Did malaria drug play role in Bales' Afghan murders?
By HAL BERNTON | The Seattle Times | Published: July 19, 2013
Staff Sgt. Robert Bales, guilty of murdering 16 Afghan civilians, used a controversial malaria drug linked to paranoia, hallucinations and psychosis while serving in Iraq, according to his lawyer.
Whether Bales took the same drug in the days leading up to his murderous rampage near a remote Army outpost in Afghanistan is unclear, even as a new document has emerged suggesting he did.
Earlier this month, the U.S. Food and Drug Administration released a 2012 "adverse event" notification from a pharmacist who reported that an unnamed Army soldier taking mefloquine murdered Afghan civilians.
The pharmacist's report states that a patient, who had suffered a traumatic brain injury, was treated with mefloquine despite restrictions on its use due to the drug's propensity "to cross blood-brain barriers" and incite psychotic behavior.
The document has surfaced just weeks before Bales faces a sentencing trial on Aug. 19 to determine whether he will spend the rest of his life in prison or eventually be eligible for parole.
Bales' lawyer, defense attorney John Henry Browne, told The Seattle Times that he has documents indicating his client took mefloquine -- known by the brand name Lariam -- while in Iraq. It was there that Browne said Bales suffered a mild traumatic brain injury.
In an interview this week, Browne would not say if he will raise Bales' use of mefloquine as a possible contributing factor to his crimes.
Browne said that Bale's medical records for his deployment to Afghanistan are incomplete, and that he hasn't asked the Army whether there was a follow-up investigation after the massacre to determine if the drug was used at the outpost.
"We know that he was given Lariam while in Iraq," Browne said. "We just don't have a complete set of medical records for that period (in Afghanistan). "He (Bales) can't help us. He just says he took 'whatever they gave me.' "
Browne also appeared skeptical of the pharmacist's report, saying he had no indication that it was filed by anyone with direct knowledge of Bales' use of the drug in Afghanistan. He said it was possible that it was filed by someone who just heard of details of the case through media reports.
Army officials have been silent on the question of whether Bales took mefloquine in Afghanistan. When asked by The Seattle Times, the Army declined to comment, citing confidentiality laws that protect a patient's records.
In June, the Joint Base Lewis-McChord infantry soldier pleaded guilty to the killing spree that took place in the early-morning hours of March 11, 2012.
Even if Bales took mefloquine only in Iraq, the drug could still have had a long-term impact on his mental health, with some symptoms resembling that of post-traumatic stress disorder and mild traumatic brain injury, according to Dr. Remington Nevin, a former Army physician who has studied the effects of the drug.
Nevin notes that Roche, the manufacturer of the drug, recently filed an updated product documentation, which acknowledges the drug "may cause long-lasting serious mental-health problems," and that adverse reactions may occur and persist up to several months after the drug is discontinued.
Browne said Bales took the drug during all three of his tours in Iraq, including the last stint that ended in 2010.
While in the Army, Nevin studied the use of mefloquine by military personnel. He said many service members took mefloquine in 2003-2004, the time period of Bale's first deployment in Iraq. But its use by the Army was phased out during the Iraq war, and it would be "highly unlikely" that Bales would have taken it during his final two tours there.
In Afghanistan, where malaria risks are much higher, mefloquine has continued to be used by some military personnel, according to Nevin.
An Army memorandum suggested that soldiers with brain injuries should not receive the drug. And if they did, Army rules called for it to be documented in medical records. Nevin said that often did not happen.
At Camp Belambay, the small outpost where Bales served, all kinds of rules were broken by the mix of Special Forces and infantry soldiers, according to testimony during earlier court-martial hearings. Soldiers, including Bales, took illegal steroids and shared Jack Daniels cocktails, although alcohol was prohibited, according to the testimony.
Bales twice left the outpost to carry out massacres at two villages. In between the killings, he awoke another soldier and asked him to "smell his gun," before finally returning to the camp wearing a blue cape and bloodstained clothes.
The FDA notification from an unnamed pharmacist appears to refer to these crimes because it cites the initial number of victims reported by the Army. The document was released to Nevin and The Military Times under the federal Freedom of Information Act. It does not detail whether such records exist for the unnamed patient involved in the homicides.
The adverse event notifications are supposed to assist the FDA in its safety surveillance of drugs. But the filing of such reports does not imply that there is a link between an adverse event and a drug, and they often lack enough information for the FDA to figure out if there is any link.
This report was first sent to Roche, the drug's manufacturer, on March 29, 2012, a few weeks after Bales was charged with the crimes. Roche then forwarded it to the FDA as required by federal law.
A Roche spokesman told The Times that many of the details about the patient's use of mefloquine, such as the dose, frequency and form, were not included in the report.
"We took a look at it, and we decided we needed to submit it," said Chris Vancheri, a spokesman for Genentech, which is part of the Roche Group.
In Afghanistan, the mefloquine pills were often referred to as "greenies," and in years past were sometimes distributed in blister packs that did not contain any of the manufacturer's warnings, according to a Special Forces soldier who took them while on two tours of duty in Afghanistan.
"There was no screening," said the soldier, who requested anonymity because he is still on active duty.
The soldier said that some soldiers actually took a liking to mefloquine because it gave them vivid dreams.
While Nevin was in the Army, his research found that about one in seven military personnel received mefloquine despite mental-health diagnoses that should have put the drug off-limits.
In 2009, concerns about mefloquine prompted the Defense Department to make mefloquine a third choice for anti-malarial protection among U.S. troops, behind two other drugs.
Then in a Jan. 17, 2012 memorandum, the assistant secretary of defense noted that some military personnel received mefloquine "without appropriate documentation in their medical records and without proper screening."
The memorandum requested that all services -- within 90 days -- ensure that military personnel are "appropriately screened and informed" when taking mefloquine, and that their prescriptions are recorded in their medical records.
By the time the review was completed, Bales had been charged with the murders of Afghan civilians.