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Lost to Lariam?

A local man's son took his own life in Afghanistan. Was he driven to it by an army-issue antimalarial drug?



John Torres's last day alive was a lot like all the other days he'd spent in the past eight months, serving on the Bagram air base in Afghanistan. The 25-year-old army reservist, who worked an administrative job as a "load planner," organizing supply movements, bought some DVDs, made and then canceled plans to get a massage, played video soccer with a buddy—Argentina versus Mexico—and talked about celebrating his friend's birthday the next day with dinner.

John normally worked nights, but the evening of July 11, 2004, was clear because he was scheduled for guard duty in the morning. He borrowed an alarm clock, but he couldn't sleep. Friends say he spent the night playing video games, listening to music, and watching the movie 21 Grams. At some point between 4:15 and 6 AM, a sergeant saw him double-timing it to the latrine with his head down. He was carrying his M-16, a towel, and a water bottle, and the sergeant thought he looked uncharacteristically disheveled, his pants dragging in the dirt. "I have damn Haji guard," John told the sergeant, who wondered why he was up so early. He was referring to the duty of overseeing the local Afghans who came onto the base to do day labor.

It was about 7 AM when John's body was found slumped in a latrine stall, with a massive gunshot wound to the head. With the body were two family photos and a note to his family scrawled on a scrap of paper.

"I'm sorry that I had to do this," it said. "I have been in so much pain in the past year that I can't take it any more. The stomach and chest pains have been getting worse and no doctor has been able to help me. The doctors here refuse to help me. Please know that I'll finally be at peace & with no more pain."

John mourned the life he might have had with his girlfriend, Liz (his family asked that her last name not be used). "I always pictured her being my wife and mother to my kids," read the note. It asked his mother to make sure Liz finished college.

It would be a year before his mother, or anyone else in the family, saw the note.

The autopsy turned up nothing physically wrong with John—no sign of gastrointestinal disease, no illicit drugs in his system. But then, the base doctors had always said the pain must have been caused by stress.

The call from his daughter, Veronica Santiago, an architect in Houston, found Juan Torres at the wheel of his car on I-94 in Chicago. "My brother's dead," she told him. Juan swerved onto the shoulder and stopped. He couldn't believe it. He thought she had to be joking. Or the army had made a mistake. John had just three weeks left in his military commitment. He was coming home for good and had already been making plans. Just two months earlier, home on leave in Houston, he'd gone house hunting with Liz. He'd also been shopping for an engagement ring.

John Torres had saved a lot of money from his civilian job as an accountant with an oil company. His dad knew how excited he was about going back to work there, and he knew John was arranging a trip to Argentina for the two of them and Liz around Christmas. But first they'd hit Las Vegas and try to win extra spending money at the blackjack tables.

In 1980, when Juan Torres was 18 and John's mother, Susana Ferro, was 16, they came to the U.S. from the Argentine city of Cordoba. Already parents, they were searching for "wonderful opportunities, the American dream," Juan tells me with a touch of sad irony. They settled in Houston, and that's where Veronica and John grew up. Torres remembers his son as so goal-oriented that he'd sometimes have to tell him to relax.

Unhappy with the pace of his public school education, John stopped attending school his junior year and instead used homeschooling materials on his own. He finished his junior- and senior-year schoolwork in one shot and earned his diploma a year early. Yet as ambitious as John was, his father remembers him as humble and generous. "He would never say anything bad to anyone, he was never mad, he would never gossip, he respected women, he was always smiling, always helping people, he would donate money to poor people online," says Juan. "John was special."

In 1991, anticipating years of college tuition, Juan left his wife and children behind in Houston to find a better job—he knew he could make three times as much in his field, banquet service, in Chicago. He wound up a banquet captain at the Embassy Suites near O'Hare. He never returned to Houston, and eventually his marriage to Susana ended.

In 1996 John signed up with the army reserves for eight years. He was just 17 and his parents disapproved, but he told them all he'd be fighting was hurricanes. Within months he was in Kosovo. But John liked that experience, and he discovered that he enjoyed the short stretches of periodic training required of reservists. His father says he was proud to serve his adopted country.

Shortly before he was deployed to Afghanistan in 2003, John became a U.S. citizen. But in Afghanistan his enthusiasm quickly waned. He told his family and closest friends that he'd stopped believing in the U.S. mission there, and he worried that when his hitch was up the army wouldn't let him out. He feared they'd send him on to Iraq.

For months, says Juan, John's death was "under investigation." It wasn't until more than a year later that the army told the family John had killed himself and turned over his suicide note.

Suicide isn't uncommon among soldiers fighting a war or just home from one. The army in January reported its highest suicide rate since it began tracking that figure 28 years ago.

But John hadn't been in combat. What's more, when a friend of his had killed himself, John had denounced suicide as a "selfish" and "stupid" act. He'd complained to his family of the extreme stomach pain mentioned in the suicide note, but would he really kill himself over a stomachache?

The longer Juan brooded over his son's death, the more certain he became that he'd been murdered. John had frightened him with the open way he talked disapprovingly on the phone about the heroin use he said was rampant at Bagram. "I would tell him, 'Don't say that, someone could kill you or something,'" says Juan. "But he felt very strongly about it. He didn't want his friends using drugs and he would talk to people about it."

Then a soldier who'd been at Bagram with John told John's mother and sister that it was possible he'd been killed because he'd seen drug deals go down.

Juan made it his mission to find out the real story and expose what he felt was a cover-up by the army. He became a fixture at antiwar protests, carrying a poster with John's picture and the message, "The CID killed my son." The CID is the army's Criminal Investigation Department.

"They ignored me. My son died and they just sent his medal in the mail and totally ignored me, they don't respect the family at all," Torres remembers. "The military doesn't tell the truth. They don't care about the family. Once the soldier dies, that's it."

John's father became one of the most active members of the Chicago Committee Against the Militarization of Youth (CCAMY), a small band that opposes military recruitment in Chicago public schools, especially when it targets Latino and black youth. He traveled around the country at his own expense speaking at high schools, trying to convince kids not to enlist. Sometimes he'd talk to students at job fairs, with the recruiters in plain sight. "They didn't like that," he says. With help from CCAMY, Torres pressed Senator Richard Durbin and then-congressman Rahm Emanuel for further investigation into John's death. Both offices did ask for more information. But in March 2006 the U.S. inspector general sent Durbin a letter telling him the investigation of John's death "was handled properly and expeditiously."

John's mother and sister were just as adamant that John couldn't have killed himself. Both women made multiple calls to bases in Texas and Afghanistan asking for information about John's death and trying to track down belongings of his that they thought the army didn't want them to see. Veronica called other soldiers in John's unit and recorded the conversations.

At a war protest in 2005, Juan's CID poster caught the eye of Shaun McCanna, a Saint Louis-based documentary filmmaker. The two got to talking, and Juan's suspicions drew McCanna in. A few weeks later, McCanna and his filmmaking partner, Lee Ann Nelson, contacted the Torres family through a Web site Veronica had set up, and the family agreed to participate in a documentary. McCanna had one condition, and he made it clear: if he and Nelson came to the conclusion that John did take his own life, the family wouldn't try to stop the project.

In May 2006, McCanna and Juan visited Bagram, where, McCanna says, base officials wouldn't let him beyond a holding area near the main gate. (While he waited there, an Afghan youth kept asking him if he "needed anything." He says he later learned kids like this sold heroin to American soldiers.)

The officials offered Juan a short tour. He told them he just wanted to see where his son had lived and died, but they said neither his tent nor the latrine was where it had been.

"Even though it wasn't the same one, I went in the bathroom and prayed," says Torres. "I just wanted to pray in the area my son had died."

"After the tour he didn't have much to say for the rest of the trip," says McCanna.

That spring, when a handwriting expert who'd analyzed the suicide note for McCanna concluded John had probably written it, he decided not to mention it to the family. The news didn't really surprise the filmmaker, but neither did it clear anything up.

"If I do not succeed in taking my life, please do not keep me alive," John had written to his family. "I can't imagine being in more pain than I'm already in and still being alive." Was the pain in his stomach and chest all there was to it? Clearly John was frustrated by the base doctors—but he was days from coming home. Back in Houston he'd have had his pick of doctors.

But in the fall of 2006 McCanna got important new information. He and Susana had filed Freedom of Information Act requests for John's medical records. In response to the third request, she received—and forwarded to him unread—a partially redacted copy of a nine-page postmortem report by army psychiatrist Robert Ensley written in June 2005.

John Torres, Ensley wrote, "was a young man with no known psychiatric history whose chronic [physical] and anxiety symptoms apparently led him to commit suicide impulsively and with little forewarning."

John's peers and superiors had seen him "as bright, competent, sociable and 'more grounded' than most soldiers"—exactly why his family now found it so hard to believe he'd killed himself. But Ensley was certain he had. He wrote that the "allegations of rampant drug trafficking—with the theory that SPC Torres was murdered because he knew too much—were dramatic overembellishments."

In his report, Ensley worked his way through the medications John was known or believed to have been taking in Afghanistan. One of them was Lariam—a brand name for mefloquine hydrochloride, an antimalarial drug whose documented side effects range from violent dreams and hallucinations to lasting brain damage. It was developed in the 70s by the Walter Reed Army Institute of Research and licensed to the manufacturer, the Swiss drug company F. Hoffmann-La Roche, more commonly known as Roche, whose representatives did not respond to a request to be interviewed for this story. It was approved for use in the U.S. in 1989. By 1997 a national organization had been founded, Lariam Action USA, whose members or their loved ones claimed to have suffered lasting harm from taking the drug.

The milder side effects listed by Roche include diarrhea, abdominal pain, rashes, headaches, trembling, and vivid dreams; rarer but more serious neurological effects include "convulsions, agitation or restlessness, anxiety, depression, mood changes, panic attacks, forgetfulness, confusion, hallucinations, aggression, psychotic or paranoid reactions and encephalopathy." Prescription materials published by the company say: "Rare cases of suicidal ideation and suicide have been reported though no relationship to drug administration has been confirmed."

In 2002 United Press International reporters Mark Benjamin and Dan Olmsted published the first in a series of more than 40 investigative stories about Lariam. That initial investigation found, among other things, that over a decade Roche documents tracked "increasing reports of suicides, suicidal behavior and other mental problems among Lariam users"; that "a 1994 Roche safety report notes that because Lariam can cause depression and depression can lead to suicide, 'a causal link to Lariam can in theory not be ruled out'"; that "dozens of soldiers, Peace Corps volunteers, other government workers and private travelers . . . said they had no history of mental illness before taking Lariam, but then attempted or considered suicide"; and that a "statistical analysis of FDA data, commissioned by UPI, indicates that Lariam users are five times more likely to report having mental problems that could lead to suicide than those taking a different drug—the antibiotic doxycycline—also used to prevent malaria."

Ensley wrote that in early May 2004 John had told base doctors that gastrointestinal problems he'd been suffering from for the past six months were getting worse, subsiding only during his leave back in the States. The doctors couldn't pinpoint the problem, and one of them "personally walked" him to the base's combat stress control clinic. Doctors there asked if he'd had any thoughts of suicide. Told by John that he hadn't, they observed his insight and judgment to be sound and advised him to keep taking an antianxiety medication.

Lariam, wrote Ensley in his report, "is linked with a number of somatic- and neuropsychiatric side effects, such as gastrointestinal symptoms, sleep disturbances and psychiatric reactions (including depression, mood changes, anxiety, panic, agitation, confusion, paranoia, etc.). . . . SPC Torres' complaints apparently dated back to the beginning of his deployment, possibly coinciding with his treatment course of Larium, but in his medical visits, no link was made between this medication and his somatic [physical] symptoms."

The autopsy didn't list Lariam among the several prescription drugs found in John's system. But, Ensley noted, "routine toxicology did not screen for it."

If its presence in John's body were confirmed, Ensley asserted, "SPC Torres' case should be viewed in light of other suicides suspected to be associated with the drug."

"I was pretty much just shocked," says McCanna. "We were looking at his death being related to an illegal drug and it turns out the legal drug that was supposed to keep him safe led to his death. So we were suddenly trying to find out everything we could about Lariam."

More than a million people a year die from malaria, and up to 500 million contract it. In Africa and southeast Asia, Lariam is considered by far the most effective drug at preventing and treating the disease; strains in those regions have become resistant to chloroquine, another commonly prescribed drug. One particularly deadly strain is Plasmodium falciparum, which can kill its victims within hours. Lariam can prevent it or stop it once it's contracted. (At least it usually can; there have long been concerns about mefloquine-resistant P. falciparum malaria, particularly in Thailand and along its borders.)

The risk malaria poses to American troops is undisputed. During a 2003 marine deployment to Liberia, 80 of the 290 people who went ashore developed malaria. A task force studying the outbreak blamed it in part on inadequate compliance with mefloquine regimens.

Lariam needs to be taken just once a week. The alternatives must be taken once a day, including the antibiotic doxycycline. Doxycycline also can make people more susceptible to severe sunburn, a problem for deployed troops. But a study by the Walter Reed Army Institute of Research published in 2004 found that as many as 25 percent of the people taking mefloquine at prophylactic doses and 70 percent of those taking it at treatment doses experienced adverse neurological or psychiatric effects. If most were minor—dizziness, insomnia, nightmares—some were described as psychotic. The study said Lariam "crosses the blood-brain barrier and accumulates as much as 30-fold in the central nervous system."

In 2003, Senator Dianne Feinstein called for congressional hearings on the drug. In February of 2004 the army surgeon general, James Peake, told a House Armed Services subcommittee that the army had investigated and found no link found between Lariam and the suicides of soldiers.

"The key causes of the suicides were failed intimate relationships, legal and financial problems," Peake testified. He said only 4 of the 24 suicides of American soldiers in Iraq occurred in units taking Lariam.

Several months later the army issued a correction. The number wasn't 4. It was 11.

Criticism of the military's use of Lariam has continued to build since John Torres's death. According to a study published by army doctor Remington Nevin in the peer-reviewed Malaria Journal in March 2008, nearly 10 percent of 11,725 active duty military personnel who'd taken Lariam in Afghanistan in early 2007 did so despite contraindications raising their risk for serious adverse effects. The contraindications are mainly neurological—depression, anxiety, and epilepsy among them—but there are certain other drugs, including anticonvulsants, that Lariam should not be combined with. But Nevin tells me the army didn't screen for these contraindications. He says he was "floored" in Afghanistan to see so many soldiers in his unit taking antidepressants and antipsychotics and Lariam at the same time. "Not only was this unit misprescribed Lariam, this was being done with the tacit approval of the command," he says. "I shared concerns with folks at the Department of Defense and was very quickly told to be quiet."

Nevin thinks many troops suffered from such serious mental conditions that not only should they never have been prescribed Lariam—they should not have been deployed at all. "The consensus is Lariam truly is a neurotoxic drug," he says, adding that he took it himself in Afghanistan and experienced the vivid dreams commonly reported. "Lariam does quite literally kill brain cells, in a certain part of the brain that is involved in the interpretation of memory," he says. "Its side effects, and how that interacts with an underlying predisposition to illness, is unclear."

Given the stresses of war, he thinks the use of Lariam by soldiers with contraindications is particularly hazardous. "If it predisposes you to paranoia, anger, psychosis, is it appropriate to expose a company of people with automatic weapons?" he wonders. "When soldiers point a rifle somewhere or interact with civilians, there are strategic consequences to the everyday choices they make. Are we setting ourselves up for potentially predisposing them to bad judgment?"

Nevin calls Lariam "a great drug for the right people" in areas where P. falciparum malaria is rampant. But he believes soldiers with contraindications should not be deployed to those areas. He'd give tourists to those regions the same advice.

But the precautions Nevin champions wouldn't have mattered to John Torres. He'd never been diagnosed with a mental health problem and he was taking no drugs that contraindicated Lariam. He was as good a candidate for Lariam as any GI in Afghanistan.

When McCanna read Ensley's report he began asking army officials about Lariam. He and the family had been focused on the idea of a concealed murder; now he wanted to pursue the possible link between Lariam and John's suicide. But he says the army's response consisted mostly of silence and evasion.

"They did an excellent investigation," said McCanna. "They knew the cause of John's death. The problem was they weren't honest about what they found."

Last year Juan and Susana hired Louis Font, a former army officer and lawyer known for representing conscientious objectors. Font graduated in the top 5 percent of his class at West Point and served in Vietnam before becoming disillusioned with the war and demanding conscientious objector status. Early last year he filed a wrongful death suit against Roche in federal court. (They didn't bother suing the military: it's extraordinarily difficult for servicemen, or their families, to successfully sue the armed forces over anything that happened to them while serving.)

Last winter a federal judge rejected the drug company's challenges and ruled that the lawsuit could go forward. Soon after that, the army announced it would replace mefloquine with doxycycline as the drug of choice in areas where doxycycline could be used instead. This February the army's current surgeon general, Eric Schoomaker, called it risky for troops on other medications or suffering from conditions including depression, traumatic brain injury, and anxiety. Schoomaker allowed that in "rare cases" it could make troops suicidal.

"It had been reported that some soldiers with contraindications to mefloquine had received the medication," Colonel Scott Stanek of the Office of the Army Surgeon General tells me. "This policy change recognizes that concern." He says it mainly affects soldiers deployed to Afghanistan. Lariam was discontinued years ago in Iraq, where there is little malaria, and a spokesperson for the U.S. Army Medical Command told me in an e-mail that its use in that country at all is now considered an "incorrect medical intervention and initial policy."

When McCanna told John's family that he and Nelson now believed John did kill himself, and that Lariam was the reason, the family didn't know what to think. Susana remained skeptical for a long time. Veronica Santiago rejected his conclusion, according to McCanna, and the two stopped communicating. Juan accepted the idea; to him, John's death remained foul play, perpetrated by army regulations and procedures rather than by a fellow soldier.

If he gains a settlement from the lawsuit, Juan hopes to use the money to set up a foundation in his son's name to aid veterans with mental health problems. "Traveling around I have seen so many kids with problems, and they aren't getting any help," he said. "John was always trying to help people; he would want to do this."

He keeps his son's camouflage shirt folded crisply in a glass display case in the front room of his spotless Schiller Park house. The case also holds several photos of John, and there's a letter of condolence from Texas governor Rick Perry. Juan wears his son's ring, which is gold with a square black stone, and often kisses it for good luck. He still cries at night, and he often dreams of flying, which he takes to mean his son's spirit is with him. He says his ex-wife is suffering greatly. "When you talk to her it's like she is somewhere else," he says. He's considering moving back to Houston to be near her and Veronica.

"They say 'Your son died and that's that,'" he says. "They don't do anything for you. But the pain isn't just for one year, it's every day for the rest of your life. When I protest in Washington or outside Bush's house in Texas or here in Chicago, it gives me more strength—like we say in Spanish, coraje. I look at my son's picture and hope what we are doing will help someone else."

In 2007 the Armed Forces Institute of Pathology conducted what a spokesperson calls an informal study looking for links between Lariam and the suicides of servicemen. In the course of that study, pathologists tested tissue samples from John Torres's body for mefloquine and found it. But the spokesperson said no connection between the drug and any suicides could be confirmed.

Roche informed the Food and Drug Administration in June that it would no longer sell Lariam in the United States. The company claimed its decision had nothing to do with accusations that the drug is unsafe. Remington Nevin, for one, doesn't believe it. There are still three generic equivalents on the U.S. market.

McCanna's documentary, Drugs and Death at Bagram, has been submitted to film festivals. He says he's working on an international distributor for a TV release, planning the DVD, and arranging some one-off Chicago screenings in the coming months (check for updates). The movie talks about the heroin trade in Afghanistan, but its focus is on Lariam.

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