On 17 October 2002, David Stuart MacLean woke up on a train platform in India with no idea who he was. “There, there,” a man dressed like a police officer said. “I have seen this many times before. You foreigners come to my country and do your drugs . . . It will be all right, my friend.”
David followed the man to a safe house for troubled foreigners, run by a Chinese woman whose son had overdosed in Singapore. “You have no idea what you do to your mother when you put these drugs into your body,” she said, crying as she told her story. David cried, too.
Later, he was taken to a neuropsychiatry centre in Hyderabad where a doctor administered antipsychotic drugs to stop the hallucinations that were keeping him awake at night. He managed to remember his parents’ phone number. “I’m so sorry,” he wept down the line. “I’ve been a terrible person. An awful son.” An Indian friend rounded up every American he knew in the city and brought them to the hospital. They arrived with newspapers and cigarettes, which David began to chain-smoke, despite never having touched a cigarette in his life.
As far as he knew, he was a junkie who had got himself into trouble. “I assembled a working self out of the behaviour of others,” he recalls in his memoir The Answer to the Riddle Is Me. In reality, he was a bright American student on a Fulbright scholarship suffering from amnesia, insomnia and convulsions. The only drug he had been taking was the antimalarial Lariam.
Lariam was developed by the US army with the Swiss pharmaceutical company F Hoffman-La Roche in the 1970s. It was approved by the US Food and Drug Administration in 1989. When a randomised double-blind study was conducted in 2001 – a study that should have been completed years earlier – researchers found 67 per cent of patients suffered at least one adverse affect; 6 per cent required medical treatment. If this data had been available, the drug may not have been approved.
Between 2002 and 2004 the journalists Mark Benjamin and Dan Olmsted filed more than 40 reports on US soldiers who had returned from malarial countries such as Rwanda, Liberia and Afghanistan and killed themselves. Sometimes they killed their wives and children, too. The murder of 16 Afghan civilians by Staff Sergeant Robert Bales in 2012 has been linked to Lariam. For those with susceptible brain chemistry (or who have suffered brain injuries, as in the case of Bales), the drug can pool in the brain, inflicting irreversible damage.
When David returned to Ohio, he was confronted by photographs of a stranger bearing his name. He met a woman named Anne, who told him they had been in love. He couldn’t picture the two of them together and ended the relationship. Over time, most of David’s memories returned but he still lives with the threat of relapse, unable to prove that Lariam caused his condition.
The US military stopped the procedural use of Lariam in 2009. Roche has ceased marketing it in the US (though it is still available to British soldiers and on the NHS). An army epidemiologist told the US Senate that it was the Agent Orange of our generation. In 1994, a Roche safety report noted that Lariam could cause depression, which may involve suicidal ideation in a few cases. That it could lead to suicide was harder to prove. The cause was more likely “the progressive breakdown of traditional values”, the company wrote. It had nothing to do with its drug.