Thank you very much, Madam Chair, and members of the committee.
I'm most pleased that the committee has chosen this topic to investigate. It's very important, and I hope that your work goes well.
You may have my bio, but just to remind you, I'm Dr. Blake Woodside, and I'm medical director for the program for eating disorders at Toronto General Hospital. It's the largest program in the country. I'm a psychiatrist and a full professor in the department of psychiatry at Toronto General Hospital. I've been here 27 years. This is all I do, so without seeming to blow my horn, I would say I would be described as an expert in the treatment of eating disorders, especially the more severe forms of anorexia nervosa, which is all I've been doing for the last 20 years. I run the in-patient service here.
Let me talk to you a little bit about the overall situation first. I'm going to talk about two very serious eating disorders, anorexia nervosa and bulimia nervosa. Anorexia nervosa is a severe medical illness characterized by significant weight loss, denial of the severity of the condition, and serious medical complications that can lead to death. Bulimia nervosa is a syndrome of binge eating, usually associated with dietary restriction, and sometimes with behaviours to undo the episodes of the binge eating, like vomiting or taking laxatives or diuretics.
These are serious medical illnesses. Anorexia occurs in about 0.5% of the population, so there are about 150,000 people across the country who have or have had this condition. Bulimia nervosa is a bit more common. It affects nearly 1% of the population, so there are about 300,000 people with bulimia nervosa across the country. That's nearly half a million people. About 80% of the sufferers are women, and almost everybody in our treatment system is female.
These are lethal disorders. The mortality rate for anorexia nervosa is 10% to 15%. What that means is that of the 150,000 people who are currently affected, between 15,000 and 23,000 will die from their illness. The rates per year are difficult to determine, because very often mental health causes are not listed on death certificates for a variety of reasons. Probably between 500 and 1,000 people die from this condition every year in Canada.
Bulimia nervosa is a bit less lethal with a death rate of about 5%. That still amounts to about 15,000 deaths per year in Canada caused by bulimia nervosa. Again, probably 500 to 700 people a year die from bulimia.
The cumulative death rate from these two conditions would be on the order of 1,000 to 1,500 people per year. To put that into context, and I'm going to come back to this a bit later, prostate cancer in Canada kills between 3,500 and 4,000 people per year, so it's a bit less than that, but we're in the same ballpark, for sure.
In addition to the mortality rate, about 15% to 20% of people with anorexia nervosa will develop a chronic form of the illness. Of the current population of people affected, that's another 23,000 to 30,000 people. For these two illnesses, we have on the order of 50,000 to 60,000 people dead over the chronic form of the illness that is normally not responsive to treatment.
Anorexia is probably the most lethal psychiatric illness in terms of gross mortality rates. That's something people find difficult to believe when they're first told about it, but it is the case. The people who have this illness, while sometimes not aware of the severity of the condition, are extremely unhappy. These are not people who are pleased with their situation. When you assess people's happiness with their life with paper and pencil measures, women with anorexia and bulimia score worse than women who have chronic schizophrenia. Women with chronic schizophrenia are an unhappy lot, by and large, and people with anorexia and bulimia are even more unhappy than them.
These are complex illnesses and they're a complex mix of hereditable genetic factors, subtle abnormalities in brain circuitry responsible for regulation of emotions, and so on. The societal focus on objectification of women which leads to unrealistic goals for weight and shape results in a society focused on dieting and weight loss. While dieting does not cause a condition per se, it can unlock or activate the underlying vulnerability factors and cause the illness to occur. There are risk factors that exist in people which get activated in a variety of ways. One way to activate those risk factors is to become a chronic dieter.
This is why the illnesses are more prevalent at present, but they are ancient illnesses. The first English-language report of anorexia nervosa was in 1693. Bulimia nervosa is reported in the Jewish holy book, the Talmud, which takes it back 5,000 years.
I was meeting with a patient earlier this afternoon who is about 40, who mentioned on her way out the door that her grandmother, who died at 98, had bulimia her entire life.
Despite the severity of these conditions, especially anorexia nervosa, there is a pervasive discriminatory and stigmatizing attitude towards these illnesses. Nothing could be further from the truth than phrases like, “Why won't she just eat?”, “She's just looking for attention”, “It's all her mother's fault”, or “These are just spoiled rich girls”.
The best example of the egregious discrimination suffered by these individuals is access to treatment. For anorexia nervosa, one of the most lethal psychiatric conditions, wait times from referral to admission to a bed in an expert treatment setting run from four to six months. The average weight of my patients who wait this length of time is 80 pounds, with a body mass index of 14, for a woman who is five feet, four inches tall. That woman will wait four to six months from referral to admission to my program.
In my province, and I can speak a little bit to the rest of the country, there are only two other facilities with in-patient beds, each of which has a similar waiting list. It is much worse in other provinces, many of which have no intensive services available at all.
If there were waits like this of four to six months for prostate cancer treatment, there would be a national outcry. There would be marches in the streets. The marches would be attended by middle-age men like me, but of course prostate cancer is a disease of middle-age men just like me, and older, so there is a clinic for prostate cancer in every hospital in this country. Compare that with the situation for anorexia nervosa where, in the province of Ontario, one of the wealthiest provinces in the country, there are only three treatment centres that have in-patient beds for a population of 12 million. If this isn't discrimination, I don't know what is. There is just no other word for it.
On top of that, we spend millions and millions of dollars sending these patients to the United States when they have waited so long for treatment in Canada that they're going to die. It costs two to three times the daily rate to send them to the United States, and the treatment results are awful. We waste tens of millions of dollars when we could invest this money in Canada to provide treatment for people in their own country.
The good news is that treatment does help the majority of those suffering; 65% to 70% of those with anorexia nervosa will eventually recover, and 70% to 80% of those with bulimia nervosa will also eventually recover.
Early treatment is associated with better outcomes, so it's important to identify these patients in the early stage of their illness and get them to treatment right away. Prompt treatment is associated with better outcomes. Expert treatment is also associated with better outcomes.
To treat one of these people in my program, they'll be attached to us, living in the hospital or coming in during the day for six months. There are about 35 members of the multidisciplinary team who treat them. The interventions are complex, far more complex, for example, than a kidney transplant or even a heart transplant, which are very expensive procedures but relatively straightforward. Yet you hear all the time that these people with anorexia should be treated in general psychiatric units by people with no experience or expertise, and that is difficult.
The expert treatment isn't cheap, but the cost is trivial compared with the rest of the hospital system.
My own program, which is the largest in Canada, provides intensive treatment to about 200 patients per year at a cost of about $2.5 million. That's $10,000 per case. That's the cost of maybe 10 heart transplants, and my hospital does 75 of those a year.
We're further hampered in our ability to do adequate research into new treatments. I'm a career researcher with millions of dollars of research money in my research portfolio. We're engaged in cutting-edge research in neurostimulation on anorexia nervosa. We are the world's leading centre in novel treatments: deep brain stimulation and transcranial magnetic stimulation for eating disorders. Every last penny of my research money, aside from donations from generous individuals, comes from the United States, either from granting agencies or from private foundations.
The most recent large study I was involved in cost $8 million. The entire budget for the Institute of Neurosciences, Mental Health and Addiction, INMHA, is on the order of $13 million to $15 million per year. It is simply impossible in this country to do meaningful research on illnesses like anorexia or bulimia, given the amount of research money that's available. That $13 million to $15 million has to cover addictions and neuroscience as well as mental health.
There is no point in—
