Veterans Affairs committee  No. I can hear you.

Veterans Affairs committee  I'll make a few brief comments. I'm a professor emeritus of pharmacology and toxicology, psychiatry and medicine at the University of Toronto. I've been involved in research, teaching, and clinical care, involving psycho-pharmacology—that is drugs that act on the brain—for over

Veterans Affairs committee  Yes. I think that Professor Quinn is nudging up to what you have to do. It's really the assessment of whether the drug has caused a reaction. In this case, we know the natural history that an acute reaction is associated with a probability of a longer term reaction. So you need t

Veterans Affairs committee  The issue here is that large doesn't make good. That's a particular retrospective kind of study that suffers from failure to document, record and have an accurate estimate, and the kind of symptoms that often get reported never show up in medical records, so—

Veterans Affairs committee  The basis of my little clip there that “large doesn't make good” is that it really depends on the source of the data. That kind of study is very typical of retrospective epidemiologic studies. The universal weakness of those studies is that one does not have information about all

Veterans Affairs committee  Of course, this goes far beyond PTSD because the neuropsychiatric consequences of mefloquine can involve depression, psychosis and a whole range of different kinds of symptoms. As a clinical pharmacologist, the kind of thing I would do is look for an index of exposure. I would tr

Veterans Affairs committee  I think the reality is that it wouldn't work out all that well. I think most primary care physicians would not be very familiar with.... We know that the management of mental health is a problem in our health care system anyway. Problems aren't recognized. This is getting very de

Veterans Affairs committee  Not to my knowledge, although I suspect Professor Quinn may have managed to stimulate this in Australia. She's quite a force.

Veterans Affairs committee  I know that you've characterized this as being a uniquely military problem, but it's actually not uniquely a military problem. This is a problem with a drug that has toxicity, and it has been observed in many populations. Whatever you decide to do, I would urge that it be a pro

Veterans Affairs committee  I guess that's probably for me. First of all, I can't conceive of a real situation where one of the alternatives—Malarone or something of that sort—would not be appropriate. I indicated in my comments that if a military person is asking for this drug, I think they would have to

Veterans Affairs committee  I want to make a footnote to this, and that is that there is evidence that women are more susceptible to mefloquine. I think that was given no mention at all in the surgeon general's report, yet the literature is fairly clear that it is an additional risk factor.

Veterans Affairs committee  I think it would be very, very rare, and I've given a way that if you had to, you would carefully monitor and be able to intervene. We know how prescribing and dispensing can sometimes go. It's “take the pill,” and that's the end of it. In fact, the surgeon general's report docum

Veterans Affairs committee  We have other examples of drugs for which we have checklists, patient information and documents you can provide to inform individuals. Actually, I have them sign a contract that they have read it and understand it, and that explicitly tells them what the risks are and what I'm go

Veterans Affairs committee  It's not very new research. It's been known for a long time that this class of compounds is transported by a particular mechanism that's presumably there to protect the brain. A lot of drugs are pushed out of the brain by this transporter. No, this is just one possible explanatio

Veterans Affairs committee  Agreed.