NQI Analysis: Charles Perry. Ohio, USA (Jan-1999)
In early 1999, six-months after returning from a safari in Africa, Charles Perry, happily married with seven children went down into the basement to get a gallon of milk… Instead, he grabbed a shotgun
Who was Charles Perry?
An excerpt from The Washington Post longread The Lariam Files. Excerpt:
In January 1999, Charles Perry--a $160,000-a-year hospital administrator with seven children--had gone downstairs in his Cincinnati home to retrieve a gallon of milk. Instead he got a shotgun, angled the barrel against the base of his skull and pulled the trigger.
He had told his wife, Linda, many times that that was where it hurt the most. The pain at the base of his cranium, the nightmares and the hallucinations--they all had started six months earlier, during a safari trip to Zimbabwe to celebrate their 30th wedding anniversary.
Because of their public health backgrounds, both Perrys had asked about Lariam's safety--at the pharmacy and at the local health department. They were told it was fine--in fact, the "drug of choice."
After a week canoeing the Zambezi River, Charles Perry began imagining there were monkeys in their room.
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1. Does the situation meet the FDA Blackbox warning rule: ‘BEHAVIOUR THAT IS UNUSUAL?’
What caught my attention: David Stuart MacLean mentioned the case in his 2014 book, The Secret to the Riddle is Me: A Tale of Amnesia over five lines. It intrigued me. So, I did the deep dive into the tragic tale of Charles Perry…
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2. Was the person(s) exposed to antimalarials. If YES…
a. Which one(s)?
b. For how long?
c. Were there multiple exposures?
CERTAIN (exact dates not confirmed but approx. mid-1998)
Mefloquine prescribed for a Safari trip to Zimbabwe six-months prior to celebrate their 30th wedding anniversary. The CDC Yellow Book in 2024 still states you should take mefloquine for Zimbabwe:
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3. How was the person(s) mental health?
Charles Perry’s had no issues with Mental Health prior to Mefloquine
Charles Perry, a hospital administrator and his wife, Linda, a registered nurse were both in good health prior to the Safari to Zimbabwe and the Lariam.
Charles Perry only started to act strangely during the month after he returned home to Ohio. This was reported in The Dark Side of Lariam via CBS News. Excerpt:
In 1998, Linda and Chuck Perry left their Midwest ranch and their seven children to go on an African safari for their 30th wedding anniversary. Linda, a registered nurse, checked with her doctor, her pharmacist, and the local health department. For malaria protection, they all recommended Lariam.
"The first warning I ever got was from the safari guide in Africa," says Linda. "She says to me, 'Well, why do you take Lariam?' It's a hallucinogen very much like LSD.' And I said, 'the CDC recommends it.' And she said, 'Well, we never take it.'"
After four doses of Lariam, the Perrys were having night sweats and vivid nightmares. But everyone, including the CDC, had stressed taking the full dose of the drug, which meant taking it for four weeks after the trip. That's when Chuck Perry's real problems began.
"(He) didn't know where he was. I mean, he ran out in the yard," Linda Perry says. "I can remember tackling him in the yard saying, 'What are you doing? What are you doing?' you know. (He said) 'The neighbors are after me, somebody's after me.' And it was just bizarre.
Linda Perry says her husband had no prior history of depression or mental illness. Chuck Perry was hospitalized and tested repeatedly. A team of doctors became convinced that Lariam was responsible. Linda says that the doctors didn't know how to help him. Six months after returning home from Africa, Chuck Perry committed suicide.
"We had no way to know that this drug would be so powerful that it could alter his personality so much and damage him so much that he would, in fact, do that in some type of delusion or hallucination. That's what we didn't know," says Linda Perry.
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4. Were there any confounding variables?
NO
· No known confounding variables or comorbidities
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5. Was there a specific clinical event or trigger?
NO. It looks like a steady decline in mental health until January 1999
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6. Other considerations?
YES. Roche settled the case after two years, then changed its product information
Another excerpt from The Dark Side of Lariam via CBS News:
But Roche did know something about Lariam and suicide. Over the past year, two UPI reporters, Dan Olmsted and Mark Benjamin, unearthed internal documents. They show that by the time Chuck Perry killed himself, the company knew of at least seven suicides, and 13 suicide attempts, by people living outside the United States - all associated with Lariam. But nowhere in its product information was there any mention of the word suicide.
After two years of trying to attribute Chuck Perry's suicide to other causes, Roche settled a wrongful death suit with Linda Perry last May.
Two months later, Roche dramatically changed its product information. Psychiatric side effects are now in the warning section, including, for the first time, rare cases of suicide.
But Roche says there is no proof linking its drug to suicide, and points out that Chuck Perry is the only reported American suicide of the more than five million who have taken Lariam in the U.S. that doesn't address the other suicide reports outside the United States, but Roche says those cases are well below the suicide rate in the general population. Roche declined to give current figures, saying that accurate numbers on all reported events are hard to come by.
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ASSESSMENT
CERTAIN
Confirmed by medical diagnosis while still alive and postmortem. Roche settle the wrongful death in May 2002 (as reported by CBS News, 2003).
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UPDATES
26.05.2024: Reviewed/Updated: Major rewrite utilising the Liverpool School of Tropical Medicine approach to reviewing mefloquine related deaths (2017).
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REFERENCES
Centers for Disease Control and Prevention (2024) Yellow Fever Vaccine & Malaria Prevention Information, by Country. CDC Yellow Book 2024 [https://wwwnc.cdc.gov/travel/yellowbook/2024/preparing/yellow-fever-vaccine-malaria-prevention-by-country/] Page accessed 14.05.2024
Epstein, K (10.10.2000) The Lariam Files [https://www.washingtonpost.com/archive/lifestyle/wellness/2000/10/10/the-lariam-files/632d355e-33a2-41d0-b76a-c876938fa813/] The Washington Post. Page accessed 12.05.2024
Kohn, D (27.01.2003) The Dark Side of Lariam [https://www.cbsnews.com/news/the-dark-side-of-lariam/] CBS News. Page accessed 12.05.2024
MacLean, D.S. (2014) The Answer to the Riddle is Me. A tale of Amnesia. Houghton Mifflin Harcourt, Boston, MA, USA
Marriot, A.G. (2022) If you wake at Midnight. The Lariam wonder drug scandal. Austin Macauley. London, UK
Tickell-Painter M, Saunders R, Maayan N, Lutje V, Mateo-Urdiales A, Garner P (2017) Deaths and parasuicides associated with mefloquine chemoprophylaxis: A systemic review. Travel Medicine and Infectious Diseases. DOI: 10.1016/j.tmaid.2017.10.011
UPI (21.05.2002) UPI Investigates: Lariam and suicide [https://www.upi.com/Top_News/2002/05/21/UPI-Investigates-Lariam-and-suicide/96011022002526/]. Page accessed 12.05.2024