Yes, I can.
I was asked to submit evidence to the Repatriation Medical Authority in order to assist them in the process of defining whether or not they would accept a statement of principles for acquired brain injury in relation to mefloquine, tafenoquine and primaquine specifically.
It was an interesting process in that I thought the remit of the investigation was flawed. It had looked across three drugs, one of which has a very discrete neuropsychiatric profile that's well documented; one that was at that time an experimental drug that had very limited evidence available about it outside of the development process for the pharmaceutical industry; and another that had not been systematically reviewed for some time in terms of its safety in terms of neuropsychiatric side effects.
It was an investigation that was very difficult to provide evidence to; therefore, the outcome, which was that the causality link was not determined, was probably quite predictable. However, what should be noted is that the Repatriation Medical Authority currently accepts 15 separate conditions associated with quinolines, or mefloquine specifically, in terms of poor health outcomes that can be claimed through the system in Australia.
If you put those 15 statements of principles together, you essentially get the syndrome we have described as mefloquine toxicity syndrome.
We were looking to confirm that the neurocognitive component could be identified as a separate condition, and unfortunately that was not upheld. I think the evidence for that is emerging and will need to be confirmed through specific, targeted case series. One of the issues around this area is that the desire to undertake those specific review case series has been extremely poor. The more recent evidence coming out of Australia in that sense will, I think, strongly assist us in the process of defining that statement of principles in the future.