WASHINGTON -- Early one Sunday evening six years ago, Army Pfc. George D.B. MacDonald made his way through his Fort Benning barracks to the bunk where a 23-year-old recruit named Rick Bulmer lay sleeping.
They were strangers.
Wielding a 3-inch, double-edged knife, MacDonald stabbed and slashed Bulmer more than 50 times. He started with the throat, but didnt stop there. Bulmer, a Fresno, California native, awoke and fought back, but he never had a chance.
With the May 18, 2008, homicide, MacDonald ended one life and tore apart many others. The 19-year-old onetime Eagle Scout created a widow and a fatherless child. He stole a son and took a beloved brother.
I snapped and didnt like it, MacDonald wrote, about nine hours after the killing. I was stretched and it made me crazy.
What triggered the promising young paratroopers homicidal outburst?
MacDonald blames Chantix, a smoking-cessation drug used to wean people from their addiction to nicotine. A military jury didnt buy his story, and in December 2009 he was convicted of premeditated murder and sentenced to life in prison without the possibility of parole.
While his homicidal claim is rare -- MacDonald may be the first, and so far only, murder defendant to go all the way to trial with a Chantix defense -- questions about the drugs safety are not.
Others have blamed the prescription pill for suicides, suicidal thoughts or other psychiatric problems. More than 2,000 joined in lawsuits against Pfizer, the drugs manufacturer. Most have largely since been settled, at a cost to Pfizer of at least $299 million.
Chantix sales, meanwhile, totaled $486 million during the first nine months of 2013.
A autopsy report on the 2009 suicide of Warner Robins Mayor Donald Walker placed partial blame on Chantix. The report said he had been drinking heavily as a result of severe depression caused by the drug.
His widow, Patricia Walker, said last week she was once part of a class-action lawsuit against Pfizer, but she was dropped because the drugs label includes a warning about drinking alcohol while taking Chantix.
Asked whether she blames the drug for Walkers death, she said, I dont know.
Walker also said her husband had not used it for a month before his death because he had not been sleeping well while taking it.
On May 13, MacDonald will get one more chance to plead his case when the nations top military appeals court will decide whether the trial judge erred when he quashed a wide-ranging subpoena for Pfizer documents. The documents, MacDonalds lawyers say, might have helped prove the potential dangers of Chantix.
The U.S. Court of Appeals for the Armed Forces will also examine the judges decision not to tell jurors about the defense of involuntary intoxication.
He was denied the right to present his defense, said MacDonalds appellate attorney, William E. Cassara.
Whatever the court decides, a McClatchy review of thousands of pages of transcripts, court documents and regulatory filings found that the medical and legal twists and turns in MacDonalds case have lagged behind the safety alarms over Chantix.
The McClatchy review shows:
Two days before Bulmers killing, the Food and Drug Administration warned that Chantix patients who develop neuropsychiatric symptoms should cease taking the drug and contact their doctors immediately. By then, MacDonald would later say, he was suffering from morbid nightmares and a growing sense of unreality. MacDonald apparently never learned of the warning.
Five days after the homicide, the Defense Department declared that missile crews and air crew members should avoid taking Chantix. Pentagon officials explained that it was essential that service members are given and use medications that do not put them and others at increased risk of injury or death.
One month after the slaying, in June 2008, the Department of Veterans Affairs began contacting 32,000 veterans whod been prescribed Chantix, advising them of potential side effects, including suicidal behavior.
One week after the trial judge refused on June 24, 2009, to compel Pfizer to comply with a wide-ranging subpoena, the FDA imposed a black box warning on Chantix, citing the potential for serious neuropsychiatric problems, including hostility. The warning -- the most serious a medication can carry and still be sold in the U.S. -- was followed by some 2,700 civil claims asserting Chantix had caused suicides, suicidal thoughts or other problems.
It is important to note that there is no reliable scientific evidence that Chantix causes serious neuropsychiatric events including those at issue here, Pfizer said in a recent statement to McClatchy.Army attorneys, in a brief filed April 23, dispute the potential effects of Chantix and MacDonalds need for more Pfizer documents.
Even if the materials sought by defense counsel proved that Chantix caused (MacDonald) to suffer from a severe mental disease or defect, there is overwhelming evidence that shows (MacDonald) was able to understand both the wrongfulness and magnitude of his crimes, Army Capt. David M. Goldberg declared in the governments brief.
Chantix, also known as varenicline, combats nicotine addiction. Nicotine stimulates the brain receptors that are responsible for releasing a neurotransmitter called dopamine. Scientists sometimes liken dopamine to strong coffee. A little can increase alertness and the sense of well-being. A lot can breed jitters, anxiety, paranoia.
Chantix stimulates those same receptors, blocking the nicotine but releasing enough dopamine to ease withdrawal. Tests show it can work.
In pre-approval clinical studies of more than 6,000 patients, 44 percent of those who used Chantix and received counseling over a 12-week period successfully quit smoking. Only 18 percent of those given a placebo and counseling quit.
Chantix is an important, effective, FDA-approved treatment option for adult smokers who want to quit, Pfizer said in its statement. Chantix is approved for use in more than 100 countries and has been prescribed to over 20 million patients worldwide, including more than 10 million in the United States.