Veterans Affairs committee  In my opening statement I shared with you what your own government scientists have said is true. I shared with you the logical implications that follow from the science that they have acknowledged is true. I don't know how much more clear I can make this. Your own scientists are implying, as clear as day, through the updated product monograph language, that there must be some degree of permanent disability as a result of your military service members' use of mefloquine.

Veterans Affairs committee  The use of mefloquine in 1992 among deploying members of the Canadian Airborne Regiment to Somalia is extremely problematic. I don't understand the legal basis for the Canadian military's use of mefloquine in that population. Drugs cannot be prescribed or distributed without a legal basis.

Veterans Affairs committee  Yes, that's correct. For someone who has never taken mefloquine, who has no experience with how they personally tolerate the medicine, or more specifically who has no experience with how susceptible their central nervous system is to the drug's toxicity, there is a very real possibility that with that very first tablet, which contains quite a bit of mefloquine—50 milligrams is a lot of mefloquine—the drug, for whatever reason, could accumulate in their brain and act as a central nervous system toxicant that could lead to permanent disability after that single tablet.

Veterans Affairs committee  It's an excellent question. The fact is there are individuals who, for whatever reason, and we don't understand why—are fortunate to have escaped the horrific adverse effects that other veterans and service members have experienced from this drug. Good for them. Thank goodness they haven't gone through what some service members have gone through.

Veterans Affairs committee  The term “quinism” was coined to describe the disease caused by poisoning by quinoline drugs. These are mefloquine, chloroquine, tafenoquine, we believe, and primaquine, the synthetic drugs used in World War II. This disease is a consequence of what we believe is the inherent toxicity of this class of drug—the quinoline class of drug.

Veterans Affairs committee  Interestingly, mefloquine and related quinoline anti-malarials have recently begun to be explored as treatments for certain types of central nervous system cancers. This makes sense, because these drugs readily penetrate the blood-brain barrier. They readily concentrate—sometimes at very high concentrations—in the brain, and they're neurotoxic; they kill brain cells.

Veterans Affairs committee  The simple answer is that it makes no sense. Health Canada, one portion of your government, is very clearly stating that in some cases this drug is acting as a poison; it's causing permanent central nervous system dysfunction. It's very obvious from the product monograph and the implications of the updated language in the product monograph that we, the prescribers—the Canadian military, the U.S. military, travel medicine communities around the world—for many years were not using the drug in the most safe manner, and disability resulted as a result of that.

Veterans Affairs committee  Let me turn the question around. Health Canada and the product manufacturer very clearly state you must discontinue this drug at the onset of any psychiatric or neurological symptoms. This means that Health Canada is telling us if you develop anxiety, depression, restlessness, confusion, insomnia, nightmares or abnormal dreams you must immediately stop taking the drug.

Veterans Affairs committee  Some common manifestations of what we believe is the brain stem dysfunction caused by mefloquine neurotoxicity are such things as central vestibulopathy and central visual disorders: chronic dizziness, chronic vertigo, chronic disequilibrium, visual impairment caused by the neurotoxic effects of this drug.

Veterans Affairs committee  Yes, I'd be happy to submit that.

Veterans Affairs committee  I am surprised. That number seems a little high. Five per cent is much higher than the rate of use in other countries. For example, in the United States military—the United States developed mefloquine—we use mefloquine so rarely now that it accounts for, I believe, less than one half of one per cent of new anti-malarial prescriptions.

Veterans Affairs committee  I believe, today, we have mostly addressed the problem of improper use of mefloquine. I would suggest that there are individuals out there who have taken mefloquine many times and, for whatever reason, they are simply not susceptible to the adverse effects of this drug. We don't know why some people are susceptible and some aren't.

Veterans Affairs committee  Thank you. So we know that mefloquine and the related quinolines are neurotoxic and we know that this neurotoxicity is demonstrated in animal models. It affects very specific areas of the brain stem and limbic system. As Dr. Ritchie was alluding to, on animal model studies, these drugs cause microscopic lesions in particular areas of the brain and brain stem, and based on our knowledge of neuroanatomy and neurophysiology, we would expect that lesions in those areas manifest as certain signs and symptoms.

Veterans Affairs committee  Thank you. The product monographs for any drug are routinely updated on the basis of new safety signals and the need to warn the public of drug safety risks. I am more familiar with the history of the U.S. label, but I believe the Canadian label language closely mirrors that of the United States.

Veterans Affairs committee  Our group was formed largely to advocate for and to support and promote education and research on this medical condition, which we have termed “quinism”. We chose this language very deliberately. We believe that quinism is a disease, that chronic quinoline encephalopathy is a medical condition caused by the poisoning of the brain by these drugs.