Wednesday 26 June 2019

Defence Forces medical chief defends use of malaria drug linked to suicide

Colonel Gerald M Kerr
Colonel Gerald M Kerr
Shane Phelan

Shane Phelan

The director of the medical branch of the Defence Forces has defended the use of anti-malaria drug mefloquine after concerns were raised by medical officers about its ongoing prescription.

The Defence Minister is currently facing 170 lawsuits in relation to the side-effects of the drug, better known by the brand name Lariam.

However, Colonel Gerald M Kerr insisted the drug was the "preferred choice" for deployments of Defence Forces personnel in sub-Saharan Africa.

In an open letter to medical officers, he also hit out at media coverage of the issue and said public opinion could not be allowed to dictate prescribing practices.

The use of Lariam as a drug of first choice on missions in sub-Saharan Africa is hugely controversial.

Manufacturer Roche says side effects can include abnormal dreams, insomnia, anxiety and depression, while the pharmaceutical giant says psychosis, suicide, suicidal thoughts and self-endangering behaviour have been reported.

The drug is no longer used by the French or German militaries, while the US, Canada and Australia consider it a drug of last resort.

Col Kerr acknowledged the policy was a "source of ongoing concern, if not actual disquiet for some medical officers". However, he insisted it was a more suitable drug than other alternatives due to the fact it can be taken weekly rather than daily.

"A weekly medication is required in a potentially volatile mission with its inherent threat to routine," he said.

Col Kerr said the drug had an extended half-life, which means a degree of protection continues even if a dose is missed for 24 to 48 hours.

He advised medical officers that if a member of personnel was sensitive to Lariam prior to deployment, it should be stopped immediately and they should be found unfit to be sent on the mission.

He also said, subject to some exceptions, it was not appropriate to prescribe an alternative daily medication.

Col Kerr's open letter said that while it was generally accepted patients had the autonomy to select their treatment or clinical management, in military medicine individual patient autonomy can be "subordinated" to the achievement of the "primary objective".

He said it was undoubted Lariam had been the subject of "very negative comment in the media". But he said public opinion "cannot be allowed to dictate prescribing practices of medical practitioners in the absence of substantiated evidence".

Col Kerr hit out at media reporting, saying there was "a total absence" of reports on patients who had not suffered any negative consequences from using the drug.

"Modern media is a very powerful weapon which can be used for good or for evil," he said.

"Sinister forces can exploit its effectiveness for their own agenda, and in an era of spin and fake news it can be extremely challenging to determine the actual truth."

The Department of Defence declined to comment on the letter as it related to Defence Forces medical policy, which is the subject of litigation.

Solicitor Norman Spicer, whose firm Coleman Legal Partners has issued 13 actions over Lariam and has instructions to issue more than 100 sets of proceedings, said it would be inappropriate to comment with cases before the courts. However, he said it was time the Government considered a redress scheme for those affected by the drug.

Irish Independent

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