Status of Women Committee on Nov. 28th, 2013

[Dr. Blake Woodside]

Absolutely. We work in multidisciplinary teams. We have many disciplines on my team.

I would probably challenge what you said. This sort of work is equivalent to what happens, let's say, in an organ transplant unit where people are monitored for many years regarding rejection levels of their organs. The family doctor doesn't do that. You need people who are expert and trained in transplantation to actually understand the results.

While you can train a wide variety of people, it's not the purview of physicians, God forbid, to do the cognitive work that's required. People have to have the training. Without the training, they won't function effectively. This is specialized work. This is not general work that anybody can do. You have to be carefully trained in order to do it.

[Stella Ambler, Conservative, Mississauga South, ON]

Would you say that in the mental health profession there's support for the concept you just described? You mentioned that eating disorders are not covered in medical school curricula. Would you say that overall in the medical profession there's support and understanding for this kind of treatment within health care, or are you fighting that discrimination even within the medical profession? I guess I'm asking if they take it seriously.

[Dr. Blake Woodside]

I think there's primarily ignorance in the health care profession. In my experience, the average family doctor, in their entire career, may see only two or three patients who are very sick with anorexia. They get very interested when they have such a person. They call me on the phone and they want to learn all about it. They're more frightened than anything else.

By and large, it's simply ignorance and lack of knowledge. There is a certain amount of discriminatory attitude present even in the medical field, but it's mostly that they just don't know. They've had no exposure. They don't know anything about it, and when they see a patient, they don't have the first idea of what to do next.

[Stella Ambler, Conservative, Mississauga South, ON]

That's because—

[Dr. Blake Woodside]

I'm not sure if that answers your question.

[Stella Ambler, Conservative, Mississauga South, ON]

Yes, sort of.

[The Vice-Chair (Mrs. Tilly O'Neill Gordon), Conservative, Tilly O'Neill-Gordon]

You have 20 seconds left.

[Stella Ambler, Conservative, Mississauga South, ON]

I'm just wondering how it can become part of the curriculum in medical schools, so students will spend more time learning about it.

[Dr. Blake Woodside]

That's public awareness and lobbying, right? That's why, for example, this national public advocacy group will be so important, if it's established and sustained. I think the federal government has a role to play as well in terms of public information.

[The Vice-Chair (Mrs. Tilly O'Neill Gordon), Conservative, Tilly O'Neill-Gordon]

Thank you.

Ms. Sellah, go ahead for five minutes.

[Djaouida Sellah, NDP, Saint-Bruno—Saint-Hubert, QC]

Thank you, Madam Chair.

Dr. Woodside, thank you for being here and for providing clarifications concerning this very serious medical condition, which is increasingly prevalent in our society.

I was happy to hear you speak about factors that predispose people to this disease. As you said, it is a disease. It is thus a medical issue, without going into the societal factors that trigger it. I am happy that you said so.

I am myself a health professional, a general practitioner by training. For this reason I know that the DSM-V, like the previous DSM-IV, are included in the books that medical students study. They take psychiatry courses. They are acquainted with these eating disorders, whether we are talking about anorexia nervosa or bulimia. As you said earlier, it is true that people have a tendency to dismiss this. We know that there are specialties. I agree with you that specialists should be handling these cases.

All of that said, I am concerned, since this is a health care issue. I know that you head up one of the best eating disorders programs in the country. However, I wonder how accessible these programs are to people who live in rural areas, for instance. That is my first question.

[Dr. Blake Woodside]

For people who live in rural areas who need intensive treatment, they have to travel. My catchment area in Ontario covers, for example, most of northern Ontario. People come from many hundreds of miles away to attend my program. That is not ideal. It would be better if they could be treated closer to home. Dealing with remote and rural populations is complicated because the volumes are low in such locations. There aren't a lot of patients. The patients there are just as sick as anyone else, but there aren't a lot of patients, so it can be hard to justify setting up proper clinics for those people.

Having said that, setting up clinics where you teach somebody to do cognitive behavioural therapy for bulimia in a micro-agency with two or three employees, that's dead simple. You can train someone to do CBT very easily. There should be CBT in every community in the country, or available in every community in the country.

Training people in diagnosis in small clinics, that's fairly straightforward. You should be able to do that. I think enhanced awareness of this among family doctors and pediatricians is very important, to at least identify patients and then refer them to the nearest treatment program.

I agree with you that there's a serious problem in terms of access to care for remote and rural communities for all aspects of medicine, not just this.

[Djaouida Sellah, NDP, Saint-Bruno—Saint-Hubert, QC]

Yes, that is precisely the issue. You recommend that there be experts in all fields.

I am from the province of Quebec, and I know that service delivery is a matter of provincial jurisdiction, and not a federal one. Has there been any contact or communication with other provinces to discuss this issue?

[Dr. Blake Woodside]

In any province where there is an advocacy group, those groups have made representations to the provincial government. Most of those groups have professionals as advisory panels, so they will help out. Usually it's family members who are doing the advocacy. That's where it comes from right now. If there's a national advocacy group, they will work on things like recommended standards, and so on.

I'm aware that the federal government has a limited role in terms of health care provision. My own view is where the federal government has an important role is by setting standards and raising awareness, and saying, “Look, this is important. Here's an area that's been neglected, and where care is probably not being delivered appropriately, and here are some ideas about how the health of these citizens could be improved.”

[The Vice-Chair (Mrs. Tilly O'Neill Gordon), Conservative, Tilly O'Neill-Gordon]

We'll move right along to Madam Crockatt for five minutes.

[Joan Crockatt, Conservative, Calgary Centre, AB]

Dr. Woodside, we're really pleased to have you here. I think we recognize there is not enough information out there and that we could advance the knowledge by having this study. It's great that you are able to be here. One of our Conservative members brought it to our attention.

I'm happy to be able to follow it through, too, because I have had quite a bit of association with Dr. April Elliott, whom you might know. She is the chief of adolescent medicine at Alberta Children's Hospital and deals with bulimia and anorexia.

I think you're in the process of trying to break down some of the myths here, and there appear to be a great many of them. I think that the public has no knowledge of the degree to which people are dying from anorexia. They do believe that it is a controllable urge. I think you've already started to change minds today by bringing some of this information forward.

I was interested in a couple of things that you said. One of them that just struck me is how we have a view in society that children's obesity is at some kind of crisis level, and you said that it isn't true. I wonder if you could explain why that is. Perhaps that's another of our issues.

[Dr. Blake Woodside]

I hope you invite Dr. Leora Pinhas to address your committee. She'll explain it to you in great detail. She is a biostatistician. In brief, and you'll get her to explain it in more detail, her read on the epidemiology is that rates of disordered eating among children are twice as high as rates of obesity, and obesity is the epidemic and disordered eating is ignored. That's the short version of what she would say.

[Joan Crockatt, Conservative, Calgary Centre, AB]

Oh, wow.

[Dr. Blake Woodside]

I'm not pro-obesity; don't get me wrong. I am anti-dieting, because I don't think dieting helps anything, not even obesity for that matter.

There is a risk for things like programs in the school, where kids' BMIs are measured and they have fingers wagged at them if they're too heavy. That's like giving people a pill that will make them anorexic. There has to be some balance here. You don't want to stigmatize eight-year-old kids because their BMI rating is two points higher than somebody thinks it should be.

[Joan Crockatt, Conservative, Calgary Centre, AB]

Absolutely.

You mentioned some new treatments that are coming forward, and you spoke about some neurological-based treatments.

Can you tell us what novel treatments need more research and study right now?

[Dr. Blake Woodside]

Sure. We are doing two things. We are world leaders in this. We're doing something called deep brain stimulation for chronic, severe, intractable anorexia, for people who are going to die. We've done 14 cases and we have six people lined up.

It's the same type of treatment done for Parkinson's disease, where electrodes are implanted in the brain and hooked up to a stimulator that is turned on permanently. It's showing good promise. Just as a sidebar comment, people will often look at these chronically ill patients and say they don't want to get better. Often what they are pessimistic about is routine treatment. These are 20 women of varying ages who have lined up for brain surgery in the hope that we will improve their condition and that they will have a chance at a recovery. These are people who are very willing to engage in even extreme treatments. We're getting some good results with that.

We're also investigating the use of something called transcranial magnetic stimulation, both for treatment of bulimia nervosa and also for treatment of important areas of comorbidity and anorexia nervosa, and particularly of obsessive-compulsive disorder and post-traumatic stress disorder, which can impair people's ability to respond to treatment.

I am proud to say we're also partnering with the Canadian Forces in piloting this treatment for post-traumatic stress disorder for combat veterans, and we're having good results there as well.

Those are two neurostimulator treatments we're working on right now.

[Joan Crockatt, Conservative, Calgary Centre, AB]

Is brain retraining one of those treatments?

[Dr. Blake Woodside]

Transcranial magnetic stimulation alters the function of specific brain circuits, mostly brain circuits related to the regulation of emotion. People who get a good response say that they feel more normal inside, that they feel like they have a better, more consistent experience of their internal emotional life. They don't need to do things like binge and purge anymore, or if they have PTSD, they don't get so activated and cut themselves and stuff like that.

I wouldn't exactly call it retraining. It's more like restoring normal function to brain circuits that have been demonstrated to be not functioning normally. It's the same for deep brain stimulation.

[The Vice-Chair (Mrs. Tilly O'Neill Gordon), Conservative, Tilly O'Neill-Gordon]

You have 15 seconds.

[Joan Crockatt, Conservative, Calgary Centre, AB]

Did I hear you correctly, that 60% of your patients have sexual or physical abuse issues?