquine in conjunction with other drugs. And in Britain, some doctors have begun prescribing Lariam three weeks prior to departure, instead of the usual one, so they can monitor adverse reactions.
Such a regimen might have helped at least one former Peace Corps worker, who claims he had to be institutionalized as a result of his Lariam use. Certainly it ended his infatuation with exotic travel. Among his most telling psychotic episodes: He fell apart in a Waldenbooks store and set about destroying a particular paperback-book area. "All of a sudden," he says, "I just hated the romance section."
Illustration by Marcos Sorensen