Friday, March 1, 2013

Is Malaria really that bad?

Today I visited Capitol Travel Medicine of Arlington, Virginia to get my immunizations ready for the trip to Ghana. I'm giving the full name because you can consider this post a wholehearted endorsement; they were very pleasant and extremely helpful. Yellow Fever shots aren't the most painful thing in the world--mine ended with small welt and a lingering medicinal sting, the kind that reassuringly reminds you that you've just had a weakened but potentially deadly virus injected into your body. For your own good, of course.

But when it came to anti-malaria medications, I had a nasty shock. I'd already gotten a prescription through my doctor for what I thought, more fool me, was Malarone (the only antimalarial I was familiar with). Instead it turned out to be the cheaper option, Mefloquine/Lariam, taken once weekly. I'd heard that Malarone, when taken for a long time, gives you strange dreams. Nobody seemed very concerned, though, so when my mother read my prescription's side effects and seemed worried about them, I dismissed it as overprotective mom syndrome.

Even though the list--headache, dizziness, vivid dreams (by which they mean nightmares), insomnia (in conjunction with the nightmares?), central nervous system disturbances including not least anxiety and, my least favorite of all possible symptoms, psychosis; with the frankly unsurprising by this point conclusion of suicidal thoughts--was disturbing enough to make my sister ask, per the title of this post, "Is malaria really that bad?"

To ease everyone's minds, I asked the nurse practitioner at the clinic about the side effects. Minds were not eased. I'd figured the side effects were very rare, but the information sheet she had on malaria medication states that 20% of people taking lariam experience them. Now, 1 out of 5 is not a particularly desirable statistic even for dizziness and unpleasant dreams, but insomnia would completely ruin my trip and, God forbid, experiencing psychosis (or even living under the perceived threat of it) while on my first international trip, one for which I'm already preparing to be tested to my physical and mental limits...

Nope, never mind!

The cincher was when she told me that she would not recommend for her own family members that they risk any of those side effects while on their first trip abroad, especially since we'll be going to some remote areas. So she wrote up a prescription for the generic version of Malarone, which I'll be happily taking daily. Side effects are much rarer with it--she told me the placebo group tends to experience more symptoms than the group on the drug. A reassuring statistic but also head-tiltingly strange. If true, what does this imply? The placebo group experiences side effects through the power of suggestion, because they're expecting to experience some. However, wouldn't the group on the drug go in with those same expectations? Would this imply that Malarone has a dampening effect on the power of suggestion?

Perhaps there was a only a problem with the double-blind experiment's methodology. In any event, I'll be taking this miracle drug for a month or less, in contrast to the 9 weeks I'd be on the potential-psychosis meds. Easy choice, though I wince at the added cost, and also I'm not sure what to do with the malaria pills I will now not be taking. A part of me that I will surely suppress wonders how much I could make fencing them to a classmate with more a benevolent personal history with psychological side effects.