Random Analytica

Random thoughts, charts, infographics & analysis. Not in that order

Tag: Tafenoquine

38. Mefloquine Dispatches: Protected Information & Confidentiality @DVSRC, 27th June 2022

It isn’t my bag, Commissioner… Yet here we are.

I didn’t participate in the early hearing blocks of the Royal Commission into Defence and Veteran Suicide. I understood that listening to the stories of other witnesses would be traumatic. I understand I can get triggered. I was being very careful.

Over the past fortnight, I have been following the proceedings with much interest. It’s my old outfit. 3 Brigade (I didn’t connect with the 3rd Combat Brigade rename). After 25-years absence I thought that with time and distance it would be enough to insulate me from further triggers.

I was very wrong.

This would be a wonderful segue into my specific topic of interest. Mefloquine. Just a note. Tafenoquine is a relevant subject too and I thought it would have been discussed in Townsville.

Wrong, on both accounts.

Yet, something else came up watching the Royal Commission. If you were watching it as a veteran or currently serving member it should send chills down your spine. According to the witness testimony this week they apparently interviewed more than a 100 people in Townsville during the fortnight of hearings. Via Transcript Day 5 − Townsville, 24 June 2022. Excerpt:

CHAIR:  Good morning, Mr Gray, Mr Free.  We want to place a number of matters on the record today before we hear from you hopefully.  By way of background, and happy to place this on the record. Counsel and Solicitors Assisting us have requested this brief procedural hearing this morning.

The background is as follows: before our hearing program began, we were concerned to do everything we could to encourage serving and former members of the Defence Force to come forward with any information they considered relevant to our Terms of Reference, and to ensure that there would be appropriate arrangements in place for sensitive information so that they would face no risk of legal liability for sharing information with us.  This is a very important issue for the Royal Commission, as you can appreciate, and we want to ensure every protection is given to those who come forward with information.  In October last year we asked Solicitors Assisting to send the Commonwealth a proposed written arrangement to achieve this.  We were not proposing to elicit any protected information or even sensitive operational information; we simply wanted an unambiguous green light given to serving and former serving members to provide appropriate and textual information for us relating to their accounts about the circumstances of service that led to their experiences of suicidality or witnessing suicidality or witnessing risk factors in service without fear that by doing so, they could in any way get into trouble for revealing Defence‑related information.

As the Townsville leg came to an end Commissioner Kaldas, to his credit tried to reassure Veterans that any evidence you give to the Royal Commission won’t be prosecuted. He brought up the powers of the Royal Commission legislation to protect witnesses and the fact that General Angus Campbell made a public commitment to not prosecute anyone for giving evidence.

The Commonwealth have yet to offer such comfort to Veterans. In fact, their reticence comes in the same week as it was confirmed the Attorney General, Mark Dreyfus would allow the Commonwealth to pursue ATO whistle-blower Richard Boyle.

220624_Letter_MDreyfus_RBoyle

Just to be clear.

If you have no protected legal rights, you effectively have no rights. Other Veterans have tried to disclose sensitive information including war-crimes and have been subjected to severe legal ramifications. This includes David McBride. I can’t believe I’m backing an Officer, but we live in strange times.

As much as I appreciated the strong words by Commissioner Kaldas, the decision to pursue witnesses legally won’t be a decision for the Royal Commission or of the Australian Defence Force. It will be a Commonwealth matter.

As for the ADF, officers and the assurances of the General Campbell. I don’t believe him. So far, the fallout from the Brereton report into extrajudicial killings in Afghanistan elicited the following actions from the ADF in regards to Operation Slipper.

  • They forgave the officers and gave then legal immunity.
  • They dismissed or charged the Diggers. Some of these guys have since taken their own life.
  • They discussed disbanding units. Still pending.
  • They were about to remove the combat medals of Veterans. Still pending.

Good article here and a reminder that General Campbell actually commanded JTF633. Officers escape legal responsibility, but what about their moral accountability? I’m trying not to sound snarky, but I’ll just assume he forgave himself while also giving himself legal immunity. Also, he just had his CDF role extended by 2-years.

That was last Friday. On the second week the matter of confidentiality and protected information was raised in the morning then quietly dropped. It was an important session.

Here is the 27th of June 2022 AM Hearing List (note the 3.15pm session):

220627_Screenshot_DVSRC_Day6_TSV

This was the official version…

I immediately queried the change and received this response.

 

To sum up. I welcome the words of Commissioner Kaldas but they are just words. Without the same assurances from the Commonwealth, they are at best misleading, at worst plain wrong.

I’m all in but if you have given evidence or are considering giving evidence which might include sensitive information, I would seek some legal advice prior to submission. Just to be on the safe side.

On that note, be safe.

 

 

My daily reminder that as of 1st July 2022 it is the 360th day of the Royal Commission and we still haven’t discussed Mefloquine or Tafenoquine..

 

37. Mefloquine Dispatches: Lieutenant General John Caligari, 22nd June 2022

Lieutenant General John Caligari.

I watched his evidence to the Royal Commission into Defence and Veteran Suicide today. Credit where credit is due. The work he has done putting together The Oasis is very impressive.

Not one question about Mefloquine or Tafenoquine though. A drug known to cause suicide.

Bit odd when you consider Submission 65 into use of the Quinoline anti-malarial drugs Mefloquine and Tafenoquine in the Australian Defence Force Senate Enquire of 2018. Excerpt via screenshot:

Two hours of testimony and not one question about this? An oversight maybe?

Anyway, you can read the entire report here: 180716_Submission_1RAR_Sub65

Just a reminder. Today is the 350th day of the Royal Commission into Defence and Veteran Suicide and we still haven’t started talking about mefloquine or tafenoquine.

 

 

31. Mefloquine Dispatches: Vanuatu, October 1996

In October 1996 the online parachute company from 3 RAR started to pre-deploy for Vanuatu after the Vanuatu Mobile Force mutinied. The U.S Department of State noted in its Human Rights report on the 30th of January 1997 that:

“The civilian authorities normally control the small police and paramilitary Vanuatu Mobile Force, however, a brief mutiny in October by elements of the VMF over pay issues shook the principle of civilian control. The mutiny was resolved without bloodshed.”

As the situation de-escalated the mission got scrubbed and was quietly forgotten, lost to history. Unfortunately, for the 3 RAR soldiers (along with attachments) they had already been given a Mefloquine Loading Dose.

Here is a text from a Digger who was exposed to Mefloquine on that Operation (along with during normal military service) and has since suffered life altering impacts from the drug. (Note: shared with permission with personal details removed). Excerpt:

Hi Shane. It’s * here. Love to catch up cause (sic) I got no idea what’s happening and am generally confused. I was contacted out of the blue by someone at dva (sic). This was 3 years ago. They said it was some mefloquine program and wanted to speak to me about my exposure to mefloquine. Told him I had no idea what he was talking about. But yes had taken malaria medication in 3 RAR and * in late 90’s. He told me he would email me. Following day a secure encrypted email show up. I ring him, he laughs, says oops and that he will resend it and just to delete it. Of course I don’t. But nothing shows up. I ring dva (sic). They keep fobbing me off saying someone from the mefloquine team will call me back. Never happened. I got shits and stopped calling. 6 months later I ring up to be told it’s an inquiry at the senate and I will need to lodge a claim. Advocates can’t tell me nothing till a month ago when advocate tells me to put in claim for mefloquine acquired anxiety disorder. I mention it to *, they say they saw some 60 mins show about it and was going to ring and ask me if I’d been on it cause of some of the shit I through in * then after discharge in *. So that’s me. I don’t really know more than that

 

This is just one example of the Department of Veterans Affairs covering up Mefloquine use in the ADF during the 1990s prior to the Senate Enquiry into the Use of the Quinoline anti-malarial drugs Mefloquine and Tafenoquine in the Australian Defence Force. Unfortunately, it is not the only example.

I’ll leave on this note.

Bureaucrats don’t authorise cover-ups. C-Level does, in this case that would be the CDF, the Departmental Secretary and the Minister.

At the time of the Senate Enquiry (June 2018) the CDF was General Angus Campbell, the Departmental Secretary of DVA was General Liz Cosson (Ret) and the Minister was the Honourable Darren Chester.

 

25. Mefloquine Dispatches: BUPA, 17th June 2021

It’s taken two years. A mixture of research/tenacity and outright good luck have got me to this point.

I have finally got into the Neurocognitive Program. It had been called the Mending Military Minds Program but in reality it is an attempt to deal with 3rd wave injuries via anti-malarial medications now opened up to other factors like IED’s or percussive injuries.

Outright good luck too. I got into the program because my Psychologist was sharp enough to pick up on an email from Open Arms.

My Open Arms Psychologist is amazing. Open Arms runs the program. I go through the barrier testing with an Open Arms staffer who is great.

Then I get this…

I don’t do private healthcare. I worked in an Operating Theatre for a year. I have witnessed the damage these companies do to hospitals. They are parasites.

At no time was BUPA mentioned throughout the process. To the best of my knowledge BUPA should have nothing to do with this program. If BUPA were running this I wouldn’t have become involved.

Yet they do… Now I’m stuck with another bullshit process and lengthy delays.

Why does BUPA have anything to do with the Neurocognitive Program?

Update (8th July 2021)

Happy to advise that I received an unsolicited follow-up call from Open Arms enquiring about the Neurocognitive Program booking process. They listened to my concerns and will get back to me about a more suitable appointment.

Good result. Thanks Open Arms.

Mefloquine Dispatches: An Index

Stories linked to my experiences after having taken mefloquine as part of my military service.

  1. Mefloquine Dispatches: My Request to Darren Chester
  2. Mefloquine Dispatches: My Daughter, 2016
  3. Mefloquine Dispatches: Raven, 1990s
  4. Mefloquine Dispatches: Harley Quinn, 1997
  5. Mefloquine Dispatches: @NAB, 20th March 2019
  6. Mefloquine Dispatches: @WHO, 8th August 1989
  7. Mefloquine Dispatches: Estadio Nacional Julio Martínez Prádanos, 11th March 2006
  8. Mefloquine Dispatches: Dr Pepper 2.2. 2011 & 1992
  9. Mefloquine Dispatches: The Joker, 1997 & 2019
  10. Mefloquine Dispatches: Acceptance, October-2019
  11. Mefloquine Dispatches: Full Bloom, 2012
  12. Mefloquine Dispatches: The Claremont Serial Killings, April 1997
  13. Mefloquine Dispatches: The Commonwealth Department of Veterans Affairs, 2000
  14. Mefloquine Dispatches: SGADF, 26th September 2019
  15. Mefloquine Dispatches: Suicide Prevention, early 1990
  16. Mefloquine Dispatches: Caravaggio, October 2012
  17. Mefloquine Dispatches: FOI, 21st November 2019
  18. Mefloquine Dispatches: Royal Commission, 2020
  19. Mefloquine Dispatches: Lord Dannatt, 28th November 2019
  20. Mefloquine Dispatches: 1800 MEFLOQUINE, 10th May 2019
  21. Mefloquine Dispatches: Mindfulness, 5th December 2019
  22. Mefloquine Dispatches: Mil Mi-24, 27th March 1997
  23. Mefloquine Dispatches: Foreign Affairs, Defence and Trade References Committee, 28th February 2020
  24. Mefloquine Dispatches: Sausage rolls and the Red Cross, 1st July 1997
  25. Mefloquine Dispatches: Mefloquine Dispatches: BUPA, 17th June 2021
  26. Mefloquine Dispatches: LBMC, 28th April 1997
  27. Mefloquine Dispatches: McKinsey & Company, 19th October 2021
  28. Mefloquine Dispatches: 3573 – Lambie, Senator Jacqui, 23rd April 2021
  29. Mefloquine Dispatches: Patricia Fernandez de Viana, 10th December 2021
  30. Mefloquine Dispatches: The Sandline Affair, 21st March 1997
  31. Mefloquine Dispatches: Vanuatu, October 1996
  32. Mefloquine Dispatches: My Letter to Matt Keogh, 4th June 2022
  33. Mefloquine Dispatches: Jim Molan, 11th March 2002
  34. REDACTED/DVSRC – Mefloquine Dispatches: Other Suicides, April-1997 (Part One)
  35. Not published
  36. Not published
  37. Mefloquine Dispatches: Lieutenant General John Caligari, 22nd June 2022
  38. Mefloquine Dispatches: Protected Information & Confidentiality @DVSRC, 27th June 2022
  39. Mefloquine Dispatches: Anti-Malarial Medications Health Assessment Program, 15th March 2019
  40. Mefloquine Dispatches: Accessing Superannuation, 17th April – 3rd May 2019
  41. Mefloquine Dispatches: FOI – The Last Signalman (9th Sep 2022)
  42. Mefloquine Dispatches: FOI – One Document (1st Oct 2022)
  43. Not published
  44. Not published
  45. Not published
  46. Not published
  47. Mefloquine Dispatches: Dun & Bradstreet (28th September 2004)
  48. Mefloquine Dispatches: Homelessness (21st November 2022)

Random Analytica: A ‘Soldiers-Five’ [trans. Basic Reading Guide] on Mefloquine

An old ‘soldiers-five’ on Mefloquine. When I first thought I was given Mefloquine I wasn’t sure where to look first. I initially got some good and some bad information. I’m not the tree of knowledge on Mefloquine but here is a suggested reading list and resource guide concerning Mefloquine. I’ve focused on veterans because that is my lived experience. Remember, this is a guide only. Consult your doctor.

Last updated 7th October 2019

World Health Organisation

8th August 1989: World Health Organisation. The original warning from WHO way back in 1989.

Consumer Medicine Information

9th October 2017: The Consumer Medicine Information guide for Lariam (linked here: 171009_ConsumerMedicineInformation_Roche_Lariam). A veteran mate has underlined the important health warnings.

Mefloquine Articles (non-specific)

27th April 1996: New Scientist.  Malaria pill stands accused – Lariam fends off malaria more effectively than any other drug, but growing evidence of disturbing side effects may soon land its manufacturer in court (via 960427_Article_NewScientist_Mefloquine). Thanks to the veteran mate who sent this through. He was given Lariam in 1994 and 1999 without the serious side-effects.

Mefloquine Articles for Veterans

27th January 2003: CBS News. The Dark Side Of Lariam. How Dangerous Is It? One of the first ‘deep-dives’ into mefloquine by a news outlet. Discusses the Fort Bragg suicide cluster where mefloquine was a factor.

19th September 2013: CBS News. Elite Army units to stop taking anti-malarial drug. The US Army’s Special Forces banned from using mefloquine in 2013.

25th September 2013: Huffpost. Mefloquine: The Military’s Suicide Pill. Dr Remington Nevin writes about mefloquine including the 2013 FDA’s ‘black-box’ warning. The world is waking up to the dangers of mefloquine. Dr Nevin is one of the leading experts in the field.

12th October 2014: Army Technology. Mefloquine – the military’s deadly malaria treatment. Dr Remington Nevin discusses the downside to mefloquine including his own personal deployment experience with the drug.

11th August 2016: Military Times. Malaria drug causes brain damage that mimics PTSD: case study. A different take on mefloquine exposure from the USA.

22nd August 2016: Australian Broadcasting Corporation. Defence force admits soldier shouldn’t have been included in East Timor anti-malaria drug trial. One of the first articles I read. Also includes a link to a 2016 7.30 Report about the Australian mefloquine/tafenoquine trials.

30th August 2018: The Irish Times. Vivid nightmares and suicidal thoughts – ex-soldiers blame drug for destroyed lives. An Irish perspective. With a standing Army of approximately 10,000 they have still administered Lariam to approx. 5,500 – 6,000 over the years.

Podcasts

12th June 2019: The Medical Republic. TMR podcast: Can this anti-malarial drug really cause “brain damage”? Thanks to my GP, Dr Mary Lamond for sending this to me. Along with other subjects the podcast covers mefloquine/tafenoquine exposure and its risks in simple language.

Books

23rd January 2014: ‘The Answer to the Riddle Is Me’ by David Stuart MacLean. The Washington Post book review can be found here.

Official Mefloquine Sites (Information & Policy)

Last accessed 7th October 2019: Department of Defence (Australia). Mefloquine. An excellent resource. One of the first sites I visited. Mefloquine Loading Doses are also explained.

Experts

Dr Remington Nevin (USA). Possibly the leading expert in the field of Quinism in 2019 when I suspected my exposure. US Army (Major – Retired). A Vermont-based physician epidemiologist and expert consultant in the adverse effects of antimalarial drugs, particularly mefloquine and tafenoquine.

 

If you or someone you know needs help, please phone Lifeline on 131 114, Kids Helpline on 1800 55 1800, Beyond Blue on 1300 224 636 or Open Arms on 1800 011 046.

Random Analytica: Mefloquine Use by the Australian Defence Force (1990s)

I’m ready to heal yet I still need to count the cost. Others have made the attempt and fallen short. It might be my most important piece of epidemiology to date. It might pan out to be nothing. At least now I can do it systemically and at a slower pace.

It’s personal for me.

191112_MefloquineUseByADF90s (UPD)

The chart above is still a work in progress. I’m starting to get some good feedback from other veterans… If you want to add to this chart please reach out.

Last updated 12th November 2019

Notes:

191112_MefloquineNotes (UPD)

 

990910_Photo_JMolan_OpSpitfire

10th September 1999. Brigadier Jim Molan & Ian Martin directing the evacuation of Dili, East Timor. Source: Twitter (John L. Gould)

 

If you or someone you know needs help, please phone Lifeline on 131 114, Kids Helpline on 1800 55 1800, Beyond Blue on 1300 224 636 or Open Arms on 1800 011 046.

4. Mefloquine Dispatches: Harley Quinn, 1997

I’m told by my GP that PTSD is just like shrapnel. Only this year did I learn that I had shrapnel in my arm back in the 90s. I don’t believe in PTSD. Now I’m trying to remove it from my head.

Not all memories are awful. Some are wonderful.

It’s late 1997. I’m doing my Secret Squirrel course in Melbourne. I’m seeing three different women in Townsville, which is unusual for me. I am operating on muscle memory and I’m certainly not looking for love.

We meet in the gym. I feel underweight for Special Forces. I’m eating seven meals a day. I work out morning and night. I still don’t feel right.

She is with two friends from other postings. I know her friends well enough to walk over and start a conversation. One of the girls is a great rugby player who also happens to be gay. She doesn’t make a big deal about it because homosexuality is still banned by the Army. The other girl has a beautiful face and a kind smile for anyone. A decade later I hear (third-hand) that she got ‘schrapped’ in the Sands on patrol with the Boys. Her face is now damaged.

I feel so sorry for everyone who carries scars now.

It’s late 1997 again. I start to chat to Harley Quinn. I know her but not well. Like most people in the peace-time Army everyone knows everyone after a few years, especially in your own Corps. I think we last caught up in Darwin in 95 but I can’t quite remember. I take a break from my work-out. We start to talk. She gets a constant stream of interruptions. She is not classically beautiful but she has a natural attractiveness that draws admirers. She knows everyone. She talks easily with those who deserve it. Dismisses time-wasters. She commands attention. She is in the prime of her youth. I get a lift from our conversation. By her presence. We all agree to meet at the mess for dinner.

A fortnight later we are in a trinity of nightclubs. It’s just Harley Quinn and me. Our friends cannot keep up. We move from one nightclub to the next and then back again. We dance for hours. We laugh with absolute joy.

We leave the building with our friends. We are both spent. The sun is out. The light surprises us both. I think we have both fallen hard. We hold hands. We really hold hands. It’s a special moment. The future looks bright.

Tears stream down my face as I have this memory yesterday. I use movement to guide the memories. I remember back to 1997. As I dance away I still don’t know anything about mefloquine. I certainly don’t know I was given it six-months previously. My face hasn’t turned red yet. That doesn’t happen for another decade and a half. I’m slowly turning into The Joker but I think I’m fine.

I get more memories of my Harley Quinn. We break up in 1999. It’s a hard break-up. A horror story for another day. She has been deployed to Bougainville on Operation BEL-ISI. The Australian Defence Force is testing a new anti-malarial drug on the troops. The Generals are excited about its potential. It’s called Tafenoquine.

It has a nickname too. Mefloquine 2.0

191021_Image_HarleyQuinn

Image: Warner Bros. Pictures

 

If you or someone you know needs help, please phone Lifeline on 131 114, Kids Helpline on 1800 55 1800, Beyond Blue on 1300 224 636 or Open Arms on 1800 011 046.

Mefloquine and Tafenoquine use by the Australian Defence Force 1990 – 2017

Mefloquine and Tafenoquine are two different types of anti-malarial drugs that have been in use potentially as far back as 1990 but trialled extensively by the Australian Defence Force at the turn of the century. From 2016 via the Australian Broadcasting Corporation. Defence force admits soldier shouldn’t have been included in East Timor anti-malaria drug trial. Excerpt:

The Australian Defence Force has acknowledged it accidentally exposed one of its soldiers to controversial anti-malarial drugs during trials in East Timor, despite the soldier having a medical history of mental illness which should have precluded his involvement.

The soldier, Chris Salter, developed chronic depression and psychosis after inclusion in the Timor trials of psychoactive drugs mefloquine and tafenoquine.His illness has led to repeated suicide attempts and more than a dozen stays in psychiatric hospitals. He is unable to work or care for his family.

Since the trials, which included thousands of Australian soldiers between 2001 and 2003, a small group of veterans have developed severe mental illnesses. They believe the ADF erred by giving them the drugs even though there was a significant body of research which pointed to the drugs’ side effects, which in some cases are permanent.

I just wanted to get a chart posted which highlighted the use of Mefloquine and Tafenoquine in Australian soldiers over the past 30-years. Currently most of the documentation concentrates on the trials conducted between 1998 – 2002, however there is some evidence that groups of soldiers were subjected to trials of mefloquine as far back as 1992 during Operation SOLACE (Somalia). I’ll update the chart as new information comes to hand.

Mefloquine~TafenoquineUsebyADF1990-2017

Explanatory Notes:

1992-93: Somalia – Awaiting more information
1993: Cambodia – Awaiting more information
1994-96: Rwanda – One confirmed mefloquine dosage. Awaiting more info
1997: PNG – One confirmed mefloquine dosage. Awaiting more info
1998: Bougainville – Peace Monitoring Group – 201 troops given Tafenoquine (note: Stuart McCarthy’s notes state 374 troops were given Tafenoquine).
2000: East Timor – 639 troops given Tafenoquine during trials.
2000: East Timor – 162 troops given Mefloquine during the Double-Blind trial
2000: East Timor – 492 troops given Tafenoquine during the Double-Blind trial
2001: Australia – 31 troops given Tafenoquine to test for Relapse Prevention
2001: East Timor – 1,157 troops given Mefloquine during the last major trial of the drug

An excellent resource for understanding the trial intensity of both anti-malarial drugs is Stuart McCarthy’s Summary of ADF Mefloquine and Tafenoquine Clinical Trials 1998 – 2002. See attached:

150724_Summary_SMcCarthy_ClinicalTrials

Data Sources

  1. Mefloquine http://www.defence.gov.au/Health/HealthPortal/Malaria/Anti-malarial_medications/Mefloquine/default.asp
  2. Randomized, double-blind study of the safety, tolerability, and efficacy of tafenoquine versus mefloquine for malaria prophylaxis in nonimmune subjects https://www.ncbi.nlm.nih.gov/pubmed/19995933
  3. Summary of ADF Mefloquine and Tafenoquine Clinical Trials 1998 – 2002 https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Foreign_Affairs_Defence_and_Trade/Mefloquine/Submissions
  4. TGA Approvals for Australian Defence Force Use of Mefloquine in Townsville (Queensland) and Somalia, 1992-93 https://www.righttoknow.org.au/request/tga_approvals_for_australian_def