comment, editorial

The stories of nightmares, mood swings, insomnia and suicidal thoughts have always made mefloquine, or Lariam, a controversial anti-malarial drug. Those psychological side effects have been known since the 1970s when the drug was developed for use by the United States Department of Defence scientists. But in situations where more benign treatments like doxycycline are not effective, the relatively small number of users experiencing adverse side effects and the temporary nature have made it an acceptable risk. A European Union safety assessment recently found the benefits outweigh the potential risks. But a growing body of evidence suggests those side effects may in fact be permanent, leading to lifelong depression, suicidal thoughts and triggering conditions like Post Traumatic Stress Disorder in some users. That evidence of potential life-long impacts is now too loud to ignore. Like Australia, Britain, has, over recent decades, given the drug to more than 2000 military personnel deployed to malaria zones like Africa and East Timor. In light of the growing concerns about the drug, the UK Defence Select Committee is conducting an investigation into the UK army's use of the drug and its potential impacts on personnel. This is a good opportunity for Australia to learn from the outcomes of that inquiry. However, the Australian Defence Force has elected to keep its own investigations into the drug internal and has so far resisted calls for a full public inquiry. The military has its own investigation and judicial processes, and often for good reason. But there are times when there is a clear public interest in the outcomes of such investigations. The courageous decision by serving Australian military personnel to break ranks and call for the investigation into mefloquine to be made public show just how seriously they view the problem. Some claim to have been permanently disabled by the drug, others believe they have lost loved ones through suicide brought on by Lariam use. The ADF argues the situation in Australia is different, because Lariam is not given as a first option for those travelling to malaria zones. Internal documents also show that Chief of Army Angus Campbell does not support a campaign against the drug because it would deny deployment opportunities, despite acknowledging the side effects. Defence's own documents acknowledge that some users experience on-going problems after going off the drug. Surely those differences between the two countries' use of the drug only further add to the case for a separate public inquiry. Hysteria and knee-jerk reactions to ban mefloquine could lead to a potentially helpful prevention for malaria taken off the table, placing personnel at a significant health risk. But it is becoming increasingly apparent that there is more to learn about the side effects of this complex medication. If Defence intends to continue supplying it to its personnel, it has a duty of care to address the concerns now being raised. Doing so publicly and openly is the best way to fight allegations of "a culture of denial, deceit and impunity", currently being levelled by some from within its own ranks.

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