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The Current Transcript for November 11, 2020

Host: Matt Galloway

STORIES FROM THIS EPISODE

Prologue

[Music: theme]

SOUNDCLIP

VOICE: If we don't understand war. I think we will probably fail to understand peace because peace isn't just an absence of war. Peace is something that has to be built.

MG: It is November 11th and on this Remembrance Day, we remember those who fought for this country and hope Canadians won't be called upon to make that sacrifice in future. In 30 minutes, the historian Margaret MacMillan joins us to discuss why now more than ever, we need to talk about war and not just today. Also this morning, you would be forgiven if in the commotion surrounding the U.S. election results, you missed some of the other big news coming out of last week's vote south of the border.

SOUNDCLIP

VOICE: To me, it feels so hopeful that we are changing the tide on the war on drugs.

MG: The state of Oregon move to decriminalize small amounts of all drugs. We'll hear why and what lessons activists in Canada should take from this. But as COVID cases rise dramatically in many provinces and the prime minister is encouraging premiers to take decisive action, we begin with calls for a short, sharp shock to the system. Good morning. I'm Matt Galloway. This is The Current.

[Music: theme]

Alberta doctors are calling for a 'circuit breaker' lockdown. Here's what that would mean

Guests: Shazma Mithani, Patricia Daly, Raywat Deonandan

SOUNDCLIP

VOICE: Manitoba is moving to critical or red on the pandemic response system and additional restrictions will be added and will last for a minimum of two weeks. The goal is to serve as a circuit breaker to stop the transmission of COVID in Manitoba, to reduce the number of connections between people, therefore reducing the amount of transmission.

MG: That's Manitoba's top doctor, Dr. Brent Roussin, announcing sweeping new changes, shutting down bars, restaurants, hair salons, entertainment venues, basically everything, but schools in that province. And the words that he used, circuit breaker, are becoming more common as COVID-19 cases rise across this country and health care workers call for more restrictions. In Alberta, over 70 doctors have signed an open letter calling for the province to bring in a short, sharp circuit breaker lockdown. Dr. Shazma Mithani is one of them. She's an emergency physician at the Royal Alexandra and Stollery Children's Hospitals in Edmonton, Alberta. She's also a public spokesperson for the section of emergency medicine within the Alberta Medical Association. Doctor, good morning.

SHAZMA MITHANI: Good morning, Matt.

MG: What is a circuit breaker lockdown and what isn't this kind of lockdown?

SHAZMA MITHANI: So a circuit breaker locked down is a short brief period of time with a defined timeline where we close services, close non-essential services in order to attempt to reset the system and give the hospital and contact tracers a chance to catch up as this second wave of the pandemic spikes.

MG: And when you say that it has a short defined timeline, that is in contrast to the lockdowns that perhaps we've seen elsewhere and maybe even in the spring where there wasn't really an end date to it.

SHAZMA MITHANI: That's exactly right. So back in the spring, we had a broad lockdown where we didn't really know what the timeline was going to be, and it was really day by day and week by week when it was decided that things were going to reopen. A circuit breaker lockdown is typically predefined period of between two and four weeks to, again, help kind of try to bend the curve.

MG: Take me inside your hospital. Why do you need this in your province now?

SHAZMA MITHANI: So one of the sites that I work at is the busiest inner city hospital within Edmonton and we're already bursting at the seams. We have critical shortages of beds. We have shortages of personnel and staff. And with this additional stress from COVID-19 patients coming in, I anticipate that the next two weeks is going to be quite challenging for our health care system.

MG: When you say quite challenging, what do you think that might look like?

SHAZMA MITHANI: So it will look like ICUs being overloaded, there not being enough ICU beds for patients to move from the emergency department to the intensive care unit, for example, and that just has a downstream effect on every other patients presented to the emergency department. So anyone that comes in with a stroke or a heart attack or appendicitis, for example, these patients may not have room to be seen. They may have to be waiting longer, and that may mean that they get sicker as a result of that.

MG: In the open letter that you signed, it says that the consequences without this circuit breaker being put in place, the consequences could be catastrophic. That's a really powerful word.

SHAZMA MITHANI: It is, and I really do believe that the consequences could be catastrophic, so if we have a situation where we can't take care of our sickest patients because our system is overloaded, that could lead to quite significant consequences with people having higher morbidity or having worse outcomes or even having deaths.

MG: What about for doctors like yourself? I mean, this has been a long haul. We've been in this for eight months now. How are staff, how are you holding up, given the pressure that you're under right now?

SHAZMA MITHANI: We're scared, we're tired. It has been a long eight months, at the beginning of the pandemic, we were paying attention to the rest of the world thinking that perhaps that was going to happen here in Canada. And thankfully, for the most part, it didn't, because we lock things down quite early. However, now we're in a situation where with the reopening of the provinces, the cases have risen dramatically over the last several weeks. And we're going into the second wave already being exhausted from the preceding seven months. And so we're really just trying to rest when we can and brace ourselves for this, the second wave of patients that's going to come through the system.

MG: Province of Manitoba is a little bit ahead on the curve of Alberta. What are you hearing from colleagues there about what they're going through and is that what you worry about?

SHAZMA MITHANI: Yes, it is what I worry about, and so what I'm hearing from colleagues there is exactly what I envision the emergency departments here are going to be like in the next two to three weeks. They are completely overrun. I had seen a communication between a couple of emergency physicians in Winnipeg describing it as an inferno. There were just so many patients there where there wasn't even room in the intensive care unit to move patients out of the emergency department. And so I I'm very worried that that's what Alberta is going to be facing in the coming weeks.

MG: There are a couple of concerns that are raised around the circuit breaker. One is that if this is just a couple of weeks that you're just kicking the can down the road, that this isn't long enough of a pause to make a difference in case numbers. What do you say in the face of that?

SHAZMA MITHANI: I understand those concerns, there is good evidence to show that a short lockdown does actually effectively bend the curve and more importantly, gives hospitals a chance to catch up so that we don't overrun the system and exceed our capacity to treat patients and again, importantly, allow contact tracers to catch up to curb the spread of COVID-19. So our contact tracers in Alberta are very overwhelmed. And in fact, last week, Dr. Hinshaw announced that because we are exceeding the capacity of contact tracers, we're now relying on Albertans to do contact tracing for themselves. And so that's concerning because that will inevitably lead to an increased number of cases as well.

MG: The other concern comes from your premier, who on Friday, Jason Kenney, said we've seen other jurisdictions implement sweeping lockdowns, indiscriminately violating people's rights and destroying livelihoods. Nobody wants that to happen here in Alberta. When you hear his concerns around this, what do you say?

SHAZMA MITHANI: I understand those concerns and nobody does want a lockdown. I agree with that. I don't want a lockdown. If you ask most people, that wouldn't be their first choice. However, our health care system is the fabric of our society. All we're doing is trying to look out for Albertans and we're not asking for sweeping changes. We're asking for non-essential services to briefly close so that we can bend the curve in the right direction. Things like schools and daycares we would, we would suggest, remain open, as in Manitoba, for example. And hopefully that will bend things in the right direction, and I do think that they would.

MG: When do you need this to happen by? I mean you're talking about the situation now, you're worried about an inferno like what's happening in Manitoba. When does the circuit breaker need to be put into place by?

SHAZMA MITHANI: Ideally, immediately, every day that goes past without having more restrictions in place is another day that we have potentially close to a thousand or more COVID cases and that then presents down the road in the next one to two weeks with patients coming to hospital.

MG: And you don't see those numbers coming down any time soon?

SHAZMA MITHANI: Unfortunately not. There was some hope that a couple of weeks ago the numbers were coming down a little bit or stabilising a little bit. But as we've seen in the last week, the numbers are continuing to climb quite rapidly.

MG: Doctor, take care of yourself. I really appreciate you speaking, you're busy and you stole a little bit of time to speak with us. I really appreciate it. Thank you.

SHAZMA MITHANI: Thank you very much for having me.

MG: Dr. Shazma Mithani is an emergency physician at the Royal Alexandra and Stollery Children's Hospitals in Edmonton and a public spokesperson for the section of emergency medicine within the Alberta Medical Association. Are circuit breaker lockdown something more jurisdictions should consider instead of resorting to the long term lockdown like the ones we saw in the spring? Dr. Patricia Daly, Chief Medical Health Officer for Vancouver Coastal Health and Raywat Deonandan, epidemiologist and associate professor at the University of Ottawa join us now. Good morning to you both.

RAYWAT DEONANDAN: Good morning.

PATRICIA DALY: Good morning Matt.

MG: Raywat let's start with you and just in terms of what you just heard from Dr. Mithani. How much would a circuit breaker lockdown help in Alberta, given what she's just described?

RAYWAT DEONANDAN: It would help, it would definitely help. The problem is, once you're done, you're right back where you started. And I liken this to treading water in the middle of the ocean. A circuit breaker is a helicopter that shows up and picks you up out of the water, gives you a chance to catch your breath, but then drops you back in the water again. So it's bought you some time but hasn't solved the problem. What we want is the helicopter to drop you down with a life raft or some kind of plan to get back to shore. So it's not an ideal scenario, but it is an option and I think they should consider it and some other options.

MG: Can I just ask you briefly just about the language, circuit breaker versus lockdown? I mean, circuit breaker sounds a little bit less draconian than a lockdown, but is it essentially the same thing?

RAYWAT DEONANDAN: It is exactly the same thing. And the terminology was invented by British advisors, I think, intentionally to make it sound more palatable to the public because it describes a process and an intent, which is great. But it is ultimately an economic restriction that is identical to an economic lockdown, it's just a shorter term.

MG: A little sound in the background there of another guest. Dr. Patricia Daly is listening in as well. You're right in the middle of a two week lockdown in B.C.'s Lower Mainland. Tell me about the decision making that went into bringing in those restrictions.

PATRICIA DALY: Well, I think we have to remember, first of all, that we've seen cases increase as other provinces have over the fall, but our goal now is not to drive those cases down to as low a level as possible, because in order to do that, that the consequences of those severe lockdowns are dire. And in some cases, they're worse than the virus itself. So we've reopened our provinces quite consciously knowing that we would get a rise in cases. Our goal now is to ensure that we don't overwhelm our health care system and also protect those who are most vulnerable to severe disease. So in B.C., listening to Dr. Mithani, our short period, two week period of new restrictions, which is only in the lower mainland, was done before we overwhelmed our hospital system. We have a slight increase in hospitalisations, but we're not at the at the place where we can't, we are having to restrict health care services or ICUs are overwhelmed. So our lockdown is and it's also targeted to where we're seeing the highest number of cases in the Lower Mainland. And we're also focussing on the locations where we know transmission is occurring. So we've learnt a lot about this virus in the spring. Those kind of broad, severe lockdowns, indiscriminate, the public would not put up with those anymore. And we need to to use the information that we've gleaned. In B.C., our two week period will restrict social gatherings in private dwellings because that's actually where we've seen most of our transmission. And we're also pausing group fitness classes and other recreational activities. It will give us a chance to to improve the safety plans and those venues. So when we do lift this lockdown, it won't be with the same guidelines as we had previously will be with new and improved guidelines.

MG: And again, the question that I asked Dr. Mithani is, is, is two weeks enough? That's only one incubation period. So is that enough, do you think, to really get transmission to a manageable level in the Lower Mainland?

PATRICIA DALY: Well, remember, our goal is to to flatten the curve, not to to reduce the number of cases to as low a level as we might we might have seen in the summer as to monitor the hospitalisations. And we will have some indicators even in a two week period of whether or not we've had a benefit. So by next week, cases may not have come down, but the new cases we're seeing, we hope, will have fewer named contacts because they won't have had those social gatherings that they might have had two or three weeks ago. And in B.C., we still are doing active patient contacts follow up. So we should be able to monitor that data. And if we can see that going forward, there's smaller numbers of contacts, we'll know that over the coming weeks we're not likely to see a dramatic rise in cases.

MG: Have a listen to Dr. Mike Tildesley. He recently co-authored a circuit breaker study, and it was presented, as Raywat mentioned, to the UK government.

SOUNDCLIP

VOICE: This is sort of the key thing with the circuit breaker that we know. We know that lockdowns are economically damaging. That's one of the key things. And we know that they're damaging for people's well-being. If you announce a control measure was going to happen maybe two or three weeks in advance of it happening, what you do is you can mitigate certain amounts of that. So, for instance, the hospitality sector, say restaurants and pubs, can maybe not sort of buy in all the sort of food and drinks that they might be using over that period. And you avoid situations like we have again in the UK in March and April, where there were pubs who were having to pour beer down the drain because they weren't able to sell it. And so there were certain kind of obvious impacts that could be minimized if it's announced that up in advance.

MG: Raywat Deonandan can a circuit breaker help with the economic factors that inevitably come into play if you are shuttering businesses?

RAYWAT DEONANDAN: Well, that is a question for an economist. That seems so on the surface, if I were to take a guess. My issue is that it probably isn't enough to solve the problem. And I told your producer, this following thing that will probably get me into trouble, get me some hate mail, I think a circuit breaker is a compromise between doing nothing and doing what you need to do. Right? So what you need to do probably is a more supression — long term supression — strategy followed by mitigation, rather than this short term break in the system, leading to a rise in the cases when you lift these efforts.

MG: So why aren't societies doing what they need to do? You'll often hear I mean, we're seeing this across the country, public health officials who are getting advice, I can put it that way, from epidemiologists, from frontline health care workers saying this is what you need to do and that action isn't being taken. Do you, people have said that this is a politicization of the second wave in some ways. Is that what you see, Raywat?

RAYWAT DEONANDAN: A little bit. There's some political fear, obviously, in not offending the business sector. And I understand that people are going to suffer from loss of jobs. That's an important consideration. But I want the economist to step up and tell us what is less painful, a series of circuit breakers over the next few months or one hard piece of pain right now in the form of the suppression, followed by an open economy with extreme public health assets in place. No one has done that analysis, as far as I know. And it may turn out that having just a sharp, extreme lockdown now followed by an open economy with restrictions, is actually the safer and less costly and less psychologically damaging way to go.

MG: Dr. Daly, you and I have spoken before about the mental health impacts of lockdowns and the concerns that you have around that. Do we need to, to Raywat's point, take extreme measures just to ensure that this is dealt with in a way that is going to be meaningful?

PATRICIA DALY: Well, first of all, as a public health physician, my concern is the overall health of the population, and that's not just the number of COVID-19 cases. I am concerned about the harms that occurred with the very indiscriminate type of lockdown that was put in place in the spring, which is absolutely necessary at the time. But I think now we need to to use the information that we've gleaned about the virus, how it spread and where it's being spread. And for some populations, the impact of the lockdown itself would be actually more harmful to their health than the virus. So that's where we need the right balance. And it's not about driving the number of cases down as low as possible. It's about flattening the curve and maintaining access to the health care system so we don't overwhelm our hospitals and our intensive care units. And that's the kind of data that we've used to make our decisions here in British Columbia. It's entirely driven by public health. For example, we have not shut down restaurants because our covid safety plans are very robust in our restaurants and we're not seeing transmission in restaurants in the recent months. Our lockdown is specifically focussed on where the data is telling us that transmission is occurring. We keep we've kept schools open, daycares open, and that's what we need to monitor. And it is a balance. This is not political. This is about public health, considering the overall health of the population.

MG: Dr. Vera Etches in Ottawa said that we need to learn to live with COVID with care. Is that in some ways what you're hinting at, Dr. Daley? That that we need to figure out this isn't going anywhere and we need to figure out what the best way is to manage this?

PATRICIA DALY: That's exactly right. I completely agree. This is an established, established virus in our population now. Even with a vaccine, the virus is not likely to disappear. We certainly will see levels come down and we're all looking forward to that. But given that that is established, our goals are different. Our goals are to protect those most vulnerable to severe disease, our older population, those who live in long term care, while also considering the overall health and well-being of the rest of the population for young, healthy adults who are primarily and very severely impacted by the lockdown. This is a very mild disease. We knew when we reopened the economy that there would be more transmission. That's not unexpected. And so we need to have that balance of goals, understanding that it will circulate in the population. Now, our goal is to protect those most vulnerable.

MG: That sounds like harm reduction.

PATRICIA DALY: It is a little bit and speaking of harm reduction populations like those who are addicted to opioids, during the spring lockdown, we saw a dramatic rise in opioid overdose deaths. Those are the kinds of harmful things that we have to prevent. And that's why we need a more measured approach. Now, even as we go into this short circuit breakers and by the way, I also think you'll get more public buy-in at this stage of the pandemic if we do this for a short period of time, monitor closely and then re-evaluate.

MG: Raywat, if we are bobbing in the ocean and we're looking for the helicopter, do we need that public buy in as well just to ensure that the public is alongside whatever measures are taken?

RAYWAT DEONANDAN: Yes, that is the great confounder here is we're, I'm fond of saying public health is the art of the possible and the public determines what is possible. If the public is not on board with a suppression technique or elimination strategy, then so be it. Then we have to find this so-called balanced approach, which involves a series probably of circuit breakers. But if the public is more amenable to an elimination strategy, as we've seen in Australia and New Zealand, possibly in Scotland or a long term supression mitigation strategy that we see in East Asia, then we can pursue that goal as well. So there are several tools on the table. And my frustration is we haven't had a national or even provincial conversation about what the long term strategy needs to be, because this is a many, many months and possibly years long ordeal we have to live with. This thinking lasting only a few weeks at a time is not going to solve the problem.

MG: But you can understand why people are focused on the immediate, given the situation that we're in right now?

RAYWAT DEONANDAN: Absolutely. But my frustrations with the leadership, not with the people. I understand people, I get it. But the leaders need to have a longer term vision.

MG: It's great to speak with you both, as always. Thank you very much.

RAYWAT DEONANDAN: Thank you.

PATRICIA DALY: My pleasure, Matt.

MG: Dr. Patricia Daly, the Chief Medical Health Officer for Vancouver Coastal Health. Raywat Deonandan is an epidemiologist and associate professor at the University of Ottawa, who is juggling his young son on his chest as he was talking. Your thoughts on this welcome. You can reach us through the email thecurrent@cbc.ca or tweet us @TheCurrentCBC. The CBC News is next and then it is Remembrance Day and we will hear in six minutes from the historian Margaret MacMillan on what studying war can teach us about maintaining the peace. I'm Matt Galloway. You're listening to The Current on CBC Radio One.

[Music]

A historian's take on the importance of Remembrance Day and understanding war

Guests: Margaret MacMillan

MG: Good morning. I'm Matt Galloway. You're listening to The Current.

[Music: theme]

MG: Still to come, a ground-breaking legislation in Oregon has decriminalized many narcotics. We'll talk about what this means for addiction and recovery later on in the program. But first, today is a day where we remember and honour our veterans, many of whom were thrust into battle before they were fully grown.

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[Music]

VOICE: France, April 16th, 1917. My dear mother, I have not written a letter for over a week and a half as I have been in the trenches for nine days and it is impossible to write up there. You've no doubt heard before the advances of the Canadians in the capture of Vimy Ridge. I was in the whole of that battle and it was hell. I got a small splinter of shrapnel through the fleshy part of my shoulder. It was some battle, and I'm glad to see that I was through it as it will be one of the biggest things in Canadian history. Well, mother, if you can please send me some socks when you can and anything else you care to send in line of eats. Well, mother, dear, please don't do any worrying as it does no good, but remember me in your prayers. I know you do that and it helps a lot. Well mother, I will close now. Give my love to all. I remain as ever, your loving son, Winnie.

MG: That's a letter from a 17-year-old Canadian private to his mom during the First World War. A child soldier fighting for a still young country. Between 1914 and 1918, millions were killed, including 61,000 members of the Canadian Armed Forces. And today we remember them and everyone who fell in battle fighting for this country. Margaret MacMillan is one of the world's most respected scholars on war and peace. She is a professor of history at the University of Toronto and emeritus professor of international history and former Warden of St. Anthony's College at the University of Oxford. Her book, Paris, 1919, was a runaway best-seller. Her new book is War: How Conflict Shaped Us. Margaret MacMillan, good morning.

MARGARET MACMILLAN: Good morning.

MG: What does Remembrance Day mean to you?

MARGARET MACMILLAN: Well, it reminds me of actually people in my own family, because I had two grandfathers who fought in the First World War, and that generation now beginning to disappear, which remembers people from the First World War. And I had a father and three uncles who fought in the Second World War. So I think of them. But as a historian, I also think of the terrible toll that war takes and how dreadful the wars of the 20th century were. I mean, it's heartrending to read a letter from a 17-year-old who's who's been through battles. I mean, it's appalling to think and yet it's still happening.

MG: Why is it and I mean, part of this is about familial connections, but it's also just about who we are as a nation. Why is it important that that we as Canadians remember what happened in a war that was more than a century ago?

MARGARET MACMILLAN: It's part of the fabric of our history and it's part of what made us what we are. I mean, our history is made up of a great deal. And luckily for us, not as much war as other countries. But war is still very much part of Canada and it was, there was a set of markers on our way to full independence. I mean, as a result of the First World War, we came out more confident of ourselves as a nation, as a player in the world. We were prepared to take more independence from the British. And as a result of the Second World War, we became pretty much fully independent from the British. And I think these were important moments. And so it's useful always, I think, to look back and see how we got to where we are today. As I said, war was not the chief thing determining our evolution, but it plays an important part.

MG: You write in the book about a day like today in terms of how we remember war. And you say that remembering war and how we remember it is often tangled up in political and social debates. What do you mean by that?

MARGARET MACMILLAN: Well, we change ourselves as a people and we change how we remember the past. And that's inevitable. I mean, we don't remember the First World War as vividly as I remember the second. We don't remember the second as vividly as we remember Canadian peacekeeping activities because we remember the more recent things. And we also change what we're remembering. And the First World War, when it was first commemorated in the 1920s on the allied side, it was commemorated as victory. And people talked in Canada and Britain, Australia, elsewhere about our dead heroes. And it was seen as a victory and a triumph. And then gradually the doubts crept in, especially as the world moved to a Second World War. And I think people began to think, was it all a waste? Was it all a mistake? And I think we now look back at the First World War and see it as a time of tremendous loss and a futile struggle, which I think, again, is oversimplifying. What I think has also happened to remembrances is we're remembering more and more not just the people on our side, as we would have once said. We're remembering all those who die in war. And I think that's an important thing. I think a lot of people in Canada who come from very different parts of the world whose countries weren't involved in the first and second world wars, or were involved on the other side. And I think remembrance now is something that we should communally think about those who died in war and reflect on the costs of war.

MG: Is that what you mean when you say that there's in some ways a struggle in terms of how best to remember war and how best to remember those who have fought in a war?

MARGARET MACMILLAN: I think so. You know, and every generation has its own way of remembering and every generation will ask these questions again. My own feeling is that we need more and more to think of war as something that crosses borders, that affects people on both sides or whatever sides are involved, and try and remember that. And there's been some very interesting developments, for example, with the French, the Germans and the British collectively, altogether, remembering the first and second world wars, not in a spirit of we won, you lost, or it was all a mistake, but in a spirit simply of remembering the costs of war. And I think that's a very welcome development.

MG: You've hinted at this. And I mean, Stephen Harper, prime minister, used to say that Canada was forged as a nation in the First World War. What was and what has been the role of Canada as a combatant on the world stage? I mean, there's the First World War and Second World War, but obviously Korea and the conflict in Afghanistan, you mentioned peacekeeping as well.

MARGARET MACMILLAN: I think what's interesting about well, I think I might disagree with the former prime minister a bit. I mean, I think we were shaped by war. Forged in war, I might think is a bit strong because many other things went in to our creation and our forging. But I think what we have always done is fight as part of coalitions. And I think that is still something very much engrained in our nature. We came of age inside a bigger grouping, the British Empire and then the British Commonwealth, and we fought in wars as part of a British Empire, British Commonwealth struggle. And then after the Second World War, we joined multilateral organizations, NATO and then the United Nations. And we've always, I think, seen ourselves as participating in collective efforts. I think this is something very deeply part of Canadian nature and our attitude towards the world.

MG: In this book, you grapple with what war is and you say that war is not an aberration, nor is it the absence of peace. Tell me more about that in terms of how we define what war is.

MARGARET MACMILLAN: Especially in the West, we've had a very long period of peace. And so we tend to see war as something that happens when things go wrong, that it's an aberration. And I think we need to recognize that war is more deeply engrained in human society and that it's been part of our history for as far back as we can tell. And there are still those and there have always been those who see war as something that can be used. It's an instrument of state. You can use it to get what you want, whether it's taking someone else's land or possessions or whatever, or those who want to build a different society. And so I think we need to recognize that war is not something that just happens by mistake and a few people want. I think it's something that goes right back into human organisation and human history. And so I think we need to really think about it, because it's always, the danger of war is always present. I'm not saying we're going to have a war anytime soon, but there still is an awful lot of war in the world. And I think we have to really think about it, because if we don't think about it, we won't think about how to stop it, how to end it, how to control it, how potentially to outlaw it altogether.

MG: When war happens elsewhere -- and to your point, I mean, there are wars that are happening elsewhere. What does that do to our relationship to war? If we aren't, if it's not, you know, right in front of us in some ways?

MARGARET MACMILLAN: I think it can do one of two things and I think I can see them both in Canadian societies. It can make war seem glamorous. You know, there are hundreds of books when you go into bookstores, about war, and a lot of it is about battles and movies. And people find or some people find war exciting, glamorous. And I suspect if you actually experience it, you wouldn't feel that. I mean, those who've actually fought don't see the glamour of war. You know, they see the hideous side of war and they see the costs of war. So I think there's that. We may falsely glamorise war thinking it's something noble and glorious because we don't actually experience it much. But the other thing I think is we tend to distance ourselves and we say I think wrongly, quite wrongly, we say, well, some parts of the world are just warlike. I mean, those people are just like that. I mean, when Yugoslavia was breaking up in the '90s, there were those who said, oh, well, those people have always been like that. And it's a way of washing our hands. You know, we don't have to take responsibility for it because these people are just foolishly warlike. And I think that's dangerous because I think we have to be aware of the costs of war and we have to be aware that those costs are borne by the world as a whole, not just by those who suffer and die in them, but the waves of refugees in the world, this is part of the cost of war, and it's something that does affect us actually.

MG: There is a great old spiritual called Ain't Gonna Study War No More. This is this is your life's work in some ways, studying war and peace. Why is that important to study war, especially now?

MARGARET MACMILLAN: Well, I think really because if we don't study it, we fail to understand something about how human society has developed. I mean, for better or worse, our societies have been deeply affected by war. I mean, Canada may not be a nation forged in war, but it's a nation which has been affected by war. I mean, governments have grown stronger, for example, partly because of the needs to respond to war. The country came very close to breaking up, I think, a couple of times in the first and second world wars over the conscription issue. So these are things that I think we need to be aware of, that even a peaceable country like Canada shows the marks of war. But I think studying it also gives us, I think, a better understanding. I mean, I'm all for more history anyway. I mean, this is not just because I teach it, because I think it's really important. And I think the more we understand about the past, the more we understand ourselves and the more we understand others. And so really, I think, war is just part of it. I mean, if you do history of the 19th and 20th centuries, as I do, you can't really ignore war. It's so much part of the history of those centuries.

MG: And yet, as you say, I mean, we don't in some ways take war seriously enough. Is that I mean, part of that's in school. But there's the larger issue as well. Why is it that that we aren't studying, or why is it the study of war is largely ignored?

MARGARET MACMILLAN: I think maybe it's because it's seen in a lot of circles as military history. So it's sort of battles and toys for boys. And I think that's a mistake because as we know, I mean, I speak as a woman. Women get affected by war in many ways as well, often as its victims or as its supporters. And so I think that we need to recognise that it is something that affects human society. And I think generally to understand how wars break out and to understand something about the nature of war may give us a healthy respect for those who try and keep peace and may make us understand the need. I mean, we still live in a world in which there's a great deal of war. It's been estimated since 1945, there's been a war virtually every year sit somewhere or other in the war. And as we know, there are wars going on at the moment in the world and new ones threatening to break out. And so I just think to understand where we are today and to be wary and to to look about ourselves, I think it is necessary to understand both history, but involved in that history I think we need to understand something about war. But I think there's a sort of distaste for studying war. And I've been told by people, why do you look at something so horrible? I mean, I was giving a talk once and someone said, why don't you study peace instead? And I said, you know, that you have to understand war if you want to understand peace, the two are tied up together. And if we avert our eyes just because we don't like something, we find it distasteful, then I think that that's rather foolish,.

MG: Does that go back to what I was saying earlier about the political and the social debates that can colour in some ways how even we remember war on a day like today?

MARGARET MACMILLAN: Oh, yes. I think, I mean, every generation asks its own questions of the past. And I think there's a feeling that we are a peace loving, peace keeping people and that therefore, I think in certain circles, I think there's a feeling that you don't really want to study war. I mean, I've been told that at some universities and this is purely anecdotal, that some universities, people don't want to hire in the area of history of war or in the history of international relations because it's seen as something that's about power and that we should be looking at, quite rightly, we should be looking at groups that have been previously marginalised or neglected or badly treated. I mean, you know, I think all of this is important. But I think to ignore the questions of power, to ignore the impact of war is to leave out a very important part of the picture. It's part of the human story.

MG: You write about civilians in this book. Have civilians always been targets in war?

MARGARET MACMILLAN: Often, yes. Pretty much always I think. I mean, civilians often as part of the prizes of war, I mean, in a number of wars, civilians were taken off as slaves or exploited in other ways. And yes, civilians are targets of war. Civilians are that awful phrase, the collateral damage in war. In other words, they may not be deliberate targets but they get hurt anyway. But civilians, I think we should recognise, have also made wars possible, you know, modern war. But all war involves a great deal of resources. It involves a great deal of mobilisation of society. And civilians play a part in that. You know without the factories, without the civilians working in the factories in the first and Second World wars, it wouldn't have been possible for those armies and Navies and air forces to keep on fighting. And sometimes, civilians have been cheerleaders for war. You know, they've pushed for war. They've demanded war. They've pushed their governments into war. And so the role that civilians play is a complex one.

MG: You paused as you were about to say collateral damage. What is it about that phrase? I mean, there are a lot of people who still recoil from it. What is it about that phrase that is so unsettling, do you think?

MARGARET MACMILLAN: I think it's because it's bureaucratic and it's covering up the real nature of what's happening. I mean it's a horrible phrase and I wish in a way I hadn't used it, but it's the one that's often used. I mean, what it means is death and injury and destruction and cruelty to innocent people. You know, a school gets bombed and children are killed and the official spokesmen can often say, well, it was a bit of collateral damage. It wasn't collateral damage in a way that, you know, knocking down a street lamp might be in a car. I mean, that's collateral damage. It was killing people. And I think we if if the language gets us away from the reality of war, I think that's a bad thing.

MG: One of the other things that you talk about in this book and again, it in some ways runs counter to what we were just speaking about is, is that war can also bring creation. There's destruction, but there's creation. What are some of the things that have come out of armed conflict that have benefited society?

MARGARET MACMILLAN: I know it sounds odd, doesn't it? But social change is changing the status of certain groups. For example, in the First World War, change in the status of labour, they got greater powers, the working class got greater powers. The governments were forced to deal with unions and forced to negotiate better terms because they needed their labour to keep the war effort going. So therefore they need the working class to be on side and changes in the status of women, for example. And then in the gain in the First World War, the British government, which had resisted giving women the vote, came to recognize that women were making a huge contribution to the war effort and that there was no reason not to give them the vote. And so social change has often come about as a result of war. I mean, it might have come about anyway, but war certainly can speed it up. War can also produce huge and sudden advances in science and technology. I mean, we're seeing it today with the search for covid virus. Suddenly, society's resources are being poured into doing something and the timetable has been short and things have been done in six months that might have taken six years. And the same thing is true of wars, huge improvements in medicine as a result of the two world wars, changes in the ways in which governments manage and organise society, changes in attitudes. We wouldn't choose to do them this way, but it is one of the many paradoxes of war that sometimes things that are beneficial for societies in peacetime will come out of a war.

MG: When you point those things, are you accused of defending war?

MARGARET MACMILLAN: Yes, quite often people saying, so you really like war and you think it's a good thing. And I keep on saying, no, I don't. I mean, in fact, the more I read about the war wars or other. More horrific, I find them I mean, I have read a lot now in my life of soldiers memoirs, people who've actually thought or studies by historians, and I'm just at the moment reading a book about the siege of Moscow by the German armies in nineteen forty one. And it's horrific. I mean, it's you can't believe what people went through. So no, I'm not defending war. I'm simply saying as an historian, let's look at it. And what difference does war make? And in some cases war does make a difference, which in peacetime we would recognize is a good one.

MG: We are in, in the West, this thing called the long peace. What is that?

MARGARET MACMILLAN: It's for us. And I think, again, this is something we better be just thinking about a little bit. Since 1945, Western countries have not seen war on their soil. And Europe, which was the most violent continent in the in the 20th century, has been at peace. And Europeans, I think, are far less warlike than they used to be. Canada, the Americas and generally the United States, South America have not suffered the scourge of war. Parts of Asia have been completely free from war. And so I think we've got used to the idea of this long peace and we think it's a permanent state of affairs. That, again, worries me because I think we can get a bit complacent about it. That's exactly how many Europeans were thinking before 1914 when they thought, well, we've had a lot of peace. Europe has moved on. We're no longer like we were. War is not something we do any longer. And I think, you know, we need to just be a little wary of complacency because wars can break out even if we don't want them. I'm not saying any country in the West is going to go to war any time soon, but there are countries still preparing for war and there are still flashpoints around the world which could trigger a war.

MG: The Canadian psychologist Steven Pinker says that in some ways societies are less violent now and that that will maintain the long peace. Do you buy that?

MARGARET MACMILLAN: Well, I think societies are less violent. We tolerate less violence. I mean, just to take an example, I mean, we no longer would contemplate public executions. I mean, we see these is absolutely appalling and we dislike unmeditated and unprovoked violence. But that's not the same as war. War is is very organised and war is organised violence. And we may be nicer individually in our societies and we may tolerate violence less, but that doesn't mean we're still not capable of fighting wars. You know, I think a lot of Americans would have said before 1941, before Pearl Harbour, that we don't want war, we're peaceable people. And then the Japanese attacked and suddenly American public opinion shifted dramatically. So even peaceable people can change if they feel that they're threatened or that they need to defend themselves. So I think, yes, I think we are less prone to violence in many countries in the world, but that doesn't mean the capacity for war isn't still there.

MG: Does that mean, just briefly, does that mean that more war is inevitable?

MARGARET MACMILLAN: No, I don't think so. And I think, you know, I never like to say things are inevitable. I think it's a very dangerous thing to say because then you sort of get more used to the idea. And once you get more used to the idea, I think you get a little bit closer to actually contemplating something actual. But I think I would say war is likely. I mean, if we look at the, well, there are wars raging in the world at the moment. It looks like there's there's something very close to a civil war breaking out in Ethiopia. This has suddenly flared up. So, yes, I think we do have wars around the world and we have countries that are planning for war, even if they're planning defensively. The United States spends a huge amount of money on its military. The Chinese are increasing the amounts of spending hugely. I mean, since 2002, the Chinese have been spending more and more and more on things military. And these may all be defensive preparations, but once you have the plans and once you have the equipment, I think the danger is that you might get into a situation where you may think, well, we better use it. And so I think war is always a likelihood, even though the weapons are getting more dreadful. And even though I think we recognize that it would be folly, that doesn't mean it might not happen. But no, I would never use the word inevitable.

MG: It's always tricky to ask a historian to predict the future as well.

MARGARET MACMILLAN: Oh, we hate doing it. Yeah.

MG: It's a real pleasure, as always, to talk to you. Thank you.

MARGARET MACMILLAN: Well, thank you very much.

MG: Margaret MacMillan, a professor of history at the University of Toronto. Her new book is War: How Conflict Shaped US.

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[Song: "The White Cliffs of Dover" by Dame Vera Lynn]

MG: That, of course, "The White Cliffs of Dover" by Dame Vera Lynn. She inspired many during the Second World War. She died this June at the age of 103. Coming up after your regional update, often called the father of modern medicine, Dr. William Osler's legacy also includes a history of racist statements. We'll hear from one doctor who wants us all to re-examine Osler's place in health care. That's coming up in 90 seconds. I'm Matt Galloway. This is The Current.

[Song: "The White Cliffs of Dover" by Dame Vera Lynn]

Allegations of having racist views could affect the legacy of William Osler

Guests: Nav Persaud

MG: Hi, I'm Matt Galloway. You're listening to The Current. The name Dr. William Osler may sound familiar to many of you. That name adorns numerous public schools across the country, a library at McGill University, an entire hospital network in the greater Toronto area, just to name a few. As a graduate of McGill and one of the founders of Johns Hopkins Hospital in Baltimore, Maryland, he's often described as the father of modern medicine. He created the first residency programs and was the first to teach students at patient's bedsides. But now Osler's legacy is being questioned. A commentary published this week in the Canadian Medical Association Journal points to the racist statements that he made, arguing that he should not be held up as a medical hero. Dr. Nav Persaud is a co-author of the commentary. He is Canada Research Chair in Health Justice and an associate professor at the University of Toronto. Doctor, good morning.

NAV PERSAUD: Good morning.

MG: Why did you want to write this commentary on Dr. William Osler?

NAV PERSAUD: William Osler is one of the most famous physicians of all time. He wrote a textbook that was translated into multiple languages and republished in multiple editions because it was in such high demand around the world. He was the first physician and chief at John Hopkins University in Baltimore, and he went on to be Regius Professor of Medicine at the University of Oxford. Today, there are regularly meetings to discuss his work and his contributions. And yet, you know, I have been learning more recently about some of the concerning statements that he made and concerning behaviours. And on the centenary of his death in December of 2019, multiple articles were written holding out William Osler as an example, who should be followed today by medical students and others.

MG: What are some of the things, the racist things that he said or that he wrote?

NAV PERSAUD: In a speech in 1914, he declared Canada a white man's country. At the time, there was a ship that was docked in a port at Vancouver. And there were would be Canadians from India who were hoping to immigrate here. And there was a strong view at the time that these people should be admitted to Canada, they were British subjects and later that same year, they would be expected to fight alongside Canadians in World War One. But there was also a different view. And Osler in the white man's country speech worried openly about, "swarm of yellow and brown men entering this country." Osler also practised medicine on segregated wards in Baltimore after the civil war in the United States. And he would have seen what African-American people were experiencing at the time and although he's held out for his love of humanity and he wrote copiously, he didn't write about racism and didn't describe the experiences of racialized people on those segregated wards. In fact, when an intern was concerned about the deaths of six African-Americans, within the course of several hours, Osler dismissed those deaths with a racist remark.

MG: He is often seen, as I said, as the father of modern medicine. What has the response been like to you questioning how he is held up in the medical world?

NAV PERSAUD: As expected, there's been a different view. You know, before our article was published, there have been two biographies written about Osler. Dozens of articles written, including recently, and almost all of those articles praise Osler and talk about what we as physicians and others can learn from him. And so I've been somewhat disappointed though that when we have pointed out racist statements that have always been available, you know, the white man's country speech was given in a public venue and it was reproduced in a newspaper. So although those who have been accessible to my colleagues for years, they have mostly been ignored. And where they've been mentioned, downplayed. And I think the response to our article has reproduced a lot of what has happened in the 100 years since Osler died. People have said he was bound to make racist statements because he was a product of his time, even though people who lived at the same time as Osler held very different views from him and many fought against racism. I think some have worried that we cherry picked racist statements when in fact we were highly selective in which racist statements we included. Many others exist, and I'm sure my colleagues know about them.

MG: Have a listen to Nadeem Toodayan, who's a medical registrar just outside of Sydney, Australia. He wrote one of the rebuttals to your commentary in the Canadian Medical Association Journal. Here's what he said.

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VOICE: Although I accept that there are issues with racial inequality in medicine, the insinuation that William Osler was racist is remarkable and it's very difficult to come to that conclusion considering the amount of information available about his life, especially with regards to his strong feeling of, you know, brotherhood, which he espoused in very many of his lectures. It's the dominant kind of theme in his life. And there are very explicit, you know, remarks in his bibliography to prove that and from his colleagues, including racialized physicians. Osler was actually very warm towards people of all different classes and backgrounds. There's clear cut evidence that Osler was there was not treating racialized physicians in a derogatory manner or that he was dismissive of them, rather, I say contrarily, he was very supportive of them. It's crystal clear it's not something that one could be confused about.

MG: Dr Persaud, what do you make of that? That there's a lot of evidence that William Osler was inclusive and supportive of racialized colleagues?

NAV PERSAUD: I think the way that racism can play out is that someone can say racist things that have an important effect. You know, for example, the white man's country speechless. I was a prominent physician at the time. I was invited to come back to Canada and decided to make a pronouncement about immigration policy that was clearly racist. And at the same time, that person can turn around and be nice and warm and supportive to an individual racialized person who they've met, especially in a professional context, where a prominent person like Auclair would be expected to behave professionally. And I don't think that the fact that Auclair was nice and supportive to some individual racialized physicians means that we should excuse him talking about a swarm of yellow and brown men entering Canada.

MG: Is it fair to judge his statements by the current standards? By today's standards?

NAV PERSAUD: No, it's not and we didn't do that. We compared Osler's conduct to the conduct of others. In fact, other physicians who lived at the same time as him. One example was Alexander Thomas Augusta, who studied at Trinity College in Toronto shortly after Osler did. And Augusta had to come here because he couldn't gain admittance to medical school in the United States. After he finished his training in Canada, he decided with his wife Mary, to work against racism in Canada, and he and they together formed several organizations that helped to address racism. When the Civil War started in the United States, he wrote to Abraham Lincoln and volunteered to fight, fight against racism, to fight against slavery, and he risked his life to do so. He's someone I never heard about when I was in medical school, although I was expected to know Auclair quotes and I heard about Auclair all the time. I never heard about Augusta, even though he trained in Toronto.

MG: In the piece that you wrote, you say as statues of once revered individuals who participated in racist crimes are being removed around the world, we should change Osler's place in medical curricula and explicitly address racism in medicine. We've spoken on this program before about racism in the medical profession. What have you faced during your career?

NAV PERSAUD: I'm relatively privileged, I think, because I'm a physician, so I don't receive the worst type of racist abuse and also because I'm a man, I receive different treatment, I think than racialized women do. But I think racism is part of society. I deal with it on a daily basis at the hospital and outside of the hospital. And I think that having a hospital like William Osler Health System that serves people in Brampton and the northwest part of Toronto, including Rexdale, named after someone who thought that Canada was a white man's country, is an additional humiliation and insult that I object to. And I think, you know, recently, as you know, there's some more recognition of racism, especially after the summer, multiple institutions, including hospitals, have issued statements against racism and have pledged to do some of the hard work to address racism, systemic racism as it pertains to health care. And that can involve changing hiring policies, changing who's amongst the leadership of hospitals right now, changing the culture in hospitals and other health care institutions. All of that is hard work. I think it's relatively easy to change the name of a hospital away from the name of someone who made racist statements. And I'm disappointed I think that some institutions have shown some reluctance and a lack of openness to making that change.

MG: Dr. Persaud, it's good to speak with you about this. Thank you.

NAV PERSAUD: Thank you.

MG: Dr. Nav Persaud is the Canada Research Chair in Health Justice and an associate professor at the University of Toronto. He co-wrote a commentary published this week in the Canadian Medical Association journal titled William Osler: Saint in a White Man's Dominion. His co-authors were Heather Butts and Dr. Philip Berger.

What Oregon’s decriminalization bill on drugs could mean for Canada

Guests: Haven Wheelock, Mark Haden

MG: This is The Current on CBC Radio One. I'm Matt Galloway. There was an election last week in the United States. Perhaps you heard about it. There was, you know, a vote for the president of the United States, but other matters as well. In many states, they were voting on specific state policies. In Oregon, more than 1.3 million people voted in favour of Ballot Measure One-Ten to decriminalize hard drugs like heroin and cocaine. As of the 1st of February, Oregonians with small amounts of those drugs will not face criminal charges. Haven Wheelock is amongst those leading the campaign for this change. She coordinates a syringe exchange program out of a Portland medical clinic Haven, good morning.

HAVEN WHEELCOK: Good morning. Thank you for having me.

MG: Thanks for joining us. Were you surprised that almost 59 percent of voters in your state voted in favour of this measure to decriminalize?

HAVEN WHEELCOK: I'm surprised I was I was ecstatic, to be honest, I don't know if I was surprised or not, because we've really been moving in the direction of taking a health-based approach to drugs. But. I wasn't 100 percent sure it was going to pass and to see it passed by such a margin was very exciting.

MG: What is it actually going to mean for the people that you work with, people who use drugs?

HAVEN WHEELCOK: I mean, I think my favourite part is that it's going to mean people aren't being punished for symptoms of what we've pretty universally deemed a health issue of addiction and. So this means that instead of getting arrested and being forced into the criminal justice system, people will have access to the kinds of care and support that they deserve.

MG: People have said that this is a health issue, but it's also the intersection of health and race coming out of the summer that we have had with protests around Black Lives Matter. Do you see that intersection as central to this?

HAVEN WHEELCOK: I do. I mean, because I work in health care, my focus has been very much health care focused. But, you know, at the end of the day, this measure will decrease racial disparities in arrests and prosecutions for these crimes by 95 percent. And so, you know, we know that the war on drugs is a tool of white supremacy and that it's been long used to, you know, perpetuate these cycles and punish communities of colour and communities of culture. And to be able to take a step in the direction of taking away that tool is really important and valuable work.

MG: How hard of a sell was it?

HAVEN WHEELCOK: It depends on the audience. You know, I think for, I think for a long time, we've been really thinking about and talking about how we treat people who live with substance use disorders and that the idea that, you know, we need to stigmatise destigmatize addiction if we want to, you know, improve access to health care for folks. So I think I like that idea and with the addiction crisis we are dealing with in this state, in this country, that many, many, many people have been impacted by the disease of addiction. And so for folks that have seen how our current system isn't working, it was a pretty easy sell. Some other groups, less easy.

MG: Well and I ask that because 41 percent of voters voted against this. So have a listen to Washington County DA Kevin Barton.

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VOICE: There's a lot to like about anyone that says that we should provide more treatment, more resources for people and for families that are struggling with drug addiction and all of the negative consequences of that, but decriminalizing drug possession and vast amounts of drug possession or some of the most addictive hard drugs, things like methamphetamine and heroin and cocaine and LSD, that's, in my opinion, a reckless and dangerous thing to do, because what that will do by decriminalizing it takes away our ability to require people to enter into drug treatment. And it turns much of the drug treatment to be voluntary. Anyone that knows when you're dealing with someone who's struggling with highly addictive drugs, giving them the voluntary choice to engage in drug treatment is not a recipe for success.

MG: Haven, there are a lot of people who follow that line of thought and say that that this might be dangerous because it takes away the ability to require people to go into treatment programmes. What would you say to those, to the 41 percent who voted against this?

HAVEN WHEELCOK: Yeah, my number one comment, whenever he says this is that we're not getting rid of the court system. Like this is really, this is only applies to possession of drugs, like less than a gram of drugs for heroin, two grams for methamphetamine. So we're talking about very, very small amounts of drugs. There are plenty of other drug crimes, like having two grams of heroin that would still funnel people into the current system. Right? I would love if this measure was doing away with the entire war on drugs, but that's not really what this is doing. This is really just allowing folks to not go to jail for a symptom of the disease that they have.

MG: So you don't see this as not the end of the war on drugs, but even the beginning of the end of the war on drugs?

HAVEN WHEELCOK: It's a big step to ending the war on drugs, but it's not, we're definitely not there yet.

MG: There is an overdose crisis that's happening, as you mentioned, throughout your state, throughout the United States, here in Canada as well. What are you hearing about what people might take from something like this in terms of how to tackle that crisis?

HAVEN WHEELCOK: Yeah, I mean, I think it's really important. So one thing that we talk a lot about, the decrim part of Measure One-ten, but it also is one of the largest investments in supports for people using drugs that Oregon has ever set aside. So i100 million dollars to support services for people who are using substances, including naloxone and overdose prevention services. Additionally, when you arrest people and you put them in jail, they are 15 to 70 times more likely to die of an overdose when they are released than if they were never incarcerated. And so to me, just like even keeping people from cycling in and out of jail will prevent that risk of overdose deaths or lessen that risk of overdose deaths, as well as being able to funnel money into services to prevent overdose.

MG: Haven, it's great to talk to you about this. There are a lot of people who are watching what's happening in Oregon. I appreciate you being here this morning. Thank you.

HAVEN WHEELCOK: Thank you so much for having me and be safe up there, okay.

MG: And you. Haven Wheelock is the syringe exchange coordinator at Portland's Outside In Medical Clinic, and she was a lead campaigner for Ballot Measure One-ten in that state that decriminalized possession of small amounts of all drugs. Mark Haden is an adjunct professor at the University of British Columbia's School of Population and Public Health. He's been watching the changes south of the border in Oregon. Mark, good morning to you.

MARK HADEN: Good morning, Matt.

MG: What bearing do you think, if any, I suppose this change in Oregon could have on the conversation around illegal drugs here in this country?

MARK HADEN: Well, as we look at countries that are moving away from a prohibitionist model, what we generally see is things go well consistently. I mean, jail is similar to Harvard Law for three reasons. When you go to either jail or Harvard Law, you learn some stuff. You're constantly told who you are and you make Connexions that you graduate from jail and you don't do very well in society. You graduate from Harvard Law and you do very well. So essentially, we're using the wrong tool. As Haven said, the tool of drug prohibition, the tool of the war on drugs isn't working. It never has worked anywhere. We look at it anywhere on the planet, the tools of health tend to work very well. So we just need to apply a different approach and we're much more effective. What we see generally in countries that move away from their drug prohibitionist model as HIV goes down, Hep C goes down, overdose death rates go down and people generally do better.

MG: How close do you think Canada is to actually making this kind of rule change? Because you've had the premier of British Columbia, John Horgan, who's called for decriminalizing small amounts of drugs. Some public health officials across the country have done that. Interestingly, the Canadian Association of Chiefs of Police have also said that this is an idea, but are we anywhere near that decision?

MARK HADEN: Well, that discussion is certainly increasing. It's interesting in Oregon, there are, there was two ballot initiatives. You've talked about Ballot initiative One-ten, which decriminalised hard drugs, but there was a second ballot initiative as well that fully legalised psilocybin services. So people in Oregon will soon adults in Oregon will be able to access a psilocybin experience outside of the diagnosis.

MG: Magic mushrooms.

MARK HADEN: Nagic mushrooms, yes. All of the current research is with people with a diagnosis of something. But what will happen in the near future is that there will be training and licencing and authorising psychedelic guides to offer people a psychedelic experience, which is absolutely fascinating. That's the first time that's happened in North America.

MG: Why, you studied this, why is that intriguing to you? The idea that in the legalization or decriminalization process you're not just decriminalizing drugs, but you're also legalizing, as you say, an experience?

MARK HADEN: Yeah, they're not legalising the sale of psilocybin. They're legal, legalising access to the experience, which is absolutely interesting. I mean, it's interesting from a number of points of view, because all of the research now has to give somebody psilocybin. And it's incredibly expensive to go through the regulatory hurdles when you're actually offering a substance, costs a lot of money and takes a lot of time. If there is a process happening in Oregon that allows people to have the experience, researchers can really, with a very low bar, go in and simply do what's called observational research and find out what happens when people have these kind of experiences. We can find out with a lot of people experience under this particular context.

MG: There's research that's being done around how psilocybin and perhaps other psychedelics can be used to treat mental health disorders. What do we know about that?

MARK HADEN: Well, they're looking at addiction issues. They're looking at end of life anxiety and they're looking at depression and those are the main ones of psilocybin or other psychedelics, looking at other things like PTSD. But what we see is is remarkable changes. We see maybe this will wind up with psychedelics, will wind up being the best practice treatments for many mental health disorders in the future.

MG: Is there actually a lot of research being done on that?

MARK HADEN: Yes, yeah, this explosion of research, in fact, I have a PowerPoint side that shows all of the different university logos that are producing papers on psychedelic research. And my PowerPoint slide is now absolutely jam packed. It's full.

MG: Part of this and this comes up in conversations that I've had with politicians around the idea of decriminalization, part of this is about trying to gauge the mood of the public. Do you think that most Canadians would support legalization? Legalizing marijuana is one thing, other drugs, perhaps there's a stigma that still exists around them and so do you think the majority of Canadians would support further legalization, further decriminalization?

MARK HADEN: Well, I found it absolutely fascinating and most recent provincial election in British Columbia and we had our, John Horgan went up in popularity after he spoke very publicly about the importance of decriminalizing all drugs. So I think what politicians are learning from these kind of experience is that it is not political suicide to actually just talk about the evidence, because really the evidence is huge. It's it's a mountain of evidence that's compelling and really not controversial for those involved with the field.

MG: But most people aren't involved with the field. So in Oregon, you saw that 41 percent of people voted against this. I just wonder whether I mean, for people who are already on side, that's one thing, but is it likely that you'll get others onside?

MARK HADEN: I think it's a slow process. I think it's a slow and linear process. The reason why cannabis got legalized in Canada is Justin Trudeau at the polls, and it was 56 percent of Canadians that wanted cannabis to be legalised. And so what we see slowly is political will will change when the polls change and they are slowly changing with exactly these kind of discussions where we just reflect on the evidence.

MG: Mark Haden, it's great to speak with you about this. Thank you.

MARK HADEN: Thank you, Matt.

MG: Mark Haden, adjunct professor at the University of British Columbia's School of Population and Public Health. He also works with the BC Centre on Substance Use to Research Psychedelic Interventions. That is The Current for today. Coming up on CBC Radio One, it's Q. Tom Power speaking with Cat Stevens, now known as Yusuf. Tea for the Tillerman, legendary album put out by Cat Stevens. There's now Tea for the Tillerman 2, a re-recording of the original hit album 50 years later. It's kind of like into the time machine and back all in one album. And you'll hear about that coming up on CBC Radio One. Then later on CBC Radio, CBC television and online, coverage of Remembrance Day ceremonies happening across this country. Of course, they're different given the pandemic, but many of the ceremonies happening virtually, other ones with some invited guests and you'll hear about that coming up. I'll be joined by Nil Koksal. We'll host our coverage on CBC Radio One beginning at 10:55 a.m. wherever you are in this country, except in Atlantic Canada, where it will be at 11:55 a.m., 12:25 in Newfoundland and Labrador. We'll leave you with music by the English composer George Butterworth. He wrote The Banks of Green Willow in 1913 when the First World War began. He enlisted in that war. And on the 5th of August 1916, George Butterworth was killed during the Battle of the Somme. This is The Banks of Green Willow, performed here by Sir Neville Marriner and the Academy of St. Martin-in-the-fields. I'm Matt Galloway. Thanks for listening to The Current and we'll talk to you later.

[Music: "The Banks of Green Willow" performed by Sir Neville Marriner and the Academy of St. Martin-in-the-Fields]

Nov. 11, 2020 episode transcript

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