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The Current Transcript for September 12 2018

Host: Anna Maria Tremonti

STORIES FROM THIS EPISODE

Listen to the full episode

Prologue

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SOUNDCLIP

A source says Donald Trump is a horrible horrible human being. Let me say it to my face. Against the people that make up stories and make up sources.

ANNA MARIA TREMONTI: Donald Trump has long tried to discredit journalists who use anonymous sources. But how is it going to play this time? After all the book on his presidency that's causing all the buzz in Washington and beyond is written by Bob Woodward the man known for his impeccable sources. Remember Detroit? Remember Watergate? And who says they are never Anonymous to him. Their names are just not shared. Bob Woodward's latest book, Fear, relies heavily on firsthand sources who spoke on deep background from NAFTA to a war almost launched on Twitter to advisers who hid or stole directives they feared could threaten national security. This is a book brimming with uncomfortable stories on the Trump White House. Bob Woodward joins me in just a moment. And then Kathy Kaufield had a mammogram a few years ago. It never even detected a tumor the size of a golf ball.

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Women are dying because they're not fighting their cancer early enough. The screening programs are not adequate for women who have dense breasts.

AMT: Women appear at greater risk of breast cancer when they have advanced breasts. But few doctors ever tell them they do. Kathy Kaufield is trying to change that. She's already got political rivals in the New Brunswick election campaign one upping each other in promises to change the system. Hear her in half an hour. And then, just when you thought you'd outgrown your childhood torments the middle child faces new threats.

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All day long at school is "How great Marcia is at this, or how wonderful Marcia did that", Marcia, Marcia, Marcia! I'm tired of being Marcia's shadow all the time.

AMT: That's right. If you have an inner Jan Brady whinging at the lack of attention, you might be distressed to know that some predict the middle child is about to become extinct. No one else in the family is going to care. But you will. So listen in an hour. I'm Anna Maria Tremonti. This is The Current.

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Staffer 'stole' letter drafted to withdraw from NAFTA from Trump's desk, Bob Woodward claims

Guest: Bob Woodward

AMT: He is truly one of the giants of American journalism for almost 50 years. Bob Woodward has dug up some of Washington's deepest secrets and he's helped change history in the process. Together with Carl Bernstein he made his name with a Pulitzer Prize winning Washington Post investigation into the criminal activities of Richard Nixon and his administration. That led to the one and only time so far that a US president has resigned from office. Now all these years later Bob Woodward's reporting has once again landing like a bombshell in D.C. with his new book Fear: Trump in the White House. He's only doing one interview with Canadian media and it's right here. Bob Woodward is in New York. Hello.

BOB WOODWARD: Hello. how are you?

AMT: Well I'm still reeling from your book. What a book. Lots of information in there.

BOB WOODWARD: Thank you.

AMT: I want to begin by talking about the four letter word on the front of this book. What role does fear play in Donald Trump's presidency?

BOB WOODWARD: An interview, Bob Costa, a young political reporter at The Post and I did with Trump two and a half years ago while he was a candidate on the verge of winning the Republican nomination, we asked him about the role of power in presidential politics and cited President Obama, who was in office at the time about real power being not using violence. And President Trump said "Real power is, I don't even want to use the word, fear." And what he was saying it was kind of a Shakespearean moment frankly where he turned aside like Hamlet to say to the audience this is what's really going on. This is how I manage and this is how you achieve and exercise real power. Fear.

AMT: Are you seeing his strategy of fear on display and how he is negotiating free trade with Canada?

BOB WOODWARD: That's one of the elements you look at the whole effort by Trump which I relayed in the book to get out of that free trade agreement with Canada in Mexico. He is obsessed with situations where we have the trade imbalance is such that it's negative and as you know with Canada it's positive. Other words, we export more goods and then we get from Canada. But he still thinks that this is unfair.

AMT: NAFTA has become such a huge issue in Canada. How close did President Trump come to signing the letter that would have given notice to Congress that he was withdrawing from the agreement?

BOB WOODWARD: Well it was on his desk and Gary Cohen the chief economic adviser in the White House took it off his desk, [unintelligible]. So and Trump didn't remember and would go back to some of these issues frequently. But in this case it stayed inactive for a while and then of course it became active earlier this year.

AMT: I mean that's incredible the story you relate. That they that his own staff actually drafted the letter and then another member of the staff said 'Don't worry I'll take it off his desk'.

BOB WOODWARD: Exactly. I've done books and articles for The Washington Post on eight presidents, from Nixon Obama. This is the ninth and I've never seen this kind of active effort and to be able to report it authoritatively while the president is still in office.

AMT: His threat to withdraw immediately from NAFTA with that letter is not an isolated case of documents being snatched from his desk by the very people who are supposed to carry out the order. You describe a scene where the same man, Gary Cohen, the chief economic adviser steals a similar directive on South Korean trade. What happenedÉ

BOB WOODWARD: Precisely that. Cohen was so worried about the possibility of withdrawing from the free trade agreement with South Korea that he took the document. But there was more of a story to that because there is a connection between the trade issues, the security issues and the very secret intelligence operations that are conducted. In fact allowed the United States to detect a North Korean missile launch within seven seconds which was a tremendous advantage and Cohen felt this was jeopardizing the whole relationship with South Korea. Actually called in the secretary of defense Mattis to plead with the president don't get out of this trade agreement. And that was successful for a while.

AMT: When we talk about trade and his reaction to trade deficits, what kind of understanding does President Trump have when it comes to trade?

BOB WOODWARD: Well he thinks that if there's a trade deficit it is money that is being lost. 99.9 Percent of the economists know that that's not the case. In fact if there's a trade deficit it can be a good thing for consumers in the United States because they're getting goods that much less expensive that they have extra money to spend on other products. And also to save money they tried to educate the president on this and he just absolutely is convinced that somehow if people buy say high speed electronic equipment from abroad from Asia or Europe or Canada, that somehow that money is gone. And they had some real which and I describe this some real bouts in try and educate the president on this. He just does not accept it, says he has views that go back 30 years and he's not going to change his mind.

AMT: He calls them effing globalists.

BOB WOODWARD: Yes.

AMT: And again in the context of a trade war and how he looks at trade and fear, what do you make of his lashing out at Prime Minister Justin Trudeau?

BOB WOODWARD: Well this is a theme in the book on all kinds of foreign policy and economic trade, immigration issues and that is there is a tendency to blame others, to use pretty rough language and to somehow think that he can win these kinds of things rather than- The bond between the United States and Canada. It's astonishing. It's important to the security of both countries. It's psychologically very important and it goes way back as you know. And to try to leverage that for some idea that actually makes no sense. When I learned about this I was surprised and then to hear how it became public this year. I was even more deeply surprised.

AMT: Your book has several other examples of his single minded insistence on changing or killing an agreement including the Iran deal, that his own advisers consider dangerous or reckless and then work to delay or thwart the implementation. And I'm wondering if you can just speak to us a bit about what that says about the presidency and democracy?

BOB WOODWARD: Well it's what it says about the presidency and democracy and this president, at this moment, is just there are scenes in the book describe where they will say Where do you get, they, the staff in the White House, where do you get this idea. And President Trump said well I've had those ideas for 30 years. And if you disagree with me you're wrong. The problem here is as we all know people in office, or even people like you and I in the media business, you have to learn. You have to grow. And there is a kind of this is the way it is and there is no alternative. And people as one of the president's aides has quoted "we're living on the edge here".

AMT: And so in these cases who's really running things?

BOB WOODWARD: Well the president still is the president and he is running things sometimes like on steel tariffs. Everyone was telling him don't put tariffs on steel or formal documents from the Defense Department, the State Department, saying don't do this. There are experts from both parties, Nobel Prize winners, people who've been chairman of the Federal Reserve here the central bank telling him 'Don't do this'. And of course he's putting tariffs on steel. In one scene he actually brags to one of his aides, an aide named Tom Bossert, who was the cyber security expert in the White House go on television and tell the world we'll put 500 billion dollars in tariffs on China. And Trump actually boasts that if this was not a Sunday talk show that this aid was going on but a Monday talk show when the financial markets were open it would tank the markets. And he speaks of this gleefully. And of course the job of the president is not [unintelligible] the financial markets but because of his determination and belief on tariffs, we're risking the kind of stable economy that we've had or that in fact President Trump has boasted about.

AMT: You make the point that you have covered many presidents. How surprised were you at some of the things you were learning?

BOB WOODWARD: Quite surprised. And there are always strange things that go on in the White House. As I say I've written eight presidents and this is the ninth so that's nine of the last presidents. That's 20 percent of the presidents we've had in this country. And there is within the White House and the administration profound concern about what is going to be decided the absence of a reasonable logical process on all of these issues is also something that is just, you know, what's going to happen? What's what's he going to decide to do on the steel tariffs? He just called in steel executives to the White House and announced he was going to do this. Even his chief of staff General Kelly did not know that this meeting was going to take place or that this was a decided new policy.

AMT: Is it enough for those people to whom you spoke to offer on deep background such troubling stories on what's happening inside the White House? Should they be doing more?

BOB WOODWARD: Well that's up to their conscience and it's something I think we now see that the political system here in the United States is going to examine and look at what we've got here and what's going on. So I think there's an obligation for people to wake up - Democrats, Republicans - and say this is very deeply carefully reported inside account. And if you've read the book you see not just on one issue or two issues but all of the main foreign policy issues, North Korea, Afghanistan, the Middle East, all of the trade issues, all of the immigration issues, tax issues and then how Trump deals with the Robert Mueller special counsel investigation into alleged Russian meddling in the election.

AMT: And I have read it word for word the White House has reportedly gone on a hunt for your sources inside the administration. Does that concern you?

BOB WOODWARD: Well you know this is what Nixon tried forty seven years ago when he added team called the Plumbers work in the White House, trying to ferret out leaks and that team conduct the break in at Daniel Ellsberg psychiatrist's office. Daniel Ellsberg had supplied the Pentagon Papers to the media. That same team was then moved to the Nixon re-election committee in 1972 and committed the Watergate burglary. So the idea of conducting this kind of search I think will not work. And I think you kind of have to be cool about it, quite frankly, even if the criticism is quite harsh but of course Trump is known for not being cool about things.

AMT: What's the most troubling thing you learned about this presidency in the course of your reporting?

BOB WOODWARD: It's I guess in the national security area where The President even earlier this year. So he'd been in office a full year exposed to all these issues where the president led really is at the National Security Council meetings in the Situation Room, at the White House, saying why are we spending all this money on the deployment of U.S. troops in South Korea, in Europe, all around the world? It's expensive. And finally the Secretary of Defense Mattis has to tell the president "Mr. President we're doing this to prevent World War Three." I was quite surprised to learn that the secretary of defense felt that things had come that far that he had to remind The President that that's kind of the number one responsibility and quote other presidents saying that in fact it is the thing that worries them the most, World War Three, the use of nuclear weapons. And if you've read through the book that whole scene on January 19th of this year is really quite a jolt.

AMT: Win line with that after he called the North Korean leader a little rocket man, he wanted to send out a tweet ordering the removal of dependents of the U.S. military personnel from South Korea. His staff freaked out. Why?

BOB WOODWARD: Yes. Because what happened the recent Su young who was foreign minister in North Korea, previously somebody's closest to the north Korean leader, through an intermediary sent a message, December 4th, saying if dependents are withdrawn it would be read as a sign that the United States is going to attack. That an attack is imminent. And of course that kind of warning alarm the Pentagon leadership and thank God that tweet did not go out. But that's the kind of back of the envelope policy making that idea of 'let's do things on the moment' and they actually put out the White House staff General Kelly a memo saying these fly by night decisions are no longer going to be considered final. That there has to be a process, there has to be a signed document by The President before policies are established. This again is the whole process of stopping this kind of 'well I'll do that. I'll sign this'. And some things have been stopped. Some things have not been stopped. It's time for everyone to wake up and realize what's going on and the volatility that we are living in right now.

AMT: Your book leaves us with a portrait of a president who's emotionally overwrought, mercurial, unpredictable. He has a short attention span and the behavior of a child. Are we witnessing a president in cognitive decline?

BOB WOODWARD: Well I'm not the medical professional or the psychological professional to make any diagnosis at all. All I have done here I took a year year and a half after the president was elected and said we are at a turning point in history, let's find out what's going on inside. And it focuses on that last month. The President, President Trump called me and expressed some distress that I had not talked to him for the book. I explained the individuals I talked to and asked to speak with him he acknowledged some of it. He tended to deny a great deal and I did tell him I said "Mr. President, I'm doing this, this look at your administration and you because we are at a pivot point in history". And he said "Right." He agreed. He said - now this is the last month, a month ago - that I had always treated him fairly. And obviously now that the book is out with all of this detail he has changed his mind and is now attacking me which obviously is his right. But the contrast of saying less than 30 days ago you've always treated me fairly, to now this this tweet storm that he is subjected to is just another example of him changing his mind and reacting emotionally impulsively to something that's before him.

AMT: And of course what is before him on an ongoing basis is some special counsel Robert Mueller's investigation. How is that impacting the day to day running of the presidency?

BOB WOODWARD: Well I describe in detail particularly day may 18 last year after Mueller had been appointed to this role and it is a vivid kind of blow by blow seen of the president coming in and just being enraged, won't even sit down and is going between the Oval Office and his dining room where there is the television, watching television [unintelligible] when some of the cable news shows, just exploding saying "My God. Now I've got this special counsel's going to investigate me personally on my finances. It's going to be there for life." And then he expresses great distress and says "Look I can fire anyone. I'm the president of the United States." It really is one of the aides who witnessed this. It was almost Nixonian entering the paranoid zone when Nixon, in his final days as president, was praying beating the carpet and talking to the pictures on the walls of the White House.

AMT: The president himself has said he doesn't want to be interviewed because he's worried about falling into a perjury trap. Is he right to be worried?

BOB WOODWARD: Well his lawyer for eight months John Dowd definitely concluded that and told Special Counsel Mueller that and actually demonstrated what it was like when he did a practice session with the President. The President would explode and would say things that were not true and make things up. And it's quite a portrait of somebody as John Dowd the president's lawyer said "You can't testify. You are disabled". He concluded The President was disabled from testifying and said "I will not sit next to you if you testify in an open forum because you're going to perjure yourself and you're going to wind up in an orange jumpsuit" as the president's lawyer put it.

AMT: I don't think we can underline the gravity of what's in here enough. Bob Woodward your investigative reporting was instrumental in bringing about the downfall of President Nixon. Is your work part of what will lead to the downfall of this president?

BOB WOODWARD: Obviously that's not known. My job is to find out what happened and present what we call the best obtainable version of the truth. I have done it here. It is and is going to continue to be very controversial. And you know we will see it now is in the hands of the American political system, what are the Democrats and the Republicans going to say or do about this. And it's going to be a fascinating time to watch.

AMT: What are you already hearing now that your book is out?

BOB WOODWARD: No definitive. People who know the process I have and the reporting track record going back 47 years realize it's true. One person act in office now last week called me and said everyone knows it's true. What you have written is a thousand percent true, and went on to say, the interesting question is going to be to see how the president responds. And he said there are two possibilities, one, he'll lash out at me which he's done. And the second is he'll try to find a way to change the subject something new. So keep your seatbelt on.

AMT: We will and we'll keep watching. Bob Woodward thank you.

BOB WOODWARD: Thanks.

ANNA MARIA TREMONTI: Bob Woodward's new book is Fear: Trump in the White House. He joins us from New York City. If you tuned in part way or you want to share it we'll be posting the interview in full on our website cbc.ca/thecurrent. You will also find it on our podcast or on the CBC Radio app.

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Telling women they have dense breasts could save lives, says cancer survivor

Guests: Kathy Kaufield, Brian Goldman

AMT: Well here's a question: How dense are your breasts? It is not something many women know and yet advocates say that is information that could save your life. It's because having dense breasts is a risk factor for breast cancer and when breasts are dense those cancers are less likely to show up on mammograms. So some patient advocates are pushing to make it mandatory for doctors to tell women about their breast density and what that means for their health. Kathy Kaufield has a personal stake in this. She is a breast cancer survivor and the brains behind an online campaign called #TellMe. So far she has managed to make breast density notification an issue in the New Brunswick provincial election, and in Prince Edward Island in Nova Scotia they pledged to look into it as well. Kathy Kaulfield joins us from our studio in St. John. Hi Kathy.

KATHY KAUFIELD: Good morning.

AMT: Before you were diagnosed with cancer did you know you had deaths dense breasts or what that even meant?

KATHY KAUFIELD: No. I'd never heard the word dense breasts or what it meant. I knew I'd had a lump way back several years earlier. That turned out to be nothing. I knew my doctor was always kind of monitoring me but I didn't hear anything about dense breasts until I was getting my biopsy for a lump the size of a golf ball.

AMT: What are dense breasts?

KATHY KAUFIELD: Well they're very common. About 40 percent of women have them, common and normal. It just means that your breasts have a little bit more fiber and glandular tissue compared to fat tissue and why that's important is it makes it they appear white on a mammogram so that if you're looking for a tumour it's like finding a snowball in a snowstorm and it increases your risk for breast cancer.

AMT: So when were you first diagnosed with cancer?

KATHY KAUFIELD: 2015 just before Christmas.

AMT: How's your health now?

KATHY KAUFIELD: It's good. It's good. So September marks two years past my that my treatment ended. I was lucky to find mine early. Mine was a fluke I found mine just by fluke but I'm doing well now.

AMT: So you found by a fluke but you'd had a mammogram right?

KATHY KAUFIELD: Yes. So I'd had a mammogram in June 2015 and then I was at a conference at a hotel. Five months later I go into the shower. I didn't have the normal shower puff that I normally would use. And I hit my breast with my hand and my God there was a lump there the size of a golf ball and I thought well this can't be anything. I just had a clear mammogram and it turns out that it was cancer and the mammogram had missed it.

AMT: And now that you've been through this you started to get involved in raising awareness. Like have you just done this or did you start right away?

KATHY KAUFIELD: No it took a while and you can't really you know once you're diagnosed with the cancer you go through your treatment and you can't really deal with things like that until your treatment is done. And then last fall I wrote a piece for The Run for the Cure to promote The Run for the Cure and a woman I had mentioned in the bottom of that column - I wrote a piece for The Huffington Post that I had dense breasts - and a woman from Dense Breasts Canada had seen that and reached out to me and they're always looking for women to tell to tell their story. So I did and I went onto their website and I learned all this information about dense breasts that that that I didn't know. And I thought well my gosh I have to move the needle on this here in New Brunswick. So I started you know small. I just wrote to the Premier and then I wrote to the health minister and then I met with a few people that I knew from political circles. I used to be a political reporter here in New Brunswick so I knew few people and you know nothing was really happening with that. And you just kind of go back to your your daily life and then it didn't really get back into it. I knew the election was coming up and maybe there's something I can do and it didn't really happen and then one day I walked into my normal follow up screening at the hospital and I walked in and sitting in the waiting room was on my very best friends. She was getting a biopsy. She didn't know I was going to be there that day and I didn't know she was going be there that day. And it turns out that she had a mammogram two months earlier and she had a lump that's a very large lump to that was missed and she's currently going through treatments. And I remember just sitting there saying look women need to know this. She was checking her breasts partially because she knew me and I harang my friends about checking their breasts and doing their exams women need to know they shouldn't trust their mammograms. If they have dense breasts they shouldn't trust mammograms as much as they do. So right then and there I thought women need to know this. I need to do something about this and I went home and I'm kind of chatting about it with my daughter and husband at the supper table. I was like oh my God I wish they would just tell us and someone said #TellMe. So an idea was born right there at the supper table with my family.

AMT: what kinds of stories you've been hearing from other women since you started this?

KATHY KAUFIELD: Oh people been contacting me on Facebook every day. They're finding me and sending me notes saying the same story. They had dense breasts. They didn't know they had dense breasts. They didn't know anything about this. The mammograms were missing. I think there's a huge gap in screening for women with dense breasts. And it's not just in New Brunswick, it's right across the country.

AMT: And again most people don't know that they need to ask more questions. But obviously the people looking at the mammograms know that the breasts are dense, do they not then say we need to do other ways to check?

KATHY KAUFIELD: No. Well what happened with me is that- so it's noted on your report the radiologists say the only way can tell whether you have dense breasts is by getting a mammogram and having it assessed. You can't tell by feeling them or looking at them, big or small that doesn't make any any difference. And they are noting it on the reports but that information is not getting to the women. So when I had my mammogram I got a letter that said you're all clear. You know mammograms aren't foolproof. It did say that you should be doing your self-exams but you don't get that information unless you ask. And women don't know to ask. I didn't know to ask.

AMT: So there is a provincial election campaign underway. You've got a couple of leaders hopping to kind of address what you're talking about. What are you hearing?

KATHY KAUFIELD: I'm over the moon with this. I just launched the website launched three weeks ago and within two weeks I had both the Premier Brian Gallant and opposition leader Layne Higg's committing to do this. I'm so thrilled that New Brunswick is taking the lead on this. I've got three provinces down, seven to go, three territories.

AMT: So what are they pledging, to make it mandatory that that that women would be told?

KATHY KAUFIELD: Yes. It just a policy change that needs to be done there. They're they're committing to make it mandatory and to educate women about it about breast density because that's the other piece of it. All they really need to do is add a line to the letters already going out. You have dense breasts and this is what it means. And then women can go and have that conversation with their doctor. I know that if I known I'd had dense breasts I would have been much more vigilant with my self exams. I would have talked to my doctor about additional screening and you know you maybe will make life style changes. Because I knew I had a grandmother who had who died from breast cancer and women kind of talk about that you know, oh I have an aunt or a sister and that terrifies them but dense breasts are even bigger risk factor than family history. And women don't know about it.

AMT: You know often with screening we are told well this could lead to unnecessary testing, worry, treatments. What do you say to that?

KATHY KAUFIELD: Well I think that I will take a few weeks of worry over a test over stage four breast cancer at any time, and I think that's the earlier you find your cancer the better it is.

AMT: So we should start asking our physicians and the people doing the mammograms as well.

KATHY KAUFIELD: Yes. And I want I hope that women right across Canada can take this #TellMe and get this done in their provinces as well. It's going to take political will for this to make this make this change. And women have to demand it. And I've already heard from women in Ireland who want to use the hash tag and it's an international issue as well. But right here in Canada I hope that women start raising this issue with their politicians. It's crazy to me in a way that we have to go this far to get this information. This is information about our bodies that we should be told. That's like not telling me that I have high blood pressure. This should be a no brainer. That's what I'm hearing from. How come they're not telling women this? Exactly how come they're not telling women this?

AMT: Okay, Kathy, good to speak to you. Thank you.

KATHY KAUFIELD: Thank you so much.

AMT: That's Kathy Kaufield. She is a former political reporter turned breast cancer advocate and she joins us from St. John New Brunswick. Well for more on the science and medicine of dense breasts I'm joined by Dr. Brian Goldman. He's the host of White Coat Black Art on CBC Radio One. Hi Brian.

BRIAN GOLDMAN: Hi Anna-Maria.

AMT: You just happened to be working on an episode on this issue that airs this weekend.

BRIAN GOLDMAN: This weekend we're going to be exploring the the issues that Kathy just talked about. Kathy was diagnosed with something that we call or what I've learned is called an interval cancer. Our dispassionate jargon once again coming to the fore. An interval cancer is a breast cancer that is diagnosed often a couple of months three months four months after a normal mammogram and it turns out that the woman had dense breasts. And as Kathy said it very well it's like trying to find a snowball in a snowstorm.

AMT: Well what are the numbers? How big a risk factor are dense breasts for cancer?

BRIAN GOLDMAN: So there's three ways of answering that. First of all cancers are hiding in dense breast tissue, particularly women who have homogeneously like it's dense all over, or extensive patches of density. And so first of all it can be hiding and half the cancers are missed. Half of the breast cancers are missed in women who have extensive breast density. That's the first factor. The second factor is that dense breasts are an independent risk factor for breast cancer. They increase the risk of breast cancer three to five times. Scientists are trying to figure out why. They're not sure. There's all kinds of studies that are taking place all around the world. So it's an independent risk factor which is equal to or greater than family history. We all harp on family history is really really important.

AMT: You always have to write that down, everybody in your family but they need to be asking us what we know about the other stuff.

BRIAN GOLDMAN: The third factor, Anna Maria, is the false sense of security that comes from the normal mammogram. There are lots of women who are premenopausal who had lumps and bumps that came, they went, they came, they went and no big whoop. And then they finally start getting mammograms and then they feel a lump. They're like "I think, I just had normal mammograms that must be okay." So it turns out to not be okay. And the problem is that by the time the cancers are diagnosed, they're often, more often than not diagnosed because the woman felt a lump which means they're diagnosed later in the process which means they're more likely to have spread.

AMT: There's another thing here most women don't get mammograms until they're 50. Right?

BRIAN GOLDMAN: That's right.

AMT: But breast density is actually higher among women in their 40s. Am I right?

BRIAN GOLDMAN: Forty percent of women over the age of 40 have extensive breast density and you're quite right. And the only way you can diagnose it today is with a mammogram. And guidelines in many countries including Canada suggests that women should start getting mammograms at the age of 50 as you said. So what happens between the ages of 40 and 50? And I put that question to some of the experts that we talked to. And you know why not say that every woman at the age of 40 should have at least one mammogram to establish their density, breast density and then act accordingly. Which means taking steps to reduce your risk. So if you're a woman who has dense breasts and maybe you've got one or two family members, you're probably going to get increased screening. But the problem is with what? Mammogram?

AMT: Because what do you need you need an ultrasound.

BRIAN GOLDMAN: Ultrasound or you know I think eventually MRI there's an MRI protocol. It will probably detect more but it has to be available and has to be quick. And so you have to be able to screen a lot of women.

AMT: We need the information. Now you've done your own straw poll among doctors too, what didi you find?

BRIAN GOLDMAN: Yes. I've been speaking to physicians and I get kind of dim comprehension to glazed looks. I was talking over the weekend to a woman who is a physician,a highly ranked physician. Top flight researcher who has gone to an Ivy League, who did postgraduate training in an Ivy League college and she had no idea what I was talking about. So this is this is a woman who personally and as a physician might have been curious about this and I have to tell you that that was my exposure to dense breasts until I started looking into this into the story.

AMT: So interesting I just think a big piece of the puzzle that no one was actually focusing on. So we hear what Kathy is doing to push the New Brunswick government. What about Canadian guidelines overall?

BRIAN GOLDMAN: Canadian guidelines overall are suggesting that they're slow and the Canadian preventive health taskforce has guidelines that are kind of slowly acknowledging that dense breasts are a risk factor for breast cancer.. They are not keeping up with what the science is saying. And and so I wouldn't go by guidelines. I think they're far behind the curve. I would tip the cap to two women. Women at Dense Breast Canada, Kathy and others who are pushing for women to be told and for radiologists to say that that should be mandatory and women should be told so that they can take steps to reduce their own personal risk whether it's losing weight or or reducing or eliminating alcohol consumption changing their diet. And I'll tell you that in the United States 33 states have make it mandatory. So it's very they're farther ahead than we are. So 33 states make it mandatory that women be told. Five states in the United States are actually paying for alternate screening methods such as ultrasound or MRI.

AMT: So in the meantime women need to know that this exists and they need to ask. They actually have to start asking their doctors.

BRIAN GOLDMAN: And hope that their doctor understands the significance of it because it's radiologists who are making the diagnosis. But the determination maybe your family doctor who's telling you.

AMT: Well we're going to hear more from you on this Dr. Brian Goldman, thank you.

BRIAN GOLDMAN: You're welcome.

AMT: Host of White Coat Black Art. You can hear more about dense breasts on the next episode of White Coat Black Art. It airs Saturday afternoon at 01:00 right after the news. Sunday evenings at 06:30 as well on CBC Radio One. So listen for a White Coat Black Art and Brian and his team done a lot of work on this and you'll hear more voices and more thoughts on how to move forward. Stay with us. We're talking middle children. Middle children of the world unite. We are devoting the last half hour to the plight of so-called middle children because well you know they're not celebrated enough. And if you are a middle child you better listen because I don't know if your siblings will want to bother. I'm Anna Maria Tremonti. This is The Current.

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Smaller families are pushing 'the middle child' into extinction, study suggests

Guests: Bruce Hopman, Rodica Damian, Catherine Salmon

AMT: Hello I'm Anna Maria Tremonti and this is The Current.

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CHILD: All I hear all day long at school is how great Marcia is at this, how wonderful she did that. Marcia, Marcia, Marcia!

VOICE 1: Sweatheart.

CHILD: All those awards staring me in the face, it's just too much, I am tired of being Marcia's shadow all the time.

VOICE 2: Basically he seems to need a lot of attention.

VOICE 1: That's nothing new for Danny.

VOICE 2: And from what you're telling me there's nothing unusual about his behavior at home.

VOICE 1: No it's just his usual unusual behavior.

VOICE 2: Okay. The problem just may be that he's the middle child.

LISA SIMPSON: Middle child, no one cares about the middle child. Noone ever is going to change.

VOICE: Lisa can I talk to you?

LISA SIMPSON: Here it is a quick check in every two years. Just like clockwork.

AMT: Well how's your TV memory. Those are the voices of Lisa Simpson. Before that we heard about Danny Partridge and Jan Brady three pop culture characters who have charted the travails of being a middle child over the TV years. Family composition has changed a lot since the Brady Bunch went off the air in 1974. Back then there were a lot of middle children in North America. According to a Pew Center study by the time they were over 40, 40 percent of mothers in the U.S. had four or more kids in the 1970s. But as a visit to any big city playground will tell you this is no longer the case. Today nearly two thirds of mothers have only one or two children. So is it the end of days for the middle child? And if it is does it matter? We're going to put that question to a couple of researchers in a few moments but first someone who definitely does not relish the extinction and that's what he calls it, the extinction of the middle born. Bruce Hoffman is the man behind Smack Dab, a middle child blog. He is also the voice behind the Pay No Attention to this Podcast. That is the oficial podcast of the International Middle Child Union of which he is the founder and president. And Bruce Hopman is talking to us today from Vollmar New Jersey on what he calls the Middle Child Hotline. Hi.

BRUCE HOPMAN: Hi Anna Maria. Child hotline never busy so you can always [unintelligible].

AMT: Now because you're neglected right.

BRUCE HOPMAN: Exactly. Not a lot of people calling the union. When you call up the international Middle Child union you get a lot of hang ups and not a lot of callbacks.

AMT: Why is it so important to you that we celebrate middle children?

BRUCE HOPMAN: Well it's important because we were given a holiday. August 12th is middle child's day. I did not invent middle child's day I came across it while I was doing research for a book I'm writing about being a middle child. And the irony of having a holiday. For middle children that nobody pays any attention to discard of inescapable to me. So I thought it would be fun to try to raise awareness for middle child. So you know we never say we get enough attention at least that one day a year we could all hope to get attention. It's become more important with this recent news about our possible extinction. I don't know how many more middle child's days will have.

AMT: Okay well you mentioned you're writing a book and I think I have the title in front of me here. Pay no Attention to this Book: The World's most Comprehensive Collection of Middle Child Highlights, Slights and Insights. Not a bad title. So you mentioned one slight that no one's paying attention to the actual day. What other sites do you see?

BRUCE HOPMAN: Well for some reason middle children were given this syndrome, middle child syndrome and I understand it. I guess they felt that a lot of middle children exhibit a lot of the same behaviors. What is interesting to me about that is they say that first borns have certain similar qualities. They say that last borns have certain similar qualities. How come they weren't given this disease like sounding syndrome? Only middle children were singled out. So when when I was growing up I didn't think about being a middle child a lot. My mother did have this poem that was hanging on the kitchen. She taped it to the kitchen wall it was called the middle child. It was a lovely poem about all the special things that middle children did. And I did wonder, that's odd. How come there's no poem there about my brother or the firstborn or how come there's no palm there about my sister the last born. Is there something wrong with me? Is there something wrong with being a middle child? So as you grow up I think there's this voyage of discovery about middle child. I went back. And found my birth announcement which I call my birth denouncement. My birth announcement read up "Dr. and Mrs. Marvin Hopman announced the arrival of Michael David's brother. Bruce Steven." So. I didn't even get top billing on my own birth announcement. So moving forward I think the stage was set. Another thing, and you don't think about these things at the time, you realised them later in life. We used to take family trips to Florida. There were the five of us who would pick up my grandmother and grandfather cars were bigger then. So four people would sit in the back and three people would sit in the front. My mother and father and me. Now at that time. I thought "Oh my God maybe my parent's favorite child. Why else would I be sitting in the front seat and my brother and sister have to get stuck in the back with grandma and grandpa" and I'd love my grandparents. But who wants to be stuck in the back of a car with two you know old people for three days. So I thought it was great. Years later I realized "Oh wait there was no seatbelt in the middle seat in the front. I was like the sacrificial lamb." They put me in the front.

AMT: Oh my god! You are really- You had a lot of problems. I'm sorry I'm sorry Bruce. But listen I have to ask you because you talk about, we've heard the slights now there and they are all yours- But what about the insights? What about the good stuff?

BRUCE HOPMAN: The good things about middle kids is they say because sometimes we feel this neglect or this lack of attention that we grow up to be diplomatic good negotiators. Our independence leads us to be good. You know like entrepreneurial. Bill Gates, Warren Buffett art middle children, Martin Luther King, the Dalai Lama, middle children.

AMT: Now you have children, do you not?

BRUCE HOPMAN: Of course. Guess how many.

AMT: You have three.

BRUCE HOPMAN: Of course I do.

AMT: So the middle child and how are you treating your middle child?

BRUCE HOPMAN: So I thought I we lucked out because I have a son a daughter and a younger son. And to me that I always thought was the optimal position for a middle child because she's the only girl. So first born, he's you know, he's special he's our first born baby. His special, he's our baby. And you are middle child. You're special. Because you're the only girl not only she the only girl in her family she's the only girl grandchild. There are 12 boys and her. So you would think that would be powerful enough to overcome a lot of these middle child issues. That is not the case. Middle child said drove is so powerful that even somebody who has that unique position in the family can still feel like they're being slighted.

AMT: There you go. Thanks for speaking with me today.

BRUCE HOPMAN: Thank you so much.

AMT: Ok so is Bruce Hoffman actually typical of a middle child. My next guest says maybe, maybe not. There is no typical middle child personality according to Rodica Damian who is an assistant professor of social personality psychology at the University of Houston. And that's where she is as she joins us now hello.

RODICA DAMIAN: Hello Anna Maria.

AMT: So what do you think? He's making his argument that middle children are unique in personality different from the first and last born siblings. He clearly believes they should be celebrated. What are you thinking?

RODICA DAMIAN: I think of course every human should celebrate that. I don't have anything against him wanting to be celebrated but I may have some good news for Bruce. So I think he was complaining right about the idea that there is such a thing as the middle child syndrome. And I would say that there shouldn't be. I don't think there is any scientific evidence to suggest that children of different birth orders actually have different personalities.

AMT: So before we go further with that let me just, because I want to know about your research and more detail but I'm also curious about the origins of this debate around birth order and personality. How did this get started?

RODICA DAMIAN: In psychology it started with the fight between Sigmund Freud and Alfred Adler. Freud was the first born. Adler was a middle child and they ended up having a fight of which is the best birth order to have a well-adjusted personality. So Freud ended up excluding Adler from the psychoanalytic society. Adler formed his own new society which is the now the parent of personality psychology which is the field that I work in.

AMT: So it was all about them. They were arguing about themselves and this is how we got it. That tells us a little bit about something but maybe we shouldn't go there today.

RODICA DAMIAN: Yeah so and then there have been a multitude of studies. A lot of them with very small samples. Originally researchers were also not controlling statistically for, or not taking into account socioeconomic status. And that's the problem because higher socioeconomic status families tend to have fewer children and therefore the probability of finding a first born is higher. So then whatever affects you have for let's say firstborns being more successful might actually be attributed to being from a higher ses families. So studies kept going back and forth for the past 200 years. Some finding a really large positive effect, some finding the opposite effect, some finding zero and then a few recent studies, so my study that had over 370,000 people this was a US sample representative, so people from all walks of life found that there were no meaningful personality differences between birth orders. We looked at it with families with more than three children so more middle borns but also it's families with only three children and looked at the personality scores separately for first, middle, last children no matter how you split the data there were no meaningful differences. And even when there were, very very tiny differences to the effect of a correlation of 0.02 which is very close to zero. Even then they did not go into a predicted direction of the theories. So it's not the case that you know first borns were more conscientious but also more neurotic or middle borns were higher in agreeableness or which would be the trait that would enable them to you know forge connections and whatever. So really there were no meaningful personality differences.

AMT: So 337,000 people where was that information that you were working with? Were you looking at someone else's? Where were those statistics? Where did they start? How long were people followed?

RODICA DAMIAN: Yes so the American Institutes for Research in D.C. collected these data, started collecting in 1960. The people are followed across time. There's even a way from 2010 where some of the people were tracked. So we didn't collect that data but we analyzed the data. They had information on birth order. They had information on a variety of socioeconomic and demographic background factors. They had information on intelligence which brings me to the other thing I wanted to say that if there was any robust finding across birth order there is a tiny tiny tiny effect of intelligence. The younger siblings have a small decrement in intelligence specifically verbal intelligence. It's just one IQ point.

AMT: A small which?

RODICA DAMIAN: A small decrease in intelligence. The supposed mechanism behind the so-called confluence model which has to do with parental attention and involvement. So basically the first child gets on divided parental attention and their parents talk more to them without this tension being diluted in any way. And then as you get younger and younger you get more and more diluted intellectual environment because it's not just the parents talking to you but it's also your younger siblings who have lower verbal skills at the time. But these effects are so so tiny that are unlikely to cause you know any long term effects on life success or anything.

AMT: So let me ask you. Let me ask you. You talked about they do look at socio economic factors but what about race? What about culture?

RODICA DAMIAN: We didn't have enough to look at each individual kind of ethnic background. So we just had kind of rough estimates like whether people were of European or American descent or not. So yeah. So I guess we don't have extremely good data at the moment on how these things may play out in different ethnicities. But given how well replicated the findings are talking about are across different nationalities across different cultures I wouldn't predict major differences based on race or ethnicity. Now when I say I wouldn't predict differences I'm specifically talking about personality and one problem I always see when people discuss birth order is that people still talk about cultural practices and achievement and other constructs that are not personality. So I am not at all denying that it's possible that in many cultures the first born gets a lot of privileges. Obviously we've had historically primogeniture practices and even now you know if you think of the royal family, the first born gets the throne. So yes if you have cultural practices that imply that the first born will get certain advantages or the born or whatever your practices are then of course that's going to shape the life of those children. But what I'm trying to say and what the research suggests is that whatever happens to people's lives depending on their birth order has nothing to do with the fact that they actually have different personalities. So whatever happens might just be a cultural practice not an actual difference in their personalities. So it's not that if first borns end up achieving more, and there are a lot of studies to suggest that firstborns end up with slightly higher levels of education, that is not because they are actually more conscientious or smarter or whatever that is because that's the cultural practice that leads them to that. Maybe the college fund runs out by the time they finish college.

AMT: Bruce thinks that there is a possibility of extinction. You know he's partly tongue in cheek but thid idea. Do you think it matters if there are not as many middle children? Would you miss middle kids if they disappeared?

RODICA DAMIAN: Sure.

AMT: Especially if you were a middle kid. Okay. We're going to leave it there. Thank you.

RODICA DAMIAN: You're welcome.

AMT: We have one more voice to hear on this and her research into birth order and how it influences family relationships goes back to her days as a student at McMaster University in the 1990s. It's had her thinking deeply about the social implications of the disappearing middle born. She is Katherine salmon now a professor of psychology at the University of Redlands in California also the co-author of The Secret Power of Middle Children: How Middle Borns can Harness their Unexpected and Remarkable Abilities. Catherine Salmon joins us from Redlands California. Hi.

CATHERINE SALMON: Hello.

AMT: So but we just finished talking to Rodica Damian who says birth order doesn't seem to matter so what are you thinking?

CATHERINE SALMON: Well I think there are two things to think about here. One is that it's not so much that birth order doesn't matter. It depends on what you're looking at. Right. So one of the things that I'm interested in is behavior whether birth order influences how people interact in the relationships with friends family lovers. And in that area I do see stronger differences in terms of looking at things, how close are children of different birth orders to the parents. What are the relationships like with their siblings. What are the relationships like with other individuals. How does this influence their behavior in the workplace and in other aspects of their lives. And so to a certain extent this is perhaps a product of their personalities. And so I am interested in the research that's been done on birth order and personality and I would argue that there certainly are some large scale studies with over hundred thousand subjects that do show some birth order effects in terms of personality. But from my own work I've been focused a lot more on how differences in parental investment which includes things like attention but also financial investment for example how parental investment and sibling conflict. So the actual interactions between the siblings worked together to produce some of the kinds of effects that I see in my studies.

AMT: And you're looking as well at myths surround middle children and truths. Can you give us some examples of what you found?

CATHERINE SALMON: Sure. I was actually interested in this partially because of hearing about things like middle child syndrome and people's perceptions of birth order, because there's always this issue about whether or not the perceptions are held by people of different birth orders whether those actually influence their own behaviors. So how much the idea that you're supposed to be like this makes you like this. So what I think you generally see is that there were a lot of sort of preconceptions that people hold about birth orders. Now whether those are formed by their experience of interacting with people or whether they're formed by exposure to things like the media clips that you're showing at the beginning that are portraying middle children in a particular way or not are first born in a particular way or not, that that influences people's myths and the beliefs that they have about them.

AMT: Is middle child syndrome a thing?

CATHERINE SALMON: I don't really think that it is. I mean from my perspective in the kind of research that I've looked at it looks to me like middle children are just as psychologically well-adjusted as anybody else right. They don't think that there's anything about that position that necessarily leads to poor adjustment. So the idea of calling it a syndrome I mean to me that kind of fits into the myth category. That doesn't mean that some individuals might not resent getting less attention. On the other hand many of them also recognize that not being overly parented was probably beneficial to them in the long run. And one of the things that your first speaker mentioned was this issue around independence and it may be in fact that middle children are more independent than their siblings partially because they had to be because they weren't getting as much attention. And of course recently we've also focused a lot on the problems of over parenting and helicopter parenting. And I suspect that if you actually looked at that specifically with regards to birth already you'd find out that middle children are very rarely helicopter parented.

AMT: Okay so if you look at the place the middle child occupies in the family home, what can you see as they move into the wider world?

CATHERINE SALMON: Well what I see is that they grow up in a home where they've sort of had to to a certain extent negotiate for what they want they've had to be a little bit more independent, so they've learned skills related to that and they take those out with them. And so when they go into the workplace I think they are more attuned to thinking about, okay, what does this other person want to get out of this? What do I need to get out of this? How do we both get to the same place together in a way that benefits us both? And so I think those kinds of skills are ones that they to a certain extent learn at home and then can apply in the workplace. But also in the relationships with other people I think there were some studies that were done looking where they talked to people like marriage counselors and what they found is that they saw less middle children in their practice and when they didn't see them you know it was very clear that they played that kind of role in the relationships that they tended to be the negotiator they tended to be the one that wanted to keep things on an even keel. And so to a certain extent I think those traits that they're learning in the home are getting applied elsewhere.

AMT: To what extent is the disappearance or the concern over the disappearance of middle children a class phenomenon?

CATHERINE SALMON: Well I mean certainly those kinds of effects the shrinking birth size. You see more amongst the sort of middle to upper class right. And what we see with the sort of demographic transition and an increase in economic stability in countries. People tend to have less children. Children are more expensive putting them through education is more expensive. And so you see this sort of shrinking family size phenomenon where you know in many cases you actually have childless couples but you also have families that choose to have one or two. And so to that extent I think that the Pew survey that people were talking about is accurate that we are seeing a decrease. We don't have the huge families that we had before. Like my mother was one of eight children. That's not nearly as common now. So in a family like that you have a whole bunch of middle children that are contributing to that demographic. And so that I think is definitely changing. I do think it's interesting that there's actually also a study that came out that also suggested that even though we have a shrinking family size the ideal size that people think you know what's the ideal family size to have does tend to be a little bit more commonly three, which is interesting because it's suggesting that while people might want to have slightly larger families there are other factors constraining their choices.

AMT: I was looking at some of Pew's research the other day. And there is a decline across, they look at what they call across all racial and ethnic groups, dramatic declines in very large families but. And it's broken down into four groups Asian, White, Black, Hispanic and Black and Hispanic. The numbers are still much higher than White or Asian.

CATHERINE SALMON: And I think that I don't know that that necessarily is going to change. Part of that is due to the demographics. The factors that we've been talking about and race and socioeconomic status in the United States anyways are quite closely intertwined. So if you look at you know income Asians do very well in some places are doing better than white Americans. And I would expect to see the smaller family sizes there to see the effects more strongly there than in populations that have a lower income or that are living sometimes in areas that are more dangerous. Living in inner cities because you do see an effect that often individuals who live in more risky environments have more children.

AMT: So what do we do with this knowledge?

CATHERINE SALMON: Mean to me. I mean again I would say you know I don't have any particular prescriptions for parents on what size of family is ideal. I do think that many of the traits that I think middle borns come by naturally by virtue of their birth order being maybe more open minded and more concerned with equity and justice and being good negotiators. Those kinds of things are in independence are traits that we may need to work a little harder to foster in our children in different kinds of family compositions. So if you think about the baby of the family you might have to work a little harder to make them really independent because they often haven't had to. Right. And I say that as a the fact that that often you get a lot of things given to you and a lot more support that may actually make it take a lot longer for you to develop some of those kinds of skills. So we just may need to foster them more if we're going to live in a world without a lot of middle children.

AMT: Thank you for your time.

CATHERINE SALMON: You're welcome. Thank you.

AMT: Catherine Salmon is a professor of psychology at the University of Redlands and the co-author of The Secret Power of Middle Children: How Middle Borns can Harness their Unexpected and Remarkable Abilities. That's our program for today stay with Radio 1 for Q. Musician and composer Jean-Michel Bley will be on the show to perform from his Polaris Prize shortlisted record Dolmen, music he recorded at night in a Montreal piano store. Now if you missed my conversation with journalist Bob Woodward about the revelations in his new book Fear: Trump in the White House you can catch it in full by going to our website cbc.ca/thecurrent or you can download the podcast or find it on the CBC Radio app. The app is free from the App Store or Google Play. Now earlier I spoke with Kathy Kaufield about her fight against breast cancer and her campaign to increase awareness about breast density. Once again you can catch a special edition of White Coat Black Art this weekend on CBC Radio One dedicated to that topic. We're going to leave you today with a special moment from Kathy Kaulfield. This is from a home video recorded two years ago. She was in the oncology department of the Saint John Regional Hospital in New Brunswick after completing months of chemotherapy as part of her breast cancer treatment. This was recorded after her last chemo in August of 2016. I'm Anna Maria Tremonti thanks for listening to The Current.

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KATHY KAUFILED: I am standing here in the St. John Regional Hospital chemo room. Today Iget to ring the bell. I remember sitting at my kitchen table and I didn't know how I was going to get through the five months. I opened up the newspaper and I read about this [unintelligible]. Thank you to the women from the Breast Ahoy Breast Cancer's Survivors who put this bell up because ever since that day all I've been thinking about is the day I get to ring this bell.

VOICE: Am I supposed to talk after that?

KATHY KAUFILED: Yes.

VOICE: Okay Ladies and gentlemen of the chemo room, this young lady has completed her chemotherapy. She's gonna ring herself out, let's clap her out as she rings out.

[Bell rings, applause, happy chatter].

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Wednesday September 12, 2018 Full Episode Transcript

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