Officials Say Malarial Marines Didn't Take Medication Properly

The 53 marines sickened by malaria after 12 days in Liberia in August caught the disease because they did not take their pills properly, Navy officials said on Thursday at a conference on tropical diseases.

Although many of the marines swore to Navy doctors that they had religiously taken their weekly mefloquine pills, blood levels showed that they had not, a Navy spokesman said. The three sickest marines, who nearly died of brain and lung complications, had almost undetectable levels.

more............

http://www.nytimes.com/2003/12/05/national/05MALA.html

they need to require them to develop a new medication for the prevention of malaria, one without all the nasty side effects.

Were the Marines lying?

If the marines aren't taking a required medication there must be a reason - maybe there are undesirable side effects or maybe they weren't instructed properly - did they know they were at risk for malaria - etc. Alternatively maybe there is a problem with the medication - either not being absorbed properly or the pills weren't manufactured properly - have all of these posssibilities been eliminated? Before I would blame the marines, I would make sure all of the other bases were covered. Problems with malarial prophylactics are notorious - it is too easy to just blame the patient.

I spent 3 years in the Marines, and a year in a malarial zone (Vietnam). I know how easy it is to forget a weekly chore like this, especially when you have other, more important things to think about on a daily basis. Like staying alive. It didn't appear to me from this article that the Marines were blaming the individuals; rather they were looking for root causes so as to prevent an outbreak like this happening again. And the soluition is simple. Hand the pills out at morning formation; everybody takes it at that time, nobody puts the pill in thier pocket. It sounds like some units were already doing that.


Since you didn't bother to read the article closely, I'll post a couple of quotes:

Tests on the mefloquine pills in the marines' pockets — a generic version of a drug better-known by its prescription name, Lariam — showed that they were "within specs" for potency, Commander Whitman added. It was initially suspected that the pills might have been weak or expired.

Sounds to me like "blaming the patient" wasn't their first response.


In an anonymous survey of the men, in which they were asked whether they avoided their mefloquine pills because of side effects like stomach pains and nightmares, "overwhelmingly, the reason was `I forgot,' " Commander Whitman said.

They first lied either out of confusion or for fear of getting in trouble, he said. Only one sergeant said his unit had someone watch each man take his weekly pill.



The reality was that it just fell by the wayside," said Lt. Cmdr. Tim Whitman, an infectious-disease specialist at the National Naval Medical Center in Bethesda, Md., who spoke to the annual conference of the American Society of Tropical Medicine and Hygiene. "These men had been in Iraq and Djibouti; if they'd gotten away with not taking their mefloquine there, they assumed they'd get away with not taking it here."


Dr. Gregory J. Martin, a Navy captain who led the military team that cared for the marines at Bethesda, said the lesson of the episode "went like a shot" to the top levels of the Department of Defense.

But Commander Whitman seemed slightly more cynical.

"The hard lessons are learned over and over and over again, in Somalia and Vietnam and World War II," he said, adding jokingly, "This will go to the top of the list after fuel and bullets and everything else."

There, the problem was that the troops didn't have sufficient notice for the drug to take effect:

"At least 16 paratroopers and RAF personnel who went to the war-torn African country appear to have contracted malaria.

Ministry of Defence guidelines recommend people travelling to high risk malaria areas start taking anti-malarial drugs up to three weeks before departure.

But an MoD spokesman said the troops sent to Sierra Leone were only given two days' notice."


The NY Times article doesn't make it clear how much notice the marines had. Anyone know?

...but I do remember the bush administration dithering over whether or not they were going to do this. Given my experience, I'm sure the Marines aboard ship headed in that direction assumed they were going in from the beginning, and began preparations for that. It was more than 2 days, but it may have been less than 2 weeks.

But it doesn't matter how much time beforehand you have, if you forget to take the pill, it doesn't do you any good.