Veterans Affairs committee  I'll defer to my colleagues in psychiatry for that question.

Veterans Affairs committee  I cannot speak to practices in the Canadian Forces. Perhaps Dr. Passey can. I can speak to my knowledge of practices in the U.S. military. In fact, some of my early research focused on this very point. The work I did while in Afghanistan determined that a sizeable fraction of our force was taking psychotropic medications: antidepressants, anti-anxiety drugs, and in some cases even anti-psychotic drugs that had been prescribed to them for prevalent mental disorders.

Veterans Affairs committee  I'll speak briefly, and then I think I'll defer to my colleagues in psychiatry, who are perhaps much more familiar with other classes of drug. I mentioned earlier that it's this entire class of synthetic quinoline drugs, including mefloquine, I suspect chloroquine, certainly atebrin or mepacrine during World War II, and possibly even quinine—which we all have enjoyed at some point in our tonic water—that may have this propensity because of a class effect.

Veterans Affairs committee  I'll emphasize Dr. Ritchie's previous comment. In my experience speaking with a number of veterans who have discovered that mefloquine could be the cause of their symptoms, there's an extraordinary amount of relief that I believe has real therapeutic value to learning what the cause of their symptoms is.

Veterans Affairs committee  Absolutely not. Both doxycycline and Malarone are as effective, if not more effective, than mefloquine. There's no area in the world that we send troops to where those drugs are not effective. In contrast, a large part of the world demonstrates some resistance to mefloquine. As for questions about whether soldiers will be as compliant with a daily dose versus a weekly dose, these issues have long since been settled.

Veterans Affairs committee  You had two questions: whether mefloquine should continue to be used by militaries, the Canadian Forces in particular; and the other was about the Somalia commission of inquiry. I do not recommend that militaries use mefloquine. I am on record as saying I do not think it should be used.

Veterans Affairs committee  I'd like to address that question. That is the subject of some of my recent research with Dr. Croft, a military colleague from the U.K. Mefloquine is a member of a class of drugs known as quinolines. In fact, it's not the first quinoline that militaries have used that has had these effects.

Veterans Affairs committee  I'll speak briefly, and then I'll defer to my colleagues who are psychiatrists. We have written about how the symptoms caused by mefloquine can in some cases be confused with post-traumatic stress disorder. I think that during brief diagnosis, brief encounters, if a clinician is not thoroughly familiar with the many symptoms caused by mefloquine, it may be tempting to assign certain combinations of symptoms caused by the drug to PTSD.

Veterans Affairs committee  Thank you very much, Mr. Chair. It is a great privilege to be invited to address the committee today to discuss the anti-malarial drug mefloquine. I'm Dr. Remington Nevin. I'm a former U.S. Army preventive medicine physician. I received my medical training at the Uniformed Services University School of Medicine, and I've earned master's and doctoral degrees in public health from Johns Hopkins University.