Veterans Affairs committee  I think that final determination came in part from the study carried out by the University of Queensland for the Department of Defence, which showed there had been clear and tangible long-term negative health outcomes specifically related to taking mefloquine during the two deployments in Bougainville and East Timor.

Veterans Affairs committee  No. They were particularly anxiety, and depression and neuropsychiatric symptoms. This again was based on a retrospective dataset, and thus was an opportunistic study. It was not targeted and defined. This is a piece of research that still needs to be carried out. But I think that with the weight of that evidence, together with the evidence presented at the Senate inquiry, plus events that are occurring internationally around acceptance and acknowledgement of the impacts of mefloquine on veterans' mental health, and settled cases of litigation, I think there was probably a cumulative effect that suggested to the government this was a necessary process.

Veterans Affairs committee  There have been no specific conferences or events outside of those organized in the veterans community.

Veterans Affairs committee  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.

Veterans Affairs committee  Yes, to some extent. We have an interesting situation and it's somewhat comparable to Canada's in that there were a number of veterans who received mefloquine during clinical trials carried out by defence during the late 1990s and early 2000s. Interestingly, because they were exposed to the drugs during a clinical trial regime, that exposure wasn't documented in their main military records.

Veterans Affairs committee  This was very much the position that we came into when designing the neurocognitive health program for Australia. We knew there was a cohort of veterans out in the community who were suffering from long-term neuropsychiatric and neurological health impacts, as well as other health impacts, that had impacted their family members and their very broad existence.

Veterans Affairs committee  There have been a number of studies done over time. Sorry, go ahead.

Veterans Affairs committee  I'm not sure.

Veterans Affairs committee  I know that there is international oversight of what's occurring globally, but I'm not sure that there's a specific initiative.

Veterans Affairs committee  Yes.

Veterans Affairs committee  First, I'm on the steering committee, so I'm not formally employed by either the Department of Veteran Affairs or Open Arms, but I sit very much as an external adviser on that committee and part of the team that has formulated how that program should look. It would hardly be applicable.

Veterans Affairs committee  I think that statement is somewhat simplistic. A set of diagnostic criteria includes both neurological as well as neuropsychiatric symptoms.

Veterans Affairs committee  I think that's what I said, namely, that it doesn't appear in any of the diagnostic manuals. However, the accumulation of symptoms has been published on numerous occasions, both in case reports and in articles that have taken broader populations into account.

Veterans Affairs committee  There are a number of specific differentials, one of which is vestibular disorder and central vestibular disorder. The others are the particularly vivid dreaming states and the decline observed in patients suffering from after-exposure to mefloquine. The other key diagnostic indicator is whether or not a person had a reaction at the time to taking the drug.

Veterans Affairs committee  Yes, I definitely think it should be considered as a major factor. If you have a clear causal relationship—and this is what we've just been discussing—then it is common sense that there needs to be a validation of that causality within the diagnosis. One of the significant issues that veterans have faced is the fact that the role of the drug in their ongoing medical conditions has not been formally acknowledged and has therefore not been allowed to be taken into account in their treatment and in the consideration of the life circumstances around how their particular medical condition arose.