Anti-malaria drug Lariam to be banned – except in very restricted cases

– Use of anti-malaria drug Lariam to end – except in very restricted cases
– MoD has a duty of care in relation to the provision of drugs for service personnel abroad
– MoD has failed to strike the right balance between protecting personnel from malaria and the potentially catastrophic side effects of Lariam

The House of Commons Defence Committee has today recommended the end of the use of Lariam for our armed services, except in very restricted circumstances.
Its report – An acceptable risk? The use of Lariam for military personnel – has been published today (Tuesday 24 May 2016) and includes a range of wide-reaching recommendations. ​

Hilary Meredith Solicitors has already been contacted by 470 former service personnel who were prescribed the drug and suffered from a range of mental health issues and psychological side-effects, including hallucinations, severe depression, sleep deprivation and anxiety.

Philippa Tuckman, military negligence specialist and partner at Hilary Meredith Solicitors Ltd provided evidence to the Inquiry. She acts for injured service men and women, including those whose lives have been affected by Lariam. She said:

“While I would have preferred a total ban, this is a welcome and much needed recommendation.

“The Committee has also confirmed that the MoD has a duty of care in relation to the provision of drugs for service personnel abroad.

“I have long campaigned for the MoD to recognise that the casual way in which it has administered Lariam to service personnel over many years constitutes yet another breach of its legal duty of care towards our military personnel.

“Service personnel have a tendency to be so dedicated that they think only of the duty they owe; it doesn’t occur to them that it should go both ways. Sadly, the MoD will sometimes take advantage of that to get away with providing dramatically substandard care. That is not deliberate, but the catastrophic effect on the lives of our soldiers, sailors and airmen and women is the same as if it were.

“I see this again and again, unfortunately not by any means only in relation to Lariam but in much of my work representing military personnel who have been injured during their service.”

Philippa added:
“This Committee has shown itself willing to make the MoD accountable to us all for the way it cares for our military men and women, and to stop it hiding behind its perceived special status to avoid scrutiny.

“I am pleased to have been able to bring the Committee’s attention to the MoD’s legal duty of care towards our military personnel, through my written evidence.

“Following the deaths of many service men and women in training, including those in 2013 of three army reservists on Brecon Beacons, the Defence Committee recently recommended an end to the MoD’s exemption from prosecution for corporate manslaughter and accepted many of my suggestions in relation to accountability and openness. This report continues that good work.”

Hilary Meredith, CEO at Hilary Meredith Solicitors, recently successfully campaigned for a recommendation that the MoD should lose its immunity from prosecution when there is a blatant disregard for life in training exercises.

She commented:
“This report shows that the MoD has failed in its responsibilities to the men and woman of our armed forces.

“It is not good enough to hand out ‘a one fits all’ pill in the hope this will solve the threat of malaria. It demonstrates a lack of care, understanding and proper risk assessments of the actual problem and a weighing up of risk over ill health.

“There was often no informed consent and no evaluation of an individual’s health. I am reminded of the rushed, mass inoculation program in Gulf War 1 with no understanding of the consequences involved.”

Former Army Commando and Diver, Grant Evatt is now a Director at Hilary Meredith Solicitors.

He said:

“Like thousands of other troops, I took anti-malarial drugs – we were totally unaware its prescription wasn’t controlled and we had no idea of the potential side effects.”

Other recommendations in Defence Committee report include:

– Protection from malaria; a sense of proportion

The report acknowledges that of course the MoD has a duty to protect service men and women from malaria.

Philippa Tuckman, military negligence expert and partner at Hilary Meredith Solicitors:

“This should be obvious. The reason it has to be reiterated by the Committee is because in almost every response to questions about Lariam that I have seen, as well as its evidence to the Inquiry to, the MoD has stressed the danger from malaria and implied, wrongly, that there is a straight choice between taking Lariam and being infected with this potentially deadly disease.

“This is an Aunt Sally. No one is realistically suggesting, or has ever suggested, that the alternative to Lariam is to take fewer precautions.

“There are equally effective drugs that deal with the same variants of the parasite as Lariam. What’s more, the MoD’s own anti-malarial guidance stresses that drugs are themselves only part of the battery of preventative procedures that a responsible soldier needs to use. Covering up, with clothing and strong insect repellent, is as important. The drugs, whatever is used, are to deal with the mosquitos that get through those two lines of defence. And where there is infection, treatments for malaria, if it is caught early, have improved enormously.”

– The risks from alternatives have been overstated
The Committee states that alternative drugs are never without risk and their use needs to be balanced against the dangers of malaria.

Philippa Tuckman, military negligence expert and partner at Hilary Meredith Solicitors:

“Again, this is obvious, but had to be said because of an attempt at evasion on the part of the MoD. It is of course true that all drugs have side effects and carry risks. Doxycycline, the main and most effective alternative to Lariam, is known to be associated with gastric upsets and can be unpopular with holidaymakers because it can make you more sensitive to sun. Certainly, it is a strong drug and should not be taken lightly. But this is true of any anti-malarial drug, because there is no vaccine. The only way for the body to ward off an infection is to flood the bloodstream with drugs that will kill the parasite as soon as it lands. The word for the technique – chemoprophylaxis – makes it clear that this is not a pleasant process.

“What is different about Lariam is that there is a very long history, rightly accepted by mainstream medical opinion for nearly twenty years, of a very strong association with extremely serious neuropsychiatric complications including suicidal impulses, depression, seizures, extreme aggression and personality change.

“This association is so extraordinarily strong that the Medicines and Healthcare Regulatory Authority (MHRA), as long ago as 1996, took the extremely rare step of saying that any doctor who is going to prescribe Lariam needs to make sure not only that the patient is completely aware of the possibility of psychiatric and other problems, but also – and in my experience, at least, this is unique – that they know they must get to a doctor, before the next dose, if they experience any of these problems. I have yet to speak to a doctor who has seen this warning for another drug.”

Philippa continued:
“Above all, the MHRA made it crystal clear that absolutely no one with any history whatever of neuropsychiatric disorders – and that would include problems that are common in the military, such as PTSD and anger management or alcohol issues – should be given the drug. That doesn’t mean just people with a strong history that is in their medical notes. It includes those who may have been having problems that they haven’t yet brought to their doctor. It follows that before Lariam is handed out to anyone, they should at the very least be asked if they have any of these problems and encouraged to come forward if they have. To do anything else is grossly irresponsible.

“It is negligent to administer Lariam without following the MHRA’s guidance. I have personally heard so many service personnel tell me that they were not asked about their history, that they were not told about the potentially catastrophic side effects of the drug.”

– The MoD has failed to strike a balance

The Committee concludes that the MoD has failed to find the right balance between protecting personnel from malaria and the catastrophic side effects of Lariam.
Philippa Tuckman, military negligence expert and partner at Hilary Meredith Solicitors:

“Finding a balance between protecting personnel from malaria on the one hand and from the catastrophic side effects of Lariam on the other appears to have put a strain on the MoD, which commonly deals with the deployment of hundreds of personnel at a time to malarial areas. But the MoD itself has admitted that it ought to be possible for it to do it, and the Committee has concluded that it has often failed. I am sorry to say that I agree strongly with that conclusion.”