Asked by: Countess of Mar (Crossbench - Excepted Hereditary)
Question to the Ministry of Defence:
To ask Her Majesty's Government, further to the Written Answer by Baroness Blackwood of North Oxford on 10 July (HL16834), what steps the Ministry of Defence has taken to address the concerns of the European Medicines Agency Pharmacovigilance Assessment Committee 2014 report on the toxicity of mefloquine (Lariam); and if they have not taken any such steps, why not.
Answered by Earl Howe - Shadow Deputy Leader of the House of Lords
Anti-malarial drugs are prescribed to Service personnel with the UK product information leaflet. For mefloquine, this reflects the recommendations of the Pharmacovigilance Risk Assessment Committee of the European Medicines Agency.
All anti-malarial drugs have contraindications and a side effect profile which can be found in the British National Formulary or online at the Electronic Medicines Compendium. It is Ministry of Defence policy that healthcare professionals undertake a health risk assessment and to warn patients of the possible side effects of any anti-malarial drug.
Asked by: Countess of Mar (Crossbench - Excepted Hereditary)
Question to the Ministry of Defence:
To ask Her Majesty's Government whether the health and wellbeing of all participants in the Surgeon-General’s 2016–17 research study on anti-malarial chemoprophylaxis (Ref: 713/MoDREC/15) was monitored to ensure that all adverse events occurring during the study were reported to the Medicines and Healthcare products Regulatory Agency (MHRA); whether participants have been monitored following the study to ensure that any adverse events that have occurred since are being reported to the MHRA; and what assessment they have made of whether suitable treatment is available to those participants suffering adverse events.
Answered by Earl Howe - Shadow Deputy Leader of the House of Lords
Adverse events are reported to the Medicines and Healthcare products Regulatory Agency (MHRA) using the Yellow card scheme and can be undertaken by a healthcare professional or the individual experiencing the adverse effect. The demographics required by the Yellow card scheme do not include the occupation of the subject, so military personnel are not uniquely identified.
The aims of the "713/MoDREC/15" study do not include assessing whether individuals or their healthcare professional reported side effects to the MHRA or to follow-up whether any person experiencing side effects required any form of treatment, including an assessment of whether suitable treatment was available. Data collated in the study is self-reported by individuals and any symptoms reported may not necessarily be related to the anti-malarial taken.
Asked by: Countess of Mar (Crossbench - Excepted Hereditary)
Question to the Ministry of Defence:
To ask Her Majesty's Government when they intend to publish the results of the research into the side effects of malaria chemo-prophylaxis referred to in their second and third six-monthly progress updates to the House of Commons Defence Committee on its report An acceptable risk? The use of Lariam for military personnel, published on 24 May 2016.
Answered by Earl Howe - Shadow Deputy Leader of the House of Lords
Data collection for this research has been completed and data cleansing, analysis and production of a report is under way, with completion anticipated in 2019.
Asked by: Countess of Mar (Crossbench - Excepted Hereditary)
Question to the Ministry of Defence:
To ask Her Majesty's Government whether they intend that an addendum should be added to the Defence Mental Health and Wellbeing Strategy Report 2017–2022 in order to address the effects of neurotoxicity from mefloquine; if so, when it will be published; and if not, why not.
Answered by Earl Howe - Shadow Deputy Leader of the House of Lords
Mefloquine is effective in the prevention and treatment of malaria and is licensed for use by the Medicines and Healthcare products Regulatory Agency, which regulates medication in the UK. Bodies such as the Advisory Committee on Malaria Prevention, the World Health Organization and the United States Centers for Disease Control and Prevention continue to include mefloquine as an option for malaria chemoprophylaxis.
The current product information for mefloquine states that neuropsychiatric adverse reactions may occur during treatment and includes warnings and precautions to minimise these risks. It also states that such adverse reactions may persist for months, or longer, even after discontinuation of the drug. It has not been established, however, that such adverse reactions may be permanent.
For these reasons, there are no plans to add an addendum to the Defence Mental Health and Wellbeing Strategy Report 2017-2022.
Asked by: Countess of Mar (Crossbench - Excepted Hereditary)
Question to the Ministry of Defence:
To ask Her Majesty's Government whether the Surgeon General of Her Majesty’s Armed Forces recognises the chronic neurotoxic effects on members of the Armed Forces and Veterans from the administration of mefloquine (Lariam); and whether they will be addressing the problems caused by those effects in the near future.
Answered by Earl Howe - Shadow Deputy Leader of the House of Lords
Mefloquine is effective in the prevention and treatment of malaria and is licensed for use by the Medicines and Healthcare products Regulatory Agency, which regulates medication in the UK. Bodies such as the Advisory Committee on Malaria Prevention, the World Health Organization and the United States Centers for Disease Control and Prevention continue to include mefloquine as an option for malaria chemoprophylaxis.
The current product information for mefloquine states that neuropsychiatric adverse reactions may occur during treatment and includes warnings and precautions to minimise these risks. It also states that such adverse reactions may persist for months, or longer, even after discontinuation of the drug. It has not been established, however, that such adverse reactions may be permanent.
For these reasons, there are no plans to add an addendum to the Defence Mental Health and Wellbeing Strategy Report 2017-2022.
Asked by: Countess of Mar (Crossbench - Excepted Hereditary)
Question to the Ministry of Defence:
To ask Her Majesty's Government what assessment they have made of neurotoxicity resulting from the administration of mefloquine to military personnel; and what steps they have taken to ensure that veterans suffering from mental health problems are not given drugs that may exacerbate their illness due to a reaction with mefloquine.
Answered by Earl Howe - Shadow Deputy Leader of the House of Lords
There is no established evidence of prophylactic drugs having long-term side effects causing mental health issues.
The Royal College of Psychiatrists' 'Good Psychiatric Practice' report states clinicians must "be competent in obtaining a full and relevant history that incorporates developmental, psychological, social, cultural and physical factors". This includes the consideration and assessment of the effect of medication and the circumstances in which it is being prescribed.
Asked by: Countess of Mar (Crossbench - Excepted Hereditary)
Question to the Ministry of Defence:
To ask Her Majesty's Government what steps they have taken to ensure that the medical histories of all military personnel are accurate and complete and that Post Traumatic Stress Disorder is accurately diagnosed.
Answered by Earl Howe - Shadow Deputy Leader of the House of Lords
Under national medical and professional body regulations and guidelines, there is a duty on health professionals to maintain accurate and comprehensive records. The Ministry of Defence (MOD) has a number of governance and other processes to ensure the accuracy and quality of the medical records of serving Armed Forces personnel. On discharge from Service, an individual's medical record is routinely checked before their care is passed to the NHS or equivalent primary healthcare services.
Every effort is made to correctly identify Armed Forces personnel with Post-Traumatic Stress Disorder (PTSD). When PTSD symptoms are recognised by a Defence Primary Care clinician it triggers a referral to an MOD Department of Community Mental Health. An assessment is then conducted by a nurse, psychiatrist or psychologist. The diagnosis of PTSD can only be confirmed by a consultant psychiatrist or psychologist and a nurse will request their review of the case to confirm the diagnosis.
Asked by: Countess of Mar (Crossbench - Excepted Hereditary)
Question to the Ministry of Defence:
To ask Her Majesty’s Government, further to the Written Answer by Earl Howe on 15 March (HL6835), whether they accept the findings of the Boston University School of Public Health that research "clearly and consistently" shows that exposure to pesticides and other toxins caused Gulf War Illness, and whether they are aware of any criticisms of this study that have been published following scientific peer review.
Answered by Earl Howe - Shadow Deputy Leader of the House of Lords
The paper published by the Boston University School of Public Health is not new research but a review of the published peer-reviewed literature on the health of 1990-91 Gulf War veterans, notably that which has been published since 2008. We have carefully considered the paper, its findings and conclusions, and cannot agree that the review and studies cited demonstrate a causal association between pesticides and other exposures and Gulf War illness or specific diagnoses. We are not aware of any comments on the Boston University paper, either critical or in support.
Asked by: Countess of Mar (Crossbench - Excepted Hereditary)
Question to the Ministry of Defence:
To ask Her Majesty’s Government what assessment they have made of the finding in the report from the Boston University School of Public Health in <i>Cortex</i> that research "clearly and consistently" shows that exposure to pesticides and other toxins caused Gulf War Illness; and what bearing that report will have on the treatment of sick Gulf War veterans.
Answered by Earl Howe - Shadow Deputy Leader of the House of Lords
The Government greatly values the service of all 1990-91 Gulf War veterans. We have long accepted that the ill-health of some veterans of the 1990-91 Gulf War may be associated with their service in the Gulf. In such cases, and where a link is proven, compensation may be claimed under the War Pensions Scheme, with appropriate medical care provided by the National Health Service across the UK.
The Department has funded extensive research into Gulf War illness including some research into rehabilitative therapies for those veterans with persistent symptoms. Our strategy on research topics and studies has been informed and overseen by independent scientific experts nominated by the Medical Research Council, taking account of published peer-reviewed international literature and international studies. We have no plans to undertake further research on Gulf War issues. We continue to monitor any Gulf War research that is published around the world, including in the United States.