Canadian mefloquine veterans have been fairly consistent in recent years in calling for three things that they need from the Canadian government: acknowledgement, outreach and research, in that order.
As I mentioned initially, acknowledgement is the single most important thing that can occur. So much will come from an acknowledgement, a mea culpa, or a statement from someone in a position of authority simply stating the obvious that follows naturally from what is in the product monograph and simply acknowledging what is very clearly true.
Individuals within the halls of government who know mefloquine is dangerous, who have patients that they would like to write case reports on, and who would like to fund and conduct research with existing funds will feel empowered to do this. Clinicians will feel empowered to diagnose on paper and for the record what they already know to be true, when previously they had perhaps been hesitant.
Acknowledgement must come first. Someone must say that this drug has caused disability among our troops. It's as obvious as day.
Then there is outreach. With that acknowledgement, which individuals are not reached by the media and which individuals are not reached by social media and word of mouth? We can identify these individuals. We should know who has deployed in the last 25 to 30 years to areas where mefloquine may have been used. Hopefully there's a postal mailing address or some other way to get in touch with them. It could be as simple as saying, “Did you take mefloquine? Did you have problems on the drug? Then call this number and we'll get you the support that you need.”
Then there is research. Research comes in many flavours and varieties. The type of research that you will hear about from government scientists and others who manufacture doubt about the dangers of this drug is not good, quality research. It's retrospective research. It's based on existing data. If we don't ask the right questions about symptoms experienced by individuals who have taken mefloquine and if we don't ask specifically about their mefloquine experiences, the existing data on which many of these studies are based is not going to capture what actually happened. New prospective research at patient level that is conducted with the involvement of clinicians is going to be essential.
It really begins with case finding and empowering individual physicians to identify those veterans who are suffering the long-term adverse affects of this drug. Then it is getting them the type of sophisticated testing that I believe one of your earlier witnesses had discussed, fully describing the extent of their symptoms, and then beginning to count them and figure out what they have in common with each other to identify these risk factors that we're alluding to.
The first step is not to ask Veterans Affairs to look at the existing data again or look at the existing research again and come to the very same conclusions. To solve this problem, we need acknowledgement, outreach and research. A component of that is the screening process that we described.