The Australian Veteran Who’s Tackling Tafenoquine

Newest anti-malarial more dangerous than mefloquine.

Stuart McCarthy was 19 years old when he joined the Australian Army in 1988. He graduated from Royal Military College – Duntroon two years later with dreams of being a pilot. That dream crashed though six months into pilot training, when he joined the ranks of the 50% who fail to get their wings.

That didn’t stop him from pursuing a career in the military though, as he transferred to the engineers where would prove to be a more than capable officer. His skills as a military engineer were second to none, good enough for him to be appointed Adjutant of the School of Military Engineering. To make the distinction, being a military engineer does not require a degree in engineering, but the feats accomplished by military engineers are themselves worthy of mention.

It is the military engineers who build the roads, bridges, and airfields where none existed before, in incredibly short periods of time. These are structures that will last for years, and some of the roads and bridges that Stuart has built are used to this day on a regular basis.

He holds a BA in History. Ancient history and the classics are of particular interest to him, but he hasn’t limited the extent of his knowledge to these subjects alone. He is an autodidact; someone who, like myself, has done the bulk of their learning outside of a formal educational setting. When Stuart wants to learn something new he takes the time to thoroughly research the subject and spends many hours reading whatever detail he could find. He’s a very intelligent man with a very highly tuned and accurate bullshit detector, and he isn’t afraid to call out BS when he see it.

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End of Op Slipper

He excelled at his job, and eleven years later, in 1999, he would be in command of a multi-national patrol in Bougainville, Papua New Guinea, which was in the midst of civil unrest at the time. This was as part of the Peace Monitoring Group (PMG), which consisted of military and civilian personnel from Australia, New Zealand, Fiji, and Vanuatu, and would be for him the most rewarding experience of his career. Near the end of that deployment however, he would attend a briefing that would change his life forever.

An unethical drug trial

The briefing was conducted by Lt.Col. Peter Nasveld, a doctor with the Australian Army Malaria Institute (AMI). McCarthy would later relate what was discussed at that meeting.

“When Dr Nasveld arrived at our team site in Bougainville we were gathered together in our common room for his briefing. We were a captive audience. Nasveld was both a senior Army officer, outranking every other member of the team site, and a military doctor – someone we believed we could trust with our health. He gave us his sales pitch about his new wonder drug. Tafenoquine was being trialled for terminal prophylaxis, at high doses. The comparator drug was primaquine, the slightly less toxic quinoline that was already being used by the Australian Defence Force. Dr Nasveld’s main sales pitch was that the tafenoquine course only needed to be taken for several days, compared to the primaquine course of two weeks. Given that you’re not supposed to drink alcohol while taking either drug, his main pitch was that if we used tafenoquine we could “get on the booze” much sooner when we arrived home. As a 29 year old, this sounded pretty good to me so I “volunteered” for the trial. We were also informed that tafenoquine was in use in the US military, which I later discovered was a lie.

“I can’t recall what if any warnings we were given about side effects but in any case it was impossible for us to receive any independent advice. There was no internet and we were entitled to one satellite phone call each week for two minutes to contact our families. Each of us tossed a coin to determine which drug we would take. My coin toss came up tafenonquine. I was given 400mg of this drug per day, for three consevutive days, which is 14 times the rate of the standard “safe” 200mg weekly dose used in subsequent trials.  We signed a few forms and Dr Nasveld was on his way. Whenever I think back to that day it makes me feel sick to the stomach.”

Maj. (Ret.) Stuart McCarthy
https://imvalliance.org/2015/11/01/our-stories-major-stuart-mccarthy/

I have often wondered how some physicians can reconcile their medical ethics and their duties as a military officer. There are often times that the two come into conflict, and this would be one of those times. The briefing that day was given by Lt.Col. Peter Nasveld, not by Dr. Peter Nasveld, and yes one can make that distinction quite easily. Col. Nasveld isn’t bound by the same set of ethics that Dr. Nasveld is.

2001-Ethiopia and Eritrea

In 2001 Stuart was deployed to Ethiopia and Eritrea for six months as part of a United Nations mission, where he was the deupty force engineer. During that deployment he was prescribed mefloquine as an anti-malarial prophylactic.

He would suffer from a variety of the adverse side-effects that are associated with mefloquine, including depression. Quite often, soldiers who are deployed on United Nations missions encounter stressors that can cause depression and anxiety. Because of this these signs of mefloquine toxicity go unrecognized for what they are.

When he began experiencing suicidal ideations he stopped taking it, as was recommended by the drug’s manufacturer, Roche. He had assumed that these side-effects would wear off and that there would be no long term ramifications to his health. When he returned to Australia however, they became even worse, and McCarthy fell into a state of severe depression. It became so severe as to be debilitating and ultimately would have a detrimental effect on his career. His chances for advancement had been all but obliterated.

Major Stuart McCarthy was given a medical release from the ADF in March of 2017 after he was finally diagnosed as having an acquired brain injury (ABI), following a lengthy fight with them.

To read Stuart McCarthy’s full story, click the link to the International Mefloquine Veteran’s Alliance page below:

https://imvalliance.org/2015/11/01/our-stories-major-stuart-mccarthy/

Mad respect for Stuart McCarthy

I have always prided myself on my skills as an investigator and researcher, but when I met Stuart, I knew that I had met someone whose skills surpassed mine and so for this and a few other reasons, I have a great deal of respect for him.

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Afghanistan

He pored over journal articles and research papers, finding evidence of the neurotoxicity of tafenoquine.

The elevated toxicity level of Mefloquine compared to eight antimalarial drugs has been verified within the neurotoxicity and general toxicity assays. In the neurotoxicity assay, Tafenoquine (IC 50 =12.1 µM) is the only antimalarial more neurotoxic than Mefloquine (IC 50 =20.1 µM) as indicated by the relative IC 50 values (Table I.) 

The application of cell culture techniques is vital for determining potential toxic effects of drugs in drug development studies.  Antimalarial Drugs are essential components for eradicating the devastating effects of malaria.  It is essential that in combating this disease, toxic levels of drugs are alleviated as much a possible.  Although substantial advancements within malaria drug research have been made over the last four decades, discovering a drug that is potent, has an extensive half life, and low adverse side effects is key to truly finding a definitive cure. In the neurotoxicity screen, mefloquine exhibited the highest toxicity with the exception of tafenoquine. In the RAW and VERO cell line general toxicity screen mefloquine was the most toxic. The patterns of toxicity in the RAW, VERO and neuronal cell line are very similar to each other with few exceptions. While mefloquine is currently considered one of the most effective drugs against malaria, additional research can be conducted to evaluate toxicity levels in mefloquine and other antimalarial drugs which exhibit degrees of toxicity.

In-Vitro Toxicity Assessment of Antimalarial Drugs on Cultured Embryonic Rat Neurons, Macrophage (RAW 264.7), and Kidney Cells (VERO- CCl-81)
Rebecca Agboruche, Kalamazoo College
Dr. Debra Yourick, Dr. Diana Caridha, Walter Reed Army Institute of Research

A journal article.

It really says a great deal about a person when they write an article that is published in a scientific journal. It says even more when that person does not hold a degree in medicine or in any other discipline of the sciences.

This is what happened in 2015, when the very reputable Journal of Parasitology Research published his review article: Malaria Prevention, Mefloquine Neurotoxicity, Neuropsychiatric Illness, and Risk-Benefit Analysis in the Australian Defence Force.

https://www.hindawi.com/journals/jpr/2015/287651/

A letter to the editor

His brilliance is evident again in a 2019 letter that was published in the New England Journal of Medicine. Stuart co-wrote that letter in response to an article titled “Tafenoquine versus Primaquine to Prevent Relapse of Plasmodium vivaxMalaria”, which reads in part below.

Letter to The Editor: Tafenoquine versus Primaquine to Prevent Relapse of Plasmodium vivaxMalaria

https://www.nejm.org/doi/full/10.1056/NEJMc1902327

When I was researching mefloquine in the early days of my investigation, there were dozens upon dozens of academic papers and articles to filter through, and these covered about a 50 year period. Quite a lot of valuable, though at times somewhat dubious, information and data.

When I tried doing the same for tafenoquine though, I didn’t get anywhere near the number of hits. Relatively speaking there was very little for me to go on, I had none of the same insight into tafenoquine that I had when it came to mefloquine. Frankly the studies that were there were of little interest to me, but they should have been. They were of extreme interest to Stuart and he was able to glean some very valuable information from them.

What he found.

Stuart McCarthy had discovered two very important things about tafenoquine, and knowing these things will save your life.

First, the studies of the neurotoxicity of tafenoquine showed that it was even more neurotoxic than mefloquine, which was the most toxic of the drugs tested. Given what is already known about mefloquine, this alone would be enough for me to decide that I would never take this drug. But, it gets even better.

The other thing McCarthy noticed was that tafenoquine was not effective in approximately a quarter of the people who take it. This is because of something called the CYP2D6 enzyme, which the body produces and is necessary for the proper metabolization of certain drugs in the human body. One of these is tafenoquine. For people who do not produce enough of this enzyme, drugs like tafenoquine will be completely ineffective.

A lose/lose situation.

So, in a nutshell, there is a reasonable probablility that tafenoquine will NOT protect you against malaria AND taking it could result in permanent, debiltating brain damage.

Somehow this drug has been approved by regulatory agencies globally, so it is now available for prescription use. If you are going to be travelling to a malaria zone and you have to take a prescribed anti-malarial prophylaxis, you MUST talk to your doctor first. Ask them to perform a blood test to check on your CYP2D6 levels, and talk to them about the potential risk of damage to the brain stem when taking this medication.

You should always use appropriate precautions when travelling to a malaria zone and use of prophylaxis is advised. It is so very important that anyone taking these medications do their own thorough due-diligence prior to taking them. As with any drug, failure to do so could result in life altering and/or potentially life ending injuries.

The fight goes on.

Like other veterans from militaries around the world, Stuart more often than not faces an uphill battle when it comes to fighting for the care and recognition he deserves. But he’s doing it for the many thousands of ADF veterans who are unable to carry on this fight themselves. He has been their leading advocate, and is a powerful force not only in Australia, but for veterans across the world.

Australia, hell the world, has been better off for the existence of a number of Australians over the years, and right now two of them are majors in the ADF, Maj.(Ret.) Stuart McCarthy and his friend Major David McBride. They stand out as two defenders of the truth not only in Australia, but for freedom loving people everywhere.

D.B.

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