Evidence of meeting #55 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was children.
A recording is available from Parliament.
11:50 a.m.
Liberal
The Chair Liberal Sean Casey
Thank you, Mr. Davies and Dr. McLaughlin.
Next, we have Mrs. Goodridge, for five minutes, please.
March 7th, 2023 / 11:50 a.m.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Thank you, and thank you to all the witnesses.
That's a good place to jump in at. As a mom, I was actually the first person to bring forward the idea of the Tylenol shortages in the liquid formulations, because I remember just feeling crazy. I thought I was crazy. I thought I was alone and it was just an issue that I was seeing. I've come to learn that this is something that happens with a lot of children's issues.
I'm not sure if it's that we don't have all the right regulations in place or that we're not putting enough emphasis on this. One of the most alarming pieces that's been brought to my attention in the last few weeks, and it's resurfaced, is the shortage of baby formula. We're seeing this from coast to coast to coast, with parents struggling, going on social media platforms to try to find basic food to feed their children.
Could you comment on how important it is to have adequate access to pediatric formula?
11:50 a.m.
Pediatrician and Clinical Assistant Professor, University of British Columbia, As an Individual
That's an excellent question. I'm also a parent and can certainly relate to what you're talking about.
I'm not an expert in formula regulation and availability. For many children who can't breastfeed, or whose parents choose not to, formula is a key form of nutrition. For some children, who require specialized formula because of an intolerance to proteins, in particular, access to that can be difficult. I suspect there are similar availability and regulatory issues, but I would have to look into that and get back to you.
11:55 a.m.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
I appreciate that. I know it's something that's challenging. I went back onto the Health Canada website here today to do more research, because it's been brought up that this is missing, yet again.
There is a big piece on breastfeeding. While many do acknowledge that breastfeeding is a very good option, and is a natural option, it's not an option that works for everybody. Not everyone can, and not every baby can have breast milk, so when these kinds of pieces aren't available, it just adds a lot of extra stress onto the parent, which intrinsically puts it on the child.
You were talking a bit about how the adult formula Tylenol wasn't available, and trying to get your kid to eat it at midnight. I know I've struggled to get my son to have any children's medication that's not grape-flavoured. I've had cherry-flavoured spit in my face.
Could you expand a bit on some of the other oral children's medications where, currently, there's a shortage?
11:55 a.m.
Pediatrician and Clinical Assistant Professor, University of British Columbia, As an Individual
Thank you.
You're absolutely right regarding feeding. Breastfeeding does have unique benefits, but that should not mean that mothers, in particular, should face an additional burden or expectation, as they are already facing the hardest job in the world. My wife went back to work at two months after our son was born, and she had difficulty with pumping, so we used formula. I'm totally okay with that.
Now, in terms of drug shortages, I think there are different pieces to it. With the pain medication, we're talking about shortages of drugs that are generally available and were acutely not available. There are also many drugs that are just never available in child-friendly formulations. There's a list from the Goodman Centre in Montreal of over 20 drugs available in other countries that are commercially made liquid formulations that are not available in Canada because their drug maker just hasn't applied for approval. This includes a key epilepsy drug, and it includes many others, so it's a mix of products that are generally available—the availability does vary and that has been the cause of the recent shortages—and products that are not available at all in child-friendly formulations but might be available in other countries.
Then there are drugs for which there aren't pediatric formulations in any country. For some of our HIV medications, if you have an infant who is born with HIV.... You know, we laugh about not taking grape-flavoured medicines, but these medicines are important. If you have to take a medicine every day—if your infant has to do that in order to not develop resistant strains of HIV—that is serious business, and these medications can be extremely unpalatable, because they're not available. As a result, some children can develop drug resistance to that, so that is something that happens.
There are actually several different layers of having the right medications for children, including some that you touched on.
11:55 a.m.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Thank you. I appreciate that.
I'm sorry I didn't get to ask questions of any of the other presenters.
11:55 a.m.
Liberal
11:55 a.m.
Liberal
Sonia Sidhu Liberal Brampton South, ON
Thank you, Mr. Chair, and thank you to all the witnesses for their valuable testimony.
My question is for Dr. Verchere.
Dr. Verchere, I saw first-hand the diabetes excellence hub and diabetes research program at the Child & Family Research Institute. Thank you for the work you are doing on that.
Can you tell us about the mini med school initiative and how it is encouraging and promoting science outreach and education? I know you have a different topic every month to engage youth. Can you elaborate on that?
11:55 a.m.
Professor, Departments of Surgery, Pathology and Laboratory Medicine, University of British Columbia, As an Individual
Yes, I'd be happy to.
Where I work—and Dr. McLaughlin does, too—at the BC Children's Hospital Research Institute, we have a unique program to try to bring science, research and medical research—pediatric research, really—to bounding young scientists, to encourage high school students of all backgrounds to consider careers in research. To do that, twice a year we host a mini med school. It's usually around one topic. We've done diabetes three times. It's held over six evenings over a month and a half, and it reaches, when we do it in person, about 250 students. They come into the hospital, and they learn with some lectures and hands-on work with our pediatricians and our scientists at BC Children's Hospital.
Interestingly, during the pandemic, when we went virtual, we were even able to expand our reach, because we wanted to reach other parts of B.C., and people find it hard to come down to the Lower Mainland. The results have been really remarkable. I should say that the mini med school spans cancer, transplantation, immunology, infectious disease, mental health and diabetes.
We've had high school students come back from that program to become summer students, and a few have even gone on to Ph.D.s in medical school. The program has been in place for some 20 years now, and some have even come back to do further research training at the institute as Ph.D. students and post-docs. That's been, I think, a remarkable success, and I would love to see it happen elsewhere in the country.
Noon
Liberal
Sonia Sidhu Liberal Brampton South, ON
Thank you. I have two follow-up questions.
This month is nutrition month. Nutrition and an active lifestyle play a big role in the prevention of diabetes. What are the most promising areas of research in childhood diabetes, and how might they lead to new treatments and therapies? Can you tell us?
Noon
Professor, Departments of Surgery, Pathology and Laboratory Medicine, University of British Columbia, As an Individual
It's a really exciting time in diabetes research. When we talk about childhood diabetes we're usually talking about type 1, although, as I said, there is an increasing prevalence of type 2. Most exciting is that we have access to such incredible technology in regenerative medicine and stem cell biology in gene editing.
One area of research that has a great Canadian story that's gone from the laboratory to clinical trial is in the transplantation of insulin-producing cells into people with type 1 diabetes. It started with pancreatic islet transplantation in Edmonton. It has gone from our ability now—and some of this work was done at UBC—in being able to make insulin-producing cells from stem cells, and now that's in clinical trials in adults with type 1 diabetes, with sites in Edmonton and Vancouver.
The big issue for us is that we really want to see some of these therapies being able to be given to children, and there are issues with that. For example, with stem cell therapies the recipients still need the immune suppression, so ethically they're not in a position to do that with kids; we need more safety studies. However, this is a very promising area of research that looks like it could lead to people with type 1 diabetes being insulin-free. I'm not sure I'd call it a functional cure, as they would still need to take immunosuppressive drugs, but we could give them better sugar control, and they could potentially be free of insulin.
Noon
Liberal
Sonia Sidhu Liberal Brampton South, ON
Lastly, what role can community-based organizations and advocacy groups play in supporting families and raising awareness about childhood diabetes and how we can prevent it?
Noon
Professor, Departments of Surgery, Pathology and Laboratory Medicine, University of British Columbia, As an Individual
This is really important, I've learned. I think it has been mandated by CIHR funding that we have an element of patient engagement whereby we interact with persons with lived experience of diabetes with our funded investigators and our trainees. We've had a lot more interaction with people in the community, both with type 1 diabetes and type 2 diabetes. That's inspired and helped instruct our research and how we communicate it.
Importantly, it's critical that we get out to the community, particularly those who are in lifestyle intervention research—especially with people who may not live, for example, in the Lower Mainland in B.C. but in more remote areas—just to learn about diabetes awareness, about the potential impact of effective diet and lifestyle. We can do much more there, and I think the research is showing that it works. One example is our BC Diabetes Research Network, which we formed now as a van that allows us to go out into the community and interact with groups, for example, in Surrey, in the South Asian community. We are hoping to do more of that.
Noon
Liberal
The Chair Liberal Sean Casey
Thank you, Ms. Sidhu and Dr. Verchere.
Mr. Thériault now has the floor for two and a half minutes.
Noon
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Mr. Chair.
Dr. Lynk, you talked about social and economic determinants. Our health care system was weakened before the pandemic and many people have come here to tell us that the pandemic exacerbated the problems related to child and youth health and well-being.
As my grandmother used to say, an ounce of prevention is worth a pound of cure, and prevention starts with education. Even before the pandemic, the system had been weakened a great deal and we were barely able to meet the demand. So we do emergency medicine. On top of that, we're moving at breakneck speed, so Canada is having trouble ranking well with UNICEF. To get a good report card from UNICEF, we would need to invest in prevention.
With respect to infant mortality, obesity, suicide and immunization, Canada ranks in the bottom third despite the fact that it's a wealthy country. Do you believe the health transfer offer will cover the next 10 years and be enough to turn the tide from emergency medicine to preventive medicine, the key to restoring our health care systems?
12:05 p.m.
Chair, Department of Pediatrics, Faculty of Medicine, Dalhousie University, As an Individual
It's an excellent question. There are probably never enough dollars for health care or health as compared with all the other competing priorities that we have in governments, I'm sure. I'm sometimes conflicted, as a pediatrician. I have a child, like Dr. McLaughlin, and I also work on the wards for children with rare diseases. The drug costs can be enormous for one family, versus that same money going to help children who are living in poverty. How do you make those decisions? It's not easy, that's for sure. They are both deserving.
I would add also that when my colleague, Dr. Verchere, was talking about diabetes and prevention and control for type 2 diabetes, obesity is a major contributing factor. More children who are living in poverty have problems with their weight, because the foods they can afford to buy are usually high in carbs. They can't afford healthy foods, and they often can't afford to participate in healthy activities like sports teams and things.
To me, poverty is at the root of a lot of our issues in terms of the social determinants of health. The federal government has made a big contribution to that in the last five years. The provinces and the feds have to continue to do that, so that those one in 10 kids living in families below the absolute poverty line are given a hand up. That will go a long way in settling not everything, but a lot of things when it comes to our health.
You also mentioned education. There is a tremendous opportunity to share best education practices across the country, including in learning to read. The Ontario government just had a “right to read” program, using new evidence-based methodologies to teach kids to read. One in three kids is below the standard in Nova Scotia, and probably many other provinces, by the time they are in grade 3 or grade 6, because we are using old methods.
There are so many good things that contribute to health and resilience and children having the best shot, and we can share them across this country. Again, I would focus on this. We need one group or body to be able to bring this all together to advise the feds and the provinces on best policies we can share, to measure outcomes, to do better and to make Canada the best place to raise kids.
12:05 p.m.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Lynk.
Mr. Davies, you have two and a half minutes, please.
12:05 p.m.
NDP
12:05 p.m.
Voices
Oh, oh!
12:05 p.m.
Liberal
The Chair Liberal Sean Casey
I'm sorry, Mr. Boulerice.
You have the floor for two and a half minutes.
12:05 p.m.
NDP
Alexandre Boulerice NDP Rosemont—La Petite-Patrie, QC
Thank you, Mr. Chair.
Dr. McLaughlin, I really wanted to hear from you as a pediatrician, because late last year in Montreal we had a crisis in our emergency rooms, including a major one at Sainte‑Justine Hospital. We saw a resurgence of childhood respiratory diseases, and they were quite virulent at the end of the year.
I learned recently that it was also caused by the pandemic, because many children had poorly developed immune systems, having been isolated for several months, even years.
In your opinion, when will we be back to normal in terms of our children's immune systems? Is this going to continue?
12:05 p.m.
Pediatrician and Clinical Assistant Professor, University of British Columbia, As an Individual
That's a fantastic question. I don't know that I have or that anyone has the answer to it. If I've learned anything—if we've learned anything—from the last several years of the pandemic, it's that making predictions about what's going to come next is hard to do.
I agree that we all faced the same crisis in our children's hospitals, and that was related to not having exposure to viral illnesses. How that will play out over the coming years, I think, remains to be seen.
12:05 p.m.
NDP
Alexandre Boulerice NDP Rosemont—La Petite-Patrie, QC
I have a question for Dr. Lynk.
When we spoke of the socio-economic determinants for children's health, you talked about poverty and education.
Can you tell us how important quality housing is?
12:10 p.m.
Chair, Department of Pediatrics, Faculty of Medicine, Dalhousie University, As an Individual
That's also one of the major determinants of health. It's not just your genetic code; it's your postal code that is so important. A lot of families are living housing-insecure. In a lot of cities across the country, rents are going up. It's a big issue. I would just say that all those issues around poverty....
I haven't lived in poverty, but I certainly deal with families every day who do. The stress that puts on parents—what that causes between partners and between parents within families—contributes to discord and conflict. We know that when children are raised in stressful households, especially as young children, that constant stress and pressure actually affect how their genetic code gets expressed, and probably brain development. You can imagine that if there's not enough food in the house, or if there's not enough money for winter jackets or rent, the stress is huge.
I'm just going to go back again to poverty, then, which to me is one of the root causes of a lot of issues that the federal government has both done something about and can continue to do something about, as can the provinces. We need a strategy; we need targets and we need outcomes. It's not acceptable to have one in 10 children living below the poverty line in this country—not at all.
12:10 p.m.
Liberal