Daily bleg: anti-malarials

Now, I like to give out inexpert, uninformed medical advice as much as the next guy. But I have more and more research assistants in the field these days, and it would be really fantastic if none of them fell deathly ill because of, well, my research papers.

Here’s the question. We have at least two perfectly common anti-malarial options–doxycycline and mefloquine–each of which cost a few cents each. They’ve been around a while, so we know what to expect. Doxy: sun sensitivity in the occasional case, and no milk in your coffee that morning (which is a tragedy). Mefloquine: crazy dreams among a few (including me).

Along comes a fancy-pants new drug, Malarone. It costs $6 a pill, with insurance, and has to be taken every day. Why would I pay 120 times more than the generic? Is it 10 times as effective? 1.2 times? Just as effective? As far as I can tell, there aren’t studies on the matter.

So why are the Yale travel nurses defaulting to Malarone? The minute I suggested that my preferred drug, Doxy, was an alternative, they agreed and wrote out the prescription.


1. Human folly: new, more expensive things must be better;

2. Because it’s new, resistance is nil, so Malarone is by definition better;

3. Very effective marketing; and

4. Doctors don’t want to advise people to explore whether they’re among the 1 in 20 who experience a side effect from the generics.

On the con side: there are no long term studies on the effects of Malarone. So it could turn your grandchildren into mutants. Oh, and we get robbed blind at the rate of $6 a day.