Of course, this goes far beyond PTSD because the neuropsychiatric consequences of mefloquine can involve depression, psychosis and a whole range of different kinds of symptoms. As a clinical pharmacologist, the kind of thing I would do is look for an index of exposure. I would try to find all individuals who were alleged to have been prescribed. In my opening comments, I made the point that prescribing, dispensing and taking are all quite different. We have examples of mefloquine being taken every day when it's meant...and so forth. All these strange kinds of things happen.
I suspect the military must have really good records of who actually was prescribed this. That would be a starting point to identify what we would call an index case, and to then go and assess that individual with respect to some of the things I outlined in this causality process. That involves establishing that it was taken, that the sequence was right, what dose it was and what concurrent issues were.... It's a systematic way of taking an individual and making an assessment.
It's convenient to talk about how the drug causes it all, but it's always a little more complicated than that when you're dealing with these kinds of disorders. The drug can very well be an important contributor, and that is just as important to determine as those rare cases when it was the only antecedent factor that caused it.
For the case that I mentioned that I assessed, it was clearly just a dose issue. Seven times the proper dose was given to a businessman, and he had a profound acute effect and a very profound neuropsychiatric consequence. You have to have the information and get the data.