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The Current Transcript for May 30, 2017

Host: Anna Maria Tremonti

STORIES FROM THIS EPISODE

Listen to the full episode

Prologue

[Music: Theme]

SOUNDCLIP

Call it what you will the pull in, the tug, the yank and pull, the grav and jerk.

SOUNDCLIP

Donald Trump can shake hands right.

ANNA MARIA TREMONTI: It is a presidential hand lock that ends up strong arming the other guy. Donald Trump's grip for all those photo ops is being parsed by pundits, professors, psychologists and historians, because it's become pretty clear that his is not an ordinary hand-shake. That crushing clench say some is intended to signal alpha dominance. You'll want to hear what they're saying about President Trump's messaging in half an hour. Because what is politics without the handshake. After all a handshake just changed BC politics.

SOUNDCLIP

This is an opportunity for people coming from an opposition perspective to bring new eyes to government. Sixty percent of the people who voted in the last election voted for our party Andrew’s Party or smaller parties.

AMT: We are looking at the implications of the deal between B.C. NDP leader John Horgan and Green Party leader Andrew Weaver, before we get to trump. And what's a handshake when the goal is a political earthquake. The conservative choice of Andrew Scheer as leader has its own message.

SOUNDCLIP

As prime minister, I will focus on results with conservative policies that create prosperity and provide opportunities for every single Canadian.

AMT: Our panel of journalists looks at the ambitions of the amiable Mr. Scheer, in just a moment and stick around for our third half hour.

SOUNDCLIP

The whole scenario in hospitals is just geared to [unintelligible] you out. You go in for whatever, especially a surgery you come out a junkie.

AMT: His own doctor called him a junkie. For him, as for so many the pain became the disease. But a Toronto doctor says rather than trying to get rid of chronic pain, he works with people so they can live with it and reclaim their lives. Our project The Disruptors here is from Dr. Hans Clark in an hour. I'm Anna Maria Tremonti. This is the current.

1

Who is Canada's new leader of the Opposition Andrew Scheer?

Guests: Laura Stone, Aaron Wherry, Murray Mandryk

SOUNDCLIP

Honorable Leader of the opposition.

Mr. Spiegel, it's hard to exaggerate just how out of touch this prime minister is with the lives of Canadian families. He thinks you help middle class by buying Broadway tickets for Wall Street big shots. He thinks will help the middle class by hiking taxes on kids sports, on their music lessons and on public transit. The prime minister explained exactly how higher taxes will improve the lives of hardworking Canadians and how hard it will be for future generations to pay back the borrowing that they're racking up.

[Sound: Applause]

AMT: If you do not already recognize that voice you will soon get used to hearing it. That is newly elected Conservative Party leader Andrew Scheer, making his first appearance in the House of Commons as leader of the official opposition, yesterday. The prime minister wasn't in the house to hear Mr. Scheer's jabs about his government's economic record. Justin Trudeau was in Rome meeting with the pope. But Mr. Scheer will surely be hammering his message that The Conservative Party is the best choice for middle class Canadians between now and the next election in 2019. Today we're delving into Mr. Scheer's history and looking at what his victory means for the political landscape. Three people are paying close attention to all of this. Murray Mandryk is a political columnist with the Regina Leader Post. He's in our Regina studio. Aaron Wherry is a senior writer with cbc.ca. Laura Stone is a parliamentary reporter with The Global Mail. They are both in our Ottawa studio. Hi everyone.

AARON WAYR: Good morning.

LAURA STONE: Good morning.

MURRAY MANDRYK: Good morning.

AMT: Laura Stone, let's start with you. What impression did Andrew Scheer make during his first appearance in The House of Commons yesterday as the new opposition leader?

LAURA STONE: Well, what Andrew share was trying to do yesterday was really put on a front of unity in the party because as we saw on the weekend, I mean between him and Maxime Bernier, the race was essentially split with Andrew's share wanting 51 percent of the vote and Maxine Bernier who we all thought was going to win, we're all suspected he would with 49 percent. And so you saw it in the caucus meeting and you saw it in the House yesterday paying tribute to his fellow leaders, leadership candidates, allowing Maxime Bernier and the others to ask a question in the House presenting a united front and focusing on the economy. I mean the question now for Andrew Scheer is how much do the social conservatives play or play a part in the party. He didn't go there yesterday he's going to attack Trudeau on the economy, absolutely from the start.

AMT: Aaron Wherry, The Prime Minister wasn't in the House yesterday but what will you be watching for when they eventually face each other in the house, and then as they move toward another election.

AARON WHERRY: I mean, I guess in the short term there's the question of how Scheer approaches The Prime Minister in the house. Andrew Scheer is not exactly a familiar figure. He wasn't a significant sort of player in the day to day debate because he was the speaker for so long, not for a terribly long time, but he was speaker previous to this. But at the same time he is a fairly experienced hand at this. He's fairly comfortable in the House of Commons. He's not to use the most immediate comparison he's not Tom Mulcair he's not you know this sort of tough brusque prosecutor. He tends to sort of want to be funny to be amiable. So we'll see how he approaches Trudeau and then we'll see sort of what themes exactly he can build on it. The conservatives have spent lots of time over the last year or so, sort of picking apart liberal, you know, ethical questions and expense controversies, but they haven't really yet gotten to the sort of meat of it. I don't think in terms of the liberal economic platform and they also haven't had to present their own alternative proposals. And that means we've kind of been shadowboxing I think over the last year and a half and we haven't really gotten to that real debate yet about what exactly the conservatives would do differently.

AMT: Murray Mandryk, how are conservatives in Saskatchewan responding to Andrew Scheers victory?

MURRAY MANDRYK: Well, very well actually. I think it's because there was a far more difficult relationship with Stephen Harper's government in Brad Wall's government and I think everyone recognized that the Harper government to be a bit brusque in whom he surrounded himself with in terms of his ministers from Saskatchewan is following in that path. In case of Scheer, he really didn't. He wasn't necessarily an outsider, because he was obviously a Harper loyalist and such, but he wasn't of that mold. So the comparisons between Harper and Scheer on a policy front are probably very, very accurate. But he's a really different person. You used the word affable in your opening introduction I think that's a great word Aaron used the words amiable which I think is a perfect word. I think that's the kind of politician he is and I think that's the kind of politician he will be.

AMT: Well you've covered him in his constituency what else is he like?

MURRAY MANDRYK: He's pleasant, he's a somebody who checks the right boxes obviously in terms of his political career. I think Aaron wrote about it today in terms of achieving a lot of at a very young age. He lucked into a very good writing in at the point of transition in being Lauren Nystrom in 2004. He's done a significant amount, met all the right people, he'll have you in for coffee at least once and sit down and you'll talk and you'll have a very pleasant conversation with him and he does that. I'm sure with everyone he meets is a good politician should. He's a lot different than a lot of his, I see the really brusque conservatives we've been used to under Harper's direction. But I think as your other guest pointed out life comes at you pretty fast as opposition leader and beyond. And one wonders how successful he will be in handling that.

AMT: He grew up in Ottawa. Murray, how did he end up in Saskatchewan?

MURRAY MANDRYK: Love. He married a girl from out here that he met at university.

AMT: That’s a good story.

MURRAY MANDRYK: That's a good story. It's an interesting story. Her family is a very actually NDP family. Her brother ran for the provincial NDP, her brother Stephen. Her other brother, everybody I think knows, plays for the Seattle Seahawks, Ryan. John Ryan is the punter there. He jokes about how it gets very quiet sometimes at Christmas and Thanksgiving dinners and such but I think he handles it really well. They're the Liberal rather closely together and Regina in terms of the family. The one thing that impresses me, you sit down with him in his office for coffee, and you suspect OK well this is something he feels obligated to do as I said checking the right boxes, he gets a call from his wife Jill and he stops the conversation with you. And by the looks of these listening quite intently is someone with five kids probably does. And you're kind of impressed with that. So the social conservative family values are more than talk. They are what he is. Although that said, I think they fit quite nicely into what he needed politically in the direction he needed to go to accomplish what he has so far.

AMT: And he does have five kids. Laura, you wrote that he's told the National Capital Commission that may have to scotchgard Stornoway.

LAURA STONE: Yeah, he’s kid proofing Stornoway. Now, with obviously Rona Ambrose lived there previously and she and her partner JP has I think three kind of older children. They didn't need to hide the vases. But, yeah. I mean it's kind of interesting because Andrew Scheer as speaker also lived at Kingsmere Farm. So this is kind of his second government run property, and it's kind of nice to have to a family around and sometimes you know, with Trudeau as well, it's an interesting contrast because of course he has his three kids and now Scheer has five.

AMT: And it's a it's a different kind of configuration all around than in Ottawa, right now.

LAURA STONE: Yeah it is. It's a lot younger or you know, a lot more family friendly and I think that's why Andrew Scheer doesn't make a formidable opponent for Trudeau. Because he's around the same age actually seven years younger, big family you know, agreeable personality, very different from the Stephen Harper, especially towards the end. So, I think he'll be a good opponent for him.

AMT: How well did he do when he served as Speaker of The House when Stephen Harper was Prime Minister, Laura?

LAURA STONE: Well, I think it depends who you ask. I mean he's still a conservative. So, there was a perception that he was conservative friendly, but he kind of had this almost like he was scolding children sometimes like, oh almost like a kindergarten teacher, now everyone be nice to each other and he was kind of difficult to not take seriously but I'd be afraid of I guess. But you know he won a lot of fans on the conservative side especially social conservatives in allowing them to speak about issues that the Harper PMO did not want them to discuss namely owl one when does life start and all these kind of a budding pro-life issue is that now he's suggesting people will be allowed to speak about again in the House or elsewhere. But you know also kind of tip toeing the line between free speech but also saying that his government is not going to reopen debates such as abortion and same sex marriage.

AMT: Aaron how much of a change does he represent for the party.

AARON MURRAY: I think that's the big question at this point. You know during the campaign he was happy to be called Stephen Harper with a smile. And his argument at the time was that it wasn't conservative policies that were the problem in 2015, it was tone. And to some degree, he may have the correct prescription there. You know, after 10 years people may have been tired of Stephen Harper they made some... I think everyone has agreed upon missteps on the kneecap and quote unquote barbaric cultural practices and policies. So, he may be on to something that a there's a basic foundation there of the party that has an appeal and that can be popular going forward. But it's not clear at all yet where the party, where else the party may go. When you contrast him with Maxine Bernier you know Mr. Bernier had a very aggressive platform that was going to take the party in some pretty dramatic directions. Mr. Scheer had a platform that was fairly scant really. You know he talked about free speech on university campuses and putting the flags of foreign countries on gas pumps to remind Canadians that their oil isn't all domestic. It wasn't a policy heavy platform. And it's possible that in 2019, that there will be, you know, some feeling within the electorate that they would like to have the policies of the previous conservative government back. But it's not clear that that's going to be nearly enough to win back office. And so it remains to be seen where this party wants to go. You know on public transit, on infrastructure, on the concerns of sort of suburban families, on climate change, for instance. This was a party that just rejected Michael Chong who was the only candidate in the race who wanted to make climate change a priority. So what does this party have to say about that. At this point he really still remains something of a blank slate and as amiable as he is, as much as he may be a safe pair of hands it's not quite clear where he wants to take the party or how much more of the party might be under him.

AMT: Well, a lot has been made of the mega-watt smile, the positivity, the amiability, can I say that word? We have a clip here of a few of the things he had to say during his victory speech Saturday night. Listen to this.

SOUNDCLIP

We have to get a grip on this out of control spending. It's not fair to future generations of Canadians. And one of the things that has motivated me so much in this campaign, is the very strong belief that I cannot allow Justin Trudeau to do the same thing to my five children that his father did to my generation. The liberal carbon tax is nothing more than a cash grab. I will repeal it. I believe that the foundation of our democracy is the ability to have a debate about any subject. I will withhold federal grants from universities that shut down debate and can’t stand different points of view.

[Sound: Cheering, Applause]

And there are threats here at home, but there are so many around the world. And I believe that radical Islamic terrorism is a threat to every single Canadian, which is why I will recommit our Air Force to the fight against ISIS.

[Sound: Cheering, Applause]

AMT: Murray Mandryk, to what extent does Andrew Scheer really bring a positive message to the table?

MURAY MANDRYK: I listen to that and it sounds like my kids talking to me when they want me to hear what they think they want me to hear. And listening to him speak to that particularly conservative audience, it strikes you how young he actually is. Andrew seriously, you were three years old when Pierre Trudeau left office so I don't necessarily think the issue is of what he did to your generation but that plays so well in that crowd, that this kind of speaks to the aspect of him the political ambition of him in wanting to say the right things to the right people. Broadening that to a wider Canadian audience might be a bit difficult. It's kind of funny because in this particular city we have Ralph Goodale who's another career politician who is very, very good at that and might be someone that job that Andrew sure would like to model, in some very real ways. But I think that that's the problematic thing right now. I listened to that and he reminds me of how young he actually is, maybe because I'm old. I don't know.

AMT: Well, Aaron, there's a lot of parallels have been made to Joe Clark with his youth and his surprise win and he's up against a Trudeau.

AARON WHERRY: Yeah, this is what I wrote about this morning and it's you know, the Joe Clark comparison at this point is a bit loaded obviously because it didn't end so well for Mr. Clark. But with all due respect he took on a Trudeau and he won in 1979. But as the Toronto Star sort of echoed with its Andrew Who headline on the weekend echoing it's Joe Who headline from 1976, he is another thirty something conservative leader who has sort of come out of nowhere to very narrowly win his party leadership, and now he's going up against a Trudeau with all of the sort of aura that comes with the Trudeau. You know, the fight isn't quite going to be the same. Justin Trudeau has a different appeal than his father did. And it's entirely possible that Andrew Scheer is going to avoid many of the missteps that got Joe Clark in so much trouble. But it is a challenge. You know it's been since 1935 that we last saw of one term majority government thrown out of office. And I think if you even go back through recent history there's interesting parallels with the fact that you know Jean Chrétien, Paul Martin, Stephen Harper, Justin Trudeau, all won their party leadership on the first ballot and won it decisively. You know other leaders like Tom Mulcair, Stephane Dion, Stockwell Day all weren't quite as popular at the start. And so I would wonder whether there was a bit of a parallel there too, which is not to say that Andrew Scheer is you know, doomed. Predictions in politics are foolish, but it is going to be a tough mountain to climb. And I think from what you saw in the clips you played, in that speech, I think he's said enough to win the leadership. It remains to be seen what more he can say and how well he can sort of broaden that appeal.

AMT: At the same time, Laura, he's thrown the liberals too. They weren't expecting him to win.

LAURA STONE: Yeah. It was really interesting at the leadership event, I'll call it because it wasn't a convention, on the weekend. The Liberals were passing around all this Maxine Bernier goody bags, attacking him for handing out Jos Louise to the troops and marking his anniversary for leaving the documents at Julie Quillard’s home. I think they were thrown off by the fact that Andrew Scheer had won. And then you know, their attack line has been that he's an extremist, has always taken you know, these pro- life issues, or voted on those issues. So they're trying to kind of pain to him as a leader who would take away women's rights who would not be as tolerant not have as diverse of a party. So that's going to be I think where the liberals are headed on an Andrew Scheer party. But I think they were for sure thrown off by the fact that Maxine Bernier didn't win. And you know by the same token Andrew Scheer's position on these things is arguably what won him the leadership. And we saw you know social conservative candidates such as Brad Trost and Pierre Lemieux, do quite well in the race especially Brad Trost and that is what pushed Andrew shear over the edge. So he might be under pressure now from those groups to allow them to introduce legislation and speak about issues that might make the rest of Canada uncomfortable.

AMT: OK. Well before you go Murray maybe you can just give us an idea. What do you think he needs to do now to win the support of Canadians, now that he's got the party?

LAURA STONE: I think typical of a younger leader he has to be seen as someone to be taken seriously. He's surprised everybody throughout his political career so maybe he'll quite be able to do that. He doesn't get quite engaging speaking style that I think you're kind of used to in terms of other federal leaderships and maybe we're used to hearing someone like Brad Wall. There's a lot of elements of his game that he has to work on. Mostly, I think he doesn't he has to be his own man policy wise and not get overrun with a lot of the checkpoint rhetoric positions on these. so far made related to the Conservative party and come forward and show that leadership.

AMT: OK, we'll all be watching and listening. Thank you all for weighing in on this one.

MURRAY MANDRYK: Thank you

LAURA STONE: Thank you.

AARON WHERRY: Thank you.

AMT: That's Marie Mandryk political columnist with the regional leader post Aaron senior writer with cbc.ca and Laura stone parliamentary reporter with The Globe and Mail. Stay with us. The CBC News is next and then his handshakes make headlines.

SOUNDCLIP

Forgot, you once called the handshake barbaric.

I'm also very much of a germophobe.

Donald Trump has been risking John’s galore with his over the top handshake.

AMT: Well, that’s from CNN. An extended hand is usually a sign of trust, cooperation, or respect. What is it with Donald Trump? We’re on that next. I’m Anna Maria Tremonti. This is The Current.

[Music: Theme]

Back To Top »

Deal with NDP is what Canadians wanted, says B.C. Green Party MLA

Guest: Sonia Furstenau

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

[Music: Theme]

AMT: Still to come in half an hour a preeminent Canadian doctor says we need to radically re-imagine and change our relationship to pain. Hans Clarke will be in to tell us how he helps his patients make peace with pain and get off opioids. Also coming up Donald Trump's handshakes are about status not solidarity. And now world leaders are catching on and clenching back. But we begin with a handshake that has launched a new political beginning in BC.

SOUNDCLIP

There are so many ideas that all parties share. In the end we had to make a difficult decision. A decision that we felt was in the best interest of British Columbia today and that decision was for the BC Greens to work with the BC NDP to provide a stable minority government for over the four year term of this next session.

AMT: And that is how BC Green Party leader Andrew Weaver ended three weeks of speculation and uncertainty. Yesterday, he and the NDP leader John Horgan announced they would join forces to support a minority NDP government in British Columbia. The fate of the government in BC had been in limbo since election night May, 9^th, when Christy Clark's liberals got 43 seats, 41 went to the NDP and the Greens captured three, giving them the balance of power. The party's negotiated right up until late Sunday night, and today the caucuses of each party are meeting to discuss their next steps. Sonia Furstenau is the deputy leader of the Green Party she's the newly elected MLA for the riding of Cowichan Valley and she joins us now.

AMT: Hello.

SONIA FURSTENAU: Good morning Anna Maria.

AMT: Were you in the room when all of this happened?

SONIA FURSTENAU: I was part of the four person negotiating team for the Green Party.

AMT: And what was it about the NDP that won you over?

SONIA FURSTENAU: Well, you know, it was the best part of two weeks that we were in meetings with both parties and the meetings were primarily focused on policy, and so we spent much of our time talking about how we could see what we considered to be really good policy put forward mostly in our platform. How could we see that brought forward and ultimately it was our discussions with the NDP and, as Andrew said yesterday, in a couple of the areas where it was clear that we had closer ties to the NDP was on the Kinder Morgan pipeline and Site C.

AMT: Were those the deal breakers then?

SONIA FURSTENAU: Well, those certainly contributed. And I think just the recognition of some additional shared values, but we certainly were pleased to see that both parties were deeply engaged in these conversations on good policy and I think that this is the important thing, is that you know we as Greens said that we would do politics differently and that we would bring in change. And one of the first changes we've done is to engage in … In BC We've lived in this very hyper partisan realm where you know ultimately the two main parties don't spend a lot of time talking to each other. But I think it's important that all the parties in BC start engaging in reasonable dialogue around policy and ways that we're going to find solutions to many of the pressing problems we had in BC.

AMT: OK well let's go back to two pressing issues then the Kinder Morgan pipeline and the BC Hydro Site C what's going to happen to those?

SONIA FURSTENAU: Well, if you have an oracle that could help.

AMT: Well, you're opposed to Site C, The Greens?

SONIA FURSTENAU: We are opposed to Site C. You know, the economic case for Site C, as we said right through the entire election doesn't make any sense. And moving forward we've never had a review from the BC. utilities commission in the first place. And we think that it wasn't good decision making, it was not that evidence based decision making. And so, when you put a megaproject like that forward in what seems like haste and crossed fingers. That's not a good way to bring policy.

AMT: The Kinder Morgan pipeline, is there anything you can do about that? Is that fait accompli?

SONIA FURSTENAU: Well, I think it wasn't done was a proper environmental assessment on the side of the province and so that's one avenue that can be looked at. And of course as we move forward with this agreement these will the conversations that we have with the other caucus.

AMT: Now assuming the NDP will form a minority government, you still collectively have won a one seat majority. That's precarious. How confident are you that this deal can work for four years?

SONIA FURSTENAU: So, the really important part and what we don't often hear about, I mean we don't get a lot of minorities in these [unintelligible] systems very often, but the people of BC elected a government and the lay out of that government as it stands is what we've inherited. And so, for me and what I think is really important it's actually our responsibility now to make that government work. It's a reflection of what the people of BC wanted. They didn't want it give majority power to one party or another. And there was a lot of discussion in this election from people saying they want to see government start to work better together. So, the opportunity that we have right now is extraordinary because instead of the power being concentrated in the hands of a few members of the executive council of a majority ruling party, we don't have a situation where essentially every MLA in the house is empowered. Because as Greens we've agreed to a supply and confidence agreement with the NDP, which means we will vote with them on matters of confidence matters of the budget, but on anything else we retain our independence.

AMT: In other words, on anything that can't fail them.

SONIA FURSTENAU: Anything that doesn't bring the government down in a confidence [unintelligible].

AMT: Right. So, why didn't you have a coalition?

SONIA FURSTENAU: Because we're an independent party and we really want to maintain that independence. We agree with portions of the NDP approach and policies but we have different approaches and policies in other areas. And I think that a diversity of voices is actually also very important to government. The upshot here is that if the caucus has some really good legislation they want to bring forward, we’ll support that. If an independent MLA has a private member's bill that they want to bring forward, we’ll support that, if we agree with the policy. And so unlike what happens in politics often in Canada or in these Westminster parliamentary system, where employees get elected and they're super excited that they can be doing good work if they happen to be a backbencher in the majority party or in the opposition, their desire to be able to bring change as an individual is thwarted.

AMT: We're almost we're almost out of time, but you're basically telling me you continue to hold the balance of power then, that you can actually swing over if you want to on certain votes.

SONIA FURSTENAU: Absolutely. And you know, we've agreed to support the NDP in supply and confidence, and so we've agreed to say that we will hold up this government, but that doesn't preclude us from supporting good policy coming from anywhere in the house. And I think that if we start to look at our problem entry system through different eye [unintelligible] through the eyes it should be looked at which is the MLAs collectively hold the power and the responsibility, we can start to see some extraordinary shifts in how we do politics everywhere.

AMT: Sonia first snow we have to leave it there, but thank you for speaking to me it's very intriguing to be able to see what's going to happen. Thank you.

SONIA FURSTENAU: Thank you so much, Anna Maria.

AMT: That is Sonia Furstenau the Deputy Leader of the Green Party. She's the new Green Party MLA for Cowichan Valley.

[Music: Theme]

3

Trump and the art of the political handshake

Guests: Geoffrey Beattie, Philip Rucker

AMT: You are listening to the current on CBC Radio One I'm Anna Maria Tremonti.

SOUNDCLIP

Not since this hot mess of a three way has a handshake gotten so much attention, clocked at almost 19 seconds. This became the handshake that left the Japanese prime minister shaken. On Monday, Canada's leader shook President Trump's hand but he held his own, resisting any tugging and inspiring headlines like: Trudeau one ups Trump. But the handshake gain.

[Sound: Cheers]

AMT: Well that is CNN reporting on Prime Minister Justin Trudeau and Japanese President Shinzo Abe’s handshakes with U.S. President Donald Trump. There were also uncomfortable moments when The President greeted Israeli Prime Minister Benjamin Netanyahu. President Trump's own Attorney General Jeff Sessions, The German Chancellor Angela Merkel, whose hand he refused to shake at the White House. And to the French president Emmanuel Macron, he admits it was no accident saying “My handshake with him it's not innocent. One must show that we won't make little concessions even symbolic ones”. In case you missed it. That handshake faceoff took place at last week's NATO meeting in Brussels. President Trump's handshakes have become legendary, sometimes for their comic appeal but also for what they reveal about his power and personality. They have ranged from tugs, yanks and pulls and in some cases snubs. Washington Post White House Bureau Chief Philip Rucker has witnessed a number of these including last week show of white knuckles with President Macron. Philip Rucker joins us from Washington. Hello.

PHILIP RUCKER: Hi, Good morning.

AMT: Well from your advantage point in the room describe what you saw in the handshake between presidents Trump and Macron.

PHILIP RUCKER: Well, it was so interesting this was just their first meeting. Macron had only been president for a couple of weeks and they were at the U.S. Ambassador’s home in Belgium. And you know they had this handshake which they were, you know, these foreign leaders normally do when they're posing for cameras at the top of these meetings. But it went on for so long. And you could see actually looking at the still the top photographs that the photographers were taking, just how tense that really was. They gripped each other's hand Macron and held on tight. There are actually two moments where President Trump tried to pull his hand away and Macron kept holding on, and the knuckles turned white and you could see their jaws were clenching and there was just a real tense atmosphere between the two men. And it was very clear to me watching it that that Macron wanted to establish himself as an Alpha, as well as Trump. He didn't want to be a secondary figure.

AMT: And was Trump surprised?

PHILIP RUCKER: I think he was a little surprised by it. And actually a few hours after that meeting when both men were at the NATO summit in Brussels, Trump went out and shook Macron’s hands quite exuberantly and almost as if they were joking about what had happened what had transpired that morning at The Ambassador's home.

AMT: So, you followed Trump you've seen him shake a lot of hands. What is some of the tactics you've seen?

PHILIP RUCKER: Well, you know Trump is somebody who cares a lot about the importance of body language and about the signals that he can send with the handshake. And we've seen this time and time again where he'll try to grab on to somebody else when he's shaking their hand, pull them closer as a way of asserting dominance and as a way as you know signaling, not only to that person but to everybody else watching that he's in control, that Donald Trump is the boss. And this is not new to Trump The President. We saw this when Trump was a real estate developer and a reality television star. He would use body language he would use handshake to try to show commands.

AMT: And he tries to pull them toward him, which is why it's significant I guess that Justin Trudeau put his hand on his arm and he couldn't actually pull him closer.

PHILIP RUCKER: That's exactly right I think. I think Trudeau knew exactly what he was doing going into that handshake as did Macron [unintelligible] you know. The politicians, public figures, you know heads of state, when they get ready for a meeting like this with Donald Trump they have to think not only about the policy issues they want to bring up and how they're going to communicate it at a certain point of disagreement perhaps. But they also have to think about the body language and what kind of signal they want to send, not only when they're meeting Trump but to the media to the people that are watching to the cameras.

AMT: So what do you think President Macron meant when he said that his handshake was not innocent?

PHILIP RUCKER: I thought that was a very revealing interview. This was a couple of days after the beating and Macron basically acknowledged that he had orchestrated that handshake on purpose in that way. I think he wanted to show that look I'm I may be younger ,30 years younger as a matter of fact, I may be from a smaller country in Europe relative to the United States of course, but I'm not going to be the second fiddle here and I'm going to be in charge. We're two equals we're both presidents from our countries and I think Macron wanted to establish himself as on equal footing with Trump and he did so with that handshake.

AMT: And at what we saw him walking toward Trump at the G7 and Trump's got his arms kind of like open and Macron swivels over Angela Merkel, makes his way finally over to trump that was also that was also well planned, wasn't it?

PHILIP RUCKER: It was. And I think one of the things that Macron is trying to do is really position himself in the early weeks of his presidency as a counter to Trump, as sort of the liberal West counter to Donald Trump and to the even authoritarian leader such as Vladimir Putin. And so I think he's trying to demonstrate not only to the people that elected him back home in France but also to the world's media and to followers around the world, that he's going to be willing to stand up to Trump that he's not going to be bullied by Trump. That he's going to you know speak out and fight back whenever necessary.

AMT: All that messaging in a handshake. Philip have you seen this with other presidents did you see this with Obama?

PHILIP RUCKER: You know we did it with every president to some extent. But I think we paid more attention with Trump in part because Trump values this Trump is an actor. He's a performer. He knows how to use body language to advance his cause politically. He cares a lot about this stuff. Trump cares a lot about personal relationships to him foreign policy is less about the ideologies and the issues and more about the relationship that he can form with his counterparts around the world. And so I think we're just so much more naturally attuned to looking for cues from body language. And certainly you know there were moments in Obama's presidency where his body language was analyzed and over analyzed, and I'm thinking of a few of the meetings that he had one on one with , it's something that he strategizes about himself. And so it's only natural that we would all tune in and pay attention to it.

AMT: OK. Well, Philip Rucker, thank you.

PHILIP RUCKER: Thank you.

AMT: That's Philip Rucker he is The White House bureau chief for The Washington Post and he joined us from Washington D.C. My next guest has a solid grip on the history of the handshake. Geoffrey Beattie is a professor of psychology at Edge Hill University in Ormskirk England. He developed a mathematical equation for the perfect handshake. He is the author of Get the Edge: How Simple Changes Will Transform Your Life. And Geoffrey Beattie joins us from Manchester England, hello.

GEOFFREY BEATTIE: Hi there.

AMT: What were you thinking as you watched that handshake between the French president and Mr. Trump?

GEOFFREY BEATTIE: Well, I think most of Donald Trump's handshakes have shocked me enormously because of course the whole point of the handshake is it's meant to be a co-operative and ritualized form of interaction and Trump somehow managed to change that. I mean we've always known that there are sort of signals sort of dominant signals when people meet for the first time. But Trump has managed to change something which is meant to be cooperative into something which is really antagonistic and quite aggressive. And of course it didn't take long for other political leaders to kind of work out what he was trying to do with it because by pulling people who are the kind of [unintelligible]. He was pretty putting people at an immediate disadvantage. He was putting them into his proximal zone where he could dominate them and of course when you're that close up to someone you can't show eye contact. So it made Donald Trump look very powerful with respect to the people he was doing this too. And of course he was quite clever, because he sends off kind of less dominant signals when he reaches forward his hand, with the palm up which is not a dominant signal to a lot of people to take his hand from above. But of course when he allows people do that he then hangs on to the hand. He did this famously with the prime minister of Japan for 19 seconds and kind of pats them on the back of the hand. And of course controlling the duration of the interaction passing which of course again is a very, very powerful dominance, you know, our superiors and can pat us on the hand or the back but we can't pat them. So he’s very good at using a range of signals here and as your previous speaker said here is someone who is understands the power of body language for sending out signals, not just to the recipient not just to the person shaking hands but to the world audience so there is an enormous iconic properties in handshaking and Trump's very presence and very aware of it.

AMT: Right. In fact The Japanese President when you watch that handshake he looks relieved when he finally gets his hand back.

GEOFFREY BEATTIE: He is. He looks quite [unintelligible while he looks obviously very shocked by what he's just been subjected to because I mean the whole point about the handshake is it's been about for two and a half dozen years. You know it's meant to be a sign of peace and reconciliation. It's meant to be co-operative and symmetrical. You're not meant to use this kind of power play early on but I say this is somebody who comes from reality television who understands the importance of the image of the body language image for sending signals about status, about relationships and so on and of course he initially took a lot of people by surprise. You can see it in their facial expressions or spontaneous expressions that they're quite shocked by what they're being subjected to. But not of course Macron and true and others are snow starting to prepare for this work ideas and Macron describes as not an innocent. Of course it wasn't innocent. He thought carefully about what he could do in response to this. And of course it really is that you are the alpha males. It's like two stags fighting it I do see the knuckles turning white. This is a power play and Macron isn't going to give way in this struggle with Trump.

AMT: Well he's not the first president to really care about the handshake but what was JFK like?

GEOFFREY BEATTIE: JFK apparently put a lot of preparation into preparing his handshake for those initial meetings with world leaders. He commissioned research into the handshakes. And it's really interesting that I think that all presidents the U.S., even Obama who's been relaxed in his handshakes. But you know again as the previous speaker said, when Obama met Putin the role of a lot of very interesting signals going on and I think world leaders are very sensitive to the efficacy of these signals for sending dominance signs. What's really interesting when you watch world leaders, kind of for example going through doors who put their hand to the other person's back who pats for the last time you can see that they know about the incredible significance of these kinds of things. And there is a kind of play on a whole series of body language signals. The point about body language of course it's meant to be spontaneous it's meant to be unconscious and so on. I know we've got into that really interesting domain where people are consciously thinking about how to send powerful signals. So when JFK commissioned the research he wanted to think about what signals he was going to send with the hands. Trump has clearly thought a lot about it. Of course the point of Trump is that if you even watch his gestures when he's making speeches he does a whole series of kind of orchestrated movements which are kind of images, to conform and normally those images to accompany talks are completely spontaneous and not under editorial control. But Trump sends out very careful signals when he gives speeches, that you know is the kind of circular You know the you know the thumb and forefinger kind of meeting signaled to kind of pointing up gesture which he used to emphasize and send signals during certain bits of the accompanying speech. Trump is someone who has thought about many aspects of body language, not just body language signals on their own, but how they lead to speech and how to send almost subliminal messages when he's talking to other people about those that we process this stuff in a very natural unconscious level.

AMT: And you spend a lot of time thinking about handshakes because you actually have a mathematical equation for the perfect handshake before I let you go what are the components of a perfect handshake.

GEOFFREY BEATTIE: Well there are something like 12 components which involve not just the sum of them or about the behaviors that come with a handshake, like eye contact the initial verbal greeting the nature of the smile whether it's a psychological Duchamp's smile which is a natural smile which goes on and off the face slowly. The complete loss of the grip the dryness of the hands and strength of shake the position of the hands the vigor the temperature of the hands the texture the degree of control the duration is on. So there are a lot of different aspects, the very, very simple handshake. And you know in order to send the right signal which is, this is about corporations, this is about ritual, this is about peace and reconciliation. You have to get them all right. In Trump's case he gets most of them wrong, deliberately so because he wants. For him it's all about Donald Trump. It's all about Center Stage. It's all about control and dominance and he said, almost all of those signals.

AMT: Well I can imagine Geoffrey Beattie that you would love to shake his hand so that you could learn more. We have to leave it there. Thank you for talking to me today.

GEOFFREY BEATTIE: OK it's a pleasure.

GEOFFREY BEATTIE: Bye bye.

AMT: That's Geoffrey Beattie, professor of psychology at Edge Hill University in Ormskirk England. He's the author of Get the Edge: How Simple Changes Will Transform Your Life. He's in Manchester England. So what's your handshake preference or what bugs you when you shake hand? What do you think makes a good grip? What do you think of the world leader handshake kerfuffle? Tweet us at the current CBC visit us on Facebook at CBC the current. E-mail us from the Web site cbc.ca/slash the current.

Click on the Contact link. And stay with us because in our next half hour he calls pain a silent epidemic that needs a radical response. We'll hear from one doctor challenging our approach to managing pain and getting people off addicted opioids at the same time. I'm Anna Maria Tremonti. This is the current on CBC Radio 1 Sirius XM. Online on cbc.ca/thecurrent and on your radio app .

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'Silent epidemic': How a doctor is changing the way we treat pain

Guest: Hance Clarke

AMT: Hello I'm Anna Maria Tremonti and you're listening to the current. Four to five Canadian adults struggle with back pain at least once in their life. Yesterday we talked about the back pain epidemic. Investigative journalist Cathryn Jakobson Ramin suffered from lower back pain for years. And in her book Crooked she delved into what she calls the back pain industry. To find out what works and what does not.

SOUNDCLIP

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 this path is going in the wrong direction. And there're 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.

AMT: Well, it seems we heard from four to five of you, or close on this. Joseph Finkler of Vancouver e-mailed this: The problem today is that people have no tolerance for discomfort. They want instant relief. They won't believe you when you tell them most pain will resolve with time. People today simply lack resilience and that is why they cannot tolerate discomfort and why they are susceptible to opiate addiction. Linda McClatchey in Toronto shared this: As a physiotherapist who has been practicing for 22 years. I've seen people with back pain literally thousands of times. I completely agree that even with pain they need to maintain movements and activities that don't aggravate the situation. Joseph Albert is a chiropractor in Sault Ste. Marie, Ontario and he takes issue with Cathryn Jakobson Ramin and her criticism of his career. He writes: Her negative mention about my profession was not based on facts and is not right. I make a living by being honest not over treating, not using fear tactics and giving people the tools to manage back pain themselves. Grant Letho from Thunder Bay shared this: I am presently [unintelligible] to see a neurosurgeon to view my ongoing back issues that I've been suffering with. It's nice to know I'm not the only one battling the back pain demon. If you missed our discussion on back pain yesterday go to our Web site and listen, cbc.ca/thecurrent or you can listen to the podcast through the CBC Radio app. My next guest hears a lot of stories from people battling back pain. A leading pain specialist in Canada he is helping people manage their pain and get off opioids in a ground breaking way.

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The first time that it happened, I thought I was getting a heart attack. I didn't know what was happening until I realized that what it was, was that I wasn’t in pain, which was the first time in 13 years that I hadn't been in pain. My whole life surrounded by hydromorphone, and waking up the morning after treatment and didn't think of hydromorphone. I could not [unintelligible]. My feelings as you can imagine were wonder, delight, but also anger.

AMT: That is Paul Ross talking about the first time in a long time he felt free of pain, his anger at a system that he says got him hooked on opioids. The latest numbers are a grim reminder of the risk of opioid use, in the first six months of 2016 there was an 11 percent jump in the number of people who died of opioid overdoses in Ontario. In British Columbia, if the current trends hold, the number of opioid deaths there will likely top 3300 this year. It is a problem the medical community has been trying to tackle. New guidelines out this month say doctors should only prescribe opioids in very specific cases of chronic pain and they should also try to wean their patients off opioids altogether. At the root of the opioid crisis is our way of managing pain. And Dr. Hance Clarke is calling for a radical overhaul of how we treat it. He joins me today as part of our project the season’s The Disruptors. Dr. Clarke is the director of pain services at Toronto General Hospital. He is the director of the transitional pain program and he's in our Toronto studio. Hello and welcome.

HANCE CLARKE: Hi, Anna.

AMT: You've called it a silent epidemic. What do you mean by that?

HANCE CLARKE: Well, Anna Maria I mean if we think about the percentage of people in Canada living with pain that's 20 percent. So you and I probably know several, if not you know more than several handfuls of people who live every day with pain. You know I got up I had my coffee this morning. I mean in here chatting with you I don't think about any of that. But there's people every day that have to think and calculate and figure out how they're going to do those two simple things of simply getting up out of bed, choosing what they're going to do in the next 30 minutes and then calculating what's their cost going to be to my life. And think about a headache that you've had that just never goes away. And this isn't something that people where it's not like a broken arm. It's not like a missing limb. It is something that is consistently in the background of their everyday life and their fabric.

AMT: You know we had that letter that I just read that said Joseph Finkler Vancouver said people want instant relief. They lack resilience and they can't tolerate discomfort. Is that your experience with pain patients?

HANCE CLARKE: No I don't think so. I think you know everyone is actually looking for help. The issue I think really became you know what we as the medical community have in our armamentarium to help these people. And you know the focus of the reduction in pain and when you ask a patient that is the holy grail.. that reduction in pain intensity but it really shouldn't be the focus of how we treat people. And that's the radical overhaul that we need to move to. We need to move to this shift in asking people how they function. Asking people what is most important to them and looking at their disability. So, if you now reset those goals and you ask people where are you going to land, it does not mean that pain medications and opioids can't be part of that solution. It means we start to prioritize how we get to that end goal of better functioning, less disability, and ultimately potentially as well a reduction in that pain over time. And some pain will reduce over time. Not all of it will go away and that's something that you know a lot of people need to understand.

AMT: So, what's wrong with how pain is generally being treated?

HANCE CLARKE: And you know you hear it all the time. So we always want to ask numbers you know what's what's your pain today is it nine out of 10. Is it eight out of 10 is a 10 out of 10. Well let's face it, it could be nine out of 10 and eight out of 10 today and it could be that way in 15 years. And really and truly that's a severe case. But it could be four out of 10 today and four out of 10 in 10 years and you could be functioning completely differently in 10 years without this focus on take this medication reduce my number. Here is the program here's how we holistically look at you. Here's how we take care of your psychological health. Here are some of the other you know non opioid pharmacological management techniques that we can utilize. If you know you mentioned those opioid guidelines that were released about a week ago. There's a huge focus on that and there's a focus on this multi-disciplinary concept and programs to do this but it's missing the A to B. So yes you've got people on opioids and yes you need to potentially wean them and take them off, but you're starting to hear terms like de-stabilising your patients where in medicine do I ever hear that I should de-stabilize my patient. If someone is functioning and doing well on a medication why should I do that to someone?

AMT: OK so let's go back to that where's your pain, and that number scale, because you don't do that.

HANCE CLARKE: No I almost never ask anybody their number.

AMT: And how radical is that?

HANCE CLARKE: We've built an entire pain treatment algorithm on reducing intensity. You know RCTs and all of our clinical trials are based on this 30 percent reduction in pain. It's very radical. We're being judged on how have you decrease that patient’s pain intensity, not what are you doing today? So in the next three months if your pain is the same number but now you're attending social gatherings or you're cooking a meal for your family, these are things that there was no value in. And now we have to bring that back as the central core to managing people as we move forward.

AMT: So am I understanding? It's not about reducing pain to a number. It's about getting people to function with their pain. And you're talking about reclaiming your life.

HANCE CLARKE: You got it. You hit it on the head. Functioning better, better quality of life, less disability in terms of how much I am doing. And the patients actually hear it all the time. And I know that when I engage with some of the patients support groups etc., they say well, I want my life back but what does that mean? Well, we need to start putting those goals at the forefront in those initial discussions regardless of whether we're going down the prescription road or whether we're going down the alternative health road. But understand what are those goals and what are the tangible goals? Because just getting your life back is a big concept. You know being able to do two or three meaningful things over the next three or four weeks that's an attainable target.

AMT: But what happens to the pain, It stays?

HANCE CLARKE: Well this is another concept so you know, I see people eight years into this journey Anna Maria and they are coming into my office and say, Dr.Clarke, I've waited a year and a half just to see you and I say that's interesting. And what would you like? Well, Doc, I want this pain gone. And unfortunately, what my first comment is to this patient is, well, unfortunately you might want to get up and leave right now. Because what makes me so much smarter than the other 10 physicians that you've seen in the past eight years to think that I'm the person going to take your pain away. And then there's a lot of tears that are shed. But then we can start and move from that aha moment of OK yeah, maybe this is going to be part of my life moving forward. And how are we actually going to get to the place where I can manage, it live with it, and move forward.

AMT: So, what happens at your clinic? What kind of treatment what a patient encounter?

HANCE CLARKE: So, it depends what we're talking about so our program was really built for those individuals who could develop a pain problem that doesn't go away especially immediately after surgery. So there's a huge population. You know depending on your surgical subtype of course that comes in. They don't have any pain they have an intervention and they go on to have this persistent pain and they don't realize this pain could be there for a long period of time and potentially lifelong. And you know we move this away from the just your pain going away, to how are we going to help you cope. How are we going to help you manage. The other part of the program now has become this opioid weaning piece where people will come into us ready to say OK, you know I've been ramped up to X number of doses and I want help to get down and so we've built an entire program around a psychological intervention, and I have a mentor who is [unintelligible] and our clinical psychologist Dr. Lisa Weinreb and these folks have created this program where we actually support that opioid weaning piece. So if you want to get from A to B, you’re going to have to go through some withdrawal, you’re have to go going through some of these things. And how do you keep centered and focused on accepting that this is part of that journey and getting there. We can't just expect physicians to de-prescribe people and have people actually follow that path. Similarly we can't expect people to cope and function with their pain without understanding what those important things are in their life, to keep them focused on these things.

AMT: What other kind of disciplines do you introduce?

HANCE CLARKE: So, you know, within our clinic we have an acupuncture program, we have a physiotherapist, we are now building in a yoga program that we're going to be doing some research in. And the key here is you know everyone says you need these programs. You need these multidisciplinary programs. And if you can't wean your patient go find one. Well there are these programs you know throughout the country. Not many of them. And when you look at the date in terms of how long it takes to access these programs it's an issue. But we have the opportunity in our program to build the evidence we're researchers we can actually show you that roadmap of how you get from A to B and that's the important piece here. So we don't just send people into programs we better know what that roadmap looks like when they get there, to help them manage their pain and to help them wean from their opioids.

AMT: We spoke to one of your patients. Norman layman he struggled with opioid addiction after surgery for pancreatic cancer. Let's listen to him.

SOUNDCLIP

A large part of pain is psychological. A large part of pain is fear of pain and anticipation of pain. So I actually believed myself to be a much higher level of pain than I actually was. And so you react to that fear into that sense of if I don't keep taking these pills I'm going to die. So it's that fear of imminent death. I actually go to the state where I started to believe that the pain itself was going to kill me.

AMT: Hans Clark how much is pain psychological and how much is it physical?

HANCE CLARKE: So very important question. And so, pain is not in someone's head, and that is quite often what people are afraid of when we start to talk about the psychological aspects of pain. And you know we know that the science world has always been focused on this bottom up approach. So, how do we stop the pain from getting to the brain. And if we can do that we can kind of eliminate pain in general, but we know there is so much more to that. It's that subjective experience how we put those thoughts together and what we get back to the patient, but we know that a lot of that what's happening in our brain and in our psyche can be manipulated and modulated by simple techniques. Such as calming the nervous system and so, it's you know, we just came back from The Canadian Pain Society meeting last week. There are several symposiums lots of talking about the opioid issue. Lots of talking about how we go about treating some of these patients, and this concept of just calming your nervous system is probably at the heart of how you shift from moving and focusing solely on the pain to functioning. If you can calm that nervous system you can actually take down that issue in just simple things like breathing that can actually have a modulatory effect on how you experience your pain.

AMT: And so you see a lot of people on opioids. Do you get some people right off?

HANCE CLARKE: Absolutely.

AMT: What percentage?

HANCE CLARKE: So it's a great question. So, we've seen about 450 patients in the last couple of years since we started this program in 2014. The most insightful number Anna Maria is, if you walk into the hospital and have an intervention, and this is ubiquitous to any hospital across the country, your likelihood of being on an opiate is somewhere between 8 to 15 percent. At our hospital in General Hospital it's twelve point five percent. So you take all of the individuals that have come to our program and these are the higher risk patients. We don't see everybody, clearly what we do we do well. Eighty five percent of the people who walk through the hospital do fantastically well. There is a subpopulation that I argue potentially do harm to. We increase these folks in terms of their opioid doses we send them out the door and we have no roadmap to get them back to where they were. And so we have a number that one in five, so 20 percent, of individuals that walked into our institution on an opioid are no longer on an opioid, as a consequence of being in our program. And that simply states to the fact that you start to have these discussions with people and all my pain it was nine out of 10 in 1999 and it's nine out of 10 in 2017. Well something's got to give maybe this medication isn't that. But it also speaks to the fact that it is important for some people and there is a huge number of patients now at risk if these opioid guidelines start to become dogma and start to become standard of practice. And I will give our government credit that we haven't gone there and hopefully our regulators don't go there because we're going to have a big problem if you think our death toll is high now wait for the next three years if this becomes standard.

AMT: So you don't want to see them banned but you want to see them used better and people can get weaned off them. But how do you get them weaned off? They come to see you. You think they're a candidate to get them off. What do you do?

HANCE CLARKE: So first of all, you have to ensure that they’re somebody appropriate to be weaned off. OK. Have the side effect profile, has the risk profile, now superseded the therapeutic benefit. If they're having the therapeutic benefit and they're functioning well in their life, they absolutely should continue on their medications and they should continue to function as they are. Typically we get those that have been let's say now on 1500ml equivalence of oral morphine. It sounds like it’s a lot, but it's out there and many patients are like that. And so how do you get that subpopulation down. And these are the patients that are at very big risk right now. And so what we do is we engage with them, and this is not a small process and so you know, the primary care docs I sympathize with them because they say OK guys we've got this epidemic. How do you help us with this scenario? I don't have 45 minutes to deal with my patients. I have 10. I have five. And this is a long term process. First you have to get somebody to that state of change where they have the insight that maybe there's something different maybe there's another way to do this, and then you get them engaged with the psychology piece.You get them moving with the physiotherapy piece, and you continue to support them as they head down this road until they hit a specific plateau. We just published a paper in the Journal of pain research about three weeks ago, Anna Maria. This paper had over 2000 views and 300 downloads in the first three weeks that people are starved for this information in terms of how you actually help wean these patients off there.

AMT: We heard Paul Ross at the beginning there, and he's one of the people you helped get off opioids, and we heard him talking about suddenly realizing he's like off this. He's not thinking about his pain or his addiction. He'd been addicted to hydromorphone until he came to you. This is him talking about his experience with one doctor who is treating him before he entered the program and he starts by telling us what his doctor told him.

SOUNDCLIP

This is one of our junkies. He is here just because he need a fix. I said, I beg your pardon? That’s all you do. That's the reason why nothing sticks with you because you're a junkie you're on hydromorphone you're hooked on it. And I, at that stage, lost it. I said lady, why don't you look in your file and see who the idiot was who prescribed this junky medicine. Why don't you look? Because I'm sure you haven't, because if you had you would be embarrassed to say that, because it was her.

AMT: Do you hear this from patients about their opioid addiction?

HANCE CLARKE: You know Paul is a fantastic individual that he's come a long way, in terms of where he is. He has that anger part to him because he spent a long time trying to figure out how the road off of this. It was a very complicated story. He’s a gentleman with inflammatory bowel disease etc. that had a very long road. There are many that don't feel as strongly as him about their opioid but yet are still struggling. And I think it's figuring out those individuals that clearly, like I said before, aren't getting that therapeutic benefit, and identifying who those people are that are appropriate to wean and who aren't. And let's be clear, when we talk about weaning there are those we wean off entirely and those that we do opioid agonist treatment. And you know that is one of the hallmarks of where the province is going in terms of funding the opiate agonist treatment, Suboxone in particular, with respect to moving people on to medications that can clearly have a better safety profile and take away some of those cravings etc.. So we do a bit of both.

AMT: And we were just talking about these new guidelines for how doctors should prescribe opioids and in part they say they should be prescribed less. Doctors should try to wean patients off. I've got another clip here. This is Kristen MacFarlin. She was in a head on collision with an 18 wheeler. She has relied on morphine for years to manage her pain and she's upset at these new guidelines.

SOUNDCLIP

I had screaming one sided migraines all the time. So I really could not function. If they take [unintelligible] away from someone like me, when I think back to what I went through, if I go back to those days, people like me we're going to be looking for relief. I'm afraid that I won't be able to work. I'm afraid I'll be back on the couch and my life will be taken away from me literally taken away from me.

AMT: You must have heard this before, this fear. How do you how do you deal with patients who have those fears.

HANCE CLARKE: It's not fear, it's real. Thank you for putting that voice on the radio this morning . You know this is the voice that really needs to start to be a little louder over the next 12 months. You know I see patients in front of me in tears. Their physician started them on their opioid 10 years ago. They're functioning just fine. An adjuster for an insurance company she has three children at home. She lives with her husband. She's now on a dose that's probably over that safe 90 milligrams maybe about 140 milligrams. She walked into her primary care physician who said you know what you're now an addict. Nothing I can do for you here is your last script and you have 30 days to find a new prescriber. She has 30 days to save her life. Right. She has 30 days to find that other prescriber or end up in an acute withdrawal type scenario. And so this is the culture that we are battling, at the same time that we're dealing with trying to solve this crisis. And so when you look at the most recent data, about a week ago by Dr. Pamela Leach in The Health Quality Ontario where we're prescribing nine million prescriptions is 1.9 million Ontarians who filled an opioid, and we’re changing guidelines and policies on 700 deaths. So now let's think about what that addiction profile might look like. For someone with an opioid misuse disorder we're looking at about 10 percent let's say, and you know we've come a long way as a pain community say opioid misuse exists in the pain world. We need to better identify, we need to help these folks. Now what if we don't, Anna Maria? and that 10 percent represents 10 percent of 1.9 million that's almost 200000 Ontarians, that potentially have this issue. And because we have this reticence of opioid prescribing they're actually doing OK right now. You close that pipeline. Make this a standard have docs do, out of fear, what they think because you know we're in this, we're all in this together. Let's solve it together. And that's everybody. That's government, that's industry, that's everybody. Let's solve it together. But where we're going to end up is that 10 percent… if you think 700 deaths are a lot within the next three to five years, those deaths will double and triple just take a look at BC.

AMT: Because?

HANCE CLARKE: Because if you restrict the pipeline for someone and you cause fear in the prescribing community, what happened in BC is clear.

AMT: They’ll go outside.

HANCE CLARKE: And what happened in BC is clear. The docs said: Well, whoa, this is now a standard of practice. I haven't been given any tools to get there and I'm going to now be called incompetent or not practicing as a guideline.

AMT: Let me just go back to the fact, you get people off opioids. I want to go back to the whole idea of pain because what you're saying is people who have chronic intense pain they're never going to get rid of their pain completely.

HANCE CLARKE: Some will not. Some will. This is a lifelong condition it's like any lifelong condition chronic pain can become a disease. There is the acute pain and when it becomes chronic, it is a disease. Absolutely.

AMT: So when people say they want their life back, do they get their life back? Or do they get a different kind of life that allows them to move forward?

HANCE CLARKE: They will never get their life back from 30 years ago. They get a different kind of life that allows them to move forward. Better psychological health and the ability to think clearly to actually function and move forward to do more important things that matter to them.

AMT: And so if they're going to be off opioids, what do they do about that pain? Because the pain is not going to go away, you talked about acupuncture you talked about... Tell me just a little bit more about the other disciplines that you bring into the field.

HANCE CLARKE: Sure. So you know to be clear, there are people that will continue to be on the opioids. We're talking about a percentage of people that will not. OK. And in any subpopulation of patients that you will take off and function better, they will then use their mindfulness techniques. They will use their psychological coping techniques. They will use yoga. They will use exercise. They will use Aqua fitness. They will use acupuncture, whatever it is that brings that calming of their nervous system, that allows them to center inwards, that allows them to focus on staying the course to do what is important to them. And this is where we have to move to as a culture of self management. We can't prescribe these things away. We need to enable and empower our patients to function. Yes with a prescription. And yes within themselves and to help them function. We've now got a mobile app that we have our patients use, so that when they sit down with me they have their multiple entries. We put up on the computer, we take a look at this and look at how they're functioning, look at how they're improving, and say well you know I know you're telling me your pain is actually the same but now I have a snapshot of all of these points you've given me at 2:00 a.m. in your bed, at 3:00 p.m. on your couch, where this is what you were saying. And yes when I see you in a six week window it looks like it's the same. But let's start to dig in a little deeper in terms of where these things go.

AMT: You want to see a national pain strategy. What would that be?

HANCE CLARKE: Well, first of all a national pain strategy needs to be developed by people who treat pain patients. And unfortunately what has happened to date is many of these guidelines etc. seem to want to exclude the people who have the most insight. And so I think that's where we need to start. People who practice and treat pain, people who understand these people on a daily basis need to create that strategy. And then that's where we need to partner. So you know, this is not new, the U.S. has done this a few years ago, Anna Maria. They brought government stakeholders, patient engagement groups, physicians, industry partners. You need billions of dollars to fix our pain issues, fix our opioid issues, fix our systemic issues. We spend $60 billion a year on pain. So 20 percent of the population is $60 billion. Illicit substance use is 1.7 percent and eight billion dollars. So let's get all of these people together and let's come up with that strategy to take our patients safely with non-pharmacological management and self-management hands.

AMT: Hance Clarke, It's really good to have you in here to talk about this. Thank you.

HANCE CLARKE: It's been an absolute pleasure, Anna Maria.

AMT: Dr. Hance Clarke director of pain services at Toronto General Hospital. Director of the Transitional
Pain Program. He's with me in our Toronto studio. Let us know what you think. We're at the current CBC on Twitter. Find us on Facebook. Go to the web site cbc.ca/thecurrent. That's our program for today stay with Radio 1 for q acclaimed humorist David Sedaris is publishing his diaries and he'll tell Tom Power why writing in his diary is one of the first things he does every day. A reminder you can take the current with you on the CBC Radio app free from the App Store or Google Play. Earlier we were talking about the sometimes fraught art of the handshake and how it plays out on the global stage. So we'll leave you with one last little giggle on the handshake. We've got Jerry Seinfeld. Here he is. I'm Anna Maria Tremonti. Thank you for listening to the current.

SOUNDCLIP

And handshakes is the worst. There is absolutely no guidelines for handshakes. You run into have people too strong, too weak, sometimes they give you the three quarter handshake, just the fingers. Early release, late release. Sometimes, people won’t dispute. You release, you let go. They're hanging on. I have actually said to people, hey the handshake is over. Too many [unintelligible] coming in too high, too sweaty, from too far away. Sometimes a guy will give you a strong grip leg release and pull you for the too close conversation. To him I say that's three strikes, you’re out.

[Sound: Laughter]

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May 30, 2017 Full Episode Transcript

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