Status of Women Committee on Feb. 5th, 2014

[Dr. April S. Elliott]

Yes.

[Dr. Debra Katzman]

Yes.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

My questions are as follows. Are there existing models that we should consider? Are some governments investing significant sums of money in awareness or treatment programs? And are there studies or reports that the committee should look at during its work?

I would also like to know how much Canada has invested in research on this subject compared to the United States or the United Kingdom. I have heard that the United Kingdom is one of the leaders in this area.

[Dr. Debra Katzman]

I'll deal with the research question first.

There are examples that you should be referring to. I would refer you to the National Institutes of Health. Tom Insel has taken eating disorders as a really important research agenda for the U.S. It would be really important for you to look at some of his thoughts about this. The U.K. has also done a significant amount of work looking at the issue of eating disorders, treatment guidelines for disorders, and in their health care system how to divide up...or look at how to create a country that delivers health care with respect to eating disorders. I would say that the U.S. and the U.K. are nowhere near developing the optimal or gold standards. I think people are working towards that.

When we're looking at eating disorder funding, I think in Canada our eating disorder funding is significantly less—I want to underscore that—than in the United States. However, the United States has very, very low funding earmarked for eating disorders.

As a researcher, a lot of my funding has been through the National Institutes of Health, because they do have earmarked funds for eating disorders. Here in Canada there are no such earmarked funds for eating disorders, and neither are there other special foundations where you can go to for funding for eating disorders.

There's a lot of room for the development of a research agenda, and there's a lot of room for increased research funding.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Mr. Harris.

[Dan Harris, NDP, Scarborough Southwest, ON]

The last part of that answer was actually a little surprising, that you're getting funding and support from the U.S. government, through the NIH, and yet we don't really have federal funding here in Canada.

Is that something you'd like to see changed?

[Dr. Debra Katzman]

Absolutely.

The studies that I do are really on the medical complications of eating disorders. We have a huge NIH study looking at the treatment of osteoporosis in young adolescents with eating disorders. That's been funded by the National Institutes of Health for seven or eight years now. It would be great to have funding for these types of things for eating disorders. I could list a whole agenda for you of needed research, and of the funding that needs to be pointed at it.

I might add to underscore this that across Canada there are very skilled clinicians in eating disorders and there are very skilled researchers in eating disorders. We in fact could, together as a country, as a collaboration across Canada, really develop some very important research initiatives.

[Dan Harris, NDP, Scarborough Southwest, ON]

Yes. Thank you very much.

Certainly anything that's going to help to improve health—in particular when we're talking about prevention, an ounce of prevention is worth a pound of cure—will save the health care system money, which will in turn give us more money to allocate into resources.

It was interesting to hear, I think it was Dr. Elliott who said this, that among the programming, there is a 75% success rate, which means there's still 25% that isn't successful.

We have now heard from the previous witness and also here now about good programming in the U.K. Do either of you know what percentage of success they have achieved in the U.K.?

[Dr. Debra Katzman]

The studies I quoted you were studies that were done in combination in the U.S. and the U.K. Together there may be now about 15 to 20 studies looking at family-based treatment, and if you look at those studies, depending on how long you follow out the patients in those studies, we would say on average 75% of them recover. That's both U.S. and U.K. data.

[Dan Harris, NDP, Scarborough Southwest, ON]

Do we have Canadian data for the programs we've engaged in? Are we near there for a success rate?

[Dr. Debra Katzman]

I think we probably are near there for a success rate at least in our program. I'm sure April can speak to her program as well.

[Dr. April S. Elliott]

One of the things I'd like to say is I'm not sure about The Hospital for Sick Children, but at our program we actually have an analyst. I think we're so lucky to have a specific person. We do measures at the beginning and end of every segment of our programming, and we have an analyst to look at it, and look at our numbers.

I think we're one of very few programs that have that luxury, so it's definitely something we need. We need the measures to make the changes and that doesn't exist everywhere.

[The Chair, NDP, Hélène LeBlanc]

Thank you very much.

Now we go to Mrs. Young for seven minutes, please.

[Wai Young, Conservative, Vancouver South, BC]

I'd like to thank you both for your presentations, which were extremely comprehensive.

I guess the reason we're doing this study is we have learned we have this incredible population who are suffering from this illness who are needing support and help. It's 1.5% of the female population, some 525,000, I think is the figure both of you mentioned.

I guess there are positive outcomes here in the sense that obviously you have worked very hard in Calgary for 14 years, and Dr. Katzman for 28 years in Canada and in Toronto, on crafting effective programs. We're hearing a success rate of 75%.

My question, being a sociologist, is how can.... You have obviously worked very hard and very long on crafting the programs you have crafted within the provincial health care systems you work within. As you know, in Canada the health care delivery system is actually provincial. Can you share with us how you're able to craft your programs, and how is it that other provinces, cities, or jurisdictions can therefore craft theirs for as high as a 75% success rate such as yours?

Perhaps we'll start with Dr. Katzman this time.

[Dr. Debra Katzman]

I think the way we did it at Sick Kids is there were champions for eating disorders when we came in. We fought long and hard within our hospital to make sure this was an important issue that needed to be attended to, because there were no other resources in the province of Ontario when I came in that tended to children and adolescents. Now, however, there are. We're really thrilled there are these other programs in the province of Ontario.

As a result of that, we created the Ontario Community Outreach Program for Eating Disorders. This is a network that really delivers education and provides support to primary care physicians, secondary care physicians, and centres. The tertiary care centres, like CHEO and like us, are really the hub.

When physicians in the community or physicians in secondary care institutions have patients with eating disorders, they can call where they get support from the hub. There are educational programs that happen once or twice a year. The Ontario Community Outreach Program for Eating Disorders provides education and support to people who are interested in caring for eating disorders.

I think having that system in place has really helped, encouraged, and empowered people to take care of patients with eating disorders. They can be very sick and it can be very time consuming, but knowing you have backup at the tertiary care centre can be very helpful.

[Wai Young, Conservative, Vancouver South, BC]

I'm just asking a supplementary question here because I think this is the nub of the issue.

Your group has been valiant and obviously successful, and kudos to you for fighting hard to ensure this happens and that these services and programs are in place.

What more needs to be done? How hard do we need to fight to raise this as an issue so that we don't just have a 75% success rate, but we reach 100%?

[Dr. Debra Katzman]

Do you want to speak?

Go ahead.

[Dr. April S. Elliott]

I just want to say that if you look at a province, and I'll use the example of Saskatchewan, you will see there are pediatricians and psychiatrists there who are very competent and could do this work and build a program—having had residents who came out of Calgary and so eagerly went back to Saskatchewan and wanted to build a program—yet there aren't the resources laid out for them. They may not be in a place in their life to actually put in the fight that we did in our time. There just isn't the infrastructure.

I think the important thing is you not only need the resources, but you also need those champions and a strategic plan. When you look across Canada, there are programs that are going for that gold standard of care. It's about getting those programs together, looking at that template and having that strategic plan, so that we can then help other provinces do that. I think that each individual fight was fine, but as a nation we have to give those other provinces the support so they don't have to start from the bottom.

[Dr. Debra Katzman]

The only thing I would add, Ms. Young, is that there are provinces that have eating disorder programs. Some of them have eating disorder programs for adults, some of them have them for children and adolescents, and some have both. There are provinces that do not have these services yet, so we're not there yet.

The other thing I would say to you is that as a pediatrician who goes for a 100% cure rate, 75% is not good enough. We are just at the very beginning. We have one treatment for anorexia nervosa, and that's family-based therapy. If that doesn't work, then we're sort of piecing together various treatments that have not been evidence based and have not been studied. We have a long way to go.

[Wai Young, Conservative, Vancouver South, BC]

I absolutely agree with you. That's why I was asking the question of how we reach 100%.

To divert a little bit, 25 years ago we were the first country in the world to say that smoking is bad, so we implemented legislation, etc., and now smoking is at its lowest levels ever in Canada. Given that this is very much societal and cultural, as we heard earlier from Ms. Bear at NEDIC, what recommendations can you give us to get to that broader messaging or that broader education?

[The Chair, NDP, Hélène LeBlanc]

You have one minute.

[Dr. April S. Elliott]

I think both Dr. Katzman and I have emphasized over and over again that this is a lethal illness, and it's the number one psychiatric illness that kills young women. I think that people are unaware. I think that a lot of physicians even think that this is a choice, that it's a life way. It's not a choice. It's a mental illness that has severe, short-term, life-threatening as well as long-term consequences. We need to get that message out.

[Dr. Debra Katzman]

We have the advantage now of social networking and other means which we can use to get this message out. Public health announcements are really important. Working with people who have had the disorder, who are in some way visible to the public and are known to the public and are speaking out about this disorder is really important. You hear lots of people, famous people, speaking out about having depression. It's very rare that you see somebody who speaks out about having an eating disorder and what it's done to their life.

[The Chair, NDP, Hélène LeBlanc]

Thank you very much.

Mrs. Duncan for maybe seven minutes.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Welcome to you both, and thank you for your excellent comprehensive testimony.

I'm going to focus on recommendations, and what you would like to see in this report in order to better serve the families you treat.

What I'm hearing from Canadians living with eating disorders, from their families, from the research community, and the various stakeholders is they would like to see a national strategy for eating disorders.

Dr. Katzman, I'm looking for a yes or a no answer, and then if you are interested in a national strategy, I'm going to drill down. Would you like to see a national strategy on eating disorders?