Evidence of meeting #115 for Veterans Affairs in the 42nd Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was symptoms.
A recording is available from Parliament.
Liberal
Optometrist, As an Individual
In the United States you only have to keep records for clinical patient files for three years after you see the patient if they're an adult. It's standard procedure to purge records after three or four years.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Okay, so this wasn't a deliberate purging of records for—
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
It was just that these records were deleted. I'm not sure purged is the right word when you get rid of records as per protocol after a number of years.
Optometrist, As an Individual
I apologize for not choosing my words more carefully.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Thank you. I just wanted to clarify what that was about.
Dr. Douglas, you mentioned, and we've heard this from some people, that PTSD can be diagnosed when in fact it's mefloquine toxicity.
How do you tell the difference? How do you know it isn't PTSD when a patient comes in?
Psychologist, Central Ontario Psychology, As an Individual
I know that in this area, there's been a lot of talk about the concept that this is misdiagnosed. To be honest, I'm not completely convinced of that because, as I said, mefloquine is often used in a context in which there are exposures to traumas. We look at the diagnosis of PTSD. We have to be able to say that it's not due to the effects of a medication. Certainly in the past that question's not even been asked, so I think there may very well be such cases and that's going to be quite challenging.
The reality is that they're often given at the same time. If we look at the criteria for PTSD—here is the event and things got worse following it—it's going to be very challenging to separate these two things, in my opinion.
I think it's a complex picture, and it's not really necessarily so much one of misdiagnosis but it could very well be one of mefloquine making the psychological reactions to trauma significantly worse. It can be much more complex than just either-or.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Thank you.
Are you aware of any data comparing the diagnosis of PTSD in combat veterans to those who have had mefloquine and those who haven't?
Psychologist, Central Ontario Psychology, As an Individual
Yes, I am. Dr. Nevin who will be coming, I believe on May 1, will be able to speak to that, but some of the research that I can recall showed something like close to 180% more diagnosis of PTSD in those who were mefloquine-exposed with a prodromal reaction.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Okay.
Would you be able to forward us the actual references, the papers, that state that?
Psychologist, Central Ontario Psychology, As an Individual
Certainly.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Thank you very much. I appreciate that.
Psychologist, Central Ontario Psychology, As an Individual
You can follow up with Dr. Nevin, as well.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Sure. All right. Thank you very much.
That's all I have. Thank you.
NDP
Rachel Blaney NDP North Island—Powell River, BC
Thank you both for being here today.
One of the things I've heard loud and clear through this process is that research is needed, and how much we don't know is the issue at hand.
Could I ask both of you to tell us what research is specifically needed in Canada?
Psychologist, Central Ontario Psychology, As an Individual
Since it's a Canadian question, I guess I'll take it.
Number one, how many soldiers have been exposed? They spoke about the issue of clinical records in clinical practice being purged. It's routine in the military that I learn of people whose medical records are missing or inadequate. In some cases, they've been redacted. It's very difficult. Plus there is simply the reality that a public health medication such as mefloquine may not even appear in anybody's medical records. The records themselves may not be a very effective strategy for identifying who was exposed. The records may simply not be there.
About the only thing we can do is ask veterans. I think we need to ask them whether they were exposed to this medication or a similar medication and whether they had that reaction. From there, we can start to get a sense of how many veterans have been so exposed. From there, we can look at the comparative rates in the presentation and the diagnoses of psychological disabilities, and we'll be able to start understanding a little bit more.
Finally, I think we need to really look at issues of treatment. Dr. Suter has some great ideas about some avenues for treatment that are not very well understood and not very well known. We need to really explore any number of options that might lead to some more effective treatment. Medications might be an answer, but they might also not be an answer if they are a complicating factor with these kinds of brain disorders in the context of psychiatric medications. They may not work the way they ordinarily would in a brain that has not been exposed to mefloquine.
It's going to be complex and a lot of research needs to be done.
NDP
Rachel Blaney NDP North Island—Powell River, BC
You talked earlier, Dr. Douglas, about the screening process. I'm just wondering if you could talk to us about mefloquine. Is there a screening process? How do you know? You talked earlier about the fact that it's not necessarily in the records, and you also spoke about something that I think is really important, which is the lack of awareness.
NDP
Rachel Blaney NDP North Island—Powell River, BC
You learned about this because one of your patients informed you—
NDP
Rachel Blaney NDP North Island—Powell River, BC
I guess I'm asking two questions. What is the screening process, and in terms of awareness—and both of you have spoken about awareness—how do we do that so that we're making people more aware that, when they're talking to veterans, these are the important questions to ask?
Psychologist, Central Ontario Psychology, As an Individual
Again Dr. Nevin has written papers on the screening, and it's really quite simple: Have you been exposed to this medication, and did you have this reaction to it? It's as simple as that in terms of understanding. Now we're identifying those who had that prodromal reaction—which is to say the symptoms that appeared when they were on the medication—which then sets them at risk of having persistent reactions.
