Michael Harty (Clare, Independent) | Oireachtas source

I welcome this motion and will be supporting it.

There is a well-known Latin tag used in the medical profession which is "primum non nocere" meaning "first do no harm". This applies to all interventions in medical practice, including prescribing when treating diseases as well as actions which are designed to prevent disease. Malaria is a very serious disease which can be debilitating, chronic, relapsing and fatal. Taking treatment to prevent its development makes perfect sense, therefore, and it would be negligent not to do so, but no treatment is without some risk. Where several treatments are available, choosing the most effective treatment, balanced with that which has the least side effects, is the best option.

Another factor which has to be taken into account when prescribing or offering any form of treatment or prophylaxis against disease is that of informed consent. Effectively, this means that the patients must have full understandable information given to them prior to prescribing the medication so that they can decide if they want to take it. Additionally, they should be informed of alternative treatments and the risk profile of those treatments. This can be a time consuming task, but it is absolutely necessary so that informed decisions can be made. It is best and safest to ensure that this has been undertaken and, for everyone's protection, signed consent should be obtained for a treatment that has controversial side effects.

Lariam, mefloquine, has several serious side effects which include depression, anxiety, hallucinations, psychosis, violence, suicidal ideation and possibly suicide. As some people are at greater risk of developing these side effects, a full face-to-face assessment should be undertaken to identify those who would be most at risk and to offer alternative medication. However, such assessments will not eliminate the development of side effects in all recipients. The lessons to be learned are that this drug, while being effective in preventing malaria, has a high risk-benefit profile. In the case of Lariam, mefloquine, this is a classic case of first do no harm, get informed consent and carry out a pre-treatment risk assessment.

There are several types of malaria and several treatments. Not all treatments are effective against all varieties of malaria so one has to balance the risk versus the benefits of each treatment. Medicine is not an exact science but safety must be a priority. There is a worrying trend in medicine which is to deny evidence of side effects of treatments until the evidence is overwhelming and obvious. We should have early-warning systems which pick up adverse reactions to medications early and then take appropriate action. I believe Lariam should be used as a drug of last resort and not a drug of first resort.

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