Regular SBM readers are no doubt familiar with Dr. Joseph Ladapo, Florida’s Surgeon General and head of the state’s Department of Health since 2021. Dr. Ladapo first rose to prominence in 2020 in the early months of the pandemic as a prominent member of the group of crank physicians and pandemic minimizers known as America’s Frontline Doctors. It’s hard to believe it, but it’s been six years since this group first made a splash in the news by promoting hydroxychloroquine as a cure for COVID-19, even as rapidly arranged clinical trials were showing that it did not work, leading me to call it the “Black Knight of treatments for COVID-19,” a nod to the infamous Black Knight scene from the movie Monty Python and the Holy Grail. Uncoincidentally, Dr. Ladapo was also a signer of the Great Barrington Declaration, that “declaration” co-authored by our current NIH Director and orchestrated by a right wing think tank and neo-Confederate conspiracy theorist Jeffrey Tucker that called for a “let ‘er rip” strategy for dealing with the pandemic, claiming that such a strategy would lead to “natural herd immunity” in 6 months. Never mind all those people at high risk of hospitalization and death due to the virus. They just got “focused protection,” the GBD never bothering to provide details regarding how we protect them from a virus that was spreading among the rest of the population. At its heart, the GBD was a profoundly social Darwinist document that, in essence, advocated abandoning the weak to the virus so that the strong could “open up” the economy again. Basically the GBD could never have worked, as one of its supporters implicitly admitted, but managed to do devastating damage to public health, due to its influence. I bring up Dr. Ladapo, because, with the upcoming gubernatorial election in Michigan, I worry that if the Republican candidate John James wins, we might have our very own Dr. Ladapo placed in charge of the Michigan Department of Health and Human Services. I’m referring to Dr. Remington Nevin, who is currently the medical director in St. Clair County and has been referred to as “Michigan’s RFK Jr,” after our current antivax Secretary of Health and Human Services, Robert F. Kennedy, Jr.
I first encountered Dr. Nevin when he emerged as a key figure in a recent political win by antivaxxers in Michigan that weakened a requirement that parents who want to claim a personal belief exemption to school vaccine mandates for their children must first attend an educational session at their local health department. To recap why he is being called “Michigan’s RFK Jr.,” since joining the St. Clair County health department in 2023, Dr. Nevin has made it easier for parents to opt their children out of school-based vaccine mandates in his county, supported parents in trying to opt out of state immunization tracking, been on record of being in favor of removing fluoride from drinking water, ended the county’s participation in the state’s school-based health clinic program after a county commissioner raised concerns that her 12-year-old daughter had been exposed to concepts of transgender identity, homosexuality and emergency contraception at Port Huron High School’s teen health center, and declared solar farms a “possible threat to public health.” Let’s just put it this way. News reports routinely describe Dr. Nevin as having given St. Clair County’s public health department a “MAGA makeover.”
What originally brought Dr. Nevin to my attention, besides his role in watering down Michigan’s requirement for a personal belief exemption to school vaccine mandates, was another case in which he spectacularly intervened in the case of Andrew Eberly and his children:
Last fall, a dispute over the waiver process involving a St. Clair County family blew up into a local controversy, and school officials asked local law enforcement to get involved.
Although the family lived in St. Clair, the children attended high school in neighboring Macomb County. Macomb had already switched to the hybrid model, but the parents didn’t want to file any documents at all, because they didn’t want their children’s vaccination status to be known by local health officials.
The father, Andrew Eberly, said in November at a St. Clair County public health meeting that getting a certified waiver “forces parents like me to register personal health decisions” with the state, which he doesn’t trust.
Unsurprisingly, Dr. Nevin landed firmly on Eberly’s side and even provided him with a vaccine exemption letter himself. Dr. Nevin also worked to make it easier for parents to opt out of vaccine tracking involving vaccination doses being entered into Michigan Care Improvement Registry, commonly just called MICR. For details on that, I refer you to my first post mentioning Dr. Nevin, lest I repeat myself more here than I already have (although I will point out that RFK Jr.’s old antivax organization, Children’s Health Defense, loves him). Before I move on to discuss Dr. Nevin some more, I’m just going to quote this bit from CHD:
Kevin Watkins, a nurse and president of the Port Huron branch of the NAACP, told the AP that Nevin’s policies are “anti-vaccine” and “anti-public health.”
Nevin pushed back on Watkins’ claims. “Nothing about this is anti-vaccine. It’s pro-choice and it’s pro-trust,” he said. “Vaccines remain available to every family that wants them.”
You get the idea. Dr. Nevin is one of those antivaxxer or antivax-adjacent ideologues who hides his antivax and anti-public health beliefs under the guise of being “anti-mandate” and “pro-freedom.”
So where did he come from?
Who is Dr. Remington Nevin?
As I mentioned the last time I wrote about him, there are a number of aspects of Dr. Nevin’s past that set my skeptical antennae twitching when I first read about them. First, though, let’s look at how Dr. Nevin describes himself on his own website:
Dr. Remington Nevin is a physician epidemiologist and expert consultant board certified in Public Health and General Preventive Medicine and in Occupational Medicine by the American Board of Preventive Medicine and certified in public health by the National Board of Public Health Examiners.
A former U.S. Army Major and Preventive Medicine Officer and faculty associate in the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, Dr. Nevin now serves as Medical Director of the Quinism Foundation.
Dr. Nevin’s research has focused primarily on the adverse effects of quinoline antimalarials. Dr. Nevin’s work has been instrumental in improving policymakers’ understanding of the potential for long-lasting and permanent neurologic and psychiatric effects from quinoline antimalarials, as exemplified by a recent FDA “black box” warning.
This all struck me as very strange, given how Dr. Nevin has behaved since being appointed as medical director in St. Clair County in 2023. Stranger still was that Dr. Nevin appears to run a consulting and expert witness business based on this entity of “quinism.” Out of curiosity, I did a quick PubMed search for the term, having never encountered it before and wanting to know what the scientific literature says about it. The search returned 14 articles. Two were prostate cancer-related, for reasons that appear to be related to the use of drugs from the quinoline and quinazoline families being researched for use in prostate cancer. Of the remaining 12 articles, 11 were single-author with Dr. Nevin as sole author, and one included him as a co-author of a paper on Trichomonas vaginalis infection and prostate specific antigen levels. Let’s just say that when a diagnosis (like “quinism”) is used by just one investigator, that’s usually an indication that it is not a widely accepted diagnosis. If it were, lots of investigators would be using it in their published papers. I did, however, find a 2013 review article by Nevin and two co-authors that discusses the psychiatric side effects of mefloquine. Most likely it didn’t show up in my search because it predates Nevin’s coining of the term “quinism.”
In fairness, the FDA did add a black box warning for a drug called mefloquine in 2013 that stated:
The U.S. Food and Drug Administration (FDA) is advising the public about strengthened and updated warnings regarding neurologic and psychiatric side effects associated with the antimalarial drug mefloquine hydrochloride. A boxed warning, the most serious kind of warning about these potential problems, has been added to the drug label. FDA has revised the patient Medication Guide dispensed with each prescription and wallet card to include this information and the possibility that the neurologic side effects may persist or become permanent. The neurologic side effects can include dizziness, loss of balance, or ringing in the ears. The psychiatric side effects can include feeling anxious, mistrustful, depressed, or having hallucinations (For a more complete list of potential side effects, see Additional Information for Patients).
Neurologic side effects can occur at any time during drug use, and can last for months to years after the drug is stopped or can be permanent. Patients, caregivers, and health care professionals should watch for these side effects. When using the drug to prevent malaria, if a patient develops neurologic or psychiatric symptoms, mefloquine should be stopped, and an alternate medicine should be used. If a patient develops neurologic or psychiatric symptoms while on mefloquine, the patient should contact the prescribing health care professional. The patient should not stop taking mefloquine before discussing symptoms with the health care professional.
On the Quinism Foundation website, Dr. Nevin states:
The term “quinism” may seem new, but the symptoms of poisoning from mefloquine (previously marketed as Lariam®), tafenoquine (marketed as Krintafel® and Arakoda®), chloroquine (marketed as Aralen®), and related quinoline drugs are all too familiar: Tinnitus. Dizziness. Vertigo. Paresthesias. Visual disturbances. Gastroesophageal and intestinal problems. Nightmares. Insomnia. Sleep apnea. Anxiety. Agoraphobia. Paranoia. Cognitive dysfunction. Depression. Personality change. Suicidal thoughts.
These symptoms are not “side effects”. They are symptoms of poisoning from a class of drug that is neurotoxic and that injures the brain and brainstem. This poisoning causes a disease, and this disease has a name: Chronic quinoline encephalopathy — also known as quinism.
So I started searching PubMed for this term and variants. The result was thousands of articles unrelated to the term, along with a notice that the term was not recognized in the phrase library of PubMed, further implying that it is not a generally accepted diagnosis. After doing some digging, it turns out that, as far as I can tell, Dr. Nevin coined both terms, using them in a book chapter [Nevin RL. “Neuropsychiatric Quinism: Chronic Encephalopathy Caused by Poisoning by Mefloquine and Related Quinoline Drugs.” In: Ritchie EC, Llorente M, eds. Veteran Psychiatry in the US. Cham, Switzerland: Springer Nature; 2019. DOI: 10.1007/978-3-030-05384-0_20].
Unfortunately, my institution does not have access to this paper, and so I couldn’t get a copy, and I wasn’t willing to shell out $29.95 to Springer for a copy, not even for SBM. However, what I did learn is that “quinism” is a term that is not used in the medical literature and is almost exclusively used by advocacy groups attributing neurological symptoms to quinine drugs used to treat and prevent malaria. As proposed, it encompasses symptoms such as nightmares, insomnia, anxiety, depression, tinnitus, cognitive dysfunction, dizziness, and paresthesias persisting after the drug has been discontinued. This diagnosis construct has not been validated in clinical trials or adopted by regulatory bodies, medical societies, or expert evidence-based guidelines. That is not to say that neurological symptoms have not been linked to mefloquine sufficient that the FDA added a black box warning. However, reports of these neurological and psychiatric complications rest largely on uncontrolled clinical observations and pharmacovigilance reports.
Also, in that chapter, at least from what I’ve been able to glean from summaries of it, Dr. Nevin appears to repurpose the term “quinism,” previously referred to as cinchonism (a classic toxic reaction to quinine/cinchona-derived drugs that includes tinnitus, headaches, and visual disturbances) to describe a broader proposed array of disorders caused by quinoline-class drugs generally. He also introduces another term, “neuropsychiatric quinism,” to describe a chronic, long-lasting variant. The chapter’s central claim is that the “unrecognized effects of neuropsychiatric quinism in veteran populations are likely to have confounded a significant body of military research and clinical diagnosis”; i.e., that a substantial portion of existing PTSD/TBI research in veterans may actually reflect misdiagnosed drug toxicity due to quinolines. He further calls for screening veterans for quinoline exposure.
So, at this point, I didn’t see anything particularly nefarious, other than Dr. Nevin perhaps going beyond what the evidence shows. We know mefloquine can cause neurological symptoms. Indeed, there’s a Cochrane review from 2017 that summarizes what was known then about the potential side effects and adverse reactions due to mefloquine, which include:
Mefloquine has not been shown to have more frequent serious side effects than either atovaquone‐proguanil (low‐certainty evidence ) or doxycycline (very low‐certainty evidence).
People who take mefloquine are more likely to stop taking the drug due to side effects than people who take atovaquone‐proguanil (high‐certainty evidence), but may be equally as likely to stop as people who take doxycyline (low‐certainty evidence).
People taking mefloquine are more likely to have abnormal dreams, insomnia, anxiety and depressed mood during travel than people who take atovaquone‐proguanil (moderate‐certainty evidence ) or doxycyline (very low‐certainty evidence ). Doxycycline users are more likely to have dyspepsia, photosensitivity, vomiting, and vaginal thrush (very low‐certainty evidence).
So, yes, mefloquine can cause psychiatric side effects. However, the Quinism Foundation goes far beyond that. For example, in a 2020 press release warning against using mefloquine to treat COVID-19—shades of hydroxychloroquine!—Dr. Nevin is quite blunt:
The Quinism Foundation has warned of a risk of sudden and lasting neuropsychiatric effects from the use of antimalarial quinolines against COVID-19, the disease caused by the novel coronavirus, and has urged policy makers, physicians, and members of the public to be alert to such effects.
“The same endosomotropic properties that likely underlie the effectiveness of quinoline antimalarial drugs such as chloroquine and hydroxychloroquine against the virus may also underlie their dangers, ” said Dr. Remington Nevin, MD, MPH, DrPH, a Johns-Hopkins trained psychiatric epidemiologist and drug safety expert and former U.S. Army public health physician, who now serves as Executive Director of The Quinism Foundation. “These are not safe drugs.”
“Tonic water is a prescription medication masquerading as a cocktail mixer,” said Dr. Nevin. “It should not be used against COVID-19.”
“In susceptible individuals, these drugs act as idiosyncratic neurotoxicants, potentially causing irreversible brain and brainstem dysfunction, even when used at relatively low doses,” said Dr. Nevin. “This drug-induced dysfunction causes a disease of the brain and brainstem called quinoline encephalopathy, or quinism, which can be marked acutely by psychosis, confusion, and risk of suicide, and by lasting psychiatric and neurological symptoms.”
“Symptoms of chronic quinoline encephalopathy include tinnitus, dizziness, vertigo, paresthesias, visual disturbances, nightmares, insomnia, anxiety, agoraphobia, paranoia, cognitive dysfunction, depression, personality change, and suicidal thoughts, among others, ” said Dr. Nevin. “Particularly among military veterans, in whom these drugs have been widely used for decades as prophylactic antimalarials, these symptoms can mimic and be mistaken for those of post-traumatic stress disorder and traumatic brain injury.”
As much as it amused me to see someone who would later go all-in on COVID contrarianism attacking hydroxychloroquine as a treatment for COVID in March 2020, you can see how what Dr. Nevin says does not align with what much more careful assessments of the evidence, such as by the Cochrane Collaboration. Later in the press release, he misrepresents what the National Academy of Sciences (NAS) published, saying that its report on side effects of antimalarial drugs identified a “critical need” for more research into psychiatric adverse events, when in reality NAS found “insufficient evidence to determine whether there is an association between antimalarial use and neurologic and psychiatric outcomes, including anxiety, depression, and the development of symptoms that mimic post-traumatic stress disorder (PTSD),” and concluded that “research is warranted because existing studies are limited in their design.” Basically, there isn’t much in the way of compelling evidence to support Dr. Nevin’s assertions. Moreover, Dr. Nevin clearly knows that his view is not mainstream. In a press release announcing that his foundation is now offering disability evaluation services to US veterans, Dr. Nevin states:
“Veterans disabled as a result of their exposure to these neurotoxic drugs should not claim quinism or chronic quinoline encephalopathy directly,” said Dr. Nevin. “Neither should they claim synonymous conditions, such as ‘mefloquine poisoning,’ or ‘mefloquine toxicity,’ as the VA does not yet recognize these formally as medical conditions.”
“Instead, veterans should claim that the service-connected use of the quinoline drug, such as mefloquine, was the cause of another medical condition, such as a drug-induced psychiatric disorder, or a drug-induced neurologic disorder, or a physical disorder, such as sleep apnea, linked to one or more such psychiatric or neurologic cause.”
Let’s just say that the level of certainty regarding the existence of “quinism” or a syndrome resembling it expressed by Dr. Nevin and the Quinism Foundation does not align with the actual existing high quality scientific evidence, which I interpret as indicating that mefloquine and related drugs can cause psychiatric symptoms as part of their side effect profile but that there is as yet little evidence for a chronic “disease” or “syndrome” with serious symptoms persisting long after discontinuation of the drug. Dr. Nevin also offers his services as a consultant and expert witness related to the pseudodiagnosis of “quinism” that he had invented.
Dr. Nevin and St. Clair County
From what I could learn, Dr. Nevin relocated from Vermont to Michigan after his father died in order to be closer to family. One rather odd thing about Dr. Nevin and his situation in St. Clair County is that currently the medical director is a part time position.
Nevin took the St. Clair County job in 2023 during a period of significant change at the local health department, which had drawn fire for mask mandates during the pandemic.
County commissioners decided to split the health department’s leadership between a medical director role, which Nevin would eventually assume, and a health officer position to oversee the organization.
And:
Despite that, St. Clair County commissioners are considering recombining the health department positions once again, but haven’t specified how.
Some residents say Nevin should be given more authority to enact his vision for the county. Others say they’re concerned about Nevin’s moves to curtail standard public health guidelines.
Because of his “make America healthy again” (MAHA) cred and his actions as medical director of St. Clair County, Dr. Nevin has drawn praise from a lot of Republican state legislators, including a 2025 legislative tribute from Rep. Jaime Greene, “Rep. Greene recognizes Dr. Remington Nevin of St. Clair Health Dept. with legislative tribute,” and a June 2026 tribute from St. Clair County GOP legislators Reps. Joseph Pavlov Jamie Greene, and Jay DeBoyer. It is highly unusual for legislators to notice, much less issue public proclamations praising, a part time county health official. Both proclamations emphasize his “vaccine choice” and antifluoride stances, for example:
“Dr. Nevin has been a phenomenal local leader serving in the St. Clair Health Department, and his impact on our community cannot be overstated,” Greene said. “We are all incredibly fortunate to benefit from not just his skill as a medical practitioner, but also his character and leadership. He has consistently been at the forefront of fights for science-backed medical policies that still respect individual freedom, even when those policies have been unpopular in the medical community. That kind of courage and moral clarity is exactly what we need from our civic leaders, and I wanted to do some small part in recognizing it with a legislative tribute.”
Dr. Nevin has worked to align St. Clair County’s vaccine exemptions with Michigan law in order to ensure parents and families seeking exemptions for medical or religious reasons are not met with hostility from their local health department. Greene, who has been an outspoken advocate for vaccine choice and individual freedom, praised Dr. Nevin for his efforts to improve the county’s vaccine exemption process. Greene’s tribute also lauds Dr. Nevin’s bold, science-based approach to fluoride in public water systems and the unexamined health risks of industrial-scale solar energy development.
From a science-based perspective, these are all reasons why Dr. Nevin is so problematic. You can see why I am concerned about him rising further to become Michigan’s Joseph Ladapo if John James wins the governorship. On the other hand, there have been allegations of sexual harassment and fostering a toxic work environment in the county health department. A report from the Hotline Review Committee to the St. Clair County Board of Commissioners noted that 12 employees had come forward, with four written statements, along with emails and letters. Among the findings, Dr. Nevin demonstrated persistent demeaning behavior to women, refused to communicate with others based on perceived lack of qualifications, declaring himself the “smartest person in Michigan,” delaying effective treatment for TB and ignoring safety guidelines dealing with TB patients, and “discriminatory comments to or about patients regarding their immigration status, income status, parental status, sexual orientation.”
The report concluded:
Overall, when reducing these concerns to paper, they appear to be unreasonable. After speaking at length with the staff, the constant bombardment of demeaning and condescending behavior; the arrogant presentation of himself to colleagues from State and County government; the disregard for the safety of staff and patients; and the disdain and prejudice toward the community he was hired to serve is untenable long term. State and local community partners are questioning our choice of medical director and as a result various partners have discontinued providing or working with SCC public health.
Sounds like a hell of a leader, doesn’t he?
Most recently, Michigan Advance reported a few days ago:
A St. Clair County Board of Commissioners committee decided on Thursday night to table a decision to launch an independent investigation into the county medical director, Dr. Remington Nevin — an investigation that public health nurses in the county have been requesting for months.
Nevin is facing complaints of a toxic workplace, including reports of unfair labor practices like retaliation as well as sexual harassment allegations, from nurses since he took over leadership of the department in 2024.
A December 2024 report from the county’s Hotline Review Committee detailing anonymous complaints submitted through the county’s Human Resources hotline included many of those concerns, which members of the local nurses union say have only escalated in the nearly two years since.
“After speaking at length with the staff, the constant bombardment of demeaning and condescending behavior; the arrogant presentation of himself to colleagues from state and county government; the disregard for the safety of staff and patients; and the disdain and prejudice toward the community he was hired to serve is untenable long term,” the report states.
Given that all of the county commissioners in St. Clair County are Republican and most are MAGA, the nurses bringing the complaints are very suspicious that the Board of Commissioners is “choosing to promote their own political agenda by keeping Nevin in his role, instead of exerting proper oversight over a county official.”
So there you have it. We in Michigan have our very own Dr. Joseph Ladapo, only worse, as I am unaware that Dr. Ladapo has ever been credibly accused of sexual harassment. I must admit, though, the findings of the Hotline Review Committee do make me think that, unfortunately, the comparison between Dr. Nevin and RFK Jr. is all too on point.
I have no specific knowledge of whether Dr. Nevin is currently under consideration for MDHHS, should James win the governorship. However, the attention of powerful Republican state legislators heaping praise on him will definitely put him in the discussion, if not on the shortlist, of candidates for the post, especially given his ideological alignment with stated positions of the James campaign, including “vaccine choice” and his stated desire “protect informed consent” and to reform MDHHS influence over county health departments (his CLEAR Initiative). The question is: If Republicans do succeed in retaking the governor’s mansion in November, will the charges of misconduct against him be enough to keep Dr. Nevin from ascending to become the director of MDHHS? Normally, I would say yes. In this era, I am no longer so sure. What I am sure of is that Dr. Nevin is definitely a crank, and his expansion from “quinism” to basically all things MAHA is an excellent demonstration of crank magnetism. He shouldn’t be running a medical practice, much less a county health department, much less a state health department.