A view of the early history of the Canadian Paediatric Endocrine Group (CPEG) / Groupe canadien d’endocrinologie pediatrique (GCEP)
Disclaimer: Each one of us will have a somewhat different view of the history of CPEG. This version represents a perspective looking back on the field of Paediatric Endocrinology in Canada over the past nearly 40 years, as told by the ‘three Ds’: Drs. Dean, Daneman and Deal.
A series of events occurred over a protracted period of time that inevitably led to the formation of CPEG, the Canadian Paediatric Endocrine Group, an independent society representing the interests of Canadian paediatric endocrine health professionals and their patients. These include (perhaps not exclusively):
- Issues to do with growth hormone therapy: at first, the Medical Research Council (MRC, now the Canadian Institutes of Health Research, CIHR) was responsible for the production and distribution of pituitary-derived GH. This was led by Henry Friesen in Winnipeg and included a small number of paediatric endocrinologists across the country (including Harvey Guyda in Montreal, John Bailey in Toronto, and eventually Heather Dean in Winnipeg). The MRC study included the pediatrician(s) caring for children with GH deficiency in every children’s hospital in Canada in order to ensure a standardized definition and equitable distribution of GH. When the Creutzfeldt–Jakob crisis arose in 1985, the MRC stopped producing pituitary-derived hormone and the pharmaceutical industry started to supply biosynthetic human growth hormone, first on a compassionate basis and then for reimbursement. The field was closely controlled by the paediatric endocrinology community with strict criteria for prescribing and dosage. The pediatric endocrinologists involved in the MRC study were committed to ongoing collaboration and formed the Canadian Growth Hormone Advisory Committee 1985–1996 to work with the pharmaceutical industry, chaired by Heather Dean. This also led to the trans-Canada GH-Turner Syndrome Trial, with the study investigators and sponsors meeting annually for study updates. This study was led sequentially by Dave Stephure (Calgary), Jack Holland (Toronto) and Guy van Vliet (Montreal). By 1996, study investigators had published early outcomes of GH use in Turner syndrome. [The completed study was published in JCEM 2005;90(6):3360–3366.]
- At the same time, a new generation of paediatric endocrinologists had begun to focus on paediatric diabetes and to ally their academic careers with the Clinical and Scientific Section of the Canadian Diabetes Association (now Diabetes Canada). Paediatric Endocrinologists participated in the first guidelines for diabetes care in Canada sponsored by Expert Committee of the Canadian Diabetes Advisory Board. (M.H. Tan, Chair, D. Daneman, Co-Chair, R.M. Ehrlich, M. Jenner, R MacArthur, participants). CMAJ 1992;147(5): 697-712. Those involved in diabetes care predominantly joined forces with the GH-interest group to begin the progress towards an independent paediatric endocrine association/society.
- The third unifying force focused on training future specialists in the field. Paediatric Endocrinology had been recognized by the Royal College of Physicians and Surgeons of Canada as an independent paediatric subspecialty with specialists involved in training and examinations. Led by Harvey Guyda, funds were garnered from pharmaceutical companies to support subspecialty training. The first fellowship from Eli Lilly Canada was awarded in 1993 to Margaret Lawson to train in Toronto. Overall, as of 2019, more than 55 trainees had received some or all of their support from these sources.
- The decision was reached in about 1995 to move from the Canadian GH Advisory Committee towards the creation of a more formal association of Canadian Paediatric Endocrinologists. At the first meeting, there were about 33 attendees. At the meeting in 1996, a number of issues surfaced:
- What name were we going to use to define our association: CPEG or the Canadian Paediatric Endocrine Group was quickly accepted (perhaps encouraged by the Australasian Paediatric Endocrine Group or APEG).
- Funding: it was unanimously agreed that we would need to quickly achieve independence from industry funding and this was a steady process achieved over a number of years.
- Incorporation: since we were a small group to start (33 in 1996 compared to about 180, including trainees in 2019), it was agreed that we would start as a section of the Canadian Society for Endocrinology and Metabolism (CSEM), meeting once a year at the combined CDA/CSEM meeting and once on our own (annual CPEG meeting).
- Governance: the first CPEG Executive was appointed in 1996 with Denis Daneman, Toronto as President (1996–1999), Cheri Deal, Montreal as Vice-President and Heather Dean, Winnipeg as Secretary-Treasurer. Subsequent Presidents of CPEG are listed here.
- We would encourage combined/collaborative projects: the Turner syndrome–GH study was the unifying study, but a number of CPEG-stimulated collaborations have occurred, some through the Canadian Paediatric Surveillance Program (cerebral edema in DKA, type 2 diabetes epidemiology, persistent microalbuminuria in type 2 diabetes, inhaled steroid-induced Addisonian crises) and independently (variation in GH assays in Canada, GH deficiency in Costello syndrome, a survey of management of congenital adrenal hyperplasia).
The success of CPEG can be measured in many different ways. Certainly the membership has expanded considerably due to the opening up of significant activity, clinical, research and education in “new” areas including bone health and bony disorders, childhood obesity and type 2 diabetes, gender dysphoria, as well as the increasingly use of technology in type 1 diabetes. CPEG also successfully partners with the Canadian Pediatric Endocrinology Nurses (CPEN) group in Canada. These activities have allowed CPEG to be independent financially and to separate from CSEM.
Personal observation: since its inception, CPEG has fostered a sense of mutual respect and belonging, and encouraged collaborations in standard setting, guidelines, multicenter trials, subspecialty training. The quality of the trainee presentations at recent meetings attests to the increasing excellence of the training programs.
A success story! Onward and upward.
Dr. Heather Dean, GH Advisory Committee Chair, 1985–1996 and CPEG Inaugural Secretary-Treasurer, 1996–1999
Dr. Denis Daneman, CPEG Inaugural President, 1996–1999
Dr. Cheri Deal, CPEG Inaugural Vice-President, 1996–1999 and CPEG President 1999–2002
CPEG as an independent association
It was in 2007 in London, Ontario that the Canadian Pediatric Endocrine Group / le Groupe canadien d’endocrinologie pédiatrique (CPEG/GCEP) was able to hold its first separate meeting. Canadian pediatric endocrinologists met regularly before this date, but these meetings always took place during meetings of larger groups, such as at the joint conferences of the Canadian Diabetes Association (now Diabetes Canada) and the Canadian Society of Endocrinology Society and metabolism, or at meetings of groups with a narrower mandate, such as the Canadian Growth Hormone Advisory Committee. CPEG formally became a section of the CSEM in 1996. However, there had been a longstanding desire of pediatric endocrinologists to form an independent group. CPEG therefore became a self-standing association in 2006 and started organizing its own annual meetings. Importantly, CPEG includes not only specialist physicians but also scientists, nurses and other health care professionals involved in pediatric endocrine care and research. Trainees benefit from competitive CPEG scholarships funded through unrestricted educational grants from industry. Since CPEG was established, its membership has grown steadily, as has attendance to its meetings.
Dr. Guy van Vliet, CPEG President, 2005–2007
See also Dr. Cheri Deal's A (Brief) Growth Hormone History in Canada.