Tink?

Not sure if this has been posted yet:

"As tragic as it is, you're going to have a lot of people living in much nicer homes as a result of this." - Shawn Steele, Republican Committeeman from California


@25:00

http://www.kcrw.com/news/programs/lr/lr ... mbed-audio

Inflation must have hit since 1984. $500 was "plenty" for an Indian injured by history's worst industrial accident, the leaks from the Sevin plant in Bhopal, India, owned by Union Carbide India and Union Carbide.

This is the abandoned Union Carbide plant on March 13, 2012:


We apply a vicious double standard: the lives of people in poor countries are worth far less than are the lives of Americans, whether we kill them by guns or by gas.

We apply the same standard here. In a wrongful death action, the compensable economic loss is measured by the net present value of what the decedent would have earned in the course of a lifetime. In short, the life of a CEO is worth considerably more than the life of a homeless person.

The life of an elderly terminally ill person is also worth very little if anything.

When you put it as terminally ill, you kinda stack the deck there skippy.

We are all terminally ill actually.

Some of us more so than others...Yep, gotta date sometime. Don't know when, but I do know it will happen NADT....

Possible defense: "Mefloquine made me crazy"
"Was Robert Bales given anti-malaria drug known to cause psychotic episodes?
A senior Pentagon official ordered an emergency review of the military's use of an anti-malaria drug known to have severe psychiatric side effects - nine days after the Afghan massacre in which a U.S. solider allegedly shot dead 17 civilians including nine children, it has been alleged.
The notorious drug Mefloquine, also known as Lariam, has been implicated in a number of suicides and homicides in the military spanning back more than ten years, with side effects including paranoia, hallucinations and psychotic behaviour.
It is now being suggested that Staff Sgt Robert Bales, who is accused of the shooting, may have taken the drug before the March 11 massacre"

I think "brain injury+Mefloquine made me shoot children in the head" is a tough sell, but I don't see what else his defense team has.

The wife said she didn't know he'd had a brain injury. Huh?

This is especially undercut by the fact that apparently, Bales went on two murder runs, several hours apart.

I don't see how he gets around the obvious premeditation. This is one of the few military cases where a capital verdict appears entirely possible.

Not a big surprise. In my experience, it's not at all uncommon for soldiers to "decline to volunteer details" of downrange events to family members. If the TBI was relatively mild, he probably wasn't evaced. Only way she would find out is if he tells her.

My wife pulled something similar on me. She was sweating a pre-deployment cognitive screening more than I would have expected. I finally got her to admit that she had "maybe kinda got my bell rung just a little bit" "I don't know, maybe once or twice" on convoys during her first deployment. I got the admission from her 6 years after the incident.

When I raised this possibility on March 16, I did not say much about the side effects of Lariam (mefloquine). The incidence of psychiatric side effects may be as high as 25%, but most of those incidents occur on the single night of the week when the patient takes the medication before going to bed. The most common side effect is vivid nightmares of violence.

However, in some much smaller set of patients, the side effects are not transient; indeed, they may last for months after the last dose is taken (5 weeks after coming out of the malaria zone). Chemically-induced paranoia is one such side effect.

A law suit against the manufacturer is impossible. The drug was hurriedly developed by Walter Reed Army Medical Center for use in Vietnam, where the anti-malarial drugs of the day had met their match in resistant strains. Hoffman-LaRoche simply agreed to manufacture it for the government, with the right to market it for use by individual patients.

There was never a clinical trial of Lariam before it was put on the market. All evidence of the drug's serious side effects have come after the fact either from patient encounters with physicians or from one of the few controlled trials of the drug in healthy patients not at risk of malaria. The main such study, conducted in Britain, was stopped very early because the side effects were frequent and were sustained over long periods. It was unethical to complete the study.

For a time the drug continued to be prescribed in the U.S., with the physician handing the patient a black label warning. I was under the impression that it is no longer prescribed in the U.S. Malarone or doxycycline are prescribed when the patient is traveling to areas where multi-resistant strains of the parasite are common. Since the late 1980s I have been prescribed only doxycycline, and I have never been infected. Photosensitivity might be a serious problem for soldiers.

Seeing what has been suspected at Fort Bragg and other bases, and what I know from personal experience, I think it is quite possible that Sgt. Bales was suffering from the effects of Lariam, with or without TBI. The military has been remarkably reluctant to discuss its experience with Lariam. However, it has been known for a while that the practice was to administer a dose to an entire unit on the same night.

At one time it was common to send patients to malaria areas with a side prescription of Fansidar to be taken if there were a fever. This was discontinued when it was discovered that the combination of Lariam and Fansidar has a most unusual side effect: it could be lethal. This was discovered at a time when I was rather out of touch in Central Africa with my supply of Lariam and Fansidar. My physician in Manhattan was most pleased that I returned.

Interesting 10 min video on Bales, Mefloquine, and the massacre. (I can't embed vid, please do so if you can)

I'd hate to be the diplomat who has to explain to the Afghans, "Look, we're awfully sorry he killed your kids, but we can't really blame him. It was all on account of a drug we gave him, and psychotic violence is simply one of the known side-effects."

...and put the weed down “You walk into a whole squad of ANA [Afghan National Army] smoking hashish. They don’t understand that the use of drugs, it effects the way that they accomplish their mission,” says one disgusted marine."

You would also have to explain to the soldiers why you chose to require the taking of Lariam rather than one of the other anti-malarials that are also effective against quinine-resistant strains of malaria. You would have to confront and deal with the lasting damage that has been done to a number of soldiers, some of whom are damaged beyond repair and some of whom are dead by suicide. You would have to admit that you required the use of an extremely dangerous drug primarily because it was easy for a medic to administer once a week (the video shows injections, but AFAIK Lariam is still taken as a pill).

You would have an even harder question to answer: why did you not attack the mosquitoes instead of or in addition to the parasites? We wiped out malaria in the Deep South by the use of DDT plus encouraging changes in behavior: do not allow water to stand stagnant; in particular, stop such things as putting rows of whitewall tires along your driveway, in which an ideal environment for the Anopheles is found at the base of every tire. The enormous debate now is whether DDT ought to be used to try to wipe out Anopheles.

Malaria infects more than half a billion people worldwide. It kills 1-3 million people every year, a high proportion of them children. It lowers the quality of life and the length of life, and it has an economic cost in lost productivity in Africa that is thought to be greater than the economic cost of African civil wars. It can be treated, but the parasite hides well. It has re-emerged in treated patients many years after it had been thought to be cured. Because of the rapid mutability of the parasite, it is difficult or impossible to develop a vaccine, although billions of dollars have been spent on the effort.

DDT accumulates in human tissue and is toxic, but what brought it to the attention of the world was the first ardently environmentalist book: Silent Spring. Because of fragile eggshells, our springs would lack the return of song birds and of majestic birds such as the American Bald Eagle. Fish would be damaged or killed, as would helpful insects, including the bees that are essential to the pollination of most fruit and some other crops worldwide.

The most frustrating thing to many of the soldiers affected by Lariam has been the lack of transparency in the military. Questions about Lariam go unanswered for years. VA hospitals often tell patients who think Lariam has affected them to go away. It presents all the problems of PTSD but squared, because the effects of the drug can be acute as well as lasting a lifetime.

For the military to admit the possibility that Sgt. Bales was disabled by taking Lariam is essentially impossible. Doing so would open the floodgates to people who believe that Lariam has also harmed them. All of the lobbying, protests, law suits, and legislation that Agent Orange required would be seen again. Soldiers would start demanding services that are now denied to them, although it is not clear that anything can be done to reverse the worst of the damage.

Back on PJ I wrote a screed about Lariam and what it was doing to our soldiers, focusing on the Fort Bragg murders and suicides. I mentioned cases in which soldiers and ex-soldiers had been killed falling off a structure, probably because they were no more able to control their bodies than are drunks. I suspect that some of the homelessness and substance abuse that we have seen in veterans of our recent wars could be traced to lasting effects of taking Lariam.

So now there is an emergency investigation about Lariam. It has been an emergency for decades. Perhaps now somebody will open up and tell the truth. The basic truth has been that the military has fully accepted the risk of soldiers dying and being disabled because of the drug in preference to the risk of having soldiers off the field and out of service because of malaria. The forces had to be kept strong and effective. If one or two soldiers in a unit were damaged beyond repair, that was acceptable.

The Lariam issues are complex, and there seem to be some misconceptions.

First, antimalarials are not assigned by unit; they're prescribed to the individual soldier. Different soldiers in the same unit may be taking different medications. The current policy is - and has been for several years - to prescribe doxycycline when possible. Doxycycline is contraindicated if there's tetracycline sensitivity, and there are some people who have side effect issues. Lariam is the second choice, unless there are contraindications present. Malarone is used in those cases.

Even before the recent push to move away from Lariam, less than half of the soldiers who went to areas with endemic malaria were prescribed Lariam. Over the past four years, the army has cut purchases by 75%. Prescription rates have fallen at least that far.

Second, the "emergency investigation" referred to in the Daily Mail article that editorkorir linked really isn't one. The order was not to investigate the effects of the drug, or to discontinue usage completely. The order was basically for military physicians to review everyone's charts and ensure that anyone who is currently on Lariam has been prescribed the drug appropriately. If you are going to do that sort of review, you want all the reviews done in a short period of time. You want to avoid having people fall through the cracks because they transferred out of Unit A before Unit A did their review, but arrived at Unit B after Unit B did the review.

The review identified, I'm sure, cases where people with known contradictions to Lariam use had been inappropriately prescribed that medication. Hopefully the review caught all cases. Probably it did not. That's not necessarily because there was a lack of effort. In both instances - inappropriate prescription and failure to identify contraindications - it's not necessary to assume a lack of care or diligence on the part of the Army as a whole or Army Medical Command in particular. It's the almost inevitable effect of having thousands of different doctors treating hundreds of thousands of individuals. Mistakes happen. Some of those mistakes are going to be the result of doctors who have not kept up with their reading, and have not paid attention to the directives. Some will be the result of carelessness - a doctor has a patient with doxycycline contraindications, fails to notice the concussion that was documented a couple of years earlier. A specialist might not have fully charted an issue, and the PCM might not be fully aware of everything before prescribing the drug. Some soldiers deny or conceal conditions for a variety of reasons. Army Medicine isn't a single monolithic agency. It's effectively one of the largest health care systems in the country. It's going to have all the issues with care that come along with that, plus the issues unique to the military.

The issue involving the psychotic side effects is also difficult. The side effects in question really are very similar to combat stress reactions. How do you distinguish the two? In the Ft. Bragg homicides, not all of the murderers had been on Lariam - IIRC, it was around 50%. All had deployed. Lariam was probably not the reason for the overall level of violence seen at that base. Was it responsible for any of it? Maybe, but when combat stress can cause the same symptoms, and the person involved was both in combat and on the drug, how do you tell for sure?

I'm not trying to minimize the issues with Lariam, or act as an apologist for the army. I'm more concerned with not letting one set of issues distract from or conceal other issues, particularly when the other issues may be less flamboyant but more prevalent.

Is the problem with inappropriate prescription of Lariam the result of the army being focused on the fitness of the force instead of the health of the individual soldier? Maybe. Or maybe it's the result of inadequate oversight of battalion physicians, many of whom are relatively junior and some of whom are not board certified. (It's not uncommon for a doctor to spend a couple of years after internship but before completing residency in a General Medical Officer slot.) Or maybe some clinic commanders are not actively ensuring that their doctors are fully educated on antimalarials. Or maybe the workload on the doctors doing pre-deployment screenings is too high and leading to fatigue and increased error rates. Or maybe none of the above, some of the above, or all of the above.

I'm also concerned that focusing on Lariam as the likely culprit in murders and suicides distracts from the overall fucked-up nature of war. Yes, Lariam might be the cause. And it's a particularly seductive cause for those directly involved, because mental illness is still stigmatized, especially in the military and especially among the combat arms troops, and if your medicine did it to you, then you're not really crazy. And it's the Army's fault for making you take the drug, not your fault for not being able to handle combat. It's probably going to be the actual cause some of the time. But how much is Lariam, and how much is war?

Do we know for sure that Robert Bales had been taking Lariam? I don't remember seeing that anywhere. During the American War in Viet Nam, there were bottles of anti-malaria tablets on every table in the US mess halls. That was in the days before Lariam was approved. I don't remember what it was, but I think it was a quinine compound.

We do not know that Bales has been taking Lariam. If he was, he probably shouldn't have been.

Meh, someone on Bales' defence team needs to research whether there is a stand your ground law in Afghanistan. Then he can claim the victims looke suspicious.

Very interesting info and consistent with others' statements about the use of Lariam.

However, in the Democracy Now video linked above, soldiers are saying that the prescription policy is not followed in the field. It is much more convenient to administer Lariam once a week than another anti-malarial once a day. So units in the field are said often to be administered Lariam when it is not prescribed for them. It is also said that Lariam is administered when a unit is posted in a remote location, as was Sgt. Bales' unit.

The video also points to an awareness among soldiers that Lariam is dangerous, citing soldiers who throw the pills over their shoulders.



Alcohol may be a sufficient explanation for Sgt. Bales' murderous rampage, or no chemical may be involved at all. My first suspicion was that he was taking revenge for the killing and wounding of American soldiers by Afghan civilians.