Veterans Affairs committee  Thank you very much, Mr. Chair. I must say, it's a tremendous honour to be invited to speak to the committee today. I am originally from Canada. I was born and raised in Toronto so it's really very satisfying for me to be able to return to my home and native land to be able to assist the committee with this important issue.

Veterans Affairs committee  Again, if I may, not speaking to the Canadian experience in particular, but overseas—

Veterans Affairs committee  I can address that question. In the United States, we have a veterans administration that awards disability claims for conditions such as post-traumatic stress disorder and the effects of traumatic brain injury. It's my experience that a fair number of veterans who have been suffering what are primarily effects from mefloquine are able to be compensated to some degree through awards for these other conditions.

Veterans Affairs committee  If I may rephrase, is there an objective testing modality? Is there an imaging modality? Is there some sort of test we can give to veterans to determine whether they may be suffering these chronic effects? Unfortunately, the answer is no. There is no imaging modality yet that I am aware of that can reliably, validly, distinguish between people who are affected from those who aren't.

Veterans Affairs committee  Mr. Chair, if I may, I'm not sure whether Dr. Ritchie has spoken with the family. I have spoken with Clayton Matchee's wife. I have also spoken with a number of his units and members. I feel very confident that I can render an opinion as to whether his behaviour during that time may have been in some way affected by the drug.

Veterans Affairs committee  If I may, that's the idea of a specific outreach to veterans who may have been affected. This is a consistent request by veterans groups internationally. We've seen this request articulated in Ireland, in the United Kingdom, in the United States, and in Australia. I think the implementation of that kind of outreach program is very helpful.

Veterans Affairs committee  I'm sorry, could you restate the question? I'm not sure I understood.

Veterans Affairs committee  If I may, Mr. Chair, the policy changes that we've seen in other country's militaries—in the United States, in the United Kingdom—they have generally followed or have reflected regulatory re-evaluation of the drug. In the United States, around the time that the U.S. military formally declared it a drug of last resort, the FDA was adding the boxed warning to the medication.

Veterans Affairs committee  It's important to understand mefloquine's development in context. This is just the latest in a series of quinoline drugs that the U.S. military, which developed mefloquine, had quite a bit of experience with. I have always thought it would be reasonable for the U.S. military to have expected that mefloquine would have many of the same side effects that it had seen previously with other synthetic quinoline drugs, including atebrin, used in World War II.

Veterans Affairs committee  Yes. We discussed this in a number of papers. There are two safer daily alternative drugs in most areas of the world where there's chloroquine resistance, and one is Malarone, which is extremely well tolerated, and true contraindications or intolerance to Malarone are exceedingly rare, with maybe 1%.

Veterans Affairs committee  Yes, I am aware of multiple suits, either completed or pending. I've been involved as a consultant or expert in a number of successful cases in the United States. I've been involved in the same capacity in a number of cases overseas, and I do expect in the coming years that the number of claims against prescribers, against the governments that oversaw the prescribing of this drug, are going to face significant financial consequence.

Veterans Affairs committee  My position on this has developed somewhat over the years, and it's a complex and nuanced issue that also acknowledges the complex politics of this issue. In the U.K., very recently, after our testimony and after a thorough parliamentary investigation, the Ministry of Defence essentially adopted a policy that mefloquine would be the drug of last resort.

Veterans Affairs committee  I will address that question, Mr. Chair. I recently published an analysis of drug safety labelling in six countries, including Canada, the United States, some European nations, New Zealand, and Australia. What's very clear from that analysis is that, of these developed western nations, the drug label for mefloquine here in Canada is far behind.

Veterans Affairs committee  Yes, thank you. I can address that question, as it relates to Canada as well as to some other jurisdictions. To my knowledge, Roche stopped manufacturing, or distributing, or marketing its brand, Lariam, some time in the past few years. It was this decade, anyway. This is coincident with a trend of Lariam being discontinued in a number of other markets.

Veterans Affairs committee  Yes, I can address the question of whether civilians have also been affected by mefloquine. I should point out that I believe this issue attracts a lot of attention. The issue of adverse health effects among veterans attracts the most attention because this is a large group of persons, a large population that is given the drug at one time, and so perhaps problems with the drug will be more apparent within groups of military veterans.