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The Current Transcript for November 27, 2018

Host: Anna Maria Tremonti

STORIES FROM THIS EPISODE

Prologue

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VOICE: I've been here 28 years. I've been through a closure in Scarborough, I've been through a closure in London. I moved my family twice for this company and they do this to me. It's terrible.

ANNA MARIA TREMONTI: That is a GM worker in Oshawa, Ontario, but that history, that sentiment, could be many people, in many places. From the sawmill to the mines to the assembly lines, technological change and corporate revision is the story of our times. And while it speaks to corporate profit and innovation, it can also silence a generation of workers who feel left behind and forgotten. What happens to those people shut out by progress, who can't just move or retrain or find new ways to earn a living? What does it do to our communities and our politics? In the wake of the GM announcement that sideswiped Oshawa, we're asking about that today. And GM says one of its aims with this change is to lower carbon emissions and prepare for a future of electric and autonomous vehicles, reinforcing the view that climate action involves an economic hit. Bill McKibben would argue that we don't have to see it that way, but we do have to face the reality that our planet's on a deadline.

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VOICE: The habitable planet is getting smaller. One wonders how many floods, how much melted permafrost before people to say we can't keep doing this in place after place around the world.

AMT: Bill McKibben, the founder of 350.org, joins me in half an hour and.

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VOICE: She was falling from insulin. I couldn't wake her up. It was kind of scary to think that the one thing that she's using to try and keep her alive is the one thing that put her in the situation she was.

AMT: The CBC's joint investigation into adverse effects of medical devices moves to questions around deaths and injuries involving insulin pumps. We're looking at that in an hour. I'm Anna Maria Tremonti. This is The Current.

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'A deep sense of betrayal': Oshawa GM plant closure could spark political fallout, warns prof

Guests: Johnny Milosh, Paul McDonald, Stephen High, Bernie Wolf

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VOICE 1: They understand where the changes are going, where the industry is heading.

VOICE 2: We see an all electric future. Going forward, we see pure electric vehicles.

VOICE 1: But they just chose not to make those investments here in Oshawa.

AMT: GM says it is driving into the future and leaving Oshawa, Ontario in its rear view mirror. You heard Unifor union president Jerry Dias there and in the middle, a short clip from GM CEO Mary Barra, with her vision of the automakers future. GM's announcement yesterday that it is shuttering its Ottawa plant, has met with defiance from the union. Here again is Jerry Dias.

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VOICE: We met with GM today and I'm here to tell you and what we told them. They are not closing our damn plant without one hell of a fight.

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AMT: What is happening at the Oshawa plant is a story about international trade and global trends, but it's also about a community just east of Toronto. Johnny Milosh has lived in Oshawa since the 60s. He owns a popular restaurant there called, Johnny's Original Eatery. Before that, he worked briefly on the line at GM. His restaurant opens early for the coffee and breakfast crowd every day and that's where we've reached him. Hello.

JOHNNY MILOSH: Good morning.

AMT: What's the mood like among your regular customers?

JM: It's very, very sad and down, I got to tell you, since that announcement came out on Sunday night.

AMT: And what are people saying?

JM: One of my customers this morning said that he was thinking about buying a new vehicle today and it's definitely not going to be GM. That is a very sad state.

AMT: As a business owner, how concerned are you about what this closure means to your restaurant?

JM: Well it's going to affect everyone, small, large businesses of all kinds. Very, very sad time for the city of Oshawa and for the people. I have a friend of mine right here beside me, Paul McDonald, that his family has worked and survived on that General Motors and now they'll be closing leaving the city of Oshawa.

AMT: Well why don't you hand him the phone for a minute and I'll come back to you.

JM: I certainly will. Here he is.

PAUL MCDONALD: Hello.

AMT: Hi Paul. This is Anna Maria.

PM: Yes.

AMT: So how long did you spend at GM?

PM: I worked there 28 years. My father retired at a GM before that and my grandfather retired at a GM before that.

AMT: And when did you leave? When did you retire?

PM: I left, it'll be 14 years ago coming up. April the 1st.

AMT: How did you react to this announcement yesterday?

PM: Well it's been sort of a progression. I didn't believe it on Sunday. I thought something would happen to change the outcome yesterday and today I think no, this is a real thing. I find it very sad myself because the company was always a great source of pride for the city, for the people who worked there and I think it's going to dissolve into a how does this affect me thing very quickly.

AMT: What do you think it's going to do to your city?

PM: It's hard to say because I was born here and it was the traditional one horse town. The old saying here was if General Motors sneezed, the city got a cold, but it's turned into so much more with the university here and the number of companies coming here. I don't think that the impact will be anywhere near as large as it was in years gone by in the 50s and the 60s, however there will be an impact because of the number of people who don't work there, but rely on the company for their income.

AMT: You made a good living there for a long time?

PM: I made an excellent living, my father made an excellent living, my grandfather made an excellent living for the time and for that I'm very grateful.

AMT: I'm imagining that you would have, all of you would have seen layoffs in the past, but this is different?

PM: Oh there's always been times of turmoil. There was a large strike here in the 50s and I remember it finely, although my father tells me in retrospect that he had almost lost his house. So there has been turmoil, but this is beyond that.

AMT: This is a whole other story now.

PM: This is completely different. It's surrendered to a market to whatever, but it affects the psyche of the people here I believe.

AMT: I'll ask you to hand the phone back to Johnny and thank you for speaking with me though.

PM: Very good. Thank you.

AMT: That's Paul McDonald in Oshawa. And I'm back with Johnny Milosh. Johnny how have you seen Oshawa change as the decades have gone by?

JM: Well over the many, many decades, like my friend said, it's been up and down, but positively I think it's moving forward and it's going to continue to move forward. It's got a lot going for itself. Everybody in Oshawa is very optimistic that the businesses will eventually find its way back here, but this morning and this week and continue forward, very sad time like my dear friend says. And I think I can speak for most Oshawa people that come to my restaurant, I think there'll be some tears in their coffee over the next few days.

AMT: Do you get a lot of people coming in before or after a shift?

JM: A few not. Not as many as I used to, over the course of years, when they were you know doing full production and they had more bodies of people working and not as many robots. So it's changed.

AMT: Oshawa has always been a place where vehicles were being made, even back to the horse and buggy days.

JM: It's rich in history and I think that's what everybody's going to feel. Mr. McLaughlin Had a vision for this city, for this country and it was very successful, kept a lot of families employed and very, very happy. So yeah, once you take that out of this city, it's going to be a big hole.

AMT: It's part of your identity, as someone who lives there, do you think?

JM: Oh absolutely. Right across this country, coast to coast, it was a city that motivated to move this country.

AMT: And so how do you think this will affect your city?

JM: Like I said, it's people are going to have to just try to suck it up and move on. You know they've been hit with these things before in their gut and fallen down, yeah. As my friend just alluded, nobody has a choice in what the global economy is going to do to small centers.

AMT: Do you blame anyone for this?

JM: Do I blame anyone for this? You know when companies, big corporations and big unions get into a juggernaut that they can't settle their differences and greed sets in, I think you know over the years, maybe it could have been averted, but greed takes over and that's the bottom line is eventually the big guys collapse.

AMT: Am I hearing you right, are you blaming the union?

JM: No, no, no, I'm not saying I'm blaming union, I'm not blaming companies. It takes more than one person to bring something down and nobody worked on this in a way that it would be restructured or try to make it viable. Everybody was taking too much out, nobody was putting in.

AMT: You know shares of GM rose 5 percent.

JM: 5 percent? When this announcement came out.

AMT: Yeah after the Sunday stories.

JM: Yeah well, this is what the market does. It plays with people's lives.

AMT: Johnny Milosh, thanks for talking to me.

JM: You're very welcome.

AMT: Jonny Milosh owns Johnny's Original Eatery in Oshawa, that's where we reached him today. The auto industry used to be an even bigger part of the economic and social landscape of Oshawa, going from horse drawn carriages in the mid-1800's to the first cars in 1908. GM Oshawa reached its heyday in the 1980s, when it was known as the GM Autoplex. At the time, one of the largest automotive production facilities in the world, employing as many as 23,000 people. Fast forward to today and there's just a fraction of employees left at the plant. General Motors is still woven into the history of Oshawa, even the junior hockey team, The Generals, takes its name from the company that has defined the town. And as we heard from a Johnny Milosh, the reality of a total shutdown is hard to process right now. They call it de-industrialisation, but my next guest will tell you it's what happens when people have nowhere to go. Stephen High is a historian and a professor at Concordia University's Centre for Oral History and Digital Storytelling and he joins us from Montreal. Hello.

STEPHEN HIGH: Good morning.

AMT: We just heard the men at Johnny's, there Johnny and his customer, talking about the identity that this industry has given Oshawa. What were you thinking as you listened?

SH: Well we've been living with this story for many years. North America is crowded with former mine, mill and factory towns. I've been interviewing displaced industrial workers you know from across Canada and the U.S. since the early 1990s and I think what we just heard from Johnny Milosh and the others was that it meant, it means more than a paycheck to people. A closure shatters people's sense of belonging and identity. Long service workers in particular lose I think a social structure in which they found validation and the human cost of job loss can also be enormous leading to depression, failing marriages or health or even suicides. I think that the people of Oshawa deserve more than our thoughts and prayers.

AMT: What kind, when you talk to people who find themselves in this position after years, especially in places where it's really it's defined where they live, what kind of language do they use when they talk about their connection to their work and what's happening?

SH: They speak about it in the most profound terms. Maybe I'll just quote a GM worker that I interviewed a few years ago, Gabriel Solano. And I asked him this exact question, you know what do you lose when the plant goes down? And he told me you know, "I lost a part of me. You know me as a person who said I have a goal and have a dream, to come home, I no longer have a job. The wife looks at you, you're looking at this baby, you're looking at this house and you're realizing you know what something's missing that's part of me. I don't so much feel that I was missing GM, but I was missing a part of me, something internal. It's hard to explain because it's an emotion, it's a feeling because it took all those years to build this emotion and this feeling and then it's not there. So you end up with a blank in your life." There's a blank. Yes there is. And again, we just heard at Johnny Milosh's place like these very profound sort of comments about what this place meant to people and to Oshawa.

AMT: You have connected the dots to that kind of feeling of loss to how we have essentially a working class revolt underway in North America.

SH: Yeah like I think there's a deep sense of betrayal that runs you know runs across working class communities right now. Decades of internalized despair had broken out into open revolt against political elites across the industrialized world. So you think of Brexit, the election of Donald Trump in the U.S. You know thanks to the Rust Belt five, you know the five states that flipped from Obama to Trump in 2016, not to mention the rise of right wing populism in Europe, you know there's a lot of working class rage. And I think like so far Canada has largely escaped political upheaval, but if our political parties continue to fail working people, this too will change.

AMT: Before we go any further, Stephen High, I want to bring another guest into the conversation. Bernie Wolf is here in the studio with me. He's a professor emeritus at the Schulich School of Business with York University. His research specializes in rapid changes to the auto industry. Bernie Wolf, welcome.

BERNIE WOLF: Good morning.

AMT: What do you think about that, the sort of the rapid change that makes people feel left behind?

BW: Yes there's certainly rapid change is what's occurring here. I mean the plant was closed because of differences in tastes of the consumer and technological change in the sense we're moving to electrical vehicles, autonomous vehicles. That plant was producing Cadillacs and Chevrolets. People don't want those. Those are going to be phased out entirely in North America. So there really wasn't anything left for that plant.

AMT: Well so what should people in auto industry towns be thinking about today?

BW: Well it really depends on what's being produced, how it's being produced. I mean if you look at Alliston, you look at Ingersoll, they're doing really well. And part of the reason is that you know, you developed say around the University of Waterloo, you've developed a kind of cluster where there is in fact a basically a movement, basically an embryo that's developing in terms of you know what's coming next.

AMT: And so if GM is announcing that it wants to prepare for a future of emissions free and driverless cars, what will the other big automakers be doing in the coming months?

BW: The same, you know and they're certainly working. You know, this is competitive and in fact in this case, you know it's going to benefit the planet. So you know change is inevitable. And as Stephen said, you know it does cause workers to lose their identity to basically be economically hurt. However, you know that's unfortunately for them the way it is and you know basically there are winners and there are losers I mean the banks are doing exactly the same thing. I mean we hear about Oshawa because it's 2500 workers, you know it's the seat of the auto industry in terms of history, but you look at you know these little branches, they're closing all over the place. The workers in the back office that aren't needed anymore. This is all part of the technological change that we have to live by and you know we gain, but there are losers and here the Oshawa workers happen to be the losers.

AMT: Stephen from the people you talked to, do those workers who are, in the case of Oshawa sideswiped, they found out through the media I think on Sunday. Did they accept that these changes are inevitable?

SH: No they don't and I think there's a real question about that. We've been living with sort of changing tastes and you know rising environmental consciousness for decades. You know in the early 80s, plants were closing because people were shifting to smaller cars. I think that you know the issue here is that I think the closure is unnecessary from a historical perspective. You know before the free trade agreement, we had the auto pact, which required the Big Three automakers to produce as many cars in Canada as they sold. Right by law, right. And so before 1988 right, GM could not have closed the plant and that's only with free trade that GM closed the Scarborough van plant, it closed the assembly line in Sainte-Therese, Quebec, it closed the Oshawa truck plant, it closed the Windsor transmission plant and now it's closed the car plant in Oshawa. And in 2009 right, GM gets bailed out from three billion dollars, right? And instead of actually negotiating that you know like we had in the past by requiring GM to reinvest in Canadian manufacturing, we let them off the hook.

AMT: So let me ask Bernie, we don't say to the CEOs, it's inevitable, you don't get your bailout we're going to give it to somebody else to run your plant because you need three billion dollars, so you don't know what you're doing. We don't do that to the guys at the top, we do that to the guys at the bottom.

BW: Yes the big problem and you know the reason that you're getting these populist governments, the discontented workers is that the benefits are not distributed appropriately. Basically, you know the rich get richer and the poor get poorer and that's really the cause of the problem. You know that bailout as far as I'm concerned, was really necessary. Those safeguards were necessary at the time, but they would be inappropriate right now. I mean to build walls around yourself is is not the way to go. I mean the Trump administration is basically doing that and that's going to have a huge, huge cost.

AMT: And it's not necessarily saving jobs to do that, but let me ask you Stephen High, given what you know, like we can talk about you know generations coming up need to shift and technology needs to shift, but what about the people who are caught in that as that wheel shifts? They're caught under that wheel. What responsibility does our society have to look after people caught in the shift?

SH: Yeah I think there's a depressing sense of inevitability around plant closings that we have come to accept you know the structural violence of industrial plant closure is a fact of life. It's become normalized that we don't even recognize it as a form of violence. And so what's going to happen is the impact of this announcement is going to ripple through you know individual lives, families and communities. And this isn't just Oshawa, it's you know dozens and dozens of Canadian towns. I'm from Northern Ontario, which has been devastated by mill and factory closures that have gone on without much attention from the national media and so this is a problem that needs to be talked about. You know what kind of society are we building? And yes there's winners and losers, but there's a heck of a lot of losers we're talking about now, right?

AMT: And Bernie Wolf, you can give me the last word. We're almost out of time. Is there responsibility of governments?

BW: Yes, I think there is some responsibility government needs to help this along, but at the same time, you have to look at the people who don't have jobs. The people who you know are getting minimum wage. They're much worse off than the workers.

AMT: That's a government decision as well though, minimum wage is a government decision.

BW: Yes and you know there are problems with minimum wages, there are you know there are always trade-offs. But I think you don't you know, the GM workers were fairly highly paid. You know you have a lot of people that are not nearly as well-off and we need to look there as well.

AMT: OK we'll have to leave it there. Gentlemen, thank you for your thoughts on this. Stephen High, history professor at Concordia University. His latest book is One Job Town: Work, Belonging and Betrayal in Northern Ontario. Bernie Wolf is a professor emeritus at the Schulich School of Business. He's in Toronto. Stay with us. The news is next and when we come back we're talking to Bill McKibben, founder of 350.org About climate action. This is The Current.

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Youth would be better leaders in fight against climate change, says veteran environmentalist

Guests: Bill McKibben

AMT: Hello. I'm Anna Maria Tremonti and you're listening to The Current.

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AMT: Still to come, more on the results of a yearlong investigation into medical devices. CBC News worked with journalists around the world to look into the issue and the reporting is already having results. The U.S. FDA says it will be overhauling the way it approves medical devices. In half an hour we focus on insulin pumps, but first a voice in the wilderness.

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VOICE: 1988, in a sense, is the year that the Earth spoke back. Our land, water and soil support a remarkable range of human activities, but they can only take so much and we must remember to treat them not as given, but as a gift. Some say these problems are too big, that it's impossible for an individual or even a nation as great as ours, to solve the problem of global warming. My response is simple. It can be done and we must do it.

AMT: Well that is George H.W. Bush, the elder Bush, on the U.S. presidential campaign trail in August of 1988, during a key environmental speech using the phrase "global warming." At the time Bill McKibben was a young environmental reporter with The New Yorker magazine, who had just published an article called, The End of Nature, about what was called the greenhouse effect. 30 years ago, climate change was a new idea. Today it is everywhere. There's a mountain of scientific data along with overwhelming anecdotal evidence, larger more powerful forest fires, larger more frequent hurricanes and ferocious hurricanes, larger more deadly heat waves. It's enough to make an environmental activist such as Bill McKibben wonder if our children's future can be saved. Bill McKibben is the founder of the grassroots climate campaign 350.org. His new book, "Falter: Has the Human Game Begun to Play Itself Out?" will be out in the spring. And we've reached Bill McKibben at his home in Ripton, Vermont. Hello.

BILL MCKIBBEN: Hey it's very good to be with you.

AMT: It's good to have you with us. Tell me first of all more about your thinking back in 1988, when you wrote The End of Nature in The New Yorker. How confident were you that the threat of climate change was real?

BM: Well I think the science was already pretty clear. At the time there wasn't that much of it. When I wrote, The End of Nature, which was the first book for a general audience about what we then called the greenhouse effect, you could assemble all the science, all the reports and articles on the top of my desk. Now you could fill an airplane hangar with them, but very little in our understanding has changed. You know it's pretty basic physics that the molecular structure of carbon dioxide traps heat that would otherwise radiate back out to space. What we didn't know 30 years ago, was how fast and how hard this would pinch and the story of those three decades is, it's pinched a lot faster and a lot harder than we thought back then. 30 years ago, this was still an abstract threat. Now it is the ferocious daily reality of an enormous number of people, whether they're having to leave their homes because of rising seas or cope with droughts that are driving farmers off their land or in dramatic cases like the ones in California last week, fleeing in panic because their entire town is burning down inside and out.

AMT: In fact, in the piece that you've just done for the New Yorker, you say the world is shrinking.

BM: The habitable planet is getting smaller. I mean human beings have been spreading out for many hundreds of thousands of years from our origins in Africa, but the world kept becoming a larger place. But now as the coasts become inhospitable people are beginning to move off of them and as they do, they're going to have to grapple with a problem that the continental interiors are getting extremely hot. The latest science for the last 18 months makes it clear that the huge belt of the planet through the tropics through Asia, into the North China plain, home to maybe two billion people, will be so hot by the end of the century on current trajectories that it really won't be a good place for humans to be at all. You can see this happening everywhere. Look at Canada, look at the far north. It's true that finally the government was able to get the rail line back up to Churchill this summer, but only at a cost of like a $130,000 per resident of Churchill. You know one wonders how many floods, how much melted permafrost, before people just saying we can't keep doing this in place after place around the world.

AMT: Well let's just stay with the idea of melting. You saw something in Greenland this summer that underlines all of that, where were you?

BM: I was in the fjord country along the south west edge of Greenland. It's of course a remarkable place to get up there and sense the scale of the huge vast ice sheet that covers most of it, but also to sense the speed at which that glacier is melting. We were one day on a boat headed across the fjord near the town of Narsaq, with you know open water for a mile around us. And I looked up at the chart, the electronic chart above the captain's wheel and it was clear that our boat showed that we were a mile inland on dry land. And when I pointed this out to the captain, he laughed and shrugged and said well the electronic chart is five years old. Five years ago this was ice as far as you could see. That's the world we live in now.

AMT: And you know you do mention as well in your article, you were talking about heat waves a minute ago. Nine of the ten deadliest heatwaves in human history have occurred since the year 2000.

BM: Well those heat waves have become, you know some of them are happening in our part of the world as you know. 70 some people died in Montreal last summer, but the worst of them are in places that are nearest to the equator, places like India where the temperatures are getting truly savage and where there's not the kind of infrastructure to cool people down, to protect people.

AMT: So we can talk about heat waves, we can look at the devastating and tragic California wildfires leading the news this month and the extreme weather conditions we've seen, do you get the sense that people are connecting climate change with the reality of the tragedies they're seeing around them?

BM: Yes. More and more and this is all the more remarkable because despite the 20-25 year effort of the fossil fuel industry to keep us from making that connection, their attempt with hundreds of millions, billions of dollars to try and confuse people and to convince them there wasn't a scientific consensus about climate change, that did a lot of damage. It cost us a generation of work on this issue, but I think that by now the evidence of what's happening is so clear that people have more and more and more understood what we're up against. You know there may be people left who look at President Trump saying oh it's all a hoax and takes some reassurance from that, but I doubt frankly that there are very many. I think most of us, whether we're willing to acknowledge it or not, now have some sense of dread about what's going on.

AMT: Well I want to pick up on what you're saying about the fossil fuel industry because we do now know that major players in the oil and gas industry were well aware of the risk of global warming and a full decade before the first President Bush's campaign promises, Exxon's own scientists were warning its executives about the dangers posed by greenhouse gas emissions. Anna Kalinsky grandfather James F. Black was one of them. Here she is on Democracy Now describing his work.

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VOICE: My grandfather worked for Exxon for about 40 years and in 1977 he gave a presentation to top Exxon management's and he laid out very clearly that the planet was warming. That this was because of rising carbon dioxide levels in the atmosphere and that those levels were rising because of the burning of fossil fuels. And at the time he told Exxon that humankind had five to ten years to start really making the hard decisions regarding climate change or else the situation could become dire.

AMT: Bill McKibben, what did Exxon executives do with the research by Mr. Black and other company scientists?

BM: Well they published it in a couple of obscure journals and then they set to work making sure that people believe the opposite, beginning about 1988-89 when Jim Hansen testified before Congress that climate change is real. Instead of Exxon saying yeah you know what our science shows the same thing, which would have been a really important moment, no one was going to accuse Exxon of being alarmist about climate. Instead they and others began the process of building a series of front groups hiring people who'd worked for the tobacco industry on and on and on, all in an attempt to instill doubt about whether this was real or not. It wasn't doubt that they shared, they were building their drilling rigs to compensate for the rising sea level that they knew was coming, but it was doubt that they wanted to spread to the rest of us, in order to maintain their business model for another generation, even at the cost of breaking the planet, which may well be the cost. People are fighting back. There's a powerful divestment movement around the world as institutions sell their shares in these companies. We passed seven trillion dollars’ worth of endowments and portfolios this year with the city of New York divesting its vast pension fund and in the nation of Ireland deciding to end its investments in any of the companies that produce fossil fuels. Shell Oil said earlier this year that this divestment movement had become a material risk. So there are ways that people are fighting back through groups like 350.org. But it's very late in the game and an immense amount of time was wasted. This was, if you're the fossil fuel industry, an effective strategy. The problem is that it came at a cost of the one planet we've got.

AMT: Have there been lawsuits as well?

BM: Yes people have now filed lawsuits on a couple of grounds. A bunch of cities have filed lawsuits with the oil companies demanding damages for things like rising sea level, on the grounds that this was a harmful product that they were being sold. And others like the state of New York have now sued some of the fossil fuel companies, not for lying about climate change. Under American law lying about things is protected under the First Amendment, but for lying to investors about climate change. Lying to investors apparently is frowned upon. So that's the legal doctrine on which they're being challenged.

AMT: I do note though that the judge threw out New York City's climate change lawsuit against five major oil companies in June.

BM: Because it's appealed it and New York is one of only you know one of a number of cities that are filed similar suits. I don't know whether you can I mean prevail or not. The power of these companies is so enormous and our legal and political history indicates that if you're really big and really rich you may be able to prevail. We shall see.

AMT: Well and the U.S. District Court Judge John F. Keenan had ruled that problems associated with climate change should be tackled by Congress and the executive branch, which brings me back to that clip we heard, George H.W. Bush because the issue has been on the political radar for decades. Why so little political action?

BM: Well look, that was actually, I was really glad you played that. It was a remarkable speech. At one point in it he said memorably, we will fight the greenhouse effect with the White House effect, which was as good a line as anyone's gotten off about climate change in 30 years. He didn't really mean it and the reason he didn't really mean it and that the people who followed him didn't really mean it was because of the immense power of the fossil fuel industry. It is the richest industry in the history of the planet. It commands enormous power. Look, not only the United States, which is the most egregious example, but look at Canada. I mean you know in the face of everything we know about climate change, in the face of watching Fort McMurray burn, the Canadian government is buying an oil pipeline in an effort to make sure that more oil flows out of Alberta into the atmosphere. That gives you some sense of the power of these industries.

AMT: So essentially, that's what you're telling me, the reason that so many things have stalled or just not gone forward is like the sheer power of lobby.

BM: This is the richest industry that the world has ever known. And you know I don't mean to be cynical in any way, but that kind of wealth and power is enough to stymie action. At least it has been so far. That's why we try to build movements like 350.org, in an effort to try and break some of the political power of that industry, so that we can actually have a real discussion about what we're going to do with the greatest crisis that human beings have wandered into.

AMT: So just help me understand something. So it is documented, the oil industry knows that climate chang, global warming is a real thing, then it decides to sow doubt and it talks and that we see the documents where different experts are saying you know talk about the doubt. And so that the oil industry raises the issue of doubt and lobbies against action. So do the politicians and I'm not talking about individuals, but just overall, do they know the same thing as the oil industries and just use or were they being played heavily by the oil industry without knowing it?

BM: It probably it depends, right. I mean Donald Trump once quite willing to believe that he doesn't know anything about anything. Who knows? But Justin Trudeau went down to Houston and gave a talk to the oil industry where he said no country would find 173 billion barrels of oil and leave it in the ground. And the oil executives stood up and cheered. One understands why he says that, but when you look at the math, if Canada burns that 173 billion barrels of oil, digs it up, sends it out to be burned, that uses up a third of the atmospheric carbon budget left between us and those goals we agreed on at Paris a few years ago. So really there are almost no profiles encourage politically on this issue that I know of around the world. We're beginning to see a few, there are a couple of countries, Costa Rica, Norway, Spain, where there have been real efforts to convert quickly to renewable energy. They demonstrate what can be done and one of the reasons this conversation is so important is because we actually have something that can be done. 10 years ago we didn't quite know what we were going to do, but the engineers have dropped the price of solar power and wind power so dramatically over the last decade and they've made such improvements in things like storage batteries that we now can see more or less where we need to go if we really were serious about dealing with climate change. It's no longer beyond the realm of the physically possible. The question is, is it in the realm of the politically possible.

AMT: Well and I want to explore that a little more with you as we go along, but let's stay with what has been politically or industrially possible or impossible so far. How much of a difference do you think it would have made if the oil and gas industry had added its voice to those early warnings and joined the early efforts to curb greenhouse gas emissions?

BM: I think it would've made all the difference in the world. If in 1988 they'd all stood up and said look this is real, then we would have gotten to work. We wouldn't have solved climate change by this point because it's really hard and because fossil fuel is at the center of our economy, but we'd be well on the way. The analogy probably is to what happened with chlorofluorocarbons in the ozone layer. We agreed in the Montreal Protocol that we would start phasing out these chemicals and industry quickly figured out substitutes and now the ozone layer is healing itself. We think by 2060, it will be more or less healed. That's the model that we should have followed, but we didn't because chlorofluorocarbons were, we didn't make that much money off of the. Oil you made more money than anybody ever made on anything. And so they took an entirely different path and now we're paying the price and indeed we'll be paying the price for many millennia to come.

AMT: And the other example of course is the combating of acid rain, in an agreement between the U.S. and Canada. Although people say you know both of those were more specific. You could point to something very specific that you needed to do, but when it comes to greenhouse gas emissions and and what's going on with global warming, there are so many tentacles that it's harder.

BM: There are a lot of, look this is no denying that this is a very big problem, but its central core is not that hard. We have to stop burning coal, oil and gas and learn how to power our lives with things that don't create greenhouse gases. That's the biggest economic transition that anyone's been asked to make probably in human history, but if we made it, not only would be save the unbelievable, almost incalculable cost of the damages that comes from climate change, but it would create immense amounts of economic activity along the way, providing lots of good jobs that you know have to be done close to home. No one's going to send their house to China to get a solar panel put on the roof you know. That's work that has to be done by Canadians or Americans and should be done and done quickly.

AMT: Well economics is at the key of the debate. Fossil fuels are a huge part of the Canadian economy and the debate over climate action is often framed as jobs versus environment. How do you convince people to take action when they say it is at odds with their own economic interests?

BM: Well I think you have to, a, make plans for how you deal with the people who are working in that industry. It's not their fault and there needs to be an economic transition away from it. And in countries around the world, people have figured out how to do that. The numbers of people working are not so enormous that we can't figure out how to retrain them. How if they're too old to be retrained, to give them a dignified retirement. It's not their fault, but one then has to do the work of actual economics. You know economists are better at addition than subtraction and really add up what the price is going to be if we don't tackle global warming. And one of the things that's so fascinating and powerful, has been the role of Indigenous people, may be in Canada more than almost any place else on the planet in taking up this fight. In many ways they've become one of the last bulwarks against the crazy climate path that we're on.

AMT: So you mentioned solar power and wind power and advances earlier. Tell us more.

BM: Well the really the great news of the last decade is that the engineers have done what engineers do. They've gotten better and better and better at building solar panels and wind turbines, so that they're now cheap. The cheapest way to produce electrons across much of planet Earth, most of planet Earth, is to do it with the sun and the wind at this point. In fact they're so cheap that investment banks and things are beginning to say, it makes more sense to build new solar energy installations than to keep running the coal fired power plants we've already built. Just because you have to keep paying for coal whereas the sun quite cooperatively provides power every single day for free.

AMT: How realistic is it or how difficult is it then to do the switch that we need to do?

BM: It's difficult to do the switch because it has to happen quickly, much more quickly than economics would dictate. So we would need real government leadership to make it happen in the time that we have. We'd have to do something like we did you know at the beginning of World War II, when North America geared up to provide the industrial plant that defeated the Axis powers. That's doable, but it takes leadership to make it happen and that's why the lack of leadership has been so sad. It's why in particular, it makes things like plans for new pipelines so crazy. If you build a new pipeline and sink all the money into building it, what you're saying is we're going to be using this for the next 40, 50, 60 years because that's that financial lifetime of that piece of infrastructure. What you're saying in essence is we don't think there's going to be any real change in the period of time that scientists tell us we have to make that change. So that's why the fight against newer expansion of the fossil fuel industry is so key.

AMT: I've been talking to 20 somethings who say they don't dare have kids because of climate change. Have you heard that kind of conversation?

BM: I have sometimes and that makes me very sad to hear. What makes me happy is the degree to which young people are now taking up and leading this fight. And I think that what young people are finding is that when they're engaged in the battle, they're able to feel more empowered, less fearful, less anxious. Not completely, this is a time when it's appropriate to be anxious and fearful because the things we're doing are devastating, but young people increasingly are in the lead here and that's important.

AMT: Do you see a real generational-political divide on this issue then?

BM: The polling is unbelievable. If the world was run by people sort of 40 and under, this is the thing we'd be working on all the time and we'd be making huge progress. The problem is people of my generation who refuse to let change happen. Who insist on keeping the same technologies, the same powered patterns of wealth and settlement and industry that we've had in their lifetimes. One understands why people want things not to change, but things are going to change on a completely different scale, if we don't make some human changes.

AMT: Bill McKibben it's good to talk to you. Thank you for your time.

BM: A real pleasure for me. Take care.

AMT: Bill McKibben is the founder of the climate campaign, 350.org. His new book, Falter: Has the Human Game Begun to Play Itself Out, will be out in the spring. He joined us from Ripton, Vermont. Let us know what you think of what he had to say. Find us on Facebook. Tweet us @TheCurrentCBC. Go to our website cbc.ca/thecurrent. Stay with us, in our next half hour, our coverage of medical devices continues. We're looking at an invention that's improved the quality of life for many Type 1 diabetics, but not for all, insulin pumps. I'm Anna Maria Tremonti. This is The Current.

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Insulin pumps require careful management to work safely and effectively, says endocrinologist

Guests: Peter Senior, Simon Heller, Nav Persaud

AMT: Hello. I'm Anna Maria Tremonti and you're listening to The Current.

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VOICE: I have had a pump for about seven years now. Really it's been very, very helpful for me in terms of managing my diabetes better.

AMT: Lindsey LeClair is one of thousands of Canadians with Type 1 diabetes, who uses an insulin pump. It is a device about the size of a pager and it allows patients who use it to control their insulin dosage and with this device, instead of multiple daily injections through syringes. A Vancouver woman's pump, her pump is made by Medtronic, one of the manufacturers of the devices that are used in Canada. Lindsey LeClair says she can't imagine life without it.

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VOICE: It does give me far more freedom I would say in terms of the monitoring and also in terms of what I have to carry around. So with the insulin pump, I'm wearing it 24 hours a day, seven days a week. So it's very hard to forget it, also. I mean the biggest benefit for me frankly has just been the level of control. So it's been easier for me to achieve those really in target blood sugar ranges. That's really been the biggest benefit for me, so less worry frankly.

AMT: Manufacturers and provincial governments agree the pumps are safe and simple to use. Many provincial governments even reimburse the cost of them for children. But unlike most other medical devices, with an insulin pump, the patient controls the machine. Yesterday we brought you the stories of two Canadians who fought an uphill battle to get help when their medical devices, vaginal mash and a hip replacement device, proved to be harmful, instead of helpful. And if you miss those stories, you can hear all of that at cbc.ca/thecurrent, our website. We have it. That story is part of a CBC News series, The Implant Files, which is a joint investigation among CBC News Radio Canada and the journalists at the Toronto Star, in collaboration with the International Consortium of Investigative Journalists. Yesterday, the US announced that it plans to overhaul a decades old system for approving most medical devices in response to the global investigation. Today, we continue our medical devices coverage by looking specifically at the insulin pump. Data received through Access to Information requests in Canada during this investigation, showed that in the past decade in Canada, there were 103 deaths and more than 1900 injuries, reported to Health Canada, involving insulin pumps, across all brands. More than for any other high risk medical device they looked at.

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VOICE: Hi, I'm just having a problem with a, I'm getting a button, which I've never had before. So I'm not sure what to do.

AMT: That's the voice of Christine Landry, reporting a problem with her pump to Medtronic in 2012. The Cornwall, Ontario nurse had been using the pump for five years. She was certified as a Medtronic product trainer. That night she went into a hypoglycaemic coma that left her with severe brain injury. Her son, Philip, found her the next morning.

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VOICE: As soon as I walked up the stairs, I could hear her breathing, but it wasn't, it was like heavy breathing it was and sure enough, whenever I went in the room she was like foaming from the mouth and I couldn't wake her up. So I called 9-1-1 right away. Yeah it was kind of scary to think that the one thing that she's using to try and keep her alive is the one thing that you know put her in the situation she was.

AMT: In September, Christine Landry's family removed her from life support. Her family is suing the company for what it alleges was a defectively designed and manufactured product that made it inherently dangerous. In a statement of defence, Medtronic says that Christine Landry failed to manage her own glucose level and follow proper safeguards when using her pump and was fully aware of and informed of the risks of her pump. We asked Medtronic for an interview, which it declined, but in a statement the company said it stands behind its products as well as their safety and efficacy. Type 1 diabetes is a complex condition to manage and problems involving all brands of pumps can happen for a variety of reasons. We have two guests with us today to talk about the benefits and the risks of insulin pumps. Peter Senior is a professor of medicine at the University of Alberta. He is an endocrinologist specializing in Type 1 diabetes. He's also a member of the clinical advisory committee for the insulin pump therapy group program in Alberta. Peter Senior joins us from Edmonton. Simon Heller is a professor of clinical diabetes at the University of Sheffield and a consulting physician at Sheffield Teaching Hospitals in the UK and he joins us from London, England. Hello to you both.

PETER SENIOR: Good morning.

SIMON HELLER: Evening.

AMT: I want to just begin with the numbers from the statistics that our team has looked at. 103 deaths, more than 1900 injuries reported to Health Canada involving insulin pumps from all manufacturers in the last decade. Hearing that and then Christine Landry's story, I'm wondering what you're thinking, Simon Heller?

SH: So I think it's I was slightly taken aback, the numbers seem high to me. And as you pointed out in your introduction, it certainly raises concerns about the safety, but I guess what I would answer is that in my experience, although technical malfunctions happen, they're relatively rare. And one would hope that the training that patients undergo when they go on a pump, should be sufficient for them to be able to take the correct action and avoid their glucose going either very high or indeed low.

AMT: And Peter Senior, what are the benefits and risks of insulin pumps for patients with Type 1 diabetes?

PS: I think as the clip we heard earlier, some of the major advantages of insulin pump therapy are in relationship to freedom and flexibility. People can be much more spontaneous because they've always got the device to take insulin with them at all times. For some people, it gives a lot of flexibility around exercise and activities and meals, which most of us take for granted. If you have to take multiple daily injections, you generally speaking, may find that life is a bit more restrictive in terms of structure and needing to the clock. So that freedom and flexibility is a major advantage and for skillful users, they can achieve better glycemic control than they might have done, if they were using injections.

AMT: And why can't adverse effects, minor problems, injuries or death happen with diabetes patients using pumps?

PS: Well I think the things which can cause adverse effects to people who use pumps is the same for people who are taking injections. Diabetes is a really difficult disease to manage and live with. You are absolutely dependent on insulin, as a therapy and if you don't take insulin or you don't take enough, you can run into potentially life threatening problems. But conversely, if you take slightly too much or much too much, you can have life threatening complications because the blood sugar goes too low. So life is walking a tightrope between blood sugars being too high or blood sugars being too low and it's a real challenge to manage, no matter how you take your insulin.

AMT: And are there specific risks with the pump because it's a drip, more than like a full injection?

PS: I think the major difference there would be that if you have a pump, which malfunctions or if let's say the pump becomes detached from the body, there is very limited, if any residual insulin left in the body and so if the delivery of insulin is interrupted, the effects on the body will wear off within a few hours. Whereas if somebody is taking injections, some of those injections have been designed to have a delayed release of insulin over a number of hours. So it's unlikely that the blood sugar will become very high, very rapidly. So certainly if there are unanticipated interruptions in insulin delivery with a pump, the blood sugar can rise quite high levels and potentially dangerous levels within a matter of hours, which might not be the case for people taking injections.

AMT: Simon Heller, in your view, what types of patients should be using insulin pumps?

PS: I think when patients who are off the pump, sometimes they're led to believe that of course there will be flexibility, but life may become less arduous in the amount of work that they have to do to manage their diabetes. But in my experience, the opposite is the case. And what happens is that they have to do far more work. As Peter said, if they can make the most of the pump. They also have to be very knowledgeable about how they manage their diabetes. Of course we hope that everybody is knowledgeable and everybody should have high quality education and training, but the sad fact is that it's such a hard disease to manage that a relatively large percentage of people prefer to do the basics and not always engage with their management.

AMT: Health Canada has said that because of recent post market concerns with all infusion pumps, including insulin pumps, they now ask for more rigorous testing before approval. We requested interviews from insulin pump manufacturers whose products are sold in Canada, Medtronic and Insulet, no one was made available to us. Medtronic did send us a statement and I'll read it in part. It says, "We take any safety related event very seriously and investigate them thoroughly. Medtronic's policy is to report these events and also reports of serious injury to Health Canada, even if a causal relationship to the device cannot be clearly established. As a result, the number of adverse event reports cannot be used in isolation to reach conclusions about the existence, severity or frequency of problems associated with devices." And Insulet sent a statement that said in part, "We listen to and speak with our patients around the world to ensure our leading Omnipod tubeless technology makes the lives of people with diabetes easier." Peter Senior, what responsibility do you see for the pump manufacturers in addressing anything that goes wrong?

PS: I think the pump manufacturers do have a duty, but they take it you know at least I believe so, very seriously. And certainly they do have to report adverse events to Health Canada. They will be subject to audit. Again, I think because the devices in the hands of users every single day, major malfunctions I think will become relatively apparent, although again you may have tragic episodes where there is malfunction. You know these I think will be rare events and rightfully so, but there's always risk with any device or treatment for diabetes.

AMT: How clear are the risks to the patients?

PS: I think the risks or the perception of risks may not always be exactly correct and that's partly based on people's own experience. I have patients who tell me that they don't worry about hypoglycemia because you know nothing bad has happened to them and yet I worry a great deal when I review them in clinic. I think the patient expectations around insulin pump therapy is a really important thing to explore and manage. And I think Simon has mentioned this already that people may come exploring insulin pump therapy with quite unrealistic expectations, that it will take care of their diabetes, they won't need to think, they won't need to work. But as we've heard already, to do pump therapy well, effectively and safely, I think it actually does require more work. It's a high needs, high maintenance situation and certainly I would be concerned about risks if people aren't taking very careful attention and looking after their pump, the infusion sets, the way that they use it each day.

AMT: I know Peter Senior, I should note that you have in the past received consulting fees from some of the major pump manufacturers including Medtronic and Insulet. How much of an effect has that had on how you see their effectiveness?

PS: I hope that it's not biased me in favour of the pumps. There's always a balance between getting access to new technology, compared with the requirements of safety. And an interesting parallel might be to look at situations in the U.S., where some new pumps were actually held up by the FDA because of concerns of safety that were available in Canada and Europe. And actually patient groups approached Congress to ask that they be allowed to have access to the new technologies and indeed the new technology was a new pump, which had the ability to turn itself off if blood sugar levels were running low. So this so-called low glucose suspend was a safety feature in the new model of pump, which again was not available on the U.S. market because of concern by the FDA to make sure that everything was just so, whereas other regulators in other parts of the world had approved this. And again clinical trials have shown that the benefits were apparent. So I have wanted to interact with companies, not really hopefully at least to be biased by them, but certainly to be aware of what's going on, see behind the scenes so that I can give my patients the best information and I think I would approach things with really quite a sceptical attitude.

AMT: Simon Heller, you researched the effects of training for patients using insulin pumps, compared to multiple daily injections. What did you find?

SH: So we did. I think the largest trial of insulin pumps that's been done and we've recruited over 300 patients and we explored the benefit of pumps for two years. We also wanted to test the theory that actually much of the benefit of pumps came from the training and education that they would inevitably receive. And so we randomized the patients to have the training course, with or without pumps. One group had injections, one had pumps and we followed them for two years. Importantly, both groups improved their blood glucose control. We deliberately chose people with high glucose levels because we wanted to see if it changed and indeed in the UK that is the kind of group who are eligible for pumps. We also noticed that severe hypoglycaemia, these are episodes which need the help of another person to recover, also went down by 50 percent in both groups. And we therefore came to the conclusion that much of the benefit of pumps was indeed because of the education they received. So I think the trial showed at least to me very clearly that we should be providing education and training for far more people. It's very cost effective. It costs 300 pounds to do the course, obviously far less than a pump. And then for those who have continued frustrations with the limitations of instant therapy, as Peter has said, and who are really up for doing all the extra things that they have to do to make the use of a pump, they are the people who are going to benefit. And indeed I think that that kind of approach works well for other technologies in diabetes. You have to make sure that these are patients who are educated, they're really keen to use the benefits and indeed they also need to be trained to use the pump safely.

AMT: Now Medtronic did say in its statement to us that numerous clinical studies have shown that its insulin pumps have "improved blood glucose control in patients with diabetes." You got some pushback from others in your field saying that the patients in your study weren't using the full range of features of insulin pumps. How do you respond to them?

SH: Yes we did. So there are extra features in pumps. So for example, they calculate the dose of bolus insulin automatically, in fact we were careful to offer to the people on multiple injections, that they had a way of calculating the dose, so we allowed for that. Both groups had that benefit. So I would challenge that. The other benefits of pumps so they can give the bolus insulin before they eat in different ways and that is a special feature. I should say that these extra features have never really been demonstrated to produce benefit and that the centers taking part in our study were very experienced pump centers. The patients were encouraged to use those, if they wanted and indeed if they did, then they had extra training. So although I accept that the patients didn't use those or many did not, some did, and I think it reflects the fact that unless you're really engaged in managing your diabetes, it's not surprising to me that they might not use those extra features. So I would defend the criticism as I said.

AMT: And Peter Senior, are there changes you would like to see for insulin pump patient training in Canada?

PS: I think the access to specialist care for Type 1 diabetes is quite challenging in many parts of Canada, particularly with the geography. I think the pump programs, which have become established, may have led to less resources being available for people who don't use pumps in terms of education and really to develop a systematic standardised self-management education program for Type 1 diabetes in Canada is one of the projects, which I have on my agenda at the moment, to see if we can establish in Canada that can be delivered you know across the country, respecting the kind of particular challenge of geography, which we have, with lots of people living quite large distances from specialised centres. So I think education is absolute key for all of Type 1 diabetes and certainly is fundamental for insulin pump therapy given the cost of delivering that resource. It would be a real shame if people had the resource, but not the skills to use it effectively and safely.

AMT: Who's responsible for training now and are patients obligated to take it?

PS: I think you know again, healthcare in Canada is a provincial matter. And so the decisions about training requirements for pump therapy vary by province. Again, I think it's often been underestimated how much the patient has to put in to get the most out of a pump, even among kind of the regulators and the provincial authorities who approve pump therapy. And certainly when Alberta was considering reimbursing pumps, the advice which came from many of the clinicians was that perhaps half the resource should go to the hardware and half should go towards training. Again, largely to improve safety and effectiveness.

AMT: Simon Heller, what should Canadians be weighing when deciding if an insulin pump is right for them?

SH: I think they need to be well aware that it has fantastic potential. I do believe in insulin pumps, but I think they need to use a pump and understand what they're getting into and I think it's extremely important that they have the skills already to manage their diabetes and they realize that when they go on a pump, that will be increased. So the benefits are great, but the responsibilities on them will undoubtedly go up.

AMT: Gentlemen, we have to leave it there. Thank you for your time today.

PS: Thank you.

SH: Thank you.

AMT: Peter Senior is a professor of medicine at the University of Alberta and an endocrinologist specializing in Type 1 diabetes. He joined us from Edmonton. Simon Heller is a professor of clinical diabetes at the University of Sheffield and a consulting physician at the Sheffield Teaching Hospitals in the UK. He joined us from London. Health Canada collects data on what is called adverse effects, minor problems, injuries or even death, for all medical devices in Canada. It is also responsible for approving the devices in the first place, but some medical professionals say patients need more information on what regulatory approval really means and on how the devices actually work when they're used by patients. Nav Persaud is a staff physician atSt. Michael's Hospital in Toronto. He's also an assistant professor in the Department of Family and Community Medicine at the University of Toronto and he joins us now. Hello.

NAV PERSAUD: Hello and thank you for having me.

AMT: What does it mean when Health Canada approves a medical device?

NP: Approval means that a product can be sold in Canada. Approval does not mean that it's known to be effective and safe. In many cases, device can be approved based on the fact that it's similar to an already approved device and it may not be well studied. Its long term effectiveness and safety may not be known, based on the information that's available at the time Health Canada gives it approval, to be sold in Canada.

AMT: So as a doctor, what additional information would you like to have about a medical device or medical devices when you are advising patients on whether they should be using them?

NP: We want clear information about the benefits and risks and also about how those benefits and risks compare to the alternatives.

AMT: Now Health Canada has said in the past, that medical device incidents as they're called, are underreported in Canada. How does that affect your work as a doctor?

NP: Yeah I think that's true. It's true of medications and also devices where estimates have been made about how many incidents and adverse effects we would expect to occur in a population and then you look at the number that are reported, either to a regulator or to a manufacturer and it's clear that only a small fraction. So while there might be an increased suspicion, if something were to go wrong. Clearly from the facts we know that most of these incidents are not being reported. And so it's important that we have complete information about what's happening to people who use these devices. That information could come from manufacturers if they reliably provided it because they know how many of these devices are being used. And they also could know about these incidents taking place. In addition, Health Canada could require studies be done, either before one of these devices is approved or after approval, the approval could be conditional upon a longer term study or a larger study involving thousands of people over let's say five or ten years. And Health Canada could say to the manufacturer, yes this product can be sold for now, but we are going to relook at the information you provide us with in the next let's say five years and then we're going to make another decision.

AMT: Now we know that manufacturers do have to report the adverse effects they find out about. But the medical professionals, as it stands right now, don't have to report adverse effects of medical devices to Health Canada, but they can do it voluntarily. What do you think of that arrangement then?

NP: Well we already know it's not working and that many of these incidents are not being reported. So I don't think that we should continue to pretend that this is reliable and accurate source of information. I think it's clear that we need to have better studies be done and Health Canada, as a regulator, is in a position where they can require these studies to be done if a company wants to continue selling these products.

AMT: We asked for an interview with someone from Health Canada and it was declined. They did however tell CBC that they're working on making reporting a medical device adverse effects mandatory for hospitals. How important is that?

NP: It's not entirely clear that making this mandatory is going to help, although obviously that's a step in the right direction and I applaud Health Canada's move. I think though rigorous studies, you know designing studies where you define a cohort of patients and then you some for example who were using an insulin pump and some who were using multiple daily injections and you compare them over time how well are they controlled, how many of them ran into trouble. That's what we need and that's what could be required after approval.

AMT: Canada does not currently have a registry for adverse effects from medical devices. It does have one for drugs.

NP: And they absolutely should be making information about these incidents that take place when people are using devices public. So everyone considering using an insulin pump or another device, should be able to go to the Health Canada website and find out about these adverse events. And obviously there should be information about what an adverse event is and it should be clear that it's not necessarily the case that the device has caused this, but information about these events is collected for a reason and it's because the device might well be causing these incidents.

AMT: Well and Health Canada told the CBC that it supports the development of registries by professional associations, manufacturers or provinces, but that they involve considerable costs. What benefit would a federal registry have compared to ones run by outside organizations?

NP: Where are you going to look for the information? I mean if you want to report an event or you want to find out about the safety or the benefits of a device, where are you going to look? Are you going to know about all of these different professional organizations for different devices? There's one federal government that regulates devices in Canada and it would be the natural institution to host this information. We are going to ultimately be paying for these registries, regardless of whether they're hosted by Health Canada or the manufacturers or professional bodies. You know indirectly they will be incorporated in the cost of the devices or in other fees that we all pay. So the question is whether or not they'll be in the logical place, hosted by Health Canada, or if it will be a mess, they'll be hosted all over the place with differing standards.

AMT: Dr. Persaud, thank you for your time today.

NP: Thank you very much.

AMT: Nav Persaud is a staff physician at St Michael's Hospital in Toronto and assistant professor in the Department of Family and Community Medicine at the University of Toronto. For more on the Implant Files, the joint investigation into medical devices, among reporters of CBC News Radio Canada and the Toronto Star, in collaboration with the International Consortium of Investigative Journalists, go to a special website, cbc.ca/medicaldevices. That's our program for today. Stay with Radio One for Q. I'm Anna Maria Tremonti. Thanks for listening to The Current.

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Nov. 27, 2018 episode transcript

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