Navy SEAL sues drug company for all others given Lariam

Navy SEAL Sues Roche over Malaria Drug, Claiming it Left Him Permanently Disabled

Military.com
By Patricia Kime
12 Dec 2018

According to the Sheetses' lawyer, Kevin Boyle, the case is significant because it could "vindicate the fact that many veterans are suffering from a legitimate condition" and "ensure that those who are responsible for these serious injuries are held accountable."

Mosquito close-up. Getty Images 

A former Navy SEAL has filed a lawsuit against the company that makes the anti-malarial drug Lariam, or mefloquine, alleging that the medication left him permanently disabled after taking it while serving in Afghanistan.

Andrew Sheets and his wife, Kristie, of Cazadero, California, allege that pharmaceutical giant Hoffman-LaRoche, known as Roche, was aware that the drug caused serious neurological and psychiatric side effects and failed to warn patients of the dangers.

Sheets, who served in the U.S. Navy from 2000 to 2006, said he immediately experienced "violent and tragic nightmares" the first time he took Lariam, during a deployment in 2003. He later developed psoriasis, extreme paranoia, hallucinations, anxiety and suicidal thoughts.

"In February 2017, Mr. Sheets was finally described as permanently disabled by his treating physician because of his debilitating, Lariam-related mental disorders," court documents state.

For more than two decades, Lariam, also known by the generic name mefloquine, was distributed to troops to prevent malaria in endemic countries. At the peak of military use in 2003, nearly 50,000 prescriptions for mefloquine were written by military doctors.
read more here

Some meds became the ties that bind veterans to suffering

What have we done to our veterans?

Combat PTSD Wounded Times
Kathie Costos
October 20, 2018


In 2004, the US Department of Veterans Affairs issued a warning on Lariam following a warning from the FDA the year before. VA Dr. Jonathan Perlin wrote it "may rarely be associated with certain long-term chronic health problems that persist for weeks, months, and even years after the drug is stopped."

There were suspected links to suicides, including Spec. Adam Kuligowski, Afghanistan veteran from Fort Campbell 101st Airborne Division. His father said that the drug was found in his system.

It was suspected in the case of Staff Sgt. Robert Bales, convicted of killing 16 Afghans. He had PTSD and TBI. He was on his third tour when it happened. His case caused the military to stop using it in 2009.

Dr. Remington Nevin, epidemiologist and Army Major said "Melfoquine is a zombie drug. It's dangerous, and should have been killed off years ago. He added it was "toxic to the brain."

It is possible that this drug had something to do with crimes committed in Canada as well. The thing is, the veteran should have to pay for what he did, but should not be further punished with incarceration without psychological treatment.

This drug was given to many NATO forces. We should all be asking, "What have we done to our veterans?"

*******

Controversial anti-malaria drug an element in Mark Donlevy's actions, says defence lawyer

CBC
Dan Zakreski
October 19, 2018

Donlevy is also scheduled to stand trial later this fall on 11 other sexual assault charges related to when he worked as a massage therapist in the city.

The lawyer for a former Saskatoon massage therapist guilty of sexual assault said Friday that his client was given a controversial anti-malaria drug in 1992, and the effects haunt him still.

Mark Donlevy at Court of Queen's Bench. (CBC)

Alan McIntyre raised the point during sentencing arguments for Mark Donlevy, at the Court of Queen's Bench in Saskatoon.

Donlevy was found guilty in September of sexually assaulting a woman he met through an online dating site. McIntyre argued for a three-year sentence, while prosecutor Cory Bliss said three-and-a-half years is more appropriate.

McIntyre raised the issue of the impact of the anti-malaria drug, while providing Justice Heather MacMillan-Brown with personal details about Donlevy's life.

McIntyre said that Donlevy took the anti-malarial drug while he was in Somalia serving with the Canadian military, and that it has affected him since then.
read more here

Is Awareness Fueling Suicide Triggers?

Is Awareness Fueling Suicide Triggers?
Combat PTSD Wounded Times
Kathie Costos
June 11, 2018

Right now there are more people talking about suicides, and more people trying to prevent their own, at the same time more are doing it? Who does this make sense to? If it make sense to anyone at all, they need to seek professional help...fast!

A report on NBC about the rise in calls to crisis lines mention this part.

Draper said the reason for the uptick is two-fold: a celebrity suicide can trigger suicidal thoughts in people who might already vulnerable to them, and publicizing the phone number to call for support increases odds that people will call.

Is it good that people are calling for help, or is it bad that with so many looking for help, seeing the rise is suicides on the flip side is worse?

How many times have you seen a commercial with happy people as the announcer talks about the medical condition making their lives miserable, followed by warnings of how the medication being advertised could make them suicidal? How many times does it take for reporters and researchers to begin to link any of them to the rise in suicides across American?

How many times do you have to read reports on opioid abuse before researchers share their warnings with reporters working on suicides?

How many times does it take before reporters understand the effects of "Lariam, an anti-malarial drug" connected to suicides as well as murders?

How many times does it take for reports from the Department of Defense and the Department of Veterans Affairs to release the suicide numbers before reporters actually understand they are two totally different reports?

How many times does it take for the reporters in this country to correct the false narrative of awareness on anything when they have been oblivious for the last decade?

The awareness folks like to trim everything down to a soundbite, a slogan, a stunt, as long as they do not have to answer any questions. Reporters have been all too willing to oblige them. 

Are these "awareness" risers triggering veterans instead of helping them? I mean, what it looks like when you are on the other end of the topic, knowing they don't seem to offer hope while feeding despair, is they really don't care at all.

When someone offers understanding, like on the Crisis lines, then you believe you do matter and that gives you an understanding that you are not only worth helping, but had someone to help you.

So when does the public get the dire warnings of suicides the same way drug companies are required to do when selling their products?

How about selling...no, make that giving, hope back to those who have lost it? Isn't that what gets you up every morning with hope that it will be better than yesterday was?

Mefloquine raises ugly head again

Mefloquine or Medusa and where is Perseus?

Veterans allege devastating side effects from anti-malaria drug they were ordered to take
WHAS ABC 11 News
Author: Andrea McCarren
May 3, 2018

More than a million Americans are believed to have taken the anti-malaria drug called mefloquine. But veterans, former Peace Corps volunteers, government employees and world travelers say they've suffered acute side effects that are getting progressively worse.

For decades, the Department of Defense ordered tens of thousands of American service members to take a drug intended to prevent malaria, a mosquito-borne disease that can kill. And now, veterans, former Peace Corps volunteers, federal employees and world travelers believe mefloquine caused some acute psychiatric and physical conditions that they say are getting progressively worse.

Mefloquine was sold under the brand name Lariam until its manufacturer stopped producing the drug in 2008. Generic versions are still available in the United States, but only by prescription. Common side effects attributed to the drug include paranoia, anxiety, depression and neurological issues, including vertigo and tinnitus, which is the perception of noise or ringing in the ears.

"We have a hidden epidemic of veterans who are suffering the chronic neuropsychiatric effects of mefloquine poisoning," said Dr. Remington Nevin, widely considered the world's expert in the potential side effects of mefloquine. "And in many cases, they’re being misdiagnosed. Misdiagnosed with conditions such as post-traumatic stress disorder."
read more here


We have been reading about this since 2008. Why are we still reading about it now?
VA issued a warning about Lariam in 2004. By 2012 after Staff Sgt. Robert Bales shot 17 in Afghanistan, later found guilty, the military "scrambled" to limit it. By 2013, the Green Berets and other Special Forces units stopped using it.

BY 2015, reports were coming out from Australia and a veteran said, "At various times it was like living in a heavily armed lunatic asylum" after taking it. In 2017, Canada was also faced with problems. 

So why after all these years are we still talking about it and who is responsible for what it did to the men and women the military gave it to?

Mefloquine Residual in Veterans Back in News Out of Australia

This report is about Australia veterans but they are just as human as US veterans are and fighting for the truth.
Veterans say report on anti-malaria drug mefloquine downplays side-effects
The Guardian
Melissa Davey
June 2, 2017

Former soldiers say they were not properly informed of potential hazards, including neurological problems, suicidal thoughts and nightmares

“The main issue of concern is the chronic health effects experienced by the 5,000 personnel given mefloquine and tafenoquine since the early 1990s,” McCarthy said. “Drug regulators including the US Food and Drug Administration warn that mefloquine is able to cause neuropsychiatric side effects that may persist or become permanent.

An unpublished government report on an anti-malarial drug given to thousands of Australian soldiers has been criticised by a decorated war veteran for downplaying the drug’s side-effects.

Mefloquine, also known as Lariam, was given to soldiers deployed to Bougainville and Timor-Leste more than 15 years ago as part of clinical trials comparing its efficacy to doxycycline, an antibiotic and the first-line medication for malaria prevention in the Australian defence force.

Since then there have been well-documented questions raised about the consent process for the soldiers involved in the trials, and veterans have said they were not properly informed of mefloquine’s potential side-effects. Veterans have also spoken of symptoms including suicidal thoughts, hallucinations and nightmares which they attribute to being on the drug, sometimes emerging years later. They have accused researchers of downplaying the extent of severe side-effects such as neurological issues.
read more here

Other reports going back to 2008

VA ISSUED WARNING ON LARIAM IN 2004
ARMY CURBS PRESCRIPTIONS OF ANTI-MALARIA DRUG MEFLOQUINE
WHEN THE CURE IS WORSE THAN THE DISEASE MILITARY SCRAMBLE TO LIMIT MALARIA DRUG
In 2013 Green Berets and other Special Forces stopped using it.

Canada Veterans Need to Look At US Reports on Mefloquine

In 2008 the VA issued a warning about Mefloquine, and there are other stories on this report going back to 2002.

Senator Dianne Feinstein wanted answers from Donald Rumsfeld in 2003

Veterans, families want answers over Forces' use of Mefloquine
Toronto Sun crime reporter Chris Doucette. (Sun files)
By Chris Doucette, Toronto Sun
Monday, January 23, 2017

The call for accountability over the Canadian Forces’ use of a controversial anti-malaria drug is growing louder and veterans and family members hope Prime Minister Justin Trudeau will hear their cries for help.

A former medic who served in Somalia, the wife of a soldier disgraced in the Somalia Affair, the mother of a soldier who killed himself in Rwanda and a doctor with expertise in the neuropsychiatric effects of Mefloquine toxicity recently submitted written statements to the Standing Committee on Veterans Affairs outlining the drugs’ devastation.

Marj Matchee writes her husband, Clayton, suffered paranoia and hallucinations prior to his 1993 arrest for the deadly beating of a Somali teen.

“You see things when you sleep. You see it in the daytime too,” she recalls him saying.

Many veterans who were forced to take the drug before it was licensed still suffer from side effects that Health Canada and AA Pharma, the Canadian supplier of the drug, quietly added to Mefloquine’s warning label last year.

“We must do more to reach out to these veterans, to acknowledge the harms that Mefloquine has caused them, and commit to funding research to study and ultimately try to reverse these effects,” Matchee writes.

Dr. Remington Nevin, of Johns Hopkins University, says Mefloquine toxicity can cause brain damage that mimics PTSD, so sufferers may receive the wrong treatment and symptoms such as suicidal thoughts persist.
read more here

These may help their case

Lariam Psychiatric and Suicidal Side Effects Research shows the anti-malaria drug mefloquine hydrochloride—formerly sold under the brand name Lariam—might cause psychiatric abnormalities, suicidal ideations and behaviors, and potentially permanent nerve damage. Because of these psychiatric side effects, the drug’s manufacturer, Hoffmann-La Roche, pulled it from the market in 2008. The U.S. Army continued to administer it to soldiers, however, until 2011, when the army ceased prescribing Lariam even for soldiers deployed in malaria-prone regions such as Afghanistan. In July 2013, the U.S. Food and Drug Administration (FDA) notified the public that mefloquine products’ drug labels would be updated with a black box warning—the agency’s most serious kind—concerning the aforementioned side effects.

Australian Defence Force Face Off With Soldiers Over Lariam

Former soldiers, families face military officials in Townsville over anti-malaria drug side effects
ABC Australia
By Jesse Dorsett
Updated yesterday at 7:28pm

PHOTO: Mefloquine, also known as Lariam, is known to cause mental health problems.

(Flickr: David Davies)

The military's top brass has come face to face with former soldiers and their families suffering depression and anxiety after being given controversial anti-malaria drugs on deployment.

Key points: 2,000 ADF personnel given anti-malaria drug in East Timor over five years
Drug side effects include mood swings and suicidal thoughts
ADF says they did not know drugs would produce chronic problems
A forum has been held in Townsville, in north Queensland, to give former soldiers, ex-service organisations and health professional the chance to discuss the effects of anti-malaria medication Mefloquine, as well as the drug Tafenoquine.

Nearly 2,000 Australian Defence Force (ADF) personnel were prescribed Mefloquine, also known as Lariam, primarily in East Timor, between July 2000 and June 2015.

The drug is known to cause agitation, mood swings, panic attacks, confusion, hallucinations, aggression, psychosis and suicidal thoughts in a small number of patients.

Another 492 took Tafenoquine as part of a trial in 2000 and 2001.
read more here and remember US soldiers took it too!

Australia Soldiers Say Mefloquine Left Them Scarred

Soldiers fear drug program has scarred them with depression, anxiety, nightmares
Sydney Morning Herald
Henry Belot
November 29, 2015

"At various times it was like living in a heavily armed lunatic asylum."

ADF veteran prescribed Lariam

Major Stuart McCarthy is calling for a public inquiry into the ADF's use of antimalarial drug mefloquine. Photo: Brendon Thorne

Australian soldiers and veterans are calling for an immediate inquiry into the use of an antimalarial drug they believe scarred them with permanent psychological damage, anxiety attacks, vertigo, nightmares, suicidal thoughts and hallucinations.

The group, which includes commandos and officers who have served in Iraq and Afghanistan, believe they have been incorrectly diagnosed with post-traumatic stress disorder or depression and were ignored by the military after raising concerns about the drug.

The Inspector-General of the Australian Defence Force has launched an internal inquiry into the use of the drug mefloquine, or Lariam, which has been used on up to 2000 personnel since a controversial drug trial in East Timorin 2001-02.

Major Stuart McCarthy was prescribed mefloquine while serving in Ethiopia and Eritrea in 2001 and has since suffered depression, vertigo, hearing and memory problems and cognitive impairment.

Major Stuart McCarthy was prescribed mefloquine while serving in Ethiopia and Eritrea in 2001 and has since suffered depression, vertigo, hearing and memory problems and cognitive impairment. Photo: Brendon Thorne

But documents obtained by Fairfax Media reveal Chief of Army Lieutenant-General Angus Campbell does not support a campaign against the drug because it would deny deployment opportunities, despite acknowledging the side effects.

"I have been an army officer 27 years and I have no trust in the Australian Defence Force's handling of this matter," he said. read more here

UK:Almost 1,000 Personnel Required Psychiatric Treatment After Taking Lariam

Almost 1,000 members of Armed Forces require psychiatric treatment after being given anti-Malaria drug linked to mental health problems
Daily Mail
By COREY CHARLTON FOR MAILONLINE
15 April 2015

Almost 1,000 personnel required psychiatric treatment after taking drug
They were prescribed anti-malarial drug Lariam by the Ministry of Defence
The discredited product's side effects include psychosis and hallucinations
Retired Major General Alastair Duncan is currently in a psychiatric unit
He was prescribed the drug prior to a deployment in Sierra Leone

A retired major general is among 1,000 British service personnel requiring psychiatric treatment after taking an anti-malarial drug issued by the Ministry of Defence.

New figures released by the MoD show that since 2008, 994 personnel have been treated for mental health issues after having been prescribed Lariam.

Despite Lariam - the brand name for the drug mefloquine - being banned by the U.S. military due to concerns over side effects, the MoD has ignored appeals to stop prescribing it in what critics say is an escalating 'scandal'.

Major-General Alastair Duncan (pictured) is currently in a psychiatric unit after having been given the drug prior to a deployment in Sierra Leone

According to The Independent's Jonathan Owen, retired Major General Alastair Duncan is currently in a psychiatric unit following a Post Traumatic Stress Disorder episode four months ago.

Maj-Gen Duncan was given the drug Lariam before a deployment to Sierra Leone.

read more here


We did know about this, but they just stopped talking about it.

Links to medications suspected with non-combat deaths

April 27, 2004 DoD, VA to study malaria drug’s side effects Associated Press

The Department of Defense and the Department of Veterans Affairs will study the side effects of Lariam, a drug given to servicemen to prevent malaria, Pentagon spokesman Jim Turner said.

The use of Lariam came up in investigations of murders and murder-suicides involving Fort Bragg soldiers in the summer of 2002, when four soldiers were accused of killing their wives. Two of those soldiers committed suicide immediately and a third killed himself in jail.

The three soldiers who killed themselves had served in Afghanistan, where Lariam is routinely used by U.S. troops. The fourth, who is still awaiting trial, did not serve there.

A November 2002 report by the office of the Army Surgeon General said two of the four soldiers had taken Lariam, but the Army would not say which. The report said Lariam probably did not factor in the killings.

Turner said a subcommittee of the Armed Forces Epidemiological Board met two weeks ago to consider ways to study the use of Lariam among service members. A Veterans Affairs spokeswoman said the VA will review the issue but has not issued a report on the study.

Lariam, which is also known as mefloquine, is routinely prescribed to soldiers working in countries where malaria is a problem. Some people have blamed it for causing psychotic reactions, including depression, hallucinations and thoughts of suicide.

Doctor: Anti-malarial drug may be harmful
Army Times

In the past six weeks, Dr. Michael Hoffer has treated nine service members who returned from Iraq or Afghanistan unable to walk a straight line or stand still without staggering. Some said objects appeared to spin around them for more than an hour at a time.

A Navy commander and director of the Department of Defense Spatial Orientation Center at Naval Medical Center, San Diego, Hoffer believes the problems are linked to a drug called Lariam "known generically as mefloquine" that the military gives to troops to prevent malaria.

Sen. Dianne Feinstein, D-Calif., has urged the Pentagon to set a timeline for a Defense Department study, announced in March, of negative effects from Lariam and other anti-malarial drugs.

And then there were more

VA Warns Doctors About Lariam, United Press International, 25 June 2004

And even more on Wounded Times for Lariam

Huffington Post did the right thing on murder-suicides report

Wounded Times
Kathie Costos
April 13, 2014

Huffington Post did the right thing and pulled the reprehensible report on murder-suicides. They not only pulled it, they apologized.

Update from Huffington Post

Editor's Note A previously published article featuring a graphic that depicted data on violent crimes by veterans has been removed. The article was intended to call attention to the lack of evidence correlating post-traumatic stress disorder to violent behavior among veterans, and to highlight the insufficient mental health services available to them. It failed in these regards, and we regret that the data as presented in our graphic was incomplete and misleading.

PTSD is not the enemy no matter what reporters say but it seems as if too many others are simply stuck on stupid.

Huffington Post has done more to educate the public on the tribulations of our veterans than any other site. Time after time, especially during Suicide Prevention Month last year when they dedicated huge sections to the troops and veterans telling their stories and asking questions. Given the fact they screwed up on this one they turned around, admitted it and apologized, which far too many other news sites fail to do.

Take a good long look at the graphic supplied on the claim that murder-suicides are an issue.

It seems that the article on the Huffington Post ended up giving other reporters what they were searching for. Another headline to use to get attention while bringing the wrong attention to something that is not, repeat not, worthy of the veterans with PTSD. This was repeated on many sites last week and now it appears on PolicyMic but no one seems to actually look at the chart itself. They are actually lower than 2002.

I did a huge report in 2007 on military suicides and there was a rise in murder-suicides but most of them were tied to Lariam and other anti-malarial drugs.

The Department of Defense and the Department of Veterans Affairs will study the side effects of Lariam, a drug given to servicemen to prevent malaria, Pentagon spokesman Jim Turner said. The use of Lariam came up in investigations of murders and murder-suicides involving Fort Bragg soldiers in the summer of 2002, when four soldiers were accused of killing their wives. Two of those soldiers committed suicide immediately and a third killed himself in jail.

The three soldiers who killed themselves had served in Afghanistan, where Lariam is routinely used by U.S. troops. The fourth, who is still awaiting trial, did not serve there.

There was and still is a huge problem with Zoloft. In 1999 the FDA gave Pfizer approval for PTSD treatment. Many thought it was what veterans had waited for.

Of 187 patients in the study, 53 percent of those receiving Zoloft (the brand name of the generic sertraline) were much or very much improved at the end of 12 weeks, Brady said, and some patients showed benefits within two weeks.

But that good PR didn't last long,

Suicides and Homicides in Patients Taking Paxil, Prozac, and Zoloft: Why They Keep Happening -- And Why They Will Continue

Underlying Causes That Continue to Be Ignored by Mainstream Medicine and the Media "From almost the day that they were introduced in the late 1980s and early 1990s, sudden, unexpected suicides and homicides have been reported in patients taking serotonin-enhancing antidepressants such as Prozac, Paxil, and Zoloft. I'm not surprised this problem hasn't disappeared, nor will it unless we look deeper."

It seems that after the soldiers were murdered at Fort Hood, the press wanted to drag up everything possible to get their names in the spotlight.

How about the chart that shows suicides going up instead?

Marines
Navy, Marines suicides fell in 2013; attempted suicides by Marines jumped

TIME reported on the rise in military suicides as well up to 2012 in The Third Surge, Battleland by Mark Thompson.

But why pay attention to the real problem? Why pay attention to the fact that suicides and attempted suicides went up after the military started the bullshit of addressing deaths caused by war but not during it? Why bother to pay attention to the fact that while the number of enlisted military folks went down the suicide rate did not really go down? After all less to count means the number of suicides would have naturally gone down. They also didn't seem to concerned with the fact that attempted suicides went up.

Guess it is just easier to make soldiers look bad instead of the actually seeing what is right in front of their face. Considering how hard they are pushing this claim right now, it makes them all look really stupid while the site where it originated looks redeemed.

Mefloquine stopped for Green Berets and Special Forces almost 10 years too late

Mefloquine stopped for Green Berets and Special Forces almost 10 years too late
Wounded Times
Kathie Costos
September 19, 2013

In 2004, the VA issued a warning. "The drug is mefloquine, known by the brand name Lariam, which has been given to tens of thousands of soldiers since the war on terrorism began. Some of those soldiers say it has provoked severe mental and physical problems including suicidal and violent behavior, psychosis, convulsions and balance disorders."

In 2009 Spc. Adam Kuligowski's problems began because he couldn't sleep. The "21-year-old soldier was working six days a week, analyzing intelligence that the military gathered while he was serving in Afghanistan. He was gifted at his job and loved being a part of the 101st Airborne Division, just like his father and his great uncle. But Adam was tired and often late for work. His eyes were glassy and he was falling asleep while on duty. His room was messy and his uniform was dirty. His father, Mike Kuligowski, attributes his son's sleeplessness and depression to an anti-malarial medication called mefloquine that was found in his system. In rare cases, it can cause psychiatric symptoms such as anxiety, paranoia, depression, hallucination and psychotic behavior." That report came out in 2010.

By 2011 "dramatic about-face follows years of complaints and concerns that mefloquine caused psychiatric and physical side effects even as it was used around the globe as a front-line defense against the mosquito-borne disease that kills about 800,000 people a year. "Mefloquine is a zombie drug. It's dangerous, and it should have been killed off years ago," said Dr. Remington Nevin, an epidemiologist and Army major who has published research that he said showed the drug can be potentially toxic to the brain. He believes the drop in prescriptions is a tacit acknowledgment of the drug's serious problems."

In 2012 "Mefloquine, also called Lariam, has severe psychiatric side effects. Problems include psychotic behavior, paranoia and hallucinations. The drug has been implicated in numerous suicides and homicides, including deaths in the U.S. military. For years the military has used the weekly pill to help prevent malaria among deployed troops."

I can do this all day but the military just decided to stop giving it to Green Berets and other Special Forces. "Quoting the FDA’s July safety warning, the Surgeon General’s Office of the Army Special Operations Command sent a message to commanders and medical personnel last Friday ordering a halt in prescribing mefloquine for malaria prevention for the approximately 25,000 Green Berets, Rangers, Civil Affairs and Psychological Operations soldiers, command spokesman Lt. Col. Dave Connolly said."

They can pretend all they want that they didn't know what was going on before but the results have been deadly.

Green Berets, other elite Army forces ordered to stop taking anti-malarial drug mefloquine
By Associated Press
Thursday, September 19, 2013

WASHINGTON — The top doctor for Green Berets and other elite Army commandos has told troops to immediately stop taking mefloquine, an anti-malaria drug found to cause permanent brain damage in rare cases.

The ban among special operations forces is the latest development in a long-running controversy over mefloquine. The drug was developed by the Army in the 1970s and has been taken by millions of travelers and people in the military over the years. As alternatives were developed, it fell out of favor as the front-line defense against malaria, a mosquito-borne disease that international health officials say kills roughly 600,000 people a year.

The new prohibition among special operations forces follows a July 29 safety announcement by the Food and Drug Administration that it had strengthened warnings about neurologic side effects associated with the drug. The FDA added a boxed warning to the drug label, the most serious kind of warning, saying neurologic side effects like dizziness, loss of balance and ringing in the ears may become permanent.
read more here

Anti-malarial drug linked to Afghan massacre a long time ago

What the hell is going on when reports do not research what they report on? Here is one more case of that.

MARCH 26, 2012 CNN reported Military Scrambles To Limit Malaria Drug Just After Afghanistan Massacre

That isn't the problem, even though reports on this drug go way back.

VA issued warning on Lariam in 2004

Spc. Adam Kuligowski's problems began because he couldn't sleep, April 2010

Army curbs prescriptions of anti-malaria drug Mefloquine NOVEMBER 20, 2011 and this one the same month. After four decades of use, the U.S. Army is banning the use of mefloquine (an anti-malaria drug) because of side effects.

Is Mefloquine the new Agent Orange? from August 2012

This report claims that it is "new information" but it isn't.

Anti-malarial drug linked to Afghan massacre
Soldier was taking mefloquine when he killed 16 civilians, report indicates
By Patricia Kime
Staff writer
Jul. 13, 2013

In less than a month, Army Staff Sgt. Robert Bales will be sentenced for the massacre of 16 Afghan civilians in March 2012.

His attorney, John Henry Browne, has not publicly disclosed whether he will use a mental health defense to fight for a parole-eligible sentence.

But an argument could be made that Bales, 40, was out of his mind:

■ He was treated for a traumatic brain injury resulting from a rollover accident in 2010 and possibly had post-traumatic stress disorder.

■ He admitted to using steroids, which can cause aggression and violence.

■ And new evidence suggests he was prescribed an anti-malaria drug known to cause hallucinations, aggression and psychotic behavior in some patients.
read more here

A Potential Therapy for PTSD?

A Potential Therapy for PTSD?
TIME
By Remington Nevin
Feb. 13, 2013

The latest edition of the medical journal Psychiatric Annals features military researchers discussing how a procedure known as stellate ganglion block can effectively treat post-traumatic stress disorder (or PTSD).

Injecting a local anesthetic agent into the sympathetic nerve tissue at the base of the neck — a so-called stellate ganglion block (or SGB) – acts to numb signals which travel to centers deep in the brainstem and brain, commonly thought to be most responsible for PTSD.

The prospect of using a medical procedure to treat PTSD would be a paradigm shift for psychiatry.

That PTSD can be thought of an injury – something whose symptoms could be alleviated by injecting numbing medicine – would support the assertion that former Vice Army Chief of Staff General Peter Chiarelli has been advocating for some time that PTSD should be renamed PTSI – with an I for injury.

“It might seem counterintuitive that treating the peripheral nervous system could affect psychiatric conditions presumably mediated in the brain,” writes Dr. Cam Ritchie, my colleague and retired Army psychiatrist, in a press release for the journal heralding the news.

Unlike Dr. Ritchie, I am not so surprised by these findings.

My research focuses on the harmful effects of a class of drugs called quinolines, most notably the antimalarial drug mefloquine (or Lariam), which has been widely prescribed to deployed troops in Somalia, Iraq, and Afghanistan at high risk of PTSD. Many of the unpleasant symptoms caused by mefloquine, including anxiety, panic attacks, nightmares, and sleep problems, can often be difficult to distinguish from those attributed to PTSD.
read more here

Military suicide studies must include drugs

Whenever I talk about treatment for PTSD, the topic usually turns to medications because for the majority of patients, this is too often all they get.

Medications are tricky to talk about. When a veteran tells me their medications are not working or make them feel worse, I tell them they need to talk to their doctor and let them know. That is the only way the doctor can decide what will work best for their own chemistry. Another factor is if they drink alcohol or take street drugs while on these medications, it will not allow them to work properly. That is about as far as I go on discussing medications because I am not a psychiatrist and far from an expert on drugs.

The next thing that has to be talked about is that medications for PTSD were not supposed to be the only answer in treating it. They need talk therapy with a psychologist that is an expert on trauma, or it will not do much good. They need to talk to people about their spiritual issues, or again, the treatment they receive will not do much good. They also need to take care of their bodies, learning how to calm themselves with being pro-active. Walking, Yoga, meditation and even their diet needs to be addressed. They have to treat the whole veteran to be able to heal the hole in the veteran.

The longer PTSD is not addressed, the longer medication will be required as part of the therapy. Vietnam veterans have accepted the fact they will be on medications the rest of their lives simply because of how long they suffered without help but the other thing they learned and offered hope to others is that it is never too late to live a better life.

Government Addresses Suicides Without Looking at Suicide-Linked Drugs
The Boom in Suicides
by MARTHA ROSENBERG
SEPTEMBER 12, 2012

It would be laughable if it weren’t tragic. This week Surgeon General Regina Benjamin introduced a plan to stem the nation’s growing suicide rate without addressing the nation’s growing use of suicide-linked drugs.

Antidepressants like Prozac and Paxil, antipsychotics like Seroquel and Zyprexa and anti-seizure drugs like Lyrica and Neurontin are all linked to suicide in published reports and in FDA warnings. (Almost 5,000 newspaper reports link antidepressants to suicide, homicide and bizarre behavior.) Asthma drugs like Singulair, antismoking drugs like Chantix, acne drugs like Accutane and the still-in-use malaria drug Lariam, are also linked to suicide.

The US’s suicide rate has risen to 38,000 a year, says USA Today, after falling in the 1990s. The rise correlates with the debut of direct-to-consumer drug advertising in the late 1990s, the approval of many drugs with suicide links and more people taking psychoactive drugs for lifestyle problems.

Dr. Benjamin announced that federal grants totaling $55 million will save 20,000 lives in the next five years through suicide hotlines, more mental health workers in the VA, better depression screening and Facebook tracking of suicidal messages. Nowhere, including in the suicide-racked military, does she suggest looking at the overmedication which has gone hand-in-hand with the deaths. And on which the government is spending a lot more than $55 million.

Suicide increased more than 150 percent in the Army and more than 50 percent in the Marine Corps between 2001 to 2009, reported Military Times displaying graphs of the suicide and prescription drug increases, in a print edition, that are similar enough to be laid over one another. One in six service members was on a psychoactive drug in 2010 and “many troops are taking more than one kind, mixing several pills in daily ‘cocktails’ for example, an antidepressant with an antipsychotic to prevent nightmares, plus an anti-epileptic to reduce headaches–despite minimal clinical research testing such combinations,” said Military Times.

Eighty-nine percent of troops with posttraumatic stress disorder (PTSD) are now given psychoactive drugs and between 2005 and 2009, half of all TRICARE (the military health plan) prescriptions for people between 18 and 34 were for antidepressants. During the same time period, epilepsy drugs like Topamax and Neurontin, increasingly given off-label for mental conditions, increased 56 percent, reports Military Times. In 2008, 578,000 epilepsy pills and 89,000 antipsychotics were prescribed to deploying troops. What?
read more here

Is Mefloquine the new Agent Orange?

Is Mefloquine the new Agent Orange?
By Samantha A. Torrence
Aug 6, 2012

During Vietnam troops were exposed to Agent Orange. Later there was Gulf War Syndrome and depleted Uranium exposure. Now the military is dealing with a rash of military members with PTSD, and another chemical agent may be responsible for the diagnosis.

Malaria is a major concern to troops who are deployed around the world where contracting the disease is a risk. It is the Department of Defense policy that service members deployed to these areas must take an anti-malaria drug. There are various drugs available such as doxycycline, chloroquine, malarone, and mefloquine. Each drug comes with its unique problems such as high monetary cost in the case of malarone and photosensitivity, nausea, vomiting, and resistance in the cases of doxycycline and chloroquine. Most anti-malaria drugs must also be taken once a day which causes problems with consistency and potency for the soldiers who miss a dose and for that reason Mefloquine, which is only taken once a week, has been prescribed.

Mefloquine(Lariam®) may have a higher rate of compliance but it comes at a high cost to soldiers and American taxpayers. Mefloquine can cause brain injury, hallucinations, paranoia, psychosis and can predispose service members to Post Traumatic Stress Disorder (PTSD).

Read more

Troop Mental Ills: Psychiatric or Organic?

Troop Mental Ills: Psychiatric or Organic?
By ELSPETH CAMERON RITCHIE
May 22, 2012

There’s a continuing tension over whether mental disorders are “organic” or “psychological”. The first is easier to define — a brain injury caused by an insult, such as a bullet wound, blow to the head or bomb blast. “Psychological” is usually chalked up to bad parenting.

Two new debates raise this issue again. One is whether “post-traumatic stress disorder” should be called “post-traumatic brain injury”. The other is the emerging findings on “CTE” — chronic traumatic encephalopathy — which shows long-acting brain changes after concussions.

The term “shell shock” was later re-named “not yet diagnosed, nervous”, “battle fatigue”, “PTSD” and “combat stress reaction”. Now the term “post-traumatic stress injury” is being considered.


Dr. Remington Nevin has proposed that some of these reactions are actually the result of neurotoxic injuries from certain anti-malarial medications given to soldiers over the years, most recently mefloquine, or Lariam®.

read more here

Military Scrambles To Limit Malaria Drug Just After Afghanistan Massacre

It is looking more and more like the medication Bales was on was part of this.

When I wrote about the connection between what Bales is accused of doing and medications he was probably on for PTSD and TBI, I didn't think about Mefloquine. Army: PTSD treatable; some diagnosed return to war,,,with meds

By most accounts, Sgt. Robert Bales has PTSD and TBI. If true, then sending him back into combat, more than likely, included medications for both. Is anyone looking into what medications he was on and if they played a role in what happened more than PTSD and TBI? Most medications the troops are given come with clear warnings about side effects.

Looks like I should have.

Robert Bales Charged: Military Scrambles To Limit Malaria Drug Just After Afghanistan Massacre
Posted: 03/25/2012
Mark Benjamin

WASHINGTON -- Nine days after a U.S. soldier allegedly massacred 17 civilians in Afghanistan, a top-level Pentagon health official ordered a widespread, emergency review of the military’s use of a notorius anti-malaria drug called mefloquine.

Mefloquine, also called Lariam, has severe psychiatric side effects. Problems include psychotic behavior, paranoia and hallucinations. The drug has been implicated in numerous suicides and homicides, including deaths in the U.S. military. For years the military has used the weekly pill to help prevent malaria among deployed troops.

The U.S. Army nearly dropped use of mefloquine entirely in 2009 because of the dangers, now only using it in limited circumstances, including sometimes in Afghanistan. The 2009 order from the Army said soldiers who have suffered a traumatic brain injury should not be given the drug.

The soldier accused of grisly Afghanistan murders on March 17 of men, women and children, Staff Sgt. Robert Bales, suffered a traumatic brain injury in Iraq in 2010 during his third combat tour. According to New York Times reporting, repeated combat tours also increase the risk of post-traumatic stress disorder.

Bales' wife, Karilyn Bales, broke her silence in an interview Sunday with NBC's Matt Lauer, airing on Monday's Today show. "It is unbelievable to me. I have no idea what happened, but he would not -- he loves children. He would not do that," she said in excerpts released Sunday.

On March 20, Assistant Secretary of Defense for Health Affairs Jonathan Woodson ordered a new, urgent review to make sure that troops were not getting the drug inappropriately. The task order from Woodson, obtained by The Huffington Post, orders an immediate “review of mefloquine prescribing practices” to be completed by the following Monday, six days after the order was issued.
read more here

This was posted here January, 2008. Just goes to show what they new back then. It is a long post with some of the results of what they got wrong in human terms.

VA issued warning on Lariam in 2004
VA Warns Doctors About Lariam
United Press International
25 June 2004
WASHINGTON - The Department of Veterans Affairs is warning doctors to watch for long-term mental problems and other health effects from an anti-malaria drug given to soldiers in Afghanistan and Iraq.The drug is mefloquine, known by the brand name Lariam, which has been given to tens of thousands of soldiers since the war on terrorism began. Some of those soldiers say it has provoked severe mental and physical problems including suicidal and violent behavior, psychosis, convulsions and balance disorders.

Last year the Food and Drug Administration began warning that problems might last "long after" someone stops taking it.

Fort Campbell tries to stop soldier suicides
Spc. Adam Kuligowski's problems began because he couldn't sleep.
Last year, the 21-year-old soldier was working six days a week, analyzing intelligence that the military gathered while he was serving in Afghanistan. He was gifted at his job and loved being a part of the 101st Airborne Division, just like his father and his great uncle.

But Adam was tired and often late for work. His eyes were glassy and he was falling asleep while on duty. His room was messy and his uniform was dirty.

His father, Mike Kuligowski, attributes his son's sleeplessness and depression to an anti-malarial medication called mefloquine that was found in his system. In rare cases, it can cause psychiatric symptoms such as anxiety, paranoia, depression, hallucination and psychotic behavior.

Army curbs prescriptions of anti-malaria drug Mefloquine
Army curbs prescriptions of anti-malaria drug
LOS ANGELES (AP) – Almost four decades after inventing a potent anti-malarial drug, the U.S. Army has pushed it to the back of its medicine cabinet.

The dramatic about-face follows years of complaints and concerns that mefloquine caused psychiatric and physical side effects even as it was used around the globe as a front-line defense against the mosquito-borne disease that kills about 800,000 people a year.

"Mefloquine is a zombie drug. It's dangerous, and it should have been killed off years ago," said Dr. Remington Nevin, an epidemiologist and Army major who has published research that he said showed the drug can be potentially toxic to the brain. He believes the drop in prescriptions is a tacit acknowledgment of the drug's serious problems.

Army dropped Lariam finally!!

Army scales back use of anti-malaria drug

Concerns centered on soldiers with brain injury, anxiety
By Kelly Kennedy - Staff writer
Posted : Sunday Mar 22, 2009 14:53:47 EDT

The Army has dropped Lariam — the drug linked to side effects including suicidal tendencies, anxiety, aggression and paranoia — as its preferred protection against malaria because doctors had inadvertently prescribed it to people who should not take it.

Lariam, the brand name for mefloquine, should not be given to anyone with symptoms of a brain injury, depression or anxiety disorder, which describes many troops who have deployed to Iraq or Afghanistan.

The Army’s new choice for anti-malarial protection is doxycycline, a generic antibiotic.

“In areas where doxycycline and mefloquine are equally efficacious in preventing malaria, doxycycline is the drug of choice,” Army Surgeon General Lt. Gen. Eric Schoomaker said in a memo dated Feb. 2.
go here for more
http://www.armytimes.com/news/2009/03/army_lariam_032209w/

VA issued warning on Lariam in 2004

VA Warns Doctors About Lariam
United Press International
25 June 2004
WASHINGTON - The Department of Veterans Affairs is warning doctors to watch for long-term mental problems and other health effects from an anti-malaria drug given to soldiers in Afghanistan and Iraq.The drug is mefloquine, known by the brand name Lariam, which has been given to tens of thousands of soldiers since the war on terrorism began. Some of those soldiers say it has provoked severe mental and physical problems including suicidal and violent behavior, psychosis, convulsions and balance disorders.

Last year the Food and Drug Administration began warning that problems might last "long after" someone stops taking it.

The VA warned its own doctors Wednesday that the drug "may rarely be associated with certain long-term chronic health problems that persist for weeks, months, and even years after the drug is stopped," according to a summary of published studies by a VA panel of experts. The summary accompanies an "information letter" from the VA's acting undersecretary for health, Dr. Jonathan B. Perlin, to healthcare professionals who treat veterans.Veterans' advocates praised the VA but said the Pentagon seems to have lost track of who has taken the drug -- making the size of a potentially serious problem unclear.While little mefloquine was used in the first Gulf War, advocates said a similar dearth of medical data has thwarted efforts to get to the bottom of Gulf War Syndrome for a decade. Investigators simply did not know what drugs or vaccines -- possible contributors to that syndrome -- were given to solders.

"We are pleased that the VA is taking a proactive approach to this situation," said Steve Smithson, assistant director of the American Legion's National Veterans Affairs and Rehabilitation Commission."It is no secret that the military did not do a good job of record keeping in the first Gulf War," said Smithson. "Early reports on Lariam make me concerned that we did not learn the lessons from the first Gulf War in that it is not being documented in health records."

http://www.refusingtokill.net/disability/va_warns_doctors_about_lariam.htm

Sgt. Marvin Lee Branch

But last Christmas, only months after the initial wave of killings, Fort Bragg was again the scene of tragedy when another service member, Sgt. Marvin Lee Branch, allegedly tried to murder his wife. How the situation was handled is indicative of the larger problem. Restraining orders protecting Carol Branch were dismissed within weeks of the attack, and she complained of receiving very little support: "I'm trying to save my life and I've got to beg (the Army) for help? I can see how those other mothers died. They were trapped." Branch said her husband had a history of abusive behavior, but he became uncontrollably violent upon returning from duty in Afghanistan. An Army spokesman confirmed that soldiers in Sgt. Branch's unit had taken Lariam, but would not confirm whether Branch had as well.
http://www.dissidentvoice.org/Articles/Wokusch_War-DomesticViolence.htm

Anthony Mertz

Anti-malaria drug cited in Illinois murder
By Mark Benjamin and Dan Olmsted
From the Washington Politics & Policy Desk
Published 2/21/2003 3:33 PM

CHARLESTON, Ill., Feb. 21 (UPI) -- The lawyer for a former Marine convicted of murder will tell an Illinois jury next week that an anti-malaria drug associated with psychotic behavior and aggression triggered the killing, and he should be spared the death penalty.

The case marks the first time that side effects of the drug, called Lariam, have been raised in front of a U.S. jury in a criminal case. Some believe the drug could have played a role in a string of killings by Fort Bragg soldiers last summer, though the Army calls that unlikely.

Anthony Mertz, 26, was convicted Feb. 12 of killing fellow Eastern Illinois University student Shannon McNamara in her Charleston, Ill., apartment on June 12, 2001. The jury is now hearing testimony before deciding whether to sentence him to death.

"When the Marines gave Lariam to my client they set in motion a chain of events that caused the death of Shannon McNamara," defense counsel David Williams told United Press International Friday.

http://www.aaconsult.com/lariam/lariam_news_52.html

This is from Jonathan Shay in his interview with PBS on a Soldier's Heart

Psychiatrist and author, Odysseus in America

And my personal theory of what lay behind those horrible, horrible murder suicides at Fort Bragg a couple of years ago, these were all staff NCOs … and officers in Special Operations, which is the most macho of all the formations. And what's more, they had been deployed repeatedly into very dangerous, very confusing and ambiguous operations, and had come back with injuries that they could not ask for help with, because they were afraid it would end their careers. And just by coincidence, a number of them broke at the same time, and broke in this catastrophic way. That's my thought about what happened there. This is not likely to be happening with junior enlisted people who I think can get help.
from Front Line Soldier's Heart
http://www.pbs.org/wgbh/pages/frontline/shows/heart/themes/stigma.html

4 Wives Slain In 6 Weeks At Fort Bragg
Husbands Blamed For Deaths, 3 Of The Men Served In Afghanistan


FORT BRAGG, N.C., July 26, 2002

Fayetteville, N.C., police said that was when Sgt. 1st Class Rigoberto Nieves — a soldier in the 3rd Special Forces Group who had been back from Afghanistan just two days — shot his wife, Teresa, and then himself in their bedroom.

Officials said Nieves had requested leave to resolve personal problems

Sheriff's investigators said Jennifer Wright was strangled June 29. Her husband, Master Sgt. William Wright of the 96th Civil Affairs Battalion, reported her missing two days later. Then on July 19, he led investigators to her body in Hoke County and was charged with murder.

Wright, who had been back from Afghanistan about a month, had moved out of his house and was living in the barracks.

The couple met in high school in Mason, Ohio, about 30 miles north of Cincinnati. They married shortly after Jennifer graduated.

Her father, Archie Watson, said the Wrights had talked recently about divorce. Jennifer had grown tired of military life, her father said, but William Wright was reluctant to let her go.


Sgt. 1st Class Brandon Floyd shot his wife, Andrea, a native of Alliance, Ohio, then killed himself in their Stedman home.

The Fayetteville Observer reported Floyd was a member of Delta Force, the secretive anti-terrorism unit based at Fort Bragg. He returned from Afghanistan in January, officials said. The couple's three children were in Ohio visiting relatives at the time of the deaths.


In the fourth case, Army Sgt. Cedric Ramon Griffin, 28, was charged with first-degree murder, two counts of attempted first-degree murder and first-degree arson in the July 9 death of his wife, Cumberland County Sheriff Moose Butler said.

Marilyn Griffin, 32, was found dead in the burning home. Her two children escaped the fire.

http://www.cbsnews.com/stories/2002/07/31/national/main517033.shtml

Third Bragg soldier took malaria drug

By Mark Benjamin and Dan Olmsted
From the Washington Politics & Policy Desk


Published 8/17/2002 3:00 PM



FAYETTEVILLE, N.C., Aug. 17 (UPI) -- Friends of the three Fort Bragg soldiers suspected of killing their wives this summer say the men exhibited unusual anger and incoherence after returning from Afghanistan where they were given an anti-malaria drug associated with aggression and mental problems.

One of the soldiers was "almost incoherent" and visibly shaking while describing marital problems to a neighbor. Another became unable to control his anger at his wife in public, startling those who knew him. A third puzzled his new neighbors with his strange behavior.

http://home.att.net/~kjo/ftbragg2.htm

Read and comment on this story from UPI on the Army's three month study the slayings of four Army wives at Fort Bragg this summer which concluded that Lariam was not a factor in the murders.

The report has sparked claims the military is covering up problems with a drug it invented and licensed. "Our military said there is no problem with (Lariam) because they developed it," said Rep. Bart Stupak, D-Mich. "The hardest thing to do is develop a drug and then admit there is a problem."

Lariam is the most effective anti-malarial drug known and has been used by thousands of Peace Corps Volunteers over the past ten years. However, the drug's potential side effects are rarely reported and include agitation, depression and aggression. In July, Sen. Chris Dodd, D-Conn., called for an independent medical investigation to protect the health of Peace Corps volunteers, who are routinely prescribed the drug.
Read our ongoing coverage of the Lariam controversy at:
The Lariam Controversy
Read the story about the results of the Fort Bragg study at:
Army Fort Bragg study faces scrutiny*
http://peacecorpsonline.org/messages/messages/2629/1010667.html

So why is it still being used?

Malaria Chemoprophylaxis for Coalition Troops in Afghanistan -

Sep 18, 2007

Although mefloquine may be the drug most often selected, Canadian Forces members have the option of using either mefloquine weekly or doxycycline daily, Journal of American Medical Association (subscription),

Phrase changed but not opinion on PTSD crimes

Tuesday, January 15, 2008

121 NY Times veterans had no criminal history before
Iraq Vets Commit PTSD-Fueled Murders in the Wake of Returning HomePosted by Amanda Marcotte, Pandagon at 12:05 PM on January 15, 2008.Unlike the majority of civilians who commit murder, the majority of the 121 veterans documented by the Times reporters had no criminal history.This story about Iraq and Afghanistan veterans who've come back from the war only to commit acts of violence at home is a must-read. The NY Times found 121 cases of murders committed by veterans back from these wars, 1/3 of which were domestic murders, and the reporters suspect this is only a percentage of the actual murders committed, because they got that number by scouring newspapers around the country, not from statistics cultivated by the Pentagon, which, surprise surprise, doesn't collect such data. The numbers are not insignificant.

When I posted the links to the NY Times piece, I tried to point out that these veterans, these combat veterans, came home changed. Some came home changed because of PTSD and some came home almost as if the brutality of war penetrated their souls. It is possible and it is a human condition when you go through some of the things they go through. Statistically however, these incidences are few and far between. Some come home changed because of PTSD and the medications they are given or the propensity to self-medicate with alcohol and street drugs. We have years of documented suspected links between medications such as Lariam and crimes. I will continue to use the "suspected" link because we simply do not know for sure if it was the PTSD and Lariam or Lariam alone.

What I was saying, but put it rather inadequately, is that if they need help, they should get it no matter if they are in jail or in the hospital. If they are so deeply changed by what they went through, prison serves no purpose or justice. If they were only slightly changed then they need therapy even in prison. If they were just using it to try to get them off the hook, then throw the book at them.

The research I did for the suicide video lead me to numerous incidences of crimes committed by veterans. Most of the time they were against family members or significant others. These were not random crimes. We have a lot of veterans in prison right now directly tied to drug use and alcoholism otherwise known as "self medicating." We also have crimes committed because they are in fact a lot like the general population and some of us commit crimes too. No one should ever get a "get out of jail card" free for any reason, unless of course they are innocent or impaired. We all need to take a serious look at all the ramifications of combat and stop putting them into group A or B. None of them go into combat the same or for the same reason and none of them come out the same as their buddy does. The only one thing connecting all of them is that they are rare and they faced death because they served in a time of horror. Some times it comes home with them and we need to deal with it, step up when it did and try to provide the right response to it.