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Let me just ask you. You suggest funding the new program of treatment capacity expansion at $150 million.

Mr. EATON. Yes.

Senator HARKIN. Would you support expanding ADMS block grant funding as a means of expanding capacity?

Mr. EATON. Absolutely. I feel that whatever efforts we make should be balanced between using those two vehicles.

Senator HARKIN. Thank you very much, Mr. Eaton.

STATEMENT OF RENE THOMAS, DIRECTOR OF EDUCATIONAL SERV. ICES, NATIONAL ASSOCIATION OF ANOREXIA NERVOSA AND ASSOCIATED DISORDERS

Senator HARKIN. Next, Rene Thomas, Anorexia Nervosa and Associated Disorders. Again to each of you, my thanks for your patience. I am sorry. I am going to have to start enforcing 3 minutes. I have a 2 p.m. hearing with Secretary Alexander, and I may not make it if we keep up at this rate.

So if you could try

MS. THOMAS. Keep it brief, yes.

Senator HARKIN. Thank you very much.

MS. THOMAS. Thank you, Senator Harkin and members of the subcommittee. I am Rene Thomas, director of educational services and member of the board of directors of the National Association of Anorexia Nervosa and Associated Disorders.

Aside from my position with ANAD, this testimony has a personal interest for me, in that I am a former anorexic; 7 million American women and 1 million American men suffer from anorexia nervosa, bulimia, and compulsive eating. An estimated 6 percent of these victims ultimately die from this illness, which has a higher mortality rate than any other psychiatric illness. ANAD, the National Association of Anorexia Nervosa and Associated Disorders, is grateful for this opportunity to plead their cause.

These epidemic disorders destroy health, emotional stability, and they kill. These disorders strike people of all ages, all races, from rich to poor. Eating disorders are compulsive, obsessive, addictive illnesses which compel people to starve, binge, or purge to attain the thinness which has become society's highest ethic.

Most people who develop eating disorders hope that such soughtafter thinness will enable them to eradicate anxiety, low self-esteem, inadequate parenting, disappointment, or whatever other psychological albatross they may carry. Affected persons are really innocent victims. They usually start out as sensitive, strong-willed teenagers who are able to starve and abuse themselves beyond our wildest imaginings as they follow the pied piper of thinness.

Who is this piper? This piper is society, created by us, a society which places an undue premium on thinness. It is the multibillion dollar diet industry, food and drink purveyors, fashion merchants, sports and fitness industries, and even some ranks of the medical profession with easy access to powerful print and television imagery that sell and oversell the idea that thinness represents perfection.

The problem also relates to a type of drug abuse. Teenagers and adults are afforded easy access to medicines which they use and abuse in this pursuit of thinness. Sold over the counter, these drugs are diet pills, laxatives, diuretics, and emetics. Little rec

ognition is given to the fact that dieting alone can reduce muscle mass and retard bone growth and that laxative and diuretics increase the risk of cardiac or respiratory arrest.

Because of the possibility of chronic illness and because thirdparty payers fail to meet treatment needs for many, it is urgent that an initial funding of $5 million be devoted to public prevention and education programs. We need:

First, programs to provide correct information on appropriate nutrition for all ages;

Second, community programs devoted to better interpersonal communication and relationship development;

Third, development of better training for professionals; and

PREPARED STATEMENT

Fourth, adequate, low cost treatment programs for those without funds. None of these programs are currently available. We feel that the highest priority should now be placed on the 1986 National Institute of Mental Health recommendation that our Government support of broad public education program. ANAD has been trying to meet the need for such a program through voluntary contributions for years, but it is severely underfunded.

We appeal to this subcommittee to join us in battling the most deadly psychiatric illness in America. Thank you very much. [The statement follows:]

STATEMENT OF RENE THOMAS

On behalf of the 7 million American women and 1 million American men who suffer from anorexia and bulimia nervosa, and compulsive eating, and on behalf of the estimated 6 percent of these victims who ultimately die from this illness-which has a higher mortality rate than any other psychiatric illness. ANAD, the National Association of Anorexia Nervosa and Associated Disorders is thankful for this opportunity to plead their cause.

These epidemic disorders destroy health, emotional stability and kill. These disorders strike people of all ages, all races-from the rich to the poor-in our society. These disorders are compulsive/obsessive, phobic, addictive illnesses which compel people to starve, binge and/or purge to attain the thinness which has become society's highest ethic. Most people who develop eating disorders hope that such sought after thinness will enable them to eradicate anxiety, low self-esteem, inadequate parenting, disappointment, or whatever other psychological albatross they may carry. If these sufferers were not partially successful, the illnesses would be less terrifying. In a very real sense, affected persons are innocent victims. They are usually sensitive, strong-willed, teenagers at the outset, who are able to starve and abuse themselves beyond our wildest imaginings as they follow the Pied Piper of Thinness. Who is this Piper? Created by us, this Piper is society; it is the multibillion dollar diet industry, food and drink purveyors, fashion merchants, sports and fitness industries, and even the medical profession with easy access to powerful print and television imagery that sells and oversells the idea that thinness represents perfection. And it is the mass media-the media barons who produce one series after another featuring streamlined heroes and overly-svelt heroines.

In addition, teenagers, along with adults, are provided easy accessibilty through over-the-counter sales of medicines which they use and abuse in the pursuit of thinness. These drugs are diet pills, laxatives, diuretics and emetics. No recognition is given to the facts that dieting alone can reduce muscle mass and retard bone growth, that laxatives and diuretics upset the body's electrolyte balance with increased risk of cardiac or respiratory arrest, and that emetics destroy cardiac tissue. For the aforementioned reasons, because of the possibility of chronic illness, and because third party payers fail to meet treatment needs for many, it is urgent that $5,000,000 be devoted to public prevention and education programs. Hopefully these programs can be as dazzling and repetitive as those messages which urge thinness. First, programs to provide correct information on appropriate nutrition for all ages should be implemented.

Second, Community programs devoted to better interpersonal communication and relationship development are crucial to this plan.

Third, development of better training for professionals and more complete programs for eating disorders are desperately needed.

Fourth, Adequate low-cost treatment programs for those without funds must be provided.

None of these programs are currently available.

We feel that the highest priority should now be placed on the 1986 National Institute of Mental Health recommendation that our government support a broad public education program. ANAD has been trying to meet the need for such a program through voluntary contributions or non-existent resources for years, but is severely underfunded.

On the road to being cured, victims face overwhelming odds: little public recognition and understanding of the disease; an alarming lack of knowledge about pathology and appropriate treatment of the disease among the general healthcare community; and lack of third-party payment for treatment of the disease. In addition, eating disorders, like alcoholism, exhibit a chronic nature. Large numbers suffer with their eating disorders for years before seeking help. Many anorexics and bulimics experience a lifetime of medical complications and psychological impair

ment.

It is becoming a matter of life and death that secondary school and university level programs be created, and that such programs include education on the danger of using and abusing diet pills, laxatives, diuretics, and emetics. Some pharmaceutical industry representatives contend that high school students do not use these drugs. The tragic answer can be illustrated by the recent death of an anorexic girl: when her parents examined her dead body, they found laxatives taped onto the inside of her clothing.

Statistical evidence also bears out the truth. Forty-nine percent of teenage girls responding to a survey conducted last year by Sassy magazine reported using diet pills. Doctors now know that large numbers of patients they treat for anorexia and bulimia routinely abuse diet pills, diuretics, emetics and laxatives, and that many ingest very large doses. Clearly, these drugs, which youngsters can buy over the counter anywhere in America, further entrench victims in the destructive cycle of their eating disorders.

Furthermore, diet pills contain the drug phenylpropanolamine, or PPA. Researchers have noted the dangerous side effects of diet pills containing PPA: seizures, hallucinations, headaches, mental disturbances, cardiac irregularities, and even cerebral hemorrhage. There have been eleven documented cases of PPA-associated intracerebral hemorrhage following ingestion of diet-aid pills.

The effect of these drugs combines with the effects of anorexia to reduce the individual physically and mentally. Self-starvation not only deteriorates muscles and bones, but also impairs the response of the immune system. Other physical effects are stunted growth, menstrual cessation, abdominal pains, hypothermia, and dehydration. Psychological effects include severe mood swings, anxiety, and suicide idea

tion.

Due to frequent vomiting bulimics suffer from tooth decay, hair loss, cracked lips, chronic sore throat, and swollen parotid glands. Bulimics can also bleed from esophagus and stomach damage.

Abuse of laxatives results in injury of the lining of the bowel, causing a condition known as cathartic colon. Laxatives also, through excessive loss of body fluids, disturb the electrolyte balance of the body and reduce potassium levels, which can and have caused cardiac arrest. Diuretics have much the same effects.

Add to these life-threatening dangers, the fact that many anorexics are also bulimics, and the Committee can get a sense of the horror of this disease.

To date, the overall response of our healthcare system has been inadequate. Each year, ANÁD receives thousands of letters and phone calls from sufferers describing their struggle with treatment programs that simply do not work. Many such programs do not address the disease itself or narrowly focus on one treatment modality alone, such as medication or nutrition. In other words, prescribing medication or returning the body to a normal weight level is not adequate treatment. Treatment needs to be individualized, and should include a variety of therapeutic modalities, covering the biological, cultural, family, and psychological factors that trigger the disease. Also treatment needs to be of sufficient duration. Because the cost of many existing programs is phenomenal, and because insurance coverage for eating disorders is inadequate, many patients cannot continue treatment for this often-chronic illness. Sufferers are left with the grim option of either shouldering the burden of cost themselves—which is impossible for many-or not seeking professional treatment altogether.

Every day of the year ANAD works closely and personally with victims of anorexia and bulimia to let them know that they are not alone, and to help them find good treatment. Often, ANAD is the only link to the outside world the victim has made in his or her cry for help. We hope this Committee joins ANAD in battling the most deadly psychiatric illness in America.

Senator HARKIN. Thank you, Ms. Thomas, for a very powerful statement. Very powerful.

What is your assessment of the Federal research effort now under way on anorexia nervosa and related disorders?

MS. THOMAS. Well, generally speaking, we feel that research is sorely lacking in this field. We are just at the beginnings of research. We are just scraping the surface. We are today where alcoholism was 30 years ago. So it is tremendously needed. We need increased research, and our organization is involved in research.

As I said, we are so underfunded that we have to find all kinds of strange ways to conduct this research. We have support groups throughout the country. We have support programs in all 50 States and in eight foreign countries.

This is not widely known. We are the oldest and the largest organization in this field. Right now, we are starting a research program with Colombia. We have been doing research with Portugal, and this is how we have found that this illness exists way down into the poorest of society. It exists in tribes in Africa.

So relating it back to this country, it is in the slums of Chicago. You know, I am from the State of Illinois. This illness is not just relegated to your upper middle-class white citizen, and it is not just relegated to women. We are seeing more and more males. We are seeing little children 5 years old. We are hearing cries from men 60 years old who have their desks filled with boxes and boxes of laxatives.

This is the illness of this decade, I believe. I believe our figures are pitifully low because the research has not been done. This figure of 8 million, I believe, is false, but we do not have the research to show what the real figures are. I believe it is closer to 30 million, personally.

Senator HARKIN. Ms. Thomas, thank you very much. We appreciate it.

Ms. THOMAS. You are welcome. We had additional testimony we gave to you which should be on the record. Thank you.

Senator HARKIN. Thank you. You make an excellent witness. That was great testimony. Thank you.

STATEMENT OF DR. WILLIAM L. DEWEY, VICE PROVOST FOR RESEARCH AND PROFESSOR OF PHARMACOLOGY, MEDICAL COLLEGE OF VIRGINIA, VIRGINIA COMMONWEALTH UNIVERSITY, ON BEHALF OF COMMITTEE ON PROBLEMS OF DRUG DEPENDENCE ACCOMPANIED BY FREDERICK H. GRAEFE, ESQUIRE, BAKER & HOSTETLER, WASHINGTON, DC

Senator HARKIN. Dr. William L. Dewey representing the Committee on Problems of Drug Dependence.

Dr. DEWEY. Thank you, Mr. Chairman. I know you know our counsel, Mr. Fred Graefe, who joins me at the table.

Senator HARKIN. A long-time friend of mine. Fred, glad to see

you.

Dr. DEWEY. I thank you very much for letting us testify this morning. I am the associate provost for research and graduate affairs and professor of pharmacology at Virginia Commonwealth University, but, as you said, today I am representing the Committee on Problems of Drug Dependence, a committee made up with liaisons to scientists of both basic and clinical nature representing nearly 3 million people in all those fields and all interested in the effects of drugs on human beings.

As you know, this is still a major problem in our country today. Yet, in the President's budget he has proposed a 21-percent decrease in investigator-initiated research projects.

My only purpose today is to request that Congress reverse that. I wanted to point out some instances why I think that should be done.

Research is working. We are making advances in this field. The opiate peptides and endogean receptors in the brain have come out of drug abuse research, and that information is useful for treating most every disease that affects the brain, including psychiatric disorders and others.

We have better urine screening because of research carried out at the National Institute on Drug Abuse. That leads to a drug-free work place and more safety for all of us.

In addition, we have a narcotic antagonist to treat an overdose; 15 years ago we did not have a good treatment for an overdose of heroin. Today we can give a narcotic antagonist, which is a drug without side effects, which in fact will reverse that effect immediately.

We have methadone, which allows people to carry on productive lives.

We have the use of drugs that are antagonistic, that block the effect of heroin and so on to treat sudden infant death syndrome. Children who are dying now can be given a drug which again has no side effects and can carry on with their normal lives.

Currently we are developing a medication called buprenorphine which is going to be useful for treating not only heroin dependence but also cocaine. This needs a great deal more research. It is not a time to cut back. What has happened, as one of the earlier people who testified said, we have momentum, we are making advances, and it is not a time to stop.

There is another reason, too, sir, why this is extremely important. For many of the diseases there are funds other than the Federal budget available for research in those particular areas. Our point is not to say one is more important than the other, but for drug abuse research 90 percent of all the funds available for drug abuse research are appropriated by your committee.

PREPARED STATEMENT

We very much appreciate what you have done in the past. For mental health research it is about 50 percent, and for alcohol research it is 82 percent; but for the other diseases represented it is about 35 percent of the total amount of dollars available for research. So we rely completely for curing this problem of drug abuse in this country and making the research advances to which I referred before on funds from this Appropriation Committee. To de

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