Congress, Peanuts & Mefloquine

In a November 9th letter to the Pentagon and the Department of Veterans Affairs, Senator Bob Menendez (D-NJ) urged them to create a registry to monitor the long-term health of veterans who took mefloquine, a once-weekly anti-malarial that the Food and Drug Administration has warned can heighten the risk of schizophrenia.

Ever the optimist that I am, I think this letter is a positive step in the right direction, since a registry is necessary to compile enough data to study the long-term effects of mefloquine exposure and to form smart policy to address any problems arising from its use. Unfortunately, it’s slow going in the United States Congress. Rep. John Carter (R-TX) had introduced an amendment to the House version of the defense bill. When there are differences in proposals between the House and Senate, a conference committee is formed to hash out a compromise.

The conferees tossed the House mefloquine provision out. Despite this, the conferees noted that they were “concerned” that “mefloquine may produce serious neuropsychiatric side effects such as depression, auditory and visual hallucinations, anxiety, and suicidal ideation.” Continuing, they wrote that “[t]he conferees urge the Department of Defense to limit the prescription of mefloquine to those servicemembers who may be unable to take other first-line anti-malarial drugs.”

The conferees made no mention of those veterans who have already used mefloquine and are no longer in the United States military. Nor did they mention the FDA’s 2013 warning. Considering that the military has already started to quietly back away from mefloquine, the conferees’ statement seems a little out of place.

Let’s put mefloquine into context and see where Congress’s priorities are. I think actions speak louder than words. In the 114th Congress (2015–2016), there have been only three pieces of legislation introduced that mention mefloquine. Before the 114th Congress, the last time anyone introduced a bill that mentioned mefloquine was a decade ago, during the 109th Congress; there were three bills, to be exact.

Now, let’s compare mefloquine to peanuts. I love peanuts like the next guy and I have nothing against hardworking peanut farmers or peanut butter distributors or the American Peanut Council. But it’s a little odd that: two bills in the 114th Congress involved peanuts; 17 in the 113th Congress; 20 in the 112th Congress; 4 in the 111th Congress; 17 in the 110th Congress; and 25 in the 109th Congress. Adding that all up, and if my math is right, that would be 85 bills that involved or otherwise referenced peanuts. Eight-five for peanuts, six for veterans’ use of mefloquine.

You see a similar trend when you dig through the Congressional Record. After all, while actions speak louder than words, words are still important. In the past decade, mefloquine was mentioned five times in the people’s diary. Peanuts? In only the 114th Congress alone — to be clear, in only the past two years — over 60 times.

If the conferees urged the Pentagon to limit mefloquine use because of its serious side effects, why wouldn’t they consider keeping a proposal to have the Pentagon maintain data on the long-term health of service members who took mefloquine? More to the point, with veteran suicides attracting so much media attention, why would people in Congress be so flippant toward neuropsychiatric side effects of mefloquine, including suicidal ideation?