Veterans Affairs committee  I believe you already have a number of institutions that focus on deployment health. We certainly do in the U.S. I wouldn't create new institutions. I would use the ones that taught you about PTSD and suicide. I would say, “Hey, this is something more that we've learned”, and use those venues to roll out information and education.

Veterans Affairs committee  I don't think you can do informed consent. We've looked at related militaries, the Australians, the Irish. I've heard, and I assume you have as well, this was back when mefloquine was given more commonly. They've thought if they didn't take mefloquine, they wouldn't be able to go.

Veterans Affairs committee  I'll just finish briefly. If you're looking at a paycheque and feeding your wife and kids and all the other things that come with being in the military, I don't think you can give informed consent.

Veterans Affairs committee  Yes.

Veterans Affairs committee  The short answer to do they have enough training is no. I mentioned, as a military psychiatrist I was not familiar with mefloquine when I was deploying to Somalia with a combat stress control unit. I think that has improved over time. We have been part of that improvement. We have given numerous lectures at various military medical conferences.

Veterans Affairs committee  Clayton Matchee was not an isolated event. We have so many reports of not only hallucinations but also rage and irritability. It wasn't a one-off. He got the most attention, but a lot of other bad things have happened because of mefloquine.

Veterans Affairs committee  I will take part two of your question, which was what the big issues are. Again, suicide is an obvious one. In the United States military, it has grown over time, although not all related to mefloquine. I understand that suicides in the Canadian military have also increased over time.

Veterans Affairs committee  But it is.

Veterans Affairs committee  Let me take your question another way. There are all kinds of ways to look at these issues. There are cross-sectional studies. There are longitudinal studies. The U.S. Army has done a very nice job of doing some of the surveys in theatre. We call them mental health advisory teams.

Veterans Affairs committee  May I add a piece to it? One thing we use to distinguish schizophrenia from drug toxicity of a number of types is that schizophrenia tends to have hearing voices, auditory hallucinations, while mefloquine is marked by visual hallucinations, as are other hallucinogens. I think the relationship of seeing the visual hallucinations when somebody's on mefloquine...that seems very likely.

Veterans Affairs committee  There are always more studies that can be done. People can set up a registry. That's been done in other settings. I wouldn't want the need for more studies to delay the public education that you were talking about earlier.

Veterans Affairs committee  There are all kinds of neurological effects of the drug. We don't have good prevalence data, but we certainly have case reports. As a matter of fact, at our conference a young lady had a seizure, and I ended up calling the ambulance and going to the hospital with her. She was in the Peace Corps, not a veteran.

Veterans Affairs committee  I believe vincristine comes from periwinkle, that little blue flower that they discovered some years ago would be useful in cancer treatment. I don't know of any connection between vincristine and mefloquine, though.

Veterans Affairs committee  Absolutely they should.

Veterans Affairs committee  We mentioned that we just had a symposium, and we had veterans from both Canada and the U.S. there. I don't want to name any names, but what several people told me quietly was that as a result of this, they had extreme homicidal thoughts about killing their most intimate family members.