Was Sgt. Robert Bales on mefloquine when he is alleged to have killed 17 Afghan civilians?

March 26, 2012, 8:22 pm

There has been increasing speculation that Robert Bales, the Army Staff Sergeant charged with killing 17 Afghan civilians in Kandahar Province on March 11, 2012, may have been suffering from  well-known neuropsychiatric effects of the anti-malaria drug mefloquine (Lariam).

Mefloquine had been widely used for malaria prophylaxis since its long half-life — 13-30 days — meant that it only had to be taken once a week. However, the drug has been associated with episodes of bizarre behavior, depression, agitation, and paranoid, as well as several cases of violent behavior — both suicides and homicides. The incidence of neuropsychiatric reactions to mefloquine seems to increase when patients on it take alcohol. There have been suggestions that Bales may have been drinking on the night of the killings. In addition, Bales is known to have suffered head trauma during a previous deployment — a condition that should have ruled-out use of mefloquine.

According to the Army Times, in 2009 the Army discontinued recommending mefloquine as the preferred malaria prophylaxis medication, substituting doxycycline which has to be taken daily. Actually, in Afghanistan, doxycycline has been considered first-choice prophylaxis since 2004, with mefloquine reserved for those who could not take doxycycline. However, a previous study demonstrated that many soldiers stationed in Afghanistan had been dispensed mefloquine even when it was contraindicated.

Was Bales on mefloquine? The Huffington Post reports that to date the Pentagon has not said whether or not that was the case. It may be noteworthy that nine days after the killings, the Assistant Secretary of Defense for Health Affairs issued an urgent order for a “review of mefloquine prescribing practices” be completed immediately. [Update (4/2/12): There have been significant questions raised about the timing and intent of this order. See Jeffrey Kaye’s comment below.] If in fact mefloquine was associated with this tragedy, it will surely figure in Bales’ legal defense.

Link: Military Deployment Information Sheet on Mefloquine

4 Comments:

  1. Jeffrey Kaye Says:

    Actually, “the Assistant Secretary of Defense [ASD-HA] for Health Affairs” did NOT issue “an urgent order for a ‘review of mefloquine prescribing practices'” to “be completed immediately.”

    Mark Benjamin was wrong about that, and he subsequently updated his article at The Huffington Post. But he still makes a link between that order — actually an implementing order from an request made by ASD-HA back in January. The order Benjamin cites was from an unrelated lower medical command, trying to catch up to the ASD request over two months later.

    See the whole story debunking this aspect of the Bales story at http://truth-out.org/news/item/8189-why-the-huffington-post-needs-to-immediately-retract-mark-benjamins-afghanistan-massacre-report

  2. Leon Says:

    Dr. Kaye:

    Thank you for this important update. I think that your post on Truthout — to which you link in your comment — raises serious questions about parts of Mark Benjamin’s coverage, and is must reading for anyone trying to make sense of this story.

    I still find it puzzling that the Pentagon has not stated definitively whether or not Bales was on mefloquine. Since such prophylaxis would not involve any underlying medical condition or treatment for an illness, is seems to me that releasing this information would not violate any significant privacy rights.

  3. Jeffrey Kaye Says:

    Thanks, Leon. As regards the privacy issue, HIPAA is written with some pretty tough language. Too tough, some would say, as even family members can’t get crucial information about the health of loved ones in many cases. And the military, being very rule-bound, tends to take these things concretely and seriously. Did you know the penalty for a violation is $10,000. Would you want to take that chance if a reporter called you?

    I can also say that sources have told me DoD is being very careful about what they’re saying in the Bales case, as the speculation is really all over the place. Of course, DoD bears some of the blame for that, by changing the story, selectively leaking in the early days, etc. But in general, many DoD departments far removed from Afghanistan and Bales are nevertheless going to field such questions, given an active ongoing investigation, very carefully.

    I’m going to come out with another article on this matter soon, and don’t wish to preempt my own story, but the number of scripts written by the military for mefloquine has shrunk to quite a small size. The likelihood of Bales having even taken mefloquine, and not doxycycline like nearly everyone else (if he even took his meds, since compliance with antimalarials is an issue), is quite small (though there are some who would disagree with me).

  4. Leon Says:

    Jeffrey:

    I look forward to you pending article. Please let me know when it is posted.