Veterans Affairs committee  Absolutely, yes.

Veterans Affairs committee  I'm not aware. That would be outside of my purview, for sure.

Veterans Affairs committee  That could also be an issue, but again, I'm not the right person for that question.

Veterans Affairs committee  Yes, exactly.

Veterans Affairs committee  Yes.

Veterans Affairs committee  Yes, I agree that this is absolutely an issue that applies to civilians as well.

Veterans Affairs committee  It's certainly a good idea to encourage different medications over mefloquine. All of the quinine-based drugs carry at least some risk. Mefloquine's risk, from what I gather, seems to be unique, but none of them are entirely without some risk. I would be concerned about people requesting mefloquine specifically and I'd be curious as to know why.

Veterans Affairs committee  The U.K.

Veterans Affairs committee  Yes. As I say, unfortunately, I'm really not an expert. I would direct that question to Dr. Nevin. I think he might be much more familiar with it than I would be, but it is my understanding that essentially what it boils down to is this: Those who are exposed to mefloquine and have had that prodromal reaction to mefloquine are substantially more likely to be diagnosed with a psychiatric disability.

Veterans Affairs committee  I think the potential is certainly there, absolutely. For example, PTSD tends to be cumulative, so if you have more and more exposures to trauma, you can absorb so many and then you'll get the one that breaks the camel's back. Obviously there are multiple factors. Life at home can add more stress and then make PTSD more likely and lead to a stronger reaction.

Veterans Affairs committee  In Canada we're not doing the tracking, no.

Veterans Affairs committee  Exactly.

Veterans Affairs committee  Right, exactly.

Veterans Affairs committee  Right.

Veterans Affairs committee  My understanding is that Veterans Affairs takes an approach that basically says, “Is there a diagnosable condition? Is it attributable to military service? To what degree is their impairment arising from that?” I think what I gather, reading between the lines of Dr. Nevin's research, is that the issue may be somewhat different in the United States, where they might put more emphasis on it having to be PTSD.