WASHINGTON, February 23, 2016 -The popular anti-malaria drug mefloquine, brand name Lariam, is again coming under fire for causing extreme side effects including drastic changes in personality and behavior.
In the latest case, the attorney for a highly decorated Navy Master Chief convicted of a child exploitation enterprise says the drug is responsible for his actions.
Robert Edward Cuff, 53, entered the Navy in 1983 and was a counter-intelligence officer serving in areas such as Somalia, Afghanistan and Iraq. He was working against major drug cartels in Mexico when he was arrested on July 15, 2011 on charges related to possession of child pornography.
The arrest shocked those who knew Cuff, and it appeared to be completely out of character.
“He’d never been in trouble with the law before besides a driving under the influence (conviction),” said Cuff’s sister, Jackie Siebert, a model and actress.
Now Cuff’s lawyer has filed a motion blaming a combination of alcoholism, untreated post-traumatic stress disorder and the anti-malaria drug mefloquine, sold under the brand name Lariam, for Cuff’s actions.
Siebert said Cuff started taking Lariam in 1992 and continued taking it on and off over the next two decades. She further noted that he had no treatment for his symptoms, even though problems associated with Lariam had been well-documented for over a decade.
A 2003 CBS report revealed problems with the drug. According to that report, the army sent a team to investigate what was behind a series of brutal crimes, including the brutal murder by four Ft. Bragg soldiers of their wives. The report stated, “One possible suspect was mefloquine — brand name Lariam, an anti-malarial drug. It was invented by the U.S. Army and is routinely given to soldiers deployed overseas. In scientific terms, Lariam can cause neuropsychiatric adverse events. In plain language, it can make lose your mind. No one questions Lariam’s effectiveness in preventing the deadly disease of malaria. Millions of tourists and other world travelers have taken it with no problem.”
An investigation by the British newspaper The Independent also found neurological problems in British soldiers caused by Lariam.
The label for mefloquine warns of possible severe side effects. By 2004, the Food and Drug Administration insisted that a patient medication guide be given to all recipients of mefloquine prescriptions. “The U.S. Food and Drug Administration (FDA) is advising the public about strengthened and updated warnings regarding neurologic and psychiatric side effects associated with the antimalarial drug mefloquine hydrochloride. A boxed warning, the most serious kind of warning about these potential problems, has been added to the drug label.”
But the military has continued to downplay the effects of Lariam. The VA’s website, for example, acknowledges only mild side effects from the drug, “Most people who take mefloquine do not experience side effects. For those who do, the most common reported side effects include nausea, vomiting, diarrhea, dizziness, difficulty sleeping, and bad dreams. These symptoms are usually mild and do not cause people to stop taking the medicine.”
A 2007 white paper published in the Journal of the Royal Society of Medicine by Lieutenant Colonel A.M. Croft, RAMC, says Lariam continues to be administered in the military long after its deleterious side effects had been well-established by others in medical professions because it was discovered in the military, making it more cost-effective.
Dr. Remington Nevin is an MD, MPH in the Department of Mental Health at Johns Hopkins University. He has studied the effects of Lariam since his own stint in the military.
Dr. Nevin examined Cuff’s medical records and spoke to him on the phone numerous times for a forensic exam after his arrest.
“The question was how did this very high-achieving guy end up being such a train wreck,” Nevin stated. “The most likely explanation was the result of Lariam.”
Dr. Nevin said the toxic effects of Lariam include evil thoughts, limbic system damage and a marked difference in sexuality.
Dr. Robert Stanulis is a neuropsychologist practicing out of Portland, Oregon, and in a report filed with the court, he concurred with Nevin’s professional opinion.
“Mr. Cuff’s criminal behavior is to a reasonable degree of medical and psychological certainty caused by and the direct result of the adverse side-effects of the medication he was ordered to take in the military.” Stanilus stated. “The first and perhaps most compelling mitigating factor in Mr. Cuff’s case is that Mr. Cuff’s criminal behavior is, to a reasonable degree of psychological and medical certainty, the direct result of a limbic encephalopathy that was caused by the adverse side effects of taking as ordered by the military the anti-malarial medication mefloquine during his deployment in Somalia.”
Stanulis’ conclusions dovetail with a 1986 University of California at Los Angeles Medical Center study that found hyper-sexuality and altered sexual preferences in middle aged patients following brain injuries.
“Eight patients are described in whom either hyper-sexuality (four cases) or change in sexual preference (four cases) occurred following brain injury. In this series disinhibition of sexual activity and hyper-sexual activity occurred following media basal frontal or diencephalic injury.”
Siebert said her brother described many symptoms consistent with the toxic effects of Lariam. She said he told her of a voice in his head he described as “the beast and Tony” and told her this was one of about 30 voices he heard regularly.
Siebert said her brother told her these voices first appeared shortly after first taking Lariam.
“His wife and daughter are clear that he returned from Somalia a changed man. He began to obsessively collect and watch torture and beheading videos. He asked his daughter to watch the torture videos with him. He obsessively downloaded movies and music from the Internet as a means to avoid intrusive thoughts,” Stanulis said in his report describing other symptoms consistent with the toxic effects of Lariam.
Nevin said authorities ignored the signals that the drug was having a toxic effect on Cuff, and that the military continued to administer the drug long after he should have been taken off it.
Dr. William “Bud” Brown is an expert on military culture who has testified more than a hundred times in military-related trials as an expert witness. He believes that untreated effects of PTSD also contributed to Cuff’s criminality.
“During the time he spent in Somalia he said that he witnessed enemy casualties several times,” said Cuff’s sister Jackie Siebert. “Robert said that he directly participated in causing the enemy casualties, and that participation caused no emotional thoughts or concerns. Robert was asked if he had ever witnessed civilian casualties during his service in Somalia. He said yes and noted there were several occasions that he witnessed civilian casualties and that he had both direct and indirect participation in those casualties.”
Brown said he has testified in a handful of child pornography cases of men Cuff’s age, and there were a few common denominators: all were older males who had served in the military for decades, and all had traumatic war-related experiences.
“Most of these got involved in child pornography as a way to divert their thought process from some of the things they experienced in the military,” Brown said.
Brown said the military culture would have forced Cuff to hide symptoms of PTSD because any report made to a medical professional that he was suffering from the effects of PTSD would have meant his immediate honorable discharge.
“Mr. Cuff also has PTSD which also involves the limbic system of the brain.” Stanulis said in his report.
Siebert said she also believes that most of her brother’s pertinent medical records are being hidden from her or have been destroyed.
She said that despite the fact that Cuff served in the Navy for nearly 30 years, the Navy provided her with only a page and a half of medical history.
A letter sent to her from the Expeditionary Medical Facility in Djibouti, Africa, where Cuff was stationed for about seven months, states,“We have searched our patient information system and have found no pharmaceutical records exist.”
It would have been impossible for her brother not to have been administered with Lariam in Africa, as the Centers for Disease Control warns travelers to take medicine before arriving, “You will need to take prescription medicine before, during, and after your trip to prevent malaria.”
Luchrecha Calleance, of the Djibouti Expeditionary Medical Facility’s Patient Administration Office did not respond to an email for comment.
When Cuff’s U.S. Congressman, Democrat Steve Israel, inquired about Cuff’s medical records, the Navy again said they couldn’t be located,
“Since the Bureau of Medicine and Surgery does not maintain medical or personnel records pertaining to members who have separated from service, inquiries were made by a member of my staff,” the letter stated. “My office did not locate his paper military records but did obtain his electronic medical record.”
The letter went on to state that electronic forms could be obtained by filling out the proper forms. However, Siebert said after all the forms were filled out she only received the same short medical summary.
Siebert said none of the military records for her brother show he was prescribed Lariam.
Siebert did, however, prove that Cuff took Lariam in Somalia after a platoon mate provided her with his medical records.
According to Siebert, after speaking with her brother and reading his interviews with Dr. Brown, she created a timeline showing Cuff took Lariam from 1992-1993 in Somalia, in 1998 in Honduras, in 2001 in Paraguay/Trinidad&Tobago, in 2004 in Sri Lanka, during a seven-month period from 2005-2006 in Djibouti, and in 2007-2008 Iraq/Afghanistan.
The U.S. Navy has stated that Cuff did not take Lariam in any of these instances.
None of this expert testimony has been entered into the court, because Cuff signed a plea deal and was sentenced to spend the rest of his life in prison.
Siebert said that Cuff was suffering from extreme anxiety and paranoia after his arrest and that he did not understand the deal he signed. Moreover, his then-attorney, Stephen Karns, had been on the case for only about a month and had not yet prepared a defense yet.
Karns’ office, located in Dallas, declined comment citing confidentiality issues.
Cuff’s attorney has filed a motion to vacate the plea, citing ineffective counsel.
Mona Hardwick, the public affairs officer at the U.S. Department of Justice whose name is attached to the press release announcing Cuff’s conviction, did not respond to an email requesting comment.
The public affairs office of Navy personnel declined an on the record comment, citing privacy under Health Insurance Portability and Accountability Act (HIPAA), but did provide releasable information that included Cuff’s numerous awards, including the:
- Joint Service Commendation Medal,
- Navy/Marine Corps Commendation Medal,
- three Navy/Marine Corps Achievement Medals,
- five Joint Meritorious Unit Awards,
- two Meritorious Unit Commendation Good Conduct Medals,
- six Navy “E” Ribbons,
- four National Defense Service Medals, an Armed Forces Expeditionary Medal Global War on Terrorism Expeditionary Medal,
- Global War on Terrorism Service Medal,
- an Armed Forces Service Medal
- Humanitarian Service Ribbon,
- three Sea Service Deployment Ribbons,
- seven Navy and Marine Corps Overseas Service Ribbons and
- eight Rifle Marksmanship Medal Pistol Marksmanship Medals.