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, the 19-year-old onetime Eagle Scott stabbed and slashed Bulmer more than 50 times. He started with the throat, but didn't stop there. Bulmer, who was in his third day of basic training, awoke and fought back, but he never had a chance.
"I snapped and didn't like it," MacDonald wrote, about nine hours after the May 18, 2008, killing. "I was stretched and it made me crazy."
What triggered the promising young paratrooper's homicidal outburst?
MacDonald blames Chantix, a smoking-cessation drug used to wean people from their addiction to nicotine. A military jury didn't 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 drug's 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 drug's 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.
On May 13, MacDonald will get one more chance to plead his case when the nation's top military appeals court will decide whether the trial judge erred when he quashed a wide-ranging subpoena for Pfizer documents. The documents, MacDonald's 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 judge's decision not to tell jurors about the defense of "involuntary intoxication."
"He was denied the right to present his defense," said MacDonald's 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 MacDonald's case have lagged behind the safety alarms over Chantix.
The McClatchy review shows:
Two days before Bulmer's 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 who'd 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.
What there's no doubt about is the anguish the case has caused Bulmer's loved ones, who learned about MacDonald's pending appeal only from a reporter. In an interview in March, his widow, Beth Bulmer, recounted a conversation she had with her 5-year-old daughter, Izzabella.
"It was father-daughter dance at her school last month," Bulmer said, "and the day she came home with the permission slip she was so upset. She just held me and cried. She said, 'Everyone's gonna be there with their daddies. Why can't I have my daddy? Why did God have to take him, mommy?'"
Wendy Smith, Rick Bulmer's birth mother, said in a telephone interview, "I don't think Chantix had anything to do with what he did. He killed my son; that's a fact."
Army attorneys, in a brief filed April 23, dispute the potential effects of Chantix and MacDonald's 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 government's 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."
MacDonald's Army career
MacDonald's brief military career began in June 2007, when he enlisted along with his identical twin, James. The New York City natives had been inseparable through an unconventional childhood. Unpaid bills repeatedly drove them from private schools and apartments. MacDonald eventually had to drop wrestling because one prior school, citing the family's nonpayment, refused to release his transcripts. Though he has a superior IQ score, he dropped out of a rural Virginia high school.
At the same time, MacDonald periodically showed grit and promise.
"I plan to spend the youth of my twenties giving back to the country that has given me so much," he wrote in an Eagle Scout essay in 2006, further vowing "to do something that changes many people's lives positively, because a life is so valuable."
The Army seemed welcoming at first.
The MacDonald brothers shared top enlisted graduate honors at Airborne School. Both were selected for the U.S. Military Academy Preparatory School, giving them a future shot at West Point, though at times George MacDonald's fellow soldiers quietly voiced some doubts, according to trial testimony.
MacDonald came to Fort Benning as a supply clerk assigned to 2nd Battalion, 19th Infantry Regiment.
On the morning of April 18, 2008, MacDonald went to the Troop Medical Clinic 5 on post and explained that he'd been smoking off and on for several years and wanted to quit. He wasn't alone. The number of Chantix prescriptions for military personnel reached 67,580 in 2007, according to the Pentagon.
After medical staff met with him for about 25 minutes, the doctor prescribed a "starter pack" of Chantix, good for 12 weeks.
MacDonald said he was soon beset by vivid nightmares and strange feelings.
"I remember the two of us waking up at night having really weird dreams, scary dreams," James MacDonald, who was also given Chantix, wrote in a 2010 clemency request for his brother. "I remember commenting to my brother that life started to feel like a video game in that I was disconnected from my body. He agreed that he felt the same way."
In 2013, James MacDonald would kill himself by jumping off a 19-story building in Philadelphia. There's been no public explanation for his death. His half sister, Paige MacDonald, said James had never recovered from his grief over his brother's ordeal.
On May 17, 2008, the day before Bulmer's death, MacDonald asked his girlfriend whether she'd still love him if he killed somebody. She did not pursue the topic.
What happened that night
Bulmer also experienced a rocky childhood. His father died in a 1987 motorcycle accident that cruelly injured his mother. He ended up in foster care, living with his new family in rural Squaw Valley, Calif., while she learned to walk again.
When Bulmer was a senior at Madera High School in the San Joaquin Valley, he badly injured his right leg when he was struck by a car, nearly derailing his Army ambitions.
Bulmer and his younger brother John had originally planned to enlist together, but his leg injury made that impossible. Gary Bulmer, Rick's foster dad, testified that Rick took several jobs and secured the insurance needed to pay for eventual removal of the titanium rod that had been inserted into his leg after the accident.
Standing 6 feet 2 inches tall, Bulmer worked hard at his physical therapy. For pleasure, Beth Bulmer said, he loved Western movies. They scouted out property where they might settle after his Army career.
"He always made it known to people around him, 'This is where I'm going. This is what I'm going to do. I'm going in the Army,'" Bulmer's mother, Fresno, Calif., resident Wendy Smith, testified.
Beth was pregnant when Bulmer, a member of the California National Guard, left for basic training at Fort Benning, which formally began for him on May 16, 2008. He began training with Company E, 1st Battalion, 50th Infantry Regiment.
"He was so excited about it," she recalled. "He was ecstatic."
On Sunday, May 18, during drills, his leg apparently hurt and he returned to the barracks. It was just past 6 p.m.
Bulmer fell asleep on his bunk. Elsewhere in the same barracks, MacDonald was reading "Lord of the Rings."
MacDonald got up to do laundry and without knowing why, he said later, slipped a 3-inch knife into his pocket. He left his room, and came to Bulmer's bunk. He said later that he thought for about 30 seconds. Then he attacked.
MacDonald fled after other soldiers arrived, alerted by screaming. Medics transported Bulmer to The Medical Center in Columbus. Smith was finally reached and a nurse placed a phone next to her unconscious son.
"I just talked to him and told him how proud I was of him and that I loved him, that we all loved him and that he had done such honor to us," Smith testified.
At about 3 in the morning, Bulmer succumbed. He would have graduated from the 14-week training program Aug. 22.
Finally caught after a chase and a struggle, MacDonald ultimately agreed to talk. At about the same time that Bulmer died, MacDonald sat on the floor of a holding room and confessed to an Army Criminal Investigation Command agent. The agent asked him what he was thinking of during the assault.
"'I wish I didn't have to do this,'" MacDonald recalled thinking. "'I hate this.'"