Evidence of meeting #27 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.
5:15 p.m.
Psychiatrist, As an Individual
Let's be clear. At the present time I don't necessarily treat PTSD. What I treat are the symptoms the person is struggling with.
5:15 p.m.
Psychiatrist, As an Individual
Whether it's due to a traumatic brain injury, PTSD, major depression, or mefloquine, right now we're limited in what we can look at and actually analyze. So what do I do? I use my current medication regime and my talking regimes to treat the symptoms they're struggling with.
5:15 p.m.
Liberal
Bob Bratina Liberal Hamilton East—Stoney Creek, ON
Thank you.
This has been a brilliant but disturbing session, I have to tell you, particularly for me, because I have a motion and a private member's bill coming forward that have to do with toxic encephalopathy with regard to lead pipes and lead in developing children. We know that lead attacks the prefrontal cortex and results in irreparable damage to the brains and, therefore, the behaviours and potential of these young people.
You mentioned imaging of the brain with regard to soldiers having used mefloquine. Is it a clear indicator, the brain imaging?
5:20 p.m.
As an Individual
If I may rephrase, is there an objective testing modality? Is there an imaging modality? Is there some sort of test we can give to veterans to determine whether they may be suffering these chronic effects?
Unfortunately, the answer is no. There is no imaging modality yet that I am aware of that can reliably, validly, distinguish between people who are affected from those who aren't.
I do feel—and perhaps the others will add to this—that there are some imaging modalities that may hold promise in conjunction with some other tests. But for the moment, the diagnosis, if you will—and we should recognize there is yet no accepted medical diagnosis of mefloquine toxicity syndrome. Perhaps one day there will be. The identification of someone who may be suffering from these effects is mostly clinical. It's based on history, when the symptoms developed, and the combination of signs and symptoms they have.
5:20 p.m.
Liberal
Bob Bratina Liberal Hamilton East—Stoney Creek, ON
Dr. Passey, do the service records show the use of mefloquine, or is it just assumed that, if you were in Afghanistan or Somalia, you likely used it?
5:20 p.m.
Psychiatrist, As an Individual
That's a good question. Typically the records should show vaccinations and a use of medication. Do the records actually show that? That's a good question. That's something that should be put to the military. When I go home I'm going to check my own medical file to see whether that's actually noted.
5:20 p.m.
Liberal
Bob Bratina Liberal Hamilton East—Stoney Creek, ON
Finally, regarding the supervision of these drugs and medicines, you say you have to take these things, but they are probably not taken in front of a medical provider. Where would the mefloquine actually be ingested by the soldier in the field?
5:20 p.m.
Psychiatrist, As an Individual
I think that's dependent on the unit itself. Typically, in the deployment I was at, it was handed out on Fridays from basically the pharmacy.
5:20 p.m.
Liberal
Bob Bratina Liberal Hamilton East—Stoney Creek, ON
My questions are going to take a lot longer, so I'll pass.
October 25th, 2016 / 5:20 p.m.
NDP
Georgina Jolibois NDP Desnethé—Missinippi—Churchill River, SK
I'm curious. Dr. Ritchie, you mentioned Dr. Matchee. How can I get information on Dr. Matchee? He's in my riding. His family is in my riding. His family has come forward to get assistance on that. Would I be able to get that from someone?
5:20 p.m.
As an Individual
Mr. Chair, if I may, I'm not sure whether Dr. Ritchie has spoken with the family. I have spoken with Clayton Matchee's wife. I have also spoken with a number of his units and members. I feel very confident that I can render an opinion as to whether his behaviour during that time may have been in some way affected by the drug.
I do have a very strong opinion of that. I don't know if this is necessarily the right forum in which to share that information. Perhaps more important is that with the information we have available today, with the literature, with the science, with the recent acknowledgements by drug regulators of this drug's effects, I think many of the points of confusion that dominated this discussion in previous decades no longer apply, and we could come to a much more solid mutual conclusion about the events of that day, including the role of the drug in his particular case.
5:20 p.m.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Thank you.
I guess I'll throw this question open to everyone on the panel. It has come to my attention that some U.S. veterans have been compensated for conditions caused by mefloquine.
Do we have an estimate of how many service members have been given awards for this, and what levels of compensation? I'm interested in the numbers and the level of compensation they would get.
5:25 p.m.
As an Individual
Again, if I may, not speaking to the Canadian experience in particular, but overseas—
5:25 p.m.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Sorry. I was thinking mostly about the American experience.
5:25 p.m.
As an Individual
I can address that question.
In the United States, we have a veterans administration that awards disability claims for conditions such as post-traumatic stress disorder and the effects of traumatic brain injury.
It's my experience that a fair number of veterans who have been suffering what are primarily effects from mefloquine are able to be compensated to some degree through awards for these other conditions. It is possible that some veterans have been essentially misdiagnosed with post-traumatic stress disorder. That's an academic subject whether it's a correct diagnosis or not in the presence of mefloquine effects. Others have been mistakenly attributed to traumatic brain injury.
Where veterans face more difficulties, though, is when mefloquine toxicity symptoms manifest, for example, primarily as a psychotic disorder, or primarily as a panic disorder, or what is sometimes called an adjustment disorder. There may be less willingness on the part of the adjudicators to attribute those conditions to combat. Of course, this speaks to the fact that we don't yet have a diagnosis for what is, I believe, a genuine syndrome.
If we ever do have formal diagnostic criteria and formal recognition in the medical community for this syndrome, then, of course, that syndrome would be what is compensated in the United States. I think many more years of research are necessary in order to ensure that we can make that distinction with clarity.
5:25 p.m.
As an Individual
If I may add, the number one disability in the Veterans Health Administration is mental disorders. A lot of that is PTSD, a lot of that is depression, and some is psychosis. In my experience it's relatively easy to get a mental health diagnosis. Of course, the DSM has been changing. In the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, the diagnosis of PTSD in my opinion has made it easier to get that diagnosis. I don't think the actual number of veterans with mental health diagnoses would change much, to say what Dr. Nevin did in another way, but whether the addition of exposure to mefloquine and toxicity would change, for example, the level of the rating, I think there is a very real chance.
In addition, in the past to get a diagnosis of PTSD you had to have exposure to combat and traumatic events and many people on mefloquine were not necessarily exposed to combat or traumatic events and may have not gotten that diagnosis because they weren't actually in a war zone, say, they were in the Horn of Africa or some place like that.
5:25 p.m.
Liberal
The Chair Liberal Neil Ellis
Thank you.
That ends the time for today for questioning.
We could give each of the witnesses a minute to wrap up.
We can start with Dr. Passey.
Do you have any concluding remarks?
5:25 p.m.
Psychiatrist, As an Individual
I think in the whole issue around mental health disorders, I don't like the term, these are brain disorders. Whether it's caused by toxic effects of chemicals, the toxic effects of cumulative or traumatic experiences, it impacts the brain in a negative manner and that's what we need to be focused on. The term “the diagnosis” is not near as important as the actual effect and the level of dysfunction that we see in our veterans. We need to be looking at a new directions in regard to being able to diagnose these disorders as well as treatment.
5:25 p.m.
Liberal
5:25 p.m.
As an Individual
Yes.
First of all, it's really exciting to have this conversation. I've worked with the Canadian Forces many times in many places. I would like to continue the conversation.
What we have seen in the areas of PTSD and suicide is that often the U.S. has been there first with larger forces and has seen the problems first. I think we've seen that with mefloquine, but then we see that Australia, the U.K., and the Canadians, down the road a few more years, are having the same problems that we are having.
I really want to congratulate all of you for being courageous enough to have this conversation.
