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The Current Transcript for May 29, 2017

Host: Anna Maria Tremonti

STORIES FROM THIS EPISODE

Listen to the full episode

Prologue

[Music: Theme]

SOUNDCLIP

What can I do for you? Well I hurt my back today really bad. What’s wrong with your back? It hurts. My professional diagnosis is, your back hurts.

ANNA MARIA TREMONTI: To those with chronic back pain who can't get answers, let alone a cure. That little comedy sketch from Louis C.K. may just hit too close to the spine. But that may be because everyone from the back pain sufferers to doctors and chiropractors, may be getting some of the basics wrong. Today we'll hear from a journalist who has spent years researching back pain and the industry that has sprung up around it. And from a man she calls back whisperer who explains why conventional back pain treatments have such low success rates. Hear them both, in half an hour. Also today.

SOUNDCLIP

When the Arab Spring started I was incredibly excited about it. Nothing had happened there politically in decades.

AMT: Journalist Scott Anderson has spent a career covering the Middle East and as he witnessed the Arab Spring unfolding he saw great hopes for change, that changed again and were often quashed. He has documented the experiences of six people across the region. In an hour, Scott Anderson with the stories of those whose destinies were shaped by life, in what he calls fractured lands. And we needn’t only look back at the Arab Spring because its consequences are right in front of us and the political ideas on how to confront the biggest fallout, the flight of so many desperate people are just as fractured.

SOUNDCLIP

Any responsible approach to refugees is one that seeks the eventual return of refugees to their home countries so that they can help to rebuild their own nations.

AMT: I'm Anna Maria Tremonti. This is the current.

Back To Top »

G7 leaders failing migrants and EU nations, says MSF rescuer

Guests: Marcela Kreey, Federico Soda

SOUNDCLIP

The U.N. that does not think of going to Nigeria to see by their self. No, they think we, the refugee, we are lying. They need to go to Nigeria and see what is going on in Nigeria. Nobody wants to go back to the country again. Because if you go back to the country you don’t know what may happen tomorrow. It’s a very big problem.

SOUNDCLIP

I just want them to give me a work, so that I can work if I’m good. If they can let me to go to school, so I can finish my education. What do you want to be? I want to be a nurse.

SOUNDCLIP

We need freedom, we need documents, to stay in this country, to work good job, to live a very good life. How long have you been here?

Two months now.

Me, I'm six months here now, six months.

Four months.

Six months, I did not do anything, I did not kill anybody, I'm not on the road walk. It just brought me here without doing anything.

We need freedom.

AMT: Three women from Nigeria speaking to the CBC's Megan Williams at the Ponte Galeria Identification and Expulsion Migrant's Center outside of Rome. Italy is one of the countries at the center of the world's migration crisis. But Italian leaders who were hoping for international agreement on the problem were left wanting after the G7 summit wrapped up this weekend. Despite the setting which is a town in Sicily that's become the latest hub for asylum seekers who've made the harrowing trip across the Mediterranean. U.S. President Donald Trump made it clear his administration was not interested in focusing on the issue. Italy is seeing more people trying to reach its shores, especially from the shores of Libya. The International Organization for Migration says more than 400 people died making the crossing this month. And last week alone, an estimated 6000 people were rescued after being stranded in the ocean. Marcela Kreey was on the water during that series of rescues last week. She's the coordinator on the Medecins Sans Frontieres rescue boat, the Aquarius. And we've reached her in Catania, Sicily. Hello.

MARCELA KREEY: Hello Anna Maria. How are you today?

AMT: Well I'm well, and I'm wondering if you can tell us what you saw just in the last few days. Your team helped rescue more than a thousand people on the waters, I understand.

MARCELA KREEY: That is correct. We were out earlier this week and at one point found ourselves surrounded by multiple rubber and wooden boats in distress. You can imagine it's quite a crazy situation where our boat is there and there are many boats around that are completely unseaworthy and very, very full with something like 120 or 140 people on board of each of those rubber [unintelligible].

AMT: And so when they saw your ship what was the look on their faces like:

MARCELA KREEY: So when we up here on the scene with our small rescue boats to approach the people in distress, in the river boats, often they're quite relieved to see us, obviously. And then a big part of our job is to make sure that people stay safe and stay calm. Because in that kind of situation which is very precarious. If there's any unrest the boats can turn over and it's actually really a question of life and death in that particular moment.

AMT: And how many people would have been on each of those little boats, Marcella, how crowded are they?

MARCELA KREEY: What you can see is a rubber boat that's actually suited for maybe 15, 20 people and they could easily have 100 to 130 people inside. So they're really, really jam-jam packed. And we actually see people sometimes that get crushed inside the boat and sustain injuries that way.

AMT: Well, there were reports that the Libyan coast guard was shooting at some of the boats. Can you tell us anything about that?

MARCELA KREEY: This is quite an unusual and scary situation. We had approached one of the rubber boats handed out life jackets and taken some of the people off. At that moment, there was another boat that was in a more precarious situation and needed our immediate assistance. So we went there. In the meantime, a larger vessel from the Libyan coast guard appeared on the scene and two men from that Libyan coast guard vessel boarded the rubber boat, they were wearing military uniforms and one of them was carrying a Kalashnikov. This is what we observed from our shift. After that, we had reports from people that were on that rubber boat that said that these two men went to intimidate them and take any valuables money and any other valuables people had on them from them. We did see at one point that one of the men raised his Kalashnikov and started shooting in the air. At which point they started the engine and started driving the boat back towards Libya. After that many of the people started jumping off the rubber boat and one of the survivors that we spoke to later actually told us that he'd rather die at sea than go back to Libya, which is a testament to the desperation that people feel, that step into these overcrowded rubber boats and risk their lives to get out of Libya.

AMT: Well, and it also raises the question of the conditions of the migrant camps in Libya. The U.N. and NGOs like yours have raised serious concerns about those conditions. And often I guess the migrants are intercepted and they're sent right back.

MARCELA KREEY: This is what we hear from people that have tried multiple times to get out of Libya via the Mediterranean Sea. We often speak to people that said this is their second or third time they try to get out. And every time when they're taken back they end up in arbitrary detention again in some form of captivity and for many of them the only way out is either to do forced labor, and they're actually you know sent to farms to work. For women, prostitution is often their only way out or by paying a large sum of money.

AMT: So some of the people who you end up rescuing have been spending months just trying to get to those boats, then once they get to Libya.

MARCELA KREEY: Correct. So basically, what we see on board are people that have often been traveling for a long, long time, months, if not years, from their home countries where they're fleeing violence or fleeing war they're fleeing abject poverty and they find themselves trapped in Libya. And the stories that come from that place are horrific. And it it's very clear that for many people it's very difficult to get out. And their only option their very only, only option, is to step onto an overcrowded dangerous rubber boat. Many of the people cannot swim. And again this shows how desperate they are to get out of that place and just find another future and a safety for themselves in Europe.

AMT: Well, we know there's been a 40 percent increase in the number of migrants trying to make that crossing from Libya to Italy. Why is that?

MARCELA KREEY: It's hard to say exactly and by the numbers are increasing, except for to say that there are many couples in Africa but also in other places. We see people coming from places like Bangladesh and even Syria that make the journey through Libya. Because I guess there are no other options for people to find a safe place. And this is the only option they see to escape from the untenable situation that they're in. And all those people want is safety and a place where they can provide for themselves, for their families and to contribute to the community. And you know, this is the only way they can go. Unfortunately, you know, in the past there was a possibility for people to take more legal and safer ways to travel, by taking the airplane. These have all been cut off in recent years. And these voyages that people are taking now are often the only option they have.

AMT: We know that many of those who died making the crossing last week were toddlers. We're also hearing about a dramatic increase in unaccompanied minors on these boats. Why are so many children making the crossing alone? Do you know?

MARCELA KREEY: I'm not sure why it’s many young people unaccompanied. It is true that we're seeing a lot of 16, 17 year olds going on their own. I just can't imagine. And we also see very small children often with their mothers coming. And I can only imagine that for parents to make this kind of decision, it's really a testament to how bad the situation is where they are currently, that they have no hope for the future and their only option they have is to find a better life elsewhere.

AMT: And what kind of support do they get from Italian officials when they get to Italy?

MARCELA KREEY: What we can see in the reception centers in Italy is that they're completely overwhelmed. And this is where I think it's also a question of the European Union and also the G7 leaders, failing not only the people that are fleeing violence and distress but also countries like Italy and Greece, who are then left to deal with the situation pretty much on their own. And this is where we would really like to call on the G7 leaders on political leaders in Europe to try to come to the assistance of Italy and Greece and other countries that are receiving the majority of these people in distress.

AMT: Marcela Kreey, thank you for your insights.

MARCELA KREEY: You're very welcome Anna Maria.

Marcela Kreey, the coordinator for the Aquarius which is a rescue boat operated by Medecins sans Frontiere. We reached her in Catania, Sicily. With a lack of a substantive policy from the G7 summit on the migration crisis is troubling for many who rescue those risking their lives in the Mediterranean Sea. Federico soda is a Canadian. He is the director of the coordination office for the Mediterranean at the International Organization for Migration or the IOM. The IOM is a UN agency that provides services to governments and migrants around the world. Federico soda is near Sienna Italy today.

FEDERICO SODA: Hello and good morning and good morning to your listeners.

AMT: The Italian prime minister had hoped to make the Mediterranean migration crisis central to the G-7 talks that ended on the weekend. Well what do you make of the way the G7 leaders dealt with this issue?

FEDERICO SODA: Well, I think they really shied away from it. And I think there was a real, even though it's very small, and by and large very like minded group, there was a very clear fragmentation in relation to the Italian hope that they could discuss some more long term sustainable solutions in relation to migration issues and refugee issues.

AMT: Well, what's to blame for the lack of consensus within the G7, then?

FEDERICO SODA: Well, I think that we're seeing clearly clearly some of the consequences of the change in line that's been taken in the United States. We've been seeing this already for the last several months on other immigration and refugee related issues. I think also with the U.K. it's it's a very, very toxic political issue. I mean in the current political context I can't say that it was a shock. I think it is concerning that even just seven countries, seven industrialized countries that have shared common values and broad principles for decades and really between one another don't have thorny immigration related issues. It's concerning that even they can't find enough common ground.

AMT: Well give us an idea of how urgent the situation is right now? Your office tracks the level of migration flows in the region.

FEDERICO SODA: I mean we have to keep it into perspective. The numbers are very manageable, even in 2015 when over a million migrants and refugees reached Europe. We're still talking about 0.2 percent of the European population. And this, you know last year we were far lower than that closer to just over 200000. And this year you know we'll be probably around that number again. So it is something that can be better managed. But I think by and large, the absence of both migration and asylum policies, Europe wide, make it very, very difficult. And now in the last couple of years with how politically charged the issue has become, it's virtually impossible to find even a small group of like minded countries even within Europe. So, we have this we have fragmentation among the G-7. But we have some very, very difficult issues within the 28 EU member states as well.

AMT: How many have arrived then? What are the numbers?

FEDERICO SODA: Well, as of last week we had 60000, this weekend almost 10000 arrived, so we're close to 70000 this year already. Which is substantially higher than last year this time because of a dramatic increase through the central Mediterranean.

AMT: And why are they risking their lives with such a treacherous crossing?

FEDERICO SODA: Look, I think a lot of what's happening now is that the nationalities and the profiles that we're seeing which is primarily West African males of working age. I think they're moving across West Africa and into North Africa and Libya looking for employment and work opportunities. For many, many years when it was stable, Libya was a major labor market for migrant workers and there is still a culture of going there to work. What's happening now of course is with the very dangerous and unstable situation in northern Libya, these migrants get stuck there. And effectively have three choices, to go back which is expensive, dangerous, and effectively a total failure in terms of returning home empty handed. To stay and succumb to the violence and the abuse which we know is quite systemic and extensive, or to basically try and move on by moving across the Mediterranean. These aren't necessarily people that left home with the intention to reach Europe and I think this is also an important point in and maybe, often a myth that everybody is trying to get to Europe. I don't think that's necessarily what we are observing in Libya.

AMT: OK. So your point is they were there were actually economic migrants looking for work in North Africa and because of the situation in Libya they end up in the boats. So, what's the solution there?

FEDERICO SODA: Well, the solution is what Italy was trying to advance indeed at the G7. What a number of actors in this area are saying governmental and nongovernmental which is to open up safe legal channels, so that those entitled to international protection can access that protection without resorting to smugglers and traffickers. And then also start looking at other legal channels for work and employment. But really, we need more safe legal routes. What we're observing now is migration managed by traffickers and smugglers. That is extremely dangerous and costly both economically and in terms of human lives.

AMT: Well, whether it is at the G7 or on the streets of Rome, there appears that this heavy migrant flow into Italy is causing political tension. We've got some clips of Italians who are frustrated more isn't being done to address the crisis. Listen to this.

SOUNDCLIP

I think the whole problem has been dumped on Italy. All these migrants are arriving here and now with the borders closed in Europe. They're stuck here. And from what I understand most of them don't even want to stay in Italy.

SOUNDCLIP

No, Europe is not helping Italy enough in the proper way. It's impossible to do this without a plan. We need a plan. Italy needs a plan. Europe needs a plan and nobody's doing anything to do a plan together. Otherwise, these problems will never be resolved.

AMT: Federico Soda, what's the consequence then, of the G7’s lack of action in addressing this issue?

FEDERICO SODA: I mean in relation to those clips we're talking primarily about a European problem, I think obviously what the G7 could do is show leadership. And these countries, by coming together could really make a difference in a lot of people's lives and improve the situation. It is a combination of instruments that need to be put in place and working and playing in concert together, to recognize those that are entitled to protection, and grab that protection. To recognize that an aging population like that of Europe, is going to need youthful migrants that can contribute to the labor market. And also, recognizing as well, though, that not everybody can stay. And therefore we must do more in those countries of origin to improve the situations there to reduce the pressures on people moving out.

AMT: OK we're going to have to leave it there. Federico Sods, thank you for your time today.

FEDERICO SODA: Thank you.

AMT: Federico Soda, The Director of the Coordination Office for the Mediterranean at the IOM, the International Organization for Migration. We reached him in around Sienna Italy. Let us know what you think of what he had to say. He's saying that not everyone fleeing North Africa had plans to head to Europe. What to do about them when they appear on the shores. Let us know, you can tweet us at the current at cbc.ca/current. And stay with us the CBC News is next and then.

SOUNDCLIP

The pain around my back was raised eating was it was like it was humming and it felt like somebody was following me with the kettle boiling water and just kept pouring it on all the time.

AMT: We'll hear from a Canadian who lives with excruciating chronic pain. An investigative journalist who says we're treating back pain all wrong. And we'll meet a Canadian she calls a back whisperer. I'm Anna Maria Tremonti. This is the current on CBC Radio One Sirius XM Online on cbc.ca/thecurrent and on your radio app.

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2

Chronic back pain? Journalist investigates what works and what doesn't

Guests: Cathryn Jakobson Ramin, Stuart McGill

AMT: Hello. I'm Anna Maria Tremonti and you're listening to the current.

[Music: Theme]

AMT: Still to come, a veteran war correspondent shares his thoughts on why the Arab Spring failed and the future of the Arab world. But first, why it might be time to rethink back pain?

SOUNDCLIP

It was something I've never experienced before. It was simultaneously like an electric shock. Going down to my foot. The pain around my back was like it was like radiating, was almost like it was humming. And rather than shooting pain I have a burning pain on the top of my foot and up to half of my calfs. And it felt like somebody was following me with a kettle of boiling water and just kept pouring it on it all the time.

AMT: That's what back pain feels like for Richard Hovey. After a fall from his bike the Montrealer thought he was fine. That is until he woke up in excruciating lower back pain one night. It didn't go away at least not for good. Richard Hovey spent the next three years dealing with chronic pain and it took a serious toll on his life.

SOUNDCLIP

The emotional cost is that everything that you thought was going to happen in your life, everything that you believed could happen in your life, all of a sudden he has to be rewritten. But first of all, it's like a chalkboard. It’s all wiped off. You know, you're starting from scratch again, and that's the part that I think is most devastating . You know, when one week you're going out and meeting friends you're going to meetings you're doing you know, recreational activities, you know, you move freely you don't even think about stuff . And suddenly you have to weigh out every single thing you do. People don't understand that it is that precarious to have chronic pain.

AMT: Four out of five adults Canadians will experience at least one episode of lower back pain. In most of those cases, no specific cause of the pain is identified. But people try a range of treatments to get relief and they have varying degrees of success. My next guest understands this pain but thinks we can do better. Cathryn Jakobson Ramin is an investigative journalist who also suffered from lower back pain for years. She is the author of Crooked: Outwitting the Back pain Industry and Getting on the Road to Recovery. Cathryn Jakobson Ramin joins us from San Francisco. Hello.

CATHRYN JAKOBSON RAMIN: Hello it's so nice to be with you.

AMT: When did your back pain start?

CATHRYN JAKOBSON RAMIN: Oh a long time ago. I was about 16 years old and I was a tall skinny gal and I rode horses. And one day I took a flying fall off of one of them onto my hip and from then on, there were problems.

AMT: So, initially, what did you do to treat it?

CATHRYN JAKOBSON RAMIN: When I was 16 I was immortal so I did nothing. Now eventually, I attempted all kinds of interventions that most people with back pain try. I did various types of exercises I saw chiropractors, I did yoga, I did Pilates, I tried physical therapy several times and I was getting nowhere. And this went on for years and years, mind you.

AMR: What causes lower back pain?

CATHRYN JAKOBSON RAMIN: You know, there are a myriad of causes. But the mistake that people make is that they get really focused on what I like to call the inciting incident. And this is encouraged by physicians and chiropractors and PTs. Where a patient comes in and says: You know, I leaned over to flush the toilet and that's when it happened, or I picked up the newspaper off the floor. Well, we know very well that that's not when it happened because I mean you've been unloading the dishwasher daily for decades, right. It wasn't that. Or what it generally is, that this is kind of the straw that breaks the camel's back. Because muscles have become weak and deconditioned and they can't offer the kind of support you need. So you make a move, and it can be a very simple ordinary move and your brain gets a message that your spine is in danger. And whenever your brain gets that message it panics. It throws a fit and spasms, back spasms are the result of that. Whether merited or not merited. And they're very rarely merited. But the brain does not know that.

AMT: You write that back pain is as much an emotional problem as it is a physiological problem.

CATHRYN JAKOBSON RAMIN: Yes. You just had that gentleman on and he was talking about how everything has to be rewritten and you're starting from scratch. And people feel extremely lonely and frustrated and angry. Isolation is a major factor in making things worse because when you can no longer you no longer feel like it's safe to go out you know you start to really sit there and obsess about your pain and your situation. But what often goes unsaid and is really so important is that in nearly every case it is perfectly safe and advisable for them to continue to live the lives they were living. And that is in fact how they will get better.

AMT: Before you go too far, let's explore a few more things. There are a few conventional treatments for back pain. When someone experiences low back pain what steps do they usually take?

CATHRYN JAKOBSON RAMIN: Usually, someone is feeling kind of bad for two three days cause calls the primary care doctor says Doc I got to come in I got to talk to you about this. Or alternatively, particularly I know that you do have a fair number of chiropractors in Canada and sometimes some time is spent there. Usually the next step is well doc it's not going away. I need an MRI now. Most primary care doctors now will discourage that but they're rarely successful. And once that that imaging is done a whole series of events tend to follow such as, injections spinal injections and very often a referral to a surgeon.

AMT: I want to get back to the issue of chiropractors. You write that chiropractors will often tell people they need to be treated for vertebral subluxation. What is that?

CATHRYN JAKOBSON RAMIN: That is true. Traditional chiropractors, what they do is they quote unquote ,a just subluxations. Now the problem with that, is that no one has ever been able to track down a subluxation on an x-ray or in any other way. I do want to point out that I'm talking about traditional chiropractic which is adjustment based. You get on the table the chiropractor leans over you and cracks your back, or worse, your neck. But chiropractors have come to realize over the past decade that the basis for these procedures is more or less non-existent. And many of them have turned to rehab and exercise for their patients. And those Chiropractors can be very valuable adjuncts but if anyone wants to adjust anything, it’s time to really look at that very critically.

AMT: Chiropractors defend their practice. I have a clip for you to listen to this is Gregory Stewart who is a chiropractor in Winnipeg, and the past president of the World Federation of chiropractic. Listen to what he says.

SOUNDCLIP

In the last five years there has been over 3000 papers on chronic back pain. And in that time frame there's been substantial evidence that demonstrate the benefits of chiropractic care and management with chronic pain. As a matter of fact for the last several years pretty much every clinical practice guideline that has come across my desk has recommended manual care and spinal manipulation for the management of chronic pain. I must say your patients don't end up on [unintelligible] for the most part. I think you'll find a chiropractor patients are very satisfied with care and once you get their condition stabilized they can return to an active and productive life.

AMT: OK. Cathryn Jakobson Ramin, a lot of people say they get relief from going to the chiropractor on a regular basis. Why is that the case if the evidence says it doesn't work?

CATHRYN JAKOBSON RAMIN: Why do they get relief? OK. Well, there's such a thing in the human body. They are called endorphins and they make you feel good. Any time anyone lays hands on you. Endorphins are stimulated and you feel better. Most people that I've ever met who are who really worship chiropractic tell me that they feel good for a little while and sometimes only as long as it takes to get in the car and drive home. And then they really look forward to their next visit to the chiropractor where those same endorphins are going to be stimulated.

AMT: You had surgery. Tell us what happened with surgery?

CATHRYN JAKOBSON RAMIN: I was looking around. I thought well I've tried everything else I've just as so many back pain patients do people have had pain for a long time. I've tried everything else and now I really have to get serious. And the way you get serious is you go see a surgeon. And so I had my MRI. It scared me half to death. The discussion I had with my primary care doctor was not very helpful. He said well we see here from the report from the radiologist that you have degenerative disc disease that's a scary sounding thing. And he said So what do you want to do? Do you want to see the pain management folk? And I'm like no I write for a living I need my brain. And he said all right so, you know, go see the surgical group. A person in pain does not have good judgment. That is the major problem. A person in pain would hop on a gurney in Times Square if they thought it was going to do them some good. And I proceeded to fly quite a distance across the country and to sign myself up for what turned out to be an actually a very minor procedure, thank heavens. It was not successful in the long term. I felt very good for about a week after as I swallowed my painkillers on a regular basis as prescribed. When those ran out I got a good look at what the situation actually was, and I realized that I had probably just wasted an awful lot of money.

AMT: What does the evidence show for surgery as a fix for back pain?

CATHRYN JAKOBSON RAMIN: Well, it depends on what the problem is. Not surprisingly, there's very little evidence that shows that surgical procedures are more successful than intensive rehabilitation. When you get your MRI back and you have your report of herniated discs and degenerative disc disease and flat discs and black discs of course you're going to be upset and panic about it. If you have surgery you will go through months of rehab. You might as well skip the surgery and go straight to the rehab because you will end up in the same place, as multiple studies have shown.

AMT: We really can't talk about pain without talking about opioids how to back pain and the opioid epidemic intersect? Well they are so closely tied together. Basically, there was a movement in the 1990s and early 2000s to make pain. One of the vital signs the drug companies had a great deal to do with making that a mandate. So many many many back pain patients had regular prescriptions for opioid treatment. Because of the nature of those drugs, dependence occurs typically and dosages have to be raised, and patients found themselves on towering doses of opioids, and opioids have many many side effects. Some of which are considerably worse than the back pain that started with.

AMT: So there are many treatments that you describe, that you say through your research have only marginal benefits or none at all and sometimes risk harm or death. Why do people keep getting those treatments?

CATHRYN JAKOBSON RAMIN: When you're in pain you're in no position to ask a lot of questions. And most people who are in chronic pain are having problems. They often are unable to work. They have issues at home. I mean imagine if your spouse was unable to do any of the work around the house for months or years on end. How is that going to do to a marriage and how does that affect children et cetera. So, they're desperate. And I've had so many physicians come in and say you know I tell patients that surgery is not for them and you know that I can't help them. And their response is always well, Doctor, what am I to do? And people are looking for somebody to solve their problems someone who can fix them. You cannot expect to get on a table any kind of table and have the problem resolved by someone else. It is going to take hard work on your part and what you do need is a cheerleader and I refer to those people as back whisperers.

AMT: And so what does the back Whisperer?

CATHRYN JAKOBSON RAMIN: A back Whisperer is a person who really understands how chronic low back pain works. And really gets the fact that hurt does not mean harm. I think if there's a message I'd like to convey it's that for the gross majority of patients hurt does not mean harm. And when you stop moving when you take to the sofa when you let your muscles become deconditioned when you gain 40 pounds when you become addicted to opioids these are this is this path is going in the wrong direction. And there's still far too many doctors too many primary care doctors out there who say OK, you know, take it easy, rest. You know, don't do anything don't lift anything. Don't live your life. A patients get in a lot of trouble that way actually.

AMT: Well talk to us a little bit more about that, what are you saying, what does work to treat back pain?

CATHRYN JAKOBSON RAMIN: In the book I interview a number of psychologists who talk in detail about this cognitive shift that we have to go through so that we understand that yes when you start exercising there will be pain. There definitely will be because you are just as out of shape as all get out. But in the right hands in the hands of a back Whisperer you can get through that and you can get strong and you can get your back muscles and the rest of your body balanced and you can straighten out your gait and you can straighten out your posture. And these are all the kinds of interventions I discuss.

AMT: What do you say to people who feel hopeless about their back pain?

CATHRYN JAKOBSON RAMIN: Well I was one of those people. So I completely understand. I remember driving over the Golden Gate Bridge as I did this morning on my way to do this interview and thinking this is never going away. And the life I live with, at that time two teenagers, and a very very busy career. It's just not compatible. I'm not I'm not going to be able to live my life. And I found that terribly terribly depressing. But what I learned in the course of writing this is you are going to have to make a cognitive switch and yes you are going to be able to live your life.

AMT: Catherine, we have to leave it there but thank you very much.

CATHRYN JAKOBSON RAMIN: You are most welcome. I was delighted to get to talk to you about Crooked.

AMT: Cathryn Jacobson Ramin is the author of Crooked: Outwitting the Back

AMT: I've got a few more questions, then. So, you invest all this time in each patient which sounds expensive, but essentially one of the arguments, is we end up paying more in terms of medical bills because other people don't spend as much time with patients at the beginning.

STUART MCGILL: I give a lot of lectures to different medical societies and I'm asked to come and teach docs and hospitals Excedrin, and some of the doctors will say you know we can't afford to treat patients like this. And I say you cannot not afford to do it.

AMT: So, you diagnose the source of the back pain and you start to treat it and you start to look at specific exercises. Help me understand how exercises are so crucial to dealing with someone's back pain?

STUART MCGILL: Let's take a journalist who sits for six or eight hours doing their job at the computer when they stand up because of the time spent sitting. Generally speaking the hip flexor muscles the muscles in the front of the hips get tight and the gluteal muscles the muscles in the back of their hip joints get inhibited. And this is a pattern that we measure so an exercise program for them would be one that releases, particularly, a muscle called the slowest muscle in the front of the hip and it teaches the brain once again how to re-engage that gluteal muscles. Now failure to recognize that pattern means that when they bend over they now are over using their back muscles when they should have been using their hip muscles. We get another person who they will turn a certain way and they get a catch in their back that's caused by a little micro movement at the joint and it's usually the mechanism underlying mechanism is they will have a little bit of a flattened disk. So it's like letting a little air out of one of your car tires that tires a bit sloppy on the road. That disk is creating a little bit of a sloppy joint. We then would teach through exercise stabilization exercises. Which act as a girl and a guy wire system around the spine. The abdominal muscles in the front and their back muscles in the back. And so there's two different examples based on two different mechanisms of pain how we would precisely tune the exercises to address the cause.

AMT: What kind of success rate you have?

STUART MCGILL: We follow up with every single back pain patient we've seen at the university. These are people who've exhausted physical therapy chiropractic. They've been told the only last remaining intervention they should consider a surgery. We get 95 percent of those people to avoid surgery.

AMT: Stuart McGill, we have to leave it there but thank you for sharing all of your ideas with us today.

STUART MCGILL: My pleasure.

AMT: Stuart McGill professor of spine biomechanics at the University of Waterloo the author of Back Mechanic: the step by Step McGill Method to Fix Back Pain. If you want to hear more from him on the specific exercises he recommends for your back you can go to our Web site cbc.ca/thecurrent. We have posted his instructions on how to do the McGill big three, three exercises he and his team have developed over a decade. Let us know if you have chronic back pain. What you have tried to find relief what has worked for you. Tweet us at the current CBC post on this story on our Facebook page. You can even e-mail us by clicking on contact cbc.ca/the current.

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AMT: In our next half hour a veteran war correspondent Scott Anderson someone whose byline I always search for, as a go to person on what's going on in the Middle East. He brings us the stories of individuals who have lived through the hopes and disappointments of the revolutions of the Arab Spring. Scott Anderson next I'm Anna Maria Tremonti. This is the current.

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War correspondent Scott Anderson explores why Arab Spring failed in new book

Guest: Scott Anderson

ATM: Hello. I'm Anna Maria Tremonti and you're listening to the current.

SOUNDCLIP

President Hosny Mubarak is stepping down. He is stepping down ,and leaving the presidency. This culmination now of weeks of public protest. Can you hear this?

The cars honking, this is an entire city’s revolution.

Vice president Omar Soliman just confirmed Hosny Mubarak’s 30 year rule has ended tonight.

[Sound: Men shouting]

This video just released.

There he is. Crowds surrounding him the last bloody moments of his life show him wounded and begging for mercy.

[Sound: Men Shouting]

He struggles, stumbles and shouts as he fights against the enraged rebels ‘haram aleco’ he says over and over. An Arabic expression that literally means this is a sin for you. Muammar Gaddafi who showed no mercy in his own life begs for mercy as his is coming to an end.

AMT: Well, the sounds of an historical lynching in Misrata Libya, and before that the sounds of jubilation in the streets of Cairo. Two unforgettable moments from 2011, when Arab countries rose against the strong men who led them. and the possibility of freedom seemed real. Six years later that spring has turned into a cold dark reality with a military dictatorship in Egypt, chaos in Libya and a bloody civil war in Syria. Scott Anderson knows the Arab world well he is a veteran war correspondent and contributing writer to The New York Times Magazine. He has a new book out it's called Fractured Lands: How the Arab World Came Apart? And I spoke to him when he was in Toronto just a note, we recorded our conversation just before the Manchester Arena bombing. I'm really glad to have you in here to talk about this and to connect all the dots. You had met Muammar Gaddafi. When you hear that scene, of him being killed and the descriptions what do you think.

SCOTT ANDERSON: I always remember something he said to me. I interviewed him in the fall of 2002 right before the American invasion of Iraq, a few months before. And I had about two hours with him in Tripoli in this outdoor setting by this Bedouin tent, the conceit was that he lived in. And I remember the last question to him was this is kind of a throwaway question of I said how would you like to be remembered. And he started out with his very platitudinous answer of saying: well, I would hope to be remembered as someone who gave of himself. You know, who have always thought of his people first and kind of continue in this vein for a while. And then he kind of stopped and he chuckled and he said: I would actually hope that some of this is actually true, And it was this absolute cynical response, and this absolute assuredness he felt that the people of Libya were sheep and would never rise up against him. And of course it didn't happen that way.

AMT: You spent a lot of time in the Middle East before the Arab spring what did you think when it broke out?

SCOTT ANDERSON: I was initially like a lot of people, incredibly optimistic. I started going to the Middle East in the mid 1980s and what I had always been struck by especially in the Arab world, was this utter fossilisation, politically, of the entire region. Nothing had happened there politically in decades. And yet, you had these autocrats in Gaddafi in Libya, or Saddam Hussein who had been around for decades and seemed really immovable. So when the Arab Spring started I was incredibly excited about it. Right off the bat, I knew that Syria was going to be bad. I was very surprised when the revolutions went to Syria.

I knew the Assad regime would fight to the death and it would be very very bloody. Egypt happened, with kind of a minimum of bloodshed, when you think of a country of 90 million people. But I knew Syria was going to be really bad.

AMT: Well let's talk about more of this. How far back do you trace the origins of the Arab Spring?

SCOTT ANDERSON: Kind of a two part answer. To look at the composition of the Middle East and the Arab world, you really have to look at the peace that was imposed on the region and the borders were imposed on the region at the end of World War One, by the French and British Empire. They carved the region up between themselves and the colonial spheres of influence. And it's not coincidence that if you look at the countries today that have so disintegrated, as to call into question whether they'll ever be put back together, and that's Iraq, Syria, and Libya. These were all artificial creations by the colonial powers. Libya was joined together was three Ottoman provinces, the same with Iraq. Iraq never existed before the British created it. And in the case of Syria, greater Syria was divided into four countries; Syria Lebanon, Jordan, and Israel/Palestine. So you really trace the historical roots to .. What really catalyzed Arab Springs was the American invasion of Iraq in 2003.The same way that Saddam Hussein had been in power forever and he was seen as this kind of immovable force. So when he's toppled clearly Americans had no plan of what was going to take place. And what it did in the region was it just scrambled the chessboard and it had this long term effect of just catalyzing events throughout the region.

AMT: You make the point that some of these countries that were held by dictators were literally bound with the glue of those dictators. And so when the dictators are toppled or they are somehow immobilized. All of that starts to fall apart.

SCOTT ANDERSON: That's right. People revert to, in most cases, what has always been their primary allegiance which is the tribe or the clan. So, when that when the strongman goes or is threatened as Bashar Al-Assad in Syria as people revert back to family, back to clan. And you've seen that happen in Iraq, Syria and Libya.

AMT: And I want to ask you about ISIS later but it's worth mentioning because you talk about them. The peace deal that was made after the first world war, and that creation of Iraq and Syria and Libya. When ISIS moves into Syria they actually have a bulldozer and there's a little sign that says: The End of Sykes-Picot.

SCOTT ANDERSON: That's right.

AMT: They're actually saying we're getting rid of the border that you created.

SCOTT ANDERSON: That's right. Oddly enough, that is, I think, the one thing that ISIS did, almost everybody Sunni and Shia in the Arab world kind of applauded. Because I think they've always felt that you know, this was at the root of so many of the problems in the region. I was really struck. I had been in Jordan, which of course, you know, the most politically progressive country in the region. And I had traveled around for about four or five days with this man who was college educated, very modern and he loved King Abdullah. Whenever Abdullah would come up, his eyes would light u. I said: What is this with you and Abdullah? And he said he's made Jordan the most western of any country. You know, he's brought us into the 21st century. And then one night we were talking about tribes, and again this is Jordan which is a very you know modern country, and he got kind of sheepish he said: You know I'm not at all proud to say this, but if it ever came to a conflict between my family, meaning my tribe and the king, King Abdullah, the man he adored, of course I would choose my family and I it occurred to me that it's like, wow if this is true in Jordan if that tribal allegiance, that clan allegiance is just so beneath the surface here, you know what is it like in other places.

ATM: That's a really good point because you make the point that Syria, Egypt, Libya, Tunisia were republics. And kingdoms such as Jordan Saudi Arabia Kuwait they didn't have an Arab Spring.

SCOTT ANDERSON: That's right. In some of them use little seeds of it.

AMT: Kuwait tried at one point.

SCOTT ANDERSON: That's right. Yeah, but very very limited. Yes. The countries that were the most affected were invariably republics. And my theory on it is, what is a king after all what is a monarchy? It is a tribal compact that the tribes have decided to recognize this ruler and give him legitimacy through time, through centuries. And I think that that provided a glue to the monarchies. Some of the monarchies in The Middle East, in the Arab World are just as venal and repressive as the Republic. So, there's not a liberalization there. But I think that's what it comes down to, the kind of tribal compact that was made in those countries.

AMT: And the identity.

SCOTT ANDERSON: And the identity.

AMT: And so again, the military campaign of the U.S. invasion of Iraq played a role in like, we're watching the dominoes fall?

SCOTT ANDERSON: Right. Yes. I mean clearly Americans had no idea of what they were going to replace Saddam Hussein with, and Saddam Hussein had this, as brutal and [unintelligible] he was. He had this very elaborate system throughout Iraq of making alliances with tribes, with clans. So, if you know a certain large tribe would be given control of say the Ministry of Interior that would that was their fiefdom, and somebody else had Ministry of Transportation. And it was this very complicated tapestry of alliances, you're either on the in or the out. And with the Americans came in to topple Saddam Hussein then you [unintelligible] the country, you kick out everybody who has a stake in the status quo, and the existing government under Saddam Hussein. And there's nothing left to replace it. So very very quickly people reverted back to their tribal or clan Allegiance.

AMT: One of the people you center on is a woman in Egypt. Leila, how do you say her last name?

SCOTT ANDERSON: Swaif.

AMT: Swaif, Tell us about her.

SCOTT ANDERSON: Leila is a remarkable woman. She is a professor of mathematics at Cairo University. She and her husband Ahmed who's now dead, passed away a couple of years ago. They've probably been the leading political dissident couple in Egypt, actually going back to Anwar Sadat time. Leila first, first demonstration was in 1972 when she was a high school student against the Sadat regime. and has always been in the frontlines of the demonstrations against Egyptian dictatorships. Ehen the revolt in 2011 the Tahrir Square demonstration started, she's been the veteran of a thousand demonstrations and protest marches. And initially she thought this was going to be another one. Very quickly on the on the first day of the march, January 25th 2011 she realized this is this was fundamentally different. And these tens of thousands of people had turned out in Cairo and across the country. And within a few days she realized that the revolution was going to succeed. What she always worried about was that the existing political parties had always been so much in the pocket of the dictatorships, of Mubarak and Sadat that would react fast enough to take power from the so-called deep state, essentially the military. And so she just saw the writing on the wall from very early on that if the progressive powers didn't move quickly that it was all going to be for naught.

AMT: And she told them that?

SCOTT ANDERSON: She told them. Even, before Mubarak was overthrown and the whole revolution in Egypt only took about 11, 12 days. She met with him and said seize power, seize power now. If you don't it will give the chance for the deep state to regroup. And they said oh yes, and that's a great idea, we'll will organize a committee to talk about it a few days. And sure enough when Mubarak was overthrown there was this interim military council that was set up. And what they did over the next year before elections were held was gradually stripped the presidency of almost all power. So when you finally had elections and the leader of the Muslim Brotherhood Mohamed Morsi came to power, he had very little power. And as he tried to claw back power that had been stripped from the presidency, the secular population of Egypt became worried that he was going to become a new Ayatullah, and that set up a counter-coup against Morsi.

AMT: And you make the point that Mohammed Morsi is elected Muslim Brotherhood and of course already that shifting has begun. But Leila is a progressive intellectual. How did she, decide who to vote for?

SCOTT ANDERSON: Yeah. Well, as I recall there were 13 people who stood for president. And the top two went on to a runoff , and that was Mohamed Morsi and Ahmed Shafik, who had been Mubarak's prime minister. So for Leila. She absolutely didn't want Morsi but the one person she detested more than Morsi was Ahmed Shafiq. So she was stuck. So yeah, this great irony is that she had to go out and campaign for the election of Morsi, an Islamic fundamentalist and she is an ardent feminist and progressive. But you know as the lesser of two evils.

AMT: So, Egypt falls back into authoritarian rule because the deep state as you point out is still hanging on to power.

SCOTT ANDERSON: Yes. And they did everything possible, the deep state and the military did everything possible to make Morsi's administration a failure. And for me personally, this was this was the moment when I saw the Arab Spring you know, [unintelligible] large going south, was some of the same people who had been out protesting against Mubarak and you know calling for democracy. Two years later are out in the streets calling for the military to overthrow Mohamed Morsi calling for the military to step in to overthrow Egypt's first democratically elected president. And so of course, the military obliged. They they overthrew Mohamed Morsi. General Sisi came to power, who continues to hold power. And now today in Egypt there is a far more political prisoners in Egypt today, estimated 50000, than there ever were under Mubarak. It's a far more repressive regime.

AMT: One of them is Leila’s son.

SCOTT ANDERSON: That's right. Her only son is in prison on a five year prison sentence. Her youngest daughter served a year and a half in prison for you know, it's a dark comedy, for protesting a new anti protesting law that had gone into effect. And Leila's children are bearing the brunt of this. The Sisi regime can arrest anybody and imprison anybody on almost any charge they can think of. And the awful situation for someone like Leila as she as she tries to work on her son's behalf., is that now.. under Mubarak .. if enough pressure is brought to bear by say Amnesty International, or by the American government, a political prisoner would be kind of quietly released and often sent out of the country. Now, probably, it's counterproductive. You know, the more the American government.. not that this American government is going to protest human rights issues in Egypt. But again, Sisi has seen that you know, what brought down Mubarak was being seen as America's lapdog. And he never was going to allow you know his regime to be portrayed that way. So the more pressure that's put on by The West to release political prisoners to open up the country is probably counterproductive.

AMT: You profile another fascinating person Majdi Al-Mangoush. He's in Libya. What is his life like before the revolution.

SCOTT ANDERSON: Majdi was an Air Force cadet with the Libyan air force under Gaddafi when the revolution started. And the Libyan Air Force Academy was actually in his home town of Misrata. So when the revolution started he was at the compound, The Air Force Academy compound, so essentially a military base. And the remarkable thing he was 22. He and the other Air Force cadets about 500 young men were kept in isolation inside the army compound, by Libyan soldiers, by government soldiers. They heard the fighting going on all around them. Misrata was one of the first places to blow up in the Libyan revolution. After a few days of being held on The Air Force Academy base, he and the other cadets were taken to Tripoli the capital and again, put in quarantine by them by the military. So for the first three months of the revolution all that Majdi knew about the revolution is what the regime was telling him. That you know, it was a foreign mercenaries and criminal elements who are trying to take over Libya. He didn't have a cell phone. They were not allowed to watch TV, so they just lived inside this bubble which is really remarkable because especially where he was in Tripoli. He was at the vortex of all this fighting and the idea that in this day and age, somebody could be there and just have no clue what was actually happening, you know, beyond the walls it's really remarkable.

AMT: And then when he finally sees like, a foreign aircraft bombing and, part of that bombing campaign Canada was part of, he thinks initially, Oh this is exactly it. The foreign invasion.

SCOTT ANDERSON: That's exactly right.

AMT: So, the Libyan military sends him on a spying mission.

SCOTT ANDERSON: Right.

AMT: What happens?

SCOTT ANDERSON: Oh. It's an amazing story. So, someone finally realize he's from Misrata, which really is one of the main bastions of the of the rebels fighting against Gaddafi. So that military intelligence take Majdi aide and ask him to sneak back into Misrata, Misrata is being held by the rebels, to sneak back into his hometown and to identify who the rebel leadership so they can be assassinated by, you know, regime assassins. So, Majdi agrees to do it. And he sneaks across[unintelligible] journey between rebel and government lines, gets back into Misrata, goes to his home and all of a sudden realizes that everything he's been told for the past three months is a lie. That you know, it's not foreign mercenaries and criminals it's the people themselves who are rebelling, including his own family, his own brother, his older brother, harbored a group of Libyan air force pilots who defected. And so for the next few days he wanders around Misrata he sees friends who have been wounded, some of his friends have been killed. And just realizes that everything he had been led to believe was a lie. And then he decides to join the rebel side. And in this very clever way, he's supposed to be he's supposed to be checking with his handler, his spy handler in Misrata, but in this very clever way he sets up this thing, where he gets supposedly arrested along with the spy handler. Spy handler goes to prison. You know, and Majdi joins the rebels. And he continues to fight for the rebels until Gaddafi is overthrown and murdered.

ATM: When does he realize the Libyan revolution has failed?

SCOTT ANDERSON: So, it's very personal and very small moment for Majdi. And I find that again again with people, you know, it's often not the big events that that think are going to make people, you know, see that see the light, it is often very small and personal things. So for Monday it was probably about a year and a half after the revolution was over after Gaddafi was overthrown. He gets his Air Force Academy diploma and he's now an engineer. His is now a civil engineer and he goes, for the last year and a half there are no classes. I didn't I didn't graduate from anything. I'm not qualified to do anything. And for him that moment of getting that diploma, he said that's when I saw that everything in Libya was corruption. You know, it was all about money. You want to call yourself an engineer, call yourself an engineer. And along with that was already what you were seeing was the fracturing going on in Libya the armed camps either of criminal gangs or of tribes and clans carving the country up into little fiefdoms.

ATM: When you look at these stories you think there was ever a real chance for those revolutions to have had a successful outcome?

SCOTT ANDERSON: I do. You know, the one success story of the Arab Spring is of course, Tunisia where the Arab Spring revolt started. And Tunisia today is a shaky democracy but it's a democracy, it's a coalition government and it does seem to be holding. I think that certainly that could have happened in Egypt if the forces of progressivism and democracy had moved faster and realize the danger that the military posed that was always lurking behind the curtain to take over. Libya and Syria, I don't think so.

AMT: Was ISIS an unavoidable fallout of the failure of the Arab Spring?

SCOTT ANDERSON: I don't think it was. I don't think it was unavoidable. I think there's a couple of things that made ISIS likely one being the American withdrawal from Iraq. The lack of an American military presence in Iraq. That American acquiescence to the central Iraqi government becoming completely dominated by Shia. So those things allowed this kind of Sunni reawakening. The kind of revenge of just a group composed of former Baath Party officials or military officials fusing with this kind of fundamentalist religious group. And again, they stepped into this void. You know, in the Sunni majority cities of Iraq like Tikrit or Fallujah, government control was very tenuous. And so when these rebels, terrorists like rolled into town the military melted away. And clearly what happened in Syria with ISIS is there was a deal cut between ISIS and the Assad regime. ISIS was virtually unopposed, took over most of eastern Syria. They were never bombed never attacked by the regime forces.

AMT: Why do you think Assad cut that deal with ISIS?

SCOTT ANDERSON: I think Assad has always seen that his best chances of survival are to make the Syrian civil war this black and white issue. I mean it's just perverse that he's presenting himself as a force of liberalism. But the more he can make this choice between liberalism or secularism and Islamic fundamentalism, he wins. Nobody wants to see ISIS take over Syria, and not that they would take over the entire country. But the more he can present it as this black and white issue between secularism and fundamentalism. He wins.

AMT: So what now. What does it take to put the Arab world back together, those fractured lands?

SCOTT ANDERSON: Yeah.

AMT: And can we in the West even say?

SCOTT ANDERSON: Yeah, I don't know if we can. I will require a level of engagement, political, military, financial to put these countries back together. I certainly don't see in the United States developing, nor it nor in Western Europe either. I think what you have coming in Iraq, essentially almost there, is a trifurcated country. A Sunni stand, a Shia stand, along with a Kurdish state that already exist. So essentially Iraq reverting back to what existed before Sykes-Picot, before the colonial powers. Libya is going to go broke in about six months. There's going to be absolutely no money left to the country. They've been burning through their sovereign assets..

AMT: By the billions.

SCOTT ANDERSON: By the billions, by the billions. Syria, I see absolutely no reason or hope that it's going to end the fighting is going to end anytime soon. Although one thing and again, you know this is how despairing you can get about, especially about Syria is that I also kind of compare Syria maybe in a hopeful way to Lebanon in 1970s. There was a brutal brutal civil war in Lebanon that at one time had over 400 different militias or private armies. You see that now in Syria. And people said you know maybe it's just like a wildfire that eventually burns itself out. You know you reach a point of such ruin, you already have half of Syria's population, it is stunning, half the population is either refugees or internally displaced. I mean maybe you just reach a point of utter exhaustion, where something kind of rises up out of it, but it's very, very hard to see what comes, in a kind of positive way in the near future.

AMT: It's really important for us to understand how this affects individuals. So, thank you so much for your work.

SCOTT ANDERSON: Thank you Anna Maria. Thank you.

AMT: Scott Anderson, veteran, war correspondent, contributing writer to The New York Times Magazine. He's the author of the book Fractured Lands how the Arab World Came Apart. He joined us in Toronto. Let us know what you think of that conversation you can tweet us we're at the current CBC or go to our website cbc.ca/thecurrent. That's our program for today. Stay with Radio 1 for q. Tom Power speaks with Pink Floyd co-founder Roger Waters about his first solo album in 25 years. It's called is this the life we really want. Remember you can listen to episodes of all your favorite CBC radio programs and listen live with the free CBC Radio app. Now earlier we were talking about problems many people face when trying to get medical help to alleviate back pain. We're going to leave you today with a comedic take on that issue courtesy of Louis C.K.. I'm Anna Maria Tremonti. Thanks for listening to the current.

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He’ll say no. [unintelligible]

Thank you so much. Thank you very much.

[Sound: Door open]

What can I do for you?

Well I hurt my back today really bad.

What’s wrong with your back?

It hurts.

Hmm. My professional diagnosis is your back hurts.

Well what can I do about it.

Nothing.

Nothing?

Problem is you're using it wrong. The back isn't done evolving yet. You see, the spine is a row of vertebrae. It was designed to be horizontal. And people came along and used it vertical, wasn’t meant for that. So the disk gets all floppy, swollen, pop out, left out right. It can take another 20000 years to get straightened. Till then it's going to keep hurting.

So what should I do.

You shoot back as it was intended, walk around I good hands and feet. Or, accept the fact that your back is going to hurt sometime, be very grateful for the moments that it doesn't. Every second spent without back pain, is a lucky second. Stringing up for those lucky seconds together you have a lucky minute.

OK.

Come see me when you have something fun like a blood disease. That's why I went to school for

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May 29, 2017 full episode transcript

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