One of the near-universal experiences of working in development (or even just visiting an underdeveloped country) is the need to take malaria prophylaxis. Indeed, malaria is so prevalent across the developing world that it’s impossible not to think about its consequences for public health and economic growth – especially since we did our best to ban DDT spraying, the most effective means of getting rid of malaria, shortly after it was eradicated in the US.
These days the main preventive technologies are DEET-treated bednets and antimalarial pills. If you visit a travel medicine clinic, they’re probably going to try to offer you Lariam, generically known as mefloquine. The clinicians may mention side-effects, but most people talk about vivid dreams and downplay or completely disregard the more serious issues with the drug, some of which are very disturbing. They’re particularly bad given Lariam’s extremely poor effectiveness profile, which is detailed in that same Wikipedia article.
But the Wikipedia article doesn’t even get into the worst thing I’ve heard about Lariam, which is that in certain people it can trigger schizophrenia and amnesia. The anecdotes I’ve heard certainly don’t constitute proof, and proper scientific evidence on the matter is going to be hard to . However, This American Life has David MacLean’s first-hand account of severe mental side-effects from Lariam in an episode they recently re-ran in their podcast feed; it’s the last segment, titled “The Answer to the Riddle is Me”. You can click the “listen now” button, or get the mp3 via this link (it’s no longer free on iTunes). Thanks to Ophira Vishkin for helping me find the download link.
Here’s my question, which I’m hoping my co-bloggers can help me answer: why in God’s name are we still prescribing this drug? Based on what I’ve been able to find it appears to be on average less effective and more risky than all its competitors, and even discounting the possibility of induced schizophrenia it has immense downside risks that other drugs do not. It’s also on a weekly schedule that seems like it would badly reduce compliance.
Is there any case to be made in Lariam’s favor? NB that I wouldn’t consider having taken it and done okay to be valid evidence; that’s similar to vouching for Russian Roulette just because you played and won.