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The Current Transcript for June 1, 2018

Host: Anna Maria Tremonti

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Prologue

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U.S. Coast Guard detentions of drug smugglers 'violating international law,' and Canada may be complicit

ANNA MARIA TREMONTI: I'm Anna Maria Tremonti. This is The Current.

SOUNDCLIP

The haul is impressive though that it's setting the year to be a record breaking one. The demand for drugs in the U.S. is strong and the available resources being dedicated to fight it is growing.

AMT: In 2017 the U.S. Coast Guard set a record for the amount of drugs seized it's seen, nearly 223 tons of cocaine. For decades, American military and law enforcement have been pushing further into international waters in the Caribbean and the Pacific Ocean, sometimes thousands of kilometres from the U.S., looking for boats carrying drugs and detaining suspected smugglers on board. Even if there's no evidence they're bound for the United States. To that end in recent years the Americans have enlisted numerous allies including Canada to help. In November, the New York Times Magazine published a striking exposé that raised serious questions about the conditions under which these suspected smugglers are detained on Coast Guard cutters. The article was headlined The Coast Guard's Floating Guantanamo. Now the author of that story, Seth Freed Wessler, a New York based journalist with the Investigative Fund, has teamed up with the current Kristin Nelson to investigate what role Canada plays in intercepting drug smugglers at sea. Hearer's their documentary The Catch.

SOUNDCLIP

NEWS CASTER: The coast guards today shown off tons of the illegal drugs that were seized at sea.

SETH FREED WESSLER: Six Years ago, the US government launched a campaign called Operation Martillo, Spanish for hammer. It was the latest iteration of the war on drugs and it meant pushing further and further into international waters.

VOICE 1: People are really appreciating the work you're doing on stopping drugs pouring into this country and we are behind you all the way.

SETH FREED WESSLER: Under Martillo, United States has made agreements with more than a dozen countries to expand this counter narcotics effort. These countries share law enforcement intelligence, allow the use of their ports or provide ships and airplanes.

VOICE 2: The crew of the Coast Guard cutter Legare worked alongside the Canadian navy in an operation of the waters off Mexico Central and South America.

KRISTIN NELSON: Since 2010, as part of a program called Operation Caribe, Canada has allowed U.S. Coast Guard teams to ride on Canadian vessels.

VOICE 4: And this was no small find, we are talking about thirty six thousand pounds of pure cocaine...

KRISTIN NELSON: After every deployment the drugs were delivered to land. Often U.S. Coast Guard crews line up for photo ops, and the narrative: celebratory.

VOICE 5: In all 17 drug smuggling vessels were stopped ever-loving smugglers were detained.

KRISTIN NELSON: But what the reports tend to leave out who these people are, these alleged drug smugglers and how they're being treated in international waters.

SETH FREED WESSLER: In November I wrote a report for the New York Times Magazine exposing alleged mistreatment of suspected smugglers detained on Coast Guard Cutters. Detainees were held for weeks on board ships, sometimes for months. Two dozen men described being shackled all day by their ankles to the decks of ships. In letters from prison, some detail what they experienced.

KRISTIN NELSON: They wrote in Spanish. And these are actors voicing their words in translation.

DETAINEE 1: We were chained to the floor and exposed to the sun, rain and sea water. We couldn't sleep because we were cold.

SETH FREED WESSLER: They slept on the deck floor or hard rubber mats.

DETAINEE 2: And with each bus and their worries grew because they know what will happen to us.

KRISTIN NELSON: Many say they were fed only small portions of rice and beans. Some lost five, 10, even 15 kilos.

DETAINEE 2: We felt scared in this period, waiting for them to drop us off onshore.

SETH FREED WESSLER: They weren't told where they were being taken nor allowed to contact their families or consulates.

DETAINEE 3: We were unable to ask anyone for help to get us out of that hell.

KRISTIN NELSON: Given Canada's cooperation with the U.S. Coast Guard, these stories raised some serious questions; were Canadian officials aware of these allegations, and if so what's the significance of that?

SETH FREED WESSLER: We began to call through a U.S. federal court cases for evidence of Canadian involvement. In the troves of these records, we identified thirty eight alleged or convicted smugglers locked up in the US whose court papers mention a Canadian ship being involved in their interception.

KRISTIN NELSON: We wrote dozens of these men asking what happened to them and what role Canadians played. Seven of them replied with letters or calls from prison.

[Sound: GPS directions]

KRISTIN NELSON: Seth and I are driving through northwestern Florida on our way to meet a man who pleaded guilty to smuggling cocaine, and who is now waiting to be sentenced.

KRISTIN NELSON: Alvia is short and stocky with closely cropped dark hair and a thin mustache. He's wearing an oversized prison jumpsuit with the word 'inmate' on the back.

SETH FREED WESSLER: He's from Ecuador and he tells his story when he repeats again, a few days later, when he calls from the jail he says he's a fisherman.

OSCAR ALVIA ACHUNDIA: Sometimes you make some money with fish and sometimes you make nothing and you have needs. You go hungry because of that sometimes. And that is why I made a mistake.

SETH FREED WESSLER: Alvia is from the small village of Anconcito on Ecuador southern coast. He says he's been fishing since he was about 11 years old, never went to school, can't read or write and has always been poor. And he says he was worried he wouldn't be able to support his wife and their three children.

KRISTIN NELSON: One day last October after a night of fishing he says a stranger approached him.

OSCAR ALVIA ACHUNDIA: This guy is asking around which of us, fishermen, would be interested in a side job. I was desperate because I needed money. He said, it was to take a trip, 'una vuelta' as equadorians call it.

SETH FREED WESSLER: He told him it would be easy. For 2500 dollars upfront and more cash upon delivery of yet and two other recruits would smuggle cocaine in a small speed boat from Ecuador to a designated cornet point off Central America. Alvia barely part twice before accepting.

KRISTIN NELSON: They traveled more than 2000 kilometres north before arriving at the drop off point.

SETH FREED WESSLER: They waited for a boat to hand off the drugs.

OSCAR ALVIA ACHUNDIA: We called out to them and we heard some sounds, some sounds we heard then we thought they were the people who were to receive us and we started to make signs with our lanterns, flashing our flashlights.

KRISTIN NELSON: The night sky was dark. The wind was strong and the sea choppy. A blinding light illuminated their boat. Alvia realized the approaching vessel was not the other smuggling boat. It was like enforcement. A Canadian naval vessel was on a counter narcotics patrol nearby. American officials contacted it to intercept the speedboat.

OSCAR ALVIA ACHUNDIA: Yes we stayed on our boat from 2 p.m. until 9. It was raining. We were where in a little boat.

SETH FREED WESSLER: Alvia couldn't see anything. He could only hear the molder of a boat approaching and he heard voices commands not to move. Then officers boarded the smuggling boat and discovered cocaine. The Coast Guard says 478 kilos of it.

KRISTIN NELSON: Several hours later a storm was rolling in. The officers ordered the three men into a small Canadian patrol boat. They were then delivered to a 55 metre vessel; Her Majesty's Canadian ship Nanaimo. Alvia says conditions were quite good on the Canadian vessel.

OSCAR ALVIA ACHUNDIA: They took us into their ship. We remained there for only one day. They treated us well, they let us walk around. They gave us good food. They gave us some cover so we couldn't get wet.

KRISTIN NELSON: Though it was a Canadian ship, the team detainee now the air was American as part of Operation Caribe, U.S. Coast Guard law enforcement teams groups of about eight or 10 officials ride aboard Canadian ships.

SETH FREED WESSLER: Officially, Alvia was an American detainee. A day later an officer ordered of you and the others back onto the patrol boat in the distance he could see another large military ship. They sped toward it. It was a U.S. Coast Guard cutter a 64 metre long ship called the vigorous.

KRISTIN NELSON: After he was loaded onto that vessel. Alvia says things took a sharp turn for the worse. .

OSCAR ALVIA ACHUNDIA: They put it on the cuffs on us, chained us up. Our fear was to remain chained up.

SETH FREED WESSLER: Court documents show that he was held at sea for 17 days. He recalls being chained to pegs and cables on the decks of three Coast Guard cutters. On two of these boats, he and other suspects, picked up by the Coast Guards, slept outside shackled by their ankles to a cable.

OSCAR ALVIA ACHUNDIA: When it rained we were all soaked up. Do you understand?

KRISTIN NELSON: Alvia told us that the Coast Guard vessels the bathroom was just a plastic bucket and a hose to wash it out.

KRISTIN NELSON: No one told him where he was going nor was he allowed to contact his consulate, a lawyer or his family.

OSCAR ALVIA ACHUNDIA: Our fear was that all of us would die.

KRISTIN NELSON: Oscar Alvia's story is not unique.

SETH FREED WESSLER: We've heard from seven men who report experiencing similar really abusive conditions on U.S. Coast Guard boats, after they were stopped in international waters, with the help of Canadian Forces.

ALFREDO HERRERA VILARREAL: We were taken aboard an American Coast Guard vessel and placed [unintelligible] on deck and shackled to each other by the feet.

SETH FREED WESSLER: This is a translation of a letter we received from a 61 year old man from Cartagena Colombia. Alfredo Herrera Villarreal was chained on the decks of a series of American cutters in 2015.

SETH FREED WESSLER: There on the deck. We were exposed to rain, sun, for over 40 days.

KRISTIN NELSON: The 40 days that he and seven others were shackled onboard constituted the longest maritime detention of all the cases we found involving Canadian ships. And the conditions they experienced when they were on the U.S. Coast Guard cutters are consistent with other reports.

ALFREDO HERRERA VILARREAL: When we defecated we had to do it on top of other feces. Every two or three days the buckets were dumped out in the sea. He was simply inhumane. Even a phone call to our families was denied. To this day have nightmares because of the experience I went through on those boats.

SETH FREED WESSLER: Hoover Portocarrero and Willintong Ramirez, both Colombians, were captured together in 2017 in the Pacific by a U.S. Coast Guard team riding on a Canadian Navy ship.

KRISTIN NELSON: The men say they remained on their smuggling boat for two days as they were told by the Canadian ship.

HOOVER PORTOCARRERO: We asked them why do they take us with them to the big ship as the sun was scorching the nights were freezing but they say they are Canadians and they did not have the authority to do that.

SETH FREED WESSLER: They waited until a U.S. boat called the Mohawk arrived and they were loaded onboard.

HOOVER PORTOCARRERO: We would sit, the three of us, right on the deck of the ship be not been in. There was a tropical storm. We have to stand because the floor will get wet all the while chained by one foot.

WELLINTONG RAMIREZ: That's how I spent 19 days I thought not even a duck will be treated like that.

HOOVER PORTOCARRERO: The food was very, just a lump of rice and beans served cold three times a day.

WELLINTONG RAMIREZ: The worst was when you had to do your body's needs and you had to joining your pain in front of anybody who was around.

HOOVER PORTOCARRERO: We were always shackled to chore the rainy night with which sheets. We could not sleep at all under those conditions.

KRISTIN NELSON: The men were eventually delivered to Guantanamo Bay and quickly put on a plane to Florida. Only when they arrived on land nearly three weeks after they were first detained, did Portocarrero and Ramirez learned that they would be facing charges in the U.S.

CYNTHIA BOYD: Cynthia Boyd, I am a forensic neuro psychologist and practice in San Diego.

SETH FREED WESSLER: On a trip to California in April I met with Dr. Cynthia Boyd. The last three years she's been asked by defense attorneys to evaluate the mental health of more than half a dozen men who were detained by the Coast Guard. She still can't shake the memory of the first detainee she spoke with in 2015.

CYNTHIA BOYD: Well he was arrested for importing drugs. The mental illness that he then sustained was really from his capture, his arrest and his subsequent incarceration.

KRISTIN NELSON: This man Winston Valdez is from Ecuador. He gave Boyd permission to speak with us about his experience. His case did not involve Canadians but closely echo the experiences of detainees captured with Canadian involvement.

CYNTHIA BOYD: So Mr. Valdez and the other fishermen were taken aboard a Coast Guard vessel and they were on board this vessel and various vessels for twenty seven days. They were held under inhumane conditions. I confirmed the conditions by the photographs that I receive from the attorney and these photographs showed ankle chains and the vessels stack. He told me that there were several times when he thought he would die. He wondered if they would kill him aboard the ship. He's had several flashbacks of events and the ship he made attempts to put on a brave face but in my opinion one cannot under estimate the emotional effects of this ordeal on him or the other detainees. He was subjected to circumstances that led to utter helplessness and the complete loss of personal control. Mr. Valdez and the other detainees sustained this trauma 24/7 for twenty seven days. I determined that Mr. Valdez suffered from post-traumatic stress disorder.

SETH FREED WESSLER: Before Boyd started taking these cases she worked as a contractor for the U.S. military. For 11 years she evaluated soldiers returning from wars in Afghanistan and Iraq. She understood that because they were coming from battlefields she had to anticipate trauma. But this was different. It took her by surprise.

CYNTHIA BOYD: I left the jail and I looked at the translator and I said this is unbelievable to me. I've never been with anyone like this before. Mr. Veldaz wasn't the perpetrator. He was arrested and he was detained but the perpetrator was the Coast Guard. And I couldn't get my head around it because I love the military but it was very very hard for me to understand and that service members would treat these detainees in this way, that there wasn't one human being on board in uniform that didn't have empathy.

COAST GUARD MEMBER: I think there's almost a code of silence amongst the individuals who are doing this mission and I think there is maybe a little bit of fear of retaliation from the commands about this, about speaking up, but I also feel that it's a blemish on our service.

KRISTIN NELSON: Those are the words of a Coast Guard member with years of experience. He's been on a number of drug interdiction missions and he spoke with us in April and the condition that we dont identify him.

SETH FREED WESSLER: To best protect his identity. We have had an actor read his exact words.

COAST GUARD MEMBER: You know I knew doing drug interdiction was always going to be a mission of the Coast Guard. I was under the impression when I joined that a drug interdiction case was an immediate transfer of the suspects to the shore for prosecution.

KRISTIN NELSON: But that's not what he witnessed. The Coast Guard member confirmed the allegations that we heard from detainees about protracted detentions, scant rations, the shackles and exposure to the elements.

COAST GUARD MEMBER: You can get rain and sea spray at the exact same time if the weather is bad enough. It's awful when we're out there. We are miserable and we're out there for our watchers. So imagine being out there for days on end.

SETH FREED WESSLER: The Coast Guard member agreed to speak with us despite the risk because he says something needs to change.

COAST GUARD MEMBER: The Coast Guard is an honorable service and we have some of the best people that I've ever met in my entire life working in it, with good intentions to stop drugs from coming to the streets and to save lives. And I think that were put in a compromising position due to government policy.

SETH FREED WESSLER: He told us that he dislikes having detainees on board something that we've heard from other Coast Guard officials before.

COAST GUARD MEMBER: We want these guys off the decks. We don't like seeing them in pain or hungry hurrying you know. We want them to be prosecuted but we also just want them to be treated like basic human beings. We really need to treat them within the confines of our law. They have a right to be seen in front of a federal magistrate in a quick amount of time and cannot think three weeks is doing that.

KRISTIN NELSON: We asked the Coast Guard to comment for this story. They did not respond.

SETH FREED WESSLER: But after my story in The New York Times Magazine The head of the Coast Guard was quoted on the website military.com saying that detainees are "peddling poison". These aren't just down on their luck fishermen. They have a choice. You can eat fish or you can be a criminal.

KRISTIN NELSON: He then added that the U.S. Coast Guard was considering leasing a commercial armed to detain suspects one that "might have better accommodations than we have on ships with light decks and helicopter hangers to at least get people out of the elements".

COAST GUARD MEMBER: As best intentioned as the Coast Guard is we are ill equipped to hold detainees on deck for the amount of time they were holding on to them. We don't have the space to properly hold them. I think the detainees are being given food to generally be comfortable for that prolonged amount of time, and I think that overall being shackled for weeks on end is inhumane.

KRISTIN NELSON: You're listening to a documentary produced in collaboration between CBC is the current and the Investigative Fund in New York.

ROBIN LOWE: When you're dragging someone down and then everyone on the verge has their night vision goggles on their eyes [unintelligible] scanning the horizon. It's very- it's really intense.

KRISTIN NELSON: Robin Lowe was deployed to the Pacific in 2016 aboard the HMCS Edmonton.

ROBIN LOWE: I am a Master Seaman naval communicator and the Royal Canadian Naval Reserve. My home unit is HMCS Unicorn in Saskatoon Saskatchewan.

KRISTIN NELSON: Lowe is 28 years old and has been in the Navy for nearly a decade. He says he's been part of interdictions in international waters.

ROBIN LOWE: It feels really kind of exhilarating because we're basically sneaking up on people.

SETH FREED WESSLER: Interdictions generally happen after nightfall he says.

ROBIN LOWE: And all the upper deck lighting is off. We're basically invisible.

SETH FREED WESSLER: They wait track the boat and eventually pursue it.

ROBIN LOWE: Once we're close enough were allowed to shine bright lights in their face so they can't really see anything and all they see is very light coming from like 10 feet in the air.

KRISTIN NELSON: Lowe is proud of Operation Caribe, Canada's contribution to the American led effort to stop drug trafficking; operation Martillo.

ROBIN LOWE: It has a big impact on the operation of the hall. We are making a big difference to what's on the streets in Canada and America even.

KRISTIN NELSON: As far as you know how are the detainees treated on the Coast Guard boats?

ROBIN LOWE: Honestly I couldn't tell you. I have never seen it personally so I can't tell. We wouldn't really see how they interact with sea detainees, but I imagine they are very professional in what they do.

KRISTIN NELSON: Robin Lowe may not have known about the conditions under which the Coast Guard was holding detainees when he was deployed in 2016, but senior ranking members of the Canadian Armed Forces have known since at least the end of 2017.

SETH FREED WESSLER: We've learned that after my report on detainee abuse appeared last November. Senior military officials in the Canadian forces began communicating with each other about allegations of mistreatment of detainees by the Coast Guard.

KRISTIN NELSON: We've seen internal communications that show Canadian officials, up to the level of brigadier generals, were in touch about that article weeks after it was published. The communications mentioned an effort to look into the allegations and the question is raised about whether the allegations would affect Canada's forthcoming participation in operation Martillo. The communications also indicate that the Chief of Defence Staff and Deputy Minister were aware of the allegations.

SETH FREED WESSLER: Months after these concerns were raised at the highest levels the Canadian forces deployed again to assist the U.S. Coast Guard drug patrols. Court records show that four suspected traffickers were picked up with the assistance of the Canadian Forces during that deployment. They were held by the Coast Guard for three weeks before they were brought to a U.S. court.

KRISTIN NELSON: In response to our questions the Canadian Forces sent us a statement. In it they acknowledged they were aware of the allegations of mistreatment that had appeared in The New York Times and called them "of grave concern to us". It continues "although none of these claims pertain to Canada's participation in international anti-smuggling operations. We take those allegations extremely seriously".

SETH FREED WESSLER: The force has told us it quickly took several steps. "We reviewed warship logbook entries post deployment reports and significant incident report for any indications of wrongdoing in relation to all relevant Canadian Armed Forces operations. We conferred with their American counterparts and reconfirmed our respective roles and responsibilities and our expectations regarding the treatment of suspected drug smugglers".

KRISTIN NELSON: Having taken these steps. We are confident that no Canadian armed forces members participating in US carry you have witnessed or been involved in the mistreatment of suspected criminals, either on board Canadian vessels or those of our allies.

SETH FREED WESSLER: Since we began investigating this story. We've been trying to find out what rules and laws governing Canada's operations in support of the United States.

KRISTIN NELSON: At the beginning of the year. We started filing access to information request to the armed forces asking for any and all agreements memorandums of understanding and directives about Operation Caribe. Last week we received notification that our request for these agreements was denied pending consultation with the American government.

SETH FREED WESSLER: But in April we spoke with a Canadian who did obtain some of these documents.

SARAH PELOQUIN: My name is Sarah Peloquin you and I was born in Winnipeg Manitoba and I grew up there.

SETH FREED WESSLER: She moved to the United States to go to law school and has been practicing criminal defense for 11 years.

SARAH PELOQUIN: I am a federal public defender in the Southern District of California in San Diego. I represent individuals who are charged with federal criminal offenses who cant afford their own attorneys.

KRISTIN NELSON: Her office has handled dozens of boat cases some of them involving Canadian Forces. As a Canadian Sarah Peloquin wanted to know what Seth and I wanted to know.

SARAH PELOQUIN: I had questions about whether or not the Canadian government and the US Coast Guard were on the same page about the way they detainees would be treated, whether there was a consensus document or a policy about what the treatment would be.

SETH FREED WESSLER: Sarah Peloquin got back 80 pages from the Canadian Forces and 2016 which she shared with us.

SETH FREED WESSLER: [To Sarah] We will just read. This is S1...

SETH FREED WESSLER: Among the records is a directive issued by former chief of the Defence Staff Tom Lawson about how the forces should conduct itself under Operation Caribe.

KRISTIN NELSON: The 2015 directive is marked secret. It states that if Canadians ever detain someone they shall "act in strict compliance with Canada's domestic and international legal obligations".

SETH FREED WESSLER: And it outlines the rules under which a detainee can be transferred saying "detainees will not be transferred from Canadian Armed Forces care, custody or control without the express permission of the chief of a defense staff". And it goes on "to lay out something called the transfer test according to the document, any transfer of detainees requires of the chief of staff...

SARAH PELOQUIN: ...Be satisfied that there are no substantial grounds for believing that there exists a real risk that the detainees would be in danger of being subjected to torture or other forms of mistreatment at the hands of the authorities to whom they are transferred.

SETH FREED WESSLER: Forms of mistreatment. The language in the directive is clear.

KRISTIN NELSON: But the thing is the Canadian Forces asserted that none of these suspected smugglers are actually detained by Canadians. In an e-mail from February a public affairs officer wrote to us "The Canadian Armed Forces are not directly involved in law enforcement operations or the detention of vessels or persons. These detainees remain in the care custody and control of and are guarded by U.S. Coast Guard personnel".

SETH FREED WESSLER: We wanted to know what Canada's raw looks like at sea. We asked for ride along on both U.S. and Canadian ships. These were not arranged. Here's Robin Lowe again.

ROBIN LOWE: Once we get close then we send off our small boat with some other law enforcement detachment on board.

KRISTIN NELSON: He says during interdictions the Canadians will launch a small patrol boat which U.S. Coast Guard officials hop by and before they approach a suspect smuggling boat. Lowe says there are typically five people on board.

ROBIN LOWE: There is one Canadian [unintelligible]. They're the ones driving the boat and then the other four are American Coast Guard law enforcement that we have. So we switched the flag that's on the small boat to the American coast guard flag.

SETH FREED WESSLER: The Coast Guard is in control during the interdiction.

ROBIN LOWE: All that really happens from the Canadian side is you drive the b oat to the suspect boat and provide a platform for the one from law enforcement attachment to hop off and take control of the situation. They're really the ones that have all the authority and they're able to run the show.

SETH FREED WESSLER: Usually suspects are left on board their trafficking boat until an American Coast Guard ship can arrive on scene to collect them.

KRISTIN NELSON: Meanwhile the boats are often tethered to a Canadian vessel and dragged.

ROBIN LOWE: The detainees are on the small boat probably for hours at most. We give them water and we don't wear them sit there and burn.

KRISTIN NELSON: If the weather is bad or if there are concerns about the suspect's safety, the men may be brought aboard the Canadian ship. Lowe recalls one particular mission.

ROBIN LOWE: There is a point when there is a possibility that we were going to be bringing on detainees but then the American ship was close enough to take them. At that point we were considering setting up cots, giving them access to a toilet and providing a meal plan for them and making sure that they don't have any dietary restrictions or anything like that.

SETH FREED WESSLER: And those detainees were not brought on board. In that case we know what has happened.

KRISTIN NELSON: So even though detainees may be sitting on the decks of Canadian ships and provided food and shelter, as far as the forces are concerned they are not Canadian detainees.

MICHAEL BYERS: The United States is violating international law and Canada is doing so by complicities.

KRISTIN NELSON: Michael Byers is a professor of international politics and international law at University of British Columbia in Vancouver. He's been following Operation Caribe since its inception back in 2006. Here's how he describes what happens to alleged smugglers.

MICHAEL BYERS: There’s a fiction here that the suspects never actually cross into Canadian hands. Thats the fiction there. They’re detained by a U.S. officer, they’re arrested by a U.S. officer and fictionally they remain in the custody of the United States all the way through until then after they are transferred to a US vessel. Of course this has all happening on Canadian sovereign territory - A Canadian naval vessel is an extension of Canadian territory onto the high seas and that vessel can only be there because of the dozens or hundreds of Canadian Forces personnel who were operating the ship.

SETH FREED WESSLER: He says there are a range of treaties that set out the prohibition on cruel or inhumane treatment of detainees from the torture convention to the International Covenant on Civil and Political Rights. And the allegations of mistreatment may mean candidate is party of violating those treaties.

MICHAEL BYERS: Canada is providing a ship, a sovereign vessel, a Canadian Forces ship with Canadian personnel on board who are responsible to the Canadian government and ultimately to Canadian citizens and as part of that responsibility are bound by both Canadian and international law. And you know if we figured out a way to use those equipment and personnel to facilitate a US policy and the Unites States is then violating international rules, in using in Canada ships and personnel, we're complicit in that illegality. You can’t get round that.

SETH FREED WESSLER: Byers understand that the official position is that these maritime drug detainees are not in Canadian custody, but...

MICHAEL BYERS: We Sign up to treaties in order to promote human rights not to find loopholes and I would put the question to the Canadian Forces as to whether they want to be finding loopholes in laws that this country has led the creation of very proudly over the course of the last 70 years.

KRISTIN NELSON: Canada is good reason too sensitive about the treatment of detainees. It played a role, one that some say the country has not fully reckoned with in handing over Afghan suspects to authorities who later tortured the men. There have been numerous calls for an inquiry into the matter but in 2016 Justin Trudeau's government decided one was not needed. However last year the International Criminal Court made a formal request to investigate potential war crimes in Afghanistan committed by local and international forces. Some advocates have urged the court to consider candidates conduct.

SETH FREED WESSLER: Michael Byers one of the people who has called for the ICC to investigate whether Canada was complicit in alleged torture in Afghanistan. He believes there are parallels in this case. Now nobody is saying the Coast Guard is torturing detainees and no one is alleging war crimes. The war on drugs is not actually a war. But he says...

MICHAEL BYERS: The similarities are quite striking. First of all this is a mission in which Canada is partnering with the United States and the Canadian Forces are very keen to partner with the United States. But the other clear parallel is the use of legal fictions to somehow excuse Canada's behavior in Afghanistan the legal fiction was created that Canada would never formally detain people it came across on the field. If we came across someone who was suspect we would pretend that we hadn’t actually detained them until an American forces person our CIA agent came along and actually formally conducted the detention. So even though the person could not have been detained except for the presence of Canadian Forces personnel we fictionally didn’t actually detain them and therefore were fictionally didn't engage Canada's legal obligations. Again that argument is specious. It's laughable. But that's the argument that's put forward.

SETH FREED WESSLER: Now we know from those internal communications that Canadian brigadier generals raised a question; would the allegations of detainee mistreatment on American vessels in Canada's upcoming involvement in operation Martillo?

KRISTIN NELSON: When we first asked to speak with Canadian General Jonathan Vance the first instead set up an interview with the commander of the HMCS Whitehorse.

COMMANDER: Good morning, it's Lieutenant Commander Collin Forsberg.

KRISTIN NELSON: [To Commander] Hi how are you.

KRISTIN NELSON: The Whitehorse had just returned from Operation Caribe mission in eastern Pacific on May 3rd. We spoke to him on May 4th.

COMMANDER: Oh we got home yesterday afternoon. So it was actually a very successful deployment for Whitehorse. We had two drug busts. Our first was a disruption of approximately 875 kilograms. And our second was about an hour second was a seizure of fifteen hundred million pounds of cocaine. So it was a very good deployment for us.

SETH FREED WESSLER: There were also 20 suspected traffickers detained by the U.S. Coast Guard with the help of the Whitehorse according to a report on the Canadian Forces website. The first reiterated that it was the Coast Guard not the Royal Canadian Navy that had detained the suspects, and he told us he is proud of Canada's contribution to the American led counter narcotics mission.

COMMANDER: And I feel we have an excellent ongoing contribution to promote security within, not only in North America but also south and Central America to counter the efforts of the transnational criminal organizations.

KRISTIN NELSON: We asked Forsberg if he had heard about the alleged mistreatment of detainees held and Coast Guard vessels.

SETH FREED WESSLER: I have recorded in the past on concern about what happens to detainees after they are transferred to U.S. Coast Guard. Have you heard the confirmed allegations that people are held for a very very long period of time or shackled for weeks on and exposed to the elements when they're on these boats. Are these allegations [unintelligible] heard of that?

COMMANDER: I have heard of that but I've never seen that, and all I can say is, with a [unintelligible] saying that we have. So we stipulate that any personnel in the U.S. Coast Guard custody will be treated in a manner that is respectful to their lawful rights and human dignity in accordance with U.S. Coast Guard Policy and International law.

KRISTIN NELSON: So Commander Forsberg had heard of the allegations of mistreatment. We went back to the Canadian Armed Forces to ask again for an interview with Canada's top soldier General Jonathan Vance.

SETH FREED WESSLER: It was after this second request that the forces sent us their statement saying they found no indications of wrongdoing in relation to relevant Canadian Armed Forces operations.

KRISTIN NELSON: It went on to say "that said, there is no doubt that this is a matter that we take very seriously. We must and we will remain vigilant. In particular we will continue to review our operational practices and we will thoroughly investigate all credible allegations of Canadian Armed Forces involvement in mistreatment."

MICHAEL BYERS: Canada will apply high standards and will meet its international legal obligations in those unusual circumstances where Canadian personnel actually end up conduct a detention on their own. But if the U.S. is detaining someone these provisions don't apply and we look the other way.

SETH FREED WESSLER: UBC law professor Michael Byers says all of this raises deep questions about government accountability. He takes aim at Canada's top command.

MICHAEL BYERS: The leadership of the Canadian military is mandated to uphold the law. They are bound by both domestic and international law. And if the chief of the Defence Staff is knowingly allowing fundamental violations of human rights he should be fired. Now that's a really powerful thing to say. But these are really important rules and they go right to the core of decades of Canadian foreign policy. And again I have utmost respect for the abilities and the overall mandate and efforts of the Canadian Forces. My message to General Vance's 'you can do better. Please do better. You have to do better'.

DIONICO GARCIA: They tie a rope from our boat to the stern of their Canadian boat and they tow us for two and a half days.

KRISTIN NELSON: Dionico Garcia from prison.

DIONICO GARCIA: It started to rain very hard and the waves were very large and dangerous.

SETH FREED WESSLER: He was detained in March 2017 by a Coast Guard team riding aboard a Royal Canadian moving ship. Like many detainees he says he is a fisherman from a village in Ecuador. He has six children and he says he took the smuggling job because he was struggling to support his family.

KRISTIN NELSON: The Royal Canadian Navy had succeeded in helping its allies stalk first years boat from hitting land keeping its cargo- 660 kilos of cocaine - from reaching the streets.

DIONICO GARCIA: After two and a half day the Canadians handed us to an American ship.

SETH FREED WESSLER: He was taken to Florida where he was recently convicted and sentenced to seven years in federal prison. Garcia find it confounding he was prosecuted in the United States given that he was picked up so far from American territory. But mostly he struggles to comprehend how he was treated on board the U.S. Coast Guard boats.

DIONICO GARCIA: I remembered that my two companions and I were very happy to be transferred to the U.S. Coast Guard. We had heard back in our country that the United State is the land of the free and the most respectful country in the world. But what we did not know was that we were about to leave the most horrible experience of our lives.

AMT: We have been listening to The Catch. It was produced by The Current’s Kristin Nelson and the Investigative Fund's Seth Freed Wessler based in New York. As part of this collaboration the editors on this project were Esther Kaplan from the investigative fund and The Current documentary editor Joan Webber. We would like to thank the following Vancouver actors for their help voicing over the words of the following individuals. The views of the unnamed Coast Guard were voiced by Patrick Sabongui. The men convicted of drug smuggling all spoke or wrote to us in Spanish... so we asked the following actors to read the English translations. Gustavo Febres voiced Oscar Manuel Alvia Anchundia's words. Rodolfo Funes spoke for Alfredo Herrera Villarreal. Steffan Chavarria did the same for Willintong Ramirez. Omar Gallegos voiced Hoover Portcarrera Ruiz's words. And in Ottawa, David Villarroel repeated in English what we were told by Dionico Garcia. Let us know what you think of this report and the concerns over what Canadian officials knew. Tweet us @TheCurrentCBC. Find us on Facebook. Go to our website cbc.ca/thecurrent.

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'I would have been very thankful' to skip chemo, breast cancer survivor says after new study's findings

Guests: Dr.Steven Katz, Dory Kashin, Dr. Kathy Pritchard

AMT: I'm Anna Maria Tremonti and you're listening to The Current. For any woman a diagnosis of breast cancer brings with it all sorts of fears. And unfortunately something women fear very much about facing the disease is part of the cure. For decades chemotherapy has been considered a critical weapon in the fight against breast cancer and it's remission. But chemo has always also been a punishing treatment to endure. There are the well-known side effects of hair loss and nausea and it can be a miserable and an exhausting process that comes with long term risks as well. But a major new study of breast cancer patients may mean that many women facing a diagnosis in the future can look forward to a treatment that is chemo therapy free. The study, the largest breast cancer treatment trial ever conducted, suggested that 70 percent of women diagnosed with a common type of breast cancer could skip chemo. Dr. Kathy Pritchard is the Canadian share of this trial as the representative of the Canadian Cancer trials group. She is an oncologist and clinical trials research scientist at Sunnybrook Hospital in Toronto. She's guided the development of new breast cancer therapies for more than 25 years. And Dr. Kathy Pritchard joins us from her home in Toronto. Hi.

KATHY PRITCHARD: Hi Anna, how are you?

AMT: Well I'm curious to know what you know how significant is what you've found.

KATHY PRITCHARD: I think it's a very significant study. Can I put it in the context for who it is for and who it isn't for first?

AMT: Absolutely. Go ahead.

KATHY PRITCHARD: It is for women who have just been diagnosed with cancer not someone who's got widespread or [unintelligible] disease. And so it's early breast cancer, and all those patients diagnosed with early breast cancer, about 10 or 15 percent will have what's called triple negative disease which is very aggressive, about 10 or 15 percent will have a HER2 Positive disease which is now treated with receptor and other special drugs that are targeted towards that target and many of them will be ER positive which is the group that were looking at, and about half of those will be node negative. So we're looking at ER positive, no negative newly diagnosed breast cancers that are not really large, don't have positive nodes.

AMT: So when you see how positive nodes, it hasn't spread to the lymph nodes.

KATHY PRITCHARD: Has not spread to the lymph nodes.

AMT: Okay. And so you're saying that's a large number of women.

KATHY PRITCHARD: It is a large number of women. But I want to emphasize that breast cancer is a disease of subsets of smaller groups and this with the about 30 or 40 percent of early breast cancers. I think.

AMT: Give us a sense of the scale where the study. Almost 10,000 women?

KATHY PRITCHARD: There were over 11,000 women about 10000 words were randomized to this group. We divided the study into three groups. There were people with recurrence score- a gene recurrence 10 or less. And those patients were just treated with chemotherapy and did very very well. And then this report was the group between 10 and 26 and that is an intermediate score and it shows that they did just as well with endocrine therapy, hormonal therapy only as they did when we added chemotherapy.

AMT: Okay so because normally in the past those women would be getting chemo and so you followed them for what? Seven and a half years or so?

KATHY PRITCHARD: So we followed them for almost nine years in this study. Yes. Many of them would get chemotherapy. It was a group that we knew. Years Ago we didn't give them chemotherapy then we did give them all chemotherapy and now were falling somewhere between. So there's a group that we agonised a lot over whether to give chemotherapy or not. And now we know from this randomised trial that it didn't add- added only marginally if at all to the group overall.

AMT: Did you find any specific things about age?

KATHY PRITCHARD: Yes there is some suggestion that the very young patients need chemotherapy and this is still going to be a diagnosis we agonize over. It's still going to be you have to be decided between the patient and the doctors. Some suggestion that the younger women may benefit more now in the era when we did this which is - this trial was now planned over 15 years ago. You can imagine to get nine years of follow up a trial has to be old and so we were giving better and different service now than we were earlier.

AMT: The science keeps giving you more things to work with.

KATHY PRITCHARD: It may be that the younger women if we give them the optimal and different view that we now give, don't need the chemotherapy and we are going to do more analysis to see if that proves to be true.

AMT: When you say younger women are you talking women under 50 or women younger? Where's the divide? What’s the age difference?

KATHY PRITCHARD: Under 50s, women who are premenopausal which goes together roughly.

AMT: So women who are over 50 might still benefit from chemotherapy?

KATHY PRITCHARD: No it is the women under 50.

AMT: Okay.

KATHY PRITCHARD: Women over 50 with these scores, which are 11 to 26 in the essay probably should not get chemotherapy- do not need to get chemotherapy. Now there may be exceptions. Every woman has to discuss this with her doctor. Every patient has discussed this with her doctor. I Say woman, men get breast cancer and get this score. But there were no men in these trials. We now allow men into breast cancer trials which is much more sensible that many, only one in 100 of all diagnosis would be men. So we usually say very much about them. Women over 50, women who post-menopausal are probably not benefiting at all from the chemotherapy.

AMT: And so you talked about the agonising about whether to give it to someone or not. How many concerns have you had as an oncologist about how you move forward with that kind of treatment before you had this new information?

KATHY PRITCHARD: Well we had some clinical factors to go on; the size of the tumor and whether they had lymph nodes, the grading of the tumour, the level of the estrogen receptor, so we had something to go by but this is more definitive. It adds to the information we have. And it puts some women we would have thought were low risk into a more high risk group, and some women we thought were high risk into a more low risk group. So it doesn't always coincide with the clinical factors. We have the big randomised now that shows this. So I think we can go forward with more confidence.

AMT: So based on this study do you have an idea of how many women in cannabis should no longer have to be candidates for chemotherapy?

KATHY PRITCHARD: Were they're saying 300,000 in the U.S. a year. So we're usually about a tenth of that. And indeed we put about 10 percent of the patients into this study, over a thousand from Canada and so probably about 30,000 women. Now I think in Canada we've seen less- I don't know whether to say less conservative or more conservative but a little less likely to give chemotherapy than in the U.S. It's just practice and so it may not be quite there but we've certainly been as I say agonizing after 10 years in chemotherapy to a lot of these women in the past.

AMT: Chemo patients deal with health effects for years. I'm just wondering what the implications would be if thousands fewer have to take it.

KATHY PRITCHARD: Well mostly it's unpleasant and it's risky even in the short term and many women have emergency room visits. Most women have emergency room visits when they go through this course of chemotherapy, some get very sick and get an infection. In the long term, I think that it is a very very low risk of leukemia our blood disorders. It is very low risk, less than a quarter percent, I think. And very very relatively low risk of cardiac damage long term/ but in the short term it's not a very pleasant time for women who have to have it. But if we don’t need it and it's not helping why should we be giving it. I want to stress ourselves that this is in the background of women getting adequate different treatment which is to mark [unintelligible] inhibitor, and those have their own sets of side effects and are taken over five years 10 years. So it's important to realise that if they don't get that treatment then that's not good either.

AMT: And you are again talking about early diagnosis.

KATHY PRITCHARD: Early diagnosis. These are smaller tumors with no posititve nodes. And that means they diagnosed early. We're seeing many more of these screening and awareness. I think the awareness has gone with the screening. Women will start about lumps now, they will go to their doctor and I think that's very very important.

AMT: Kathy Pritchard thanks for your time and your work.

KATHY PRITCHARD: Thank you very much for having me on, Anna.

AMT: Bye bye. That is Dr. Kathy Pritchard she's the Canadian chair of the trial that we're talking about as the representative of the Canadian Cancer trials group. She's an oncologist and a clinical trials research scientist at Sunnybrook Hospital in Toronto. And we just called her at home. Breast cancer diagnosis is terrifying enough and then you have to make a series of difficult decisions as she just talked about each doctor talking with patients. And those decisions come really fast. Each new piece of research such as the study released this weekend adds another wrinkle. Joining me now is a woman who knows firsthand what it's like to weigh the options with your life and future hanging in the balance. Dory Kashin was diagnosed with breast cancer when she was just 29 years old. She's with me in our studio. Hi Dory.

DORY KASHIN: Hi.

AMT: So what did they tell you when you were first diagnosed? What did you know?

DORY KASHIN: Well right away you don’t know too much about that. You don't know the grade and the type of tumor and all that until after surgery. So I think that's a misconception like right away I am asking like what stage am I? And Everybody is asking me that. I have no clue. So I felt the lump and then I got a biopsy and from the biopsy they were pretty certain that it was cancer. But like I said in terms of if it's spread or anything like that they won't know much of that until surgery.

AMT: And you were talking with your doctor and you started to discuss treatment.

DORY KASHIN: Yes. And so you meet with the surgeon almost instantly and they recommend you know in the course of action. From there you also meet with the radiation oncologist, your oncologist oncologist, fertility doctors, like everything happens pretty instantly. It is the oncologist in terms of chemotherapy who will decide that. A lot of it does have to do with the results of the surgery.

AMT: so where were you on the scale when they finally told you what you had?

DORY KASHIN: Yes. So after my surgery it didn't spread to my lymph nodes which was really great. So it was a stage one A. So that's a lower diagnosis, lower stage grade 3 tumour. So that means it was fast growing and I was diagnosed said 29. So obviously that's premenopausal young. So even those are low grade, low stage- or sorry I guess it was a higher grade and they did decide to do a chemotherapy and radiation.

AMT: And what else did you have done?

DORY KASHIN: So my surgery was a double mastectomy. I definitely had to get a mastectomy and chose to do a double mastectomy. And also I went through some fertility treatments and got implants and then Tamoxifen and Zoladex afterwards.

AMT: So were you given options on chemotherapy and radiation? Was that like a choice?

DORY KASHIN: Chemotherapy was it really a choice. No. At the time I thought it had to do you mainly with the grades so that it was fast growing and in my age. Radiation was more of an option since they had really good margins, which means they took out the whole tumour during surgery and since it did spread to my lymph nodes they were like on the fence about radiation but I chose to just do it, since I already went through everything at that point.

AMT: And you chose a double mastectomy because?

DORY KASHIN: So I definitely had to undergo mastectomy so no matter what my left breast was going to be removed. And to me it just felt like for the rest of my life to deal with you know one like this and one like that. And I just thought it would be better for both my breasts to go through the same thing. And mentally I thought it would be easier to deal with. And also there is still a chance of cancer returning perhaps in the second brass and the doctor even said, you'll deal in 10 years. I'm like I don't want to think about this ever again. So let's just deal with this now.

AMT: So you chose- And I'm saying chose because this stuff is flying at you so it's like you're making decisions and talking to doctors but it's coming fast right?

DORY KASHIN: Oh yeah. I was diagnosed January 15th, surgery February 10th and then chemotherapy March 10th and in that time also fertility decisions were made.

AMT: Because all of this throws you into early menopause. It affects fertility anyways.

DORY KASHIN: Chemotherapy just in general affects your eggs. So I'm told I have 80 percent chance of being able to conceive on my own but then it throws you into menopause is actually post therapy. So I've been taking Tamoxifen and Zoladex throws me into actual like menopause, or fake menopause because after you go off of them it's supposed to return.

AMT: And so then you have to have your conversations with the partner right away too.

DORY KASHIN: Exactly. So I was with my now husband, my boyfriend of just over two years at the time, so yeah it was really big decisions like the fertility staff is obviously my own decision. But you have to decide between preserving eggs versus embryos, and embryos have more of a chance of surviving. So essentially we had to discuss almost right away if we wanted to have babies together and have babies together are pretty much instantly. And so luckily it wasn't so hard of a decision for us but I can imagine it being very difficult for most people.

AMT: So you chose aggressive treatment or you got aggressive treatment yet. And so now you hear about the study that came out this week and that as chemotherapy may not be necessary for some, it may not actually be in your case. But what do you think when you hear a story like that? How do you react to that?

DORY KASHIN: I have mixed feelings. When I see stuff like that it kind of upsets me. Like I just went to all of that and maybe I didn't have to. Like the doctor saying like it's not a fun experience it's about four months of your life and then there are things that happen you know things that happen after. And it is not even as much physical, psychological. It's really bad psychologically like going through those chemotherapy treatments and you feel very isolated and all of that. So if there was an opportunity for me not to go through it I think at the time I would have been very thankful to not do it. Looking back I am happy I did everything- I feel like I did everything I could so. So if God forbid something happens I know I did everything I could. I won't be regretting like 'Oh I should have done chemotherapy. I made the wrong decision five years ago, 10 years ago'.

AMT: And you've been through so much. How's your health now?

DORY KASHIN: I'm doing really good. It's been just over two years now and things are getting back to normal. I still don’t feel 100 percent myself. But I am doing good.

AMT: And you're talking about it. You think we all need to talk about it.

DORY KASHIN: Yes. Ever since I was diagnosed I was very open with it right away. It was almost cathartic for me to talk about it but also it feels really good to you know inform other people. There isn't much around for women under 40, even under 30, being diagnosed and there are amazing resources out there right now that I got involved both right away. And I wanted to get back almost instantly. So talking has been kind of a part of my mind journey, let's just call it.

AMT: Do you feel you were supportive as you made those decisions? Were you supported medically to try to navigate that?

DORY KASHIN: Yes like I was very very lucky. I know it's not the case for everyone. I was treated at Princess Margaret and they have an extremely great program for a young adolescence. And right away I spoke to someone and they gave me resources to things like Rethink Breast Cancer and Pink Pearl Foundation. I got involved straightaway but it does depend on the person too. Like I had it in me like I need to get involved. I don't want to sit at home all day by myself. So I got involved with everything and I made tons of great friends and now I volunteer at both organisations.

AMT: And any side effects from chemo today?

DORY KASHIN: It's hard to say. I don’t think- I joke around that I still have brain fog when I forget things but I don’t think so. There is lots more side effects of surgery and all of that but its really hard to say but psychologically for sure.

AMT: Well thanks for coming in.

DORY KASHIN: Thanks so much for having me.

DORY KASHIN: That Is Dory Kashin, diagnosed with breast cancer when she was 29 years old. Shes with me in our studio. My next guest was in the room and watching with some anticipation when the results of the study into chemotherapy for early stage breast cancer patients were made public. Dr. Steven Katz studies how treatment decisions are made when women are newly diagnosed with cancer. He's a professor of medicine and health management and policy at the University of Michigan which is in Ann Arbor Michigan and that's where we have reached him. Hello.

STEVEN KATZ: Hello. Thank You very much. Pleasure to join us.

AMT: So the study will affect both patients and clinicians and I want to start with patients. You have surveyed nearly 10,000 women with breast cancer through your research. Right?

STEVEN KATZ: That's correct.

AMT: So as you listen to my last guest tell her story what stood out to you about her process?

STEVEN KATZ: First of all physicians should be moved by the testimony, by the discussion that Ms. Kashin Yielded with you. And the 10,000 women who went through this trial- let's remember that clinical trials have no benefit particularly to the a who enters the trial. That person enters the trial to give information that will be useful to women who were diagnosed in the future. So those women who entered the trial had a lot a lot of courage. And we also have to give credit to the doctors who enroll those women into this trial. And I want to put this in a larger perspective. Thirty thousand women in care and I will be diagnosed with curable disease next year, this coming year, and most will have favorable prognosis. Most of those women will have a disease of favorable prognosis and the treatments that they will get next year are very effective, reducing the probability of dying from the disease by well over 60 percent. This is a real advance in treatment of breast cancer. But the key issue is those treatments are burdensome; surgery, radiation, systemic therapy. So women come to their table with important decisions to make. And Ms. Kashin, who by the way is a lie younger than the average age of women will be diagnosed this year in Canada, the average age will be close to 60. So I think we need to keep that perspective when we think about breast cancer in Canada and the United States. The treatments are burdensome and there's going to be a sea of change among doctors with greater awareness and concern about potential over treatment. And this study would have never been done in Canada and the U.S. without the support of physicians with this growing commitment to get the funding to do it, to enroll that patient to do it, and to act on these results, and they certainly will.

AMT: There are people who may not have to go through some of these treatments but they might still opt for it? Could that still be the case?

STEVEN KATZ: There is a marked decrease in the use of more extensive treatment over the last 10 years. It hasn't begun with this particular study. Clinicians are concerned about the extensiveness of surgery, the extensiveness of radiation and whether women do or don't need systemic chemotherapy. So read the more burdensome treatment have actually decreased over the last 10 years as doctors have become more aware of the harms of treatment against the potential lack of benefit. Systemic chemotherapy has been the best example of that because it is one of the most toxic medicines that we have in the medical cabinet. It's delivered much more safely now than it was 20 years ago but still as you pointed out at the beginning of your show the short term side effects and there is one that people don’t think enough about which is that women can be vulnerable to long term permanent job loss, because they’ve got systemic therapy knocked out of their job, and the current environment; hard to get back in there. So doctors are much more women now than they were 20 years ago of those harms and more were in the context of the clinical counter encounter the kinds of reactions that patients can have that can make them vulnerable to a potential over treatment.

AMT: You look at something called anticipated regret. What is that?

STEVEN KATZ: Well for any of your listeners on the phone who have faced a life threatening news regarding their health they know exactly what I mean when I say that the threat of disease foments powerful intuitive and emotional reactions in all of us. And the dangling uncertainty in the exam room about what to do about it really fuels the desire to take everything that they can possibly get right now because they think 'well I've done that now so that in the future if something bad happens I will have gotten everything'. And so they're anticipating the regret they may have in the future and that fuels the desire to take everything they possibly take now to give home to their family members to their work quickly as they can here. So those reactions are difficult to elicit and patients are vulnerable, in partnership with their doctors, to receive surgery more extensive than they need, radiation more extensive than they need, and chemotherapy that they may not have needed. So one of the great results of this study is that adds to the accuracy of the evaluative testing that doctors have, to say 'you dont need the chemotherapy. You can do fine with other kinds of therapies here; less taxing and you a survivorship and quality of life will even be better'.

AMT: And all of this is happening at a rapid pace for anybody, the discussions, the decisions.

STEVEN KATZ: Patients are not trained to be patients. Were forced into it and it's a rough decision context for us to enter, especially in cancer. However, doctors are trained to be doctors. So although patients are vulnerable to over treatment from their reactions - of course in some context of the system which favours are incensed doctors to do, we are not really incented not to do, both in Canada and the U.S. we are incented to do. And in the context of the encounter it can be a partnership that can lead to overtreatment. I think the doctor is ultimately responsible for addressing the overtreatment issue, again, doctors are trained to be doctors. Patients are not trained to be patient.

AMT: Dr. Katz thanks for speaking with me today.

STEVEN KATZ: Thank you very much.

AMT: Dr. Steven Katz professor of medicine and health management policy at the University of Michigan in Ann Arbor Michigan. And that's where we reached 10. And that is our program for today. Stay with Radio 1 for Q Today's mega bestselling author James Patterson is on the show to talk about penning his latest blog together with former U.S. President Bill Clinton. Now after our documentary The Catch about U.S. drug interdiction, a program that involves Canadian armed forces, we thought we would leave you with music from the Philadelphia Indie rock band The War on Drugs. This is their song Pain. I am Anna Maria Tremonti. Thanks for listening to The Current.

SOUNDCLIP

[Song: Pain By Philadelphia]

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