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The Current Transcript for February 4, 2025

Host: Matt Galloway

STORIES FROM THIS EPISODE

Prologue

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SOUNDCLIP

SPEAKER: I've just been looking at the lettuce and I can't find so far anything that's not USA.

MATT GALLOWAY: Why are you doing this?

SPEAKER: Oh, because of the tariffs. Yeah. It's a protest.

MG: Ever since Donald Trump threatened Canada with punishing tariffs, Canadians have been peering closer at the labels in shops to find out where the things they're buying are coming from. Even with a temporary tariff reprieve, many are still looking to keep their spending closer to home. And so in just a moment, a trip to the grocery store to see what buy Canadian, or at the very least, not buying American looks like, especially in the dead of winter. Also this morning.

SOUNDCLIP

ELDRED ALLEN: I'm just outside at night with my camera and taking pictures. And, you know, we've got this beautiful inukshuk right in front of the cabin that you can see in the image as well. And there's so many amazing scenes that is right on my doorstep, and it's great to be able to capture them.

MG: Eldred Allen only picked up a camera six years ago. Turns out he's a pretty good photographer. The Labrador native presents a stunningly beautiful and uncommon view of his Inuk community in his photographs, from seals lounging on ice floes and the northern lights blazing in the sky to the impact of climate change on the natural environment that people depend on. In 30 minutes, Eldred Allen and the portrait of Labrador he wants to show the rest of Canada. Plus, a diagnosis of cancer is the news no one wants to hear. In an hour, a new study that suggests the punishing treatments many undergo do not help patients live longer or feel better, and why doctors are asking for better evidence before they make a plan. But we begin with the quest to keep it Canadian. Good morning. I'm Matt Galloway, and this is The Current.

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MADE IN CANADA

Guests: Fred Nelson, Michael Von Massow

MG: So that was quite a day yesterday. After a call with Prime Minister Justin Trudeau, US President Donald Trump decided to pause the planned 25% tariffs on Canadian goods. But despite the 30-day delay, Canadians are still, let's be blunt about it, pissed. There are many Canadians who feel outraged by calls to become the 51st state. And across the country, there have been collective calls to buy Canadian. A few hours before the tariff pause was announced, I headed to the grocery store in Toronto to see what fills a Canadian cart.

SOUNDCLIP

MG: All right, let's get a cart and do some grocery shopping. So if we were just looking for things that are grown in Ontario, I mean, as soon as you come in, there's these bell peppers. Product of Mexico. Not for us. Tomatoes from Mexico, Mandarin oranges from the US. I wonder if you can get any fruit at this time of the year. Well, look, these tomatoes here, a package of little cherry tomatoes are from Ontario. We can get this. That's great. And these too, these salad tomatoes, the larger ones, also products of Canada. There's apples from Ontario, mini cucumbers, also a product of Ontario. So you can still get some fruit and some vegetables. What about on this side? Spain, Mexico, USA, USA, Mexico. Look, there's carrots, multicoloured carrots. Product of Ontario. But you’ve got cauliflowers from the United States. The lettuce is from the US, but not the baby carrots. Up here, these greens, if you're looking for romaine lettuce, that's from the USA.

SPEAKER: Like all of the lettuce is from the USA.

MG: Have you been looking to try and find some grown in Canada things?

SPEAKER: I'm buying all. Yeah.

MG: Are you?

SPEAKER: Oh yeah. Yeah. Oh, that’s Matt Galloway.

MG: No, no, no, that’s fine. We’re from CBC Radio. Can we ask you a couple of questions?

SPEAKER: Sure.

MG: Sure. Tell us what your name is.

SPEAKER: Gail Funston.

MG: And tell us what you're doing here now. You're doing your grocery shopping?

SPEAKER: Doing my, yeah, weekly grocery shopping.

MG: You have the list there. And are you looking for buying Made in Canada things?

SPEAKER: Yes, completely. So far, I've been able to get everything that was either Canada or Spain or some other place. But I've just been looking at the lettuce and I can't find so far anything that's not USA.

MG: Why are you doing this?

SPEAKER: Oh, because of the tariffs. Yeah, it's a protest for sure.

MG: Do you think it's going to be difficult to fill the cart? I mean, the list, there's a lot on that list. Do you think it's going to be difficult to check everything off and not have to buy something grown in the United States?

SPEAKER: Oh no. I'm really going to try.

MG: Good luck.

SPEAKER: Okay.

MG: Thanks. Nice to talk to you. Thank you.

SPEAKER: Thank you Thank you.

MG: Should we head out of the vegetable section into… what about like in the packaged foods if we go down this way? We’ve got cereal. If you're looking for breakfast cereals, what do we have here? Maybe you want like some Cheerios. I have no idea. It says product of USA. Okay, so your Cheerios are not made in Canada. What is this? Don't try this at home, kids, but the Lucky Charms, product of USA as well. There you go. No Lucky Charms for you. Life cereal, Quaker Life, made in Canada from domestic and imported ingredients. So you get both kinds there. Right. Maple syrup. You want to get your Canadian maple syrup, no shortage of that. Peanut butter. The giant maple leaf right on that package there says prepared in Canada. Now, if you're looking for beans here, like chickpeas and things like that, where are these from? Are you shopping locally?

SPEAKER: Buying Canadian.

MG: I'm from CBC. Can I ask you a couple of questions?

SPEAKER: Sure.

MG: Sure. Tell us what your name is.

SPEAKER: Jeffrey.

MG: Jeffrey, what are you looking for here?

SPEAKER: Anything that I can replace American brands with.

MG: And what have you got so far?

SPEAKER: right now, I’ve got the Clark beans, cheddar from Quebec, cottage cheese from Ontario. Nothing American is going in my shopping bag.

MG: Are there things that you have had to do without because you've made that decision?

SPEAKER: Sure, absolutely. But I would rather do without them cater to what Trump is trying to do to us.

MG: Thanks for being here. Thank you.

SPEAKER: Thank you for asking.

MG: Good luck. Let's have a look down here. If we were to make some pasta, you might want some tomatoes. These tomatoes are from California. These tomatoes, product of Italy. Italy number one, Moutai. These are Canadian, though. These are products of Canada, these Unico Diced Tomatoes. So you could get these. We're working on it.

SPEAKER: Yeah, we all are.

MG: Can I ask you about that? Do you mind? We're from CBC.

SPEAKER: No. No, yeah.

MG: Tell us what your name is.

SPEAKER: Elaine.

MG: Elaine, tell me about buying Canadian.

SPEAKER: Well, with what's going on in the States, I refuse to buy anything American. I would cancel my trip to the States. I'm telling people, forget it.

MG: Oh my goodness.

SPEAKER: And I'll pay more for a product if I have to rather than the States.

MG: Why is that so important to you?

SPEAKER: Because we're Canadian and we have that bully over there. So like whatever. We're not discussing politics, but…

MG: Thank you. Good luck.

SPEAKER: Oh, my pleasure.

MG: Yeah, nice to meet you.

SPEAKER: Nice to meet you.

MG: Take care, Elaine.

SPEAKER: You too.

MG: As you heard, it's not particularly easy to keep it Canadian. There are things out there, but you have to be paying close attention to what you're putting into the cart. Fred Nelson is trying to help with that. He runs a Facebook group called Buy Canadian First. Fred is in Vernon, British Columbia. Fred, good morning.

FRED NELSON: Good morning.

MG: It's interesting in talking to people. We just ran into a load of people who were making the decision to look very carefully perhaps at what they were buying, a decision that would be different than before these tariffs were announced and before the pause was announced. Are you surprised that there's been a real uptick in people who are wanting to buy Canadian?

FRED NELSON: You know, not so much. I think we're slowly becoming activists at, you know, we're really trying to become much more supportive of our country.

MG: Tell us what you do with the Facebook group Buy Canadian First. It's kind of crowdsourcing information, right?

FRED NELSON: It is. You know, what really started this whole thing is I had found a list of things that were posted as being Canadian. And, you know, I had shared that in a local group. And I got trolled pretty quickly because people found that, you know, some of the things on the list weren't really accurate, that kind of thing, and I have it wrong. And one person actually said, well, you know, I should be doing my research. And I realize it's kind of hard to research things across Canada because one thing, because of trade barriers and because of the vast size of our country. So I created this group and started asking people to, you know, post the products that you've sourced that are Canadian, and that's really gained momentum. A lot of people are getting involved to do that, to be able to share, you know, the locally resourced products that, you know, they're purchasing and they're trying to support. So it's been a really good thing.

MG: Are there some Canadian products that you have discovered in the last week or so that you didn't know about, that you didn't know were Canadian?

FRED NELSON: No, absolutely. There is, you know, from here in British Columbia, there is so many things that we see coming across through the group that we don't see. You know, simply one off the top of my head, there's one called Caprina Farms Soap. It’s a hand Soap. We don't see that out here. Apparently, it's available through Dollarama. You know, that's going to be a go to soap rather than an Irish Spring or other types of soaps going forward. Seeing Jean’s Cannery tuna and salmons on the West Coast here. It has been long that we used the bridges. We've kind of forgotten about it. Now, we've gone back to it. And another one, Kaslo salad pastas from this little village in Kaslo, British Columbia. Incredible pasta. You know, it's so much better to be buying this type of thing, supporting our, you know, local, regional and national brands. It's really exciting to see how much product is really out there that, you know, we really don't get to see.

MG: Are the things that you have had to cut out of your life because they come from the States?

FRED NELSON: Yeah, there has been. You know, it hasn't been painful. My wife and I are both foodies. And we've gone through and gone through our cupboard, and we were actually quite surprised by how much we do already buy Canadian. It was just a choice. It wasn't an act of the thing. It was just what we did and the varieties we liked. But yeah, there's some things we've definitely been putting back. And the further we go into this, the much more we're going to be zooming in on, you know, eliminating, you know, personal care products, deodorants and that kind of stuff. That will definitely be sourced out Canadian over, you know, the old-fashioned Old Spice and those kind of things.

MG: Just before I let you go, do you think this is going to last? I mean, this was supposed to be the day that these tariffs are coming into place. There's now a 30-day reprieve that may go longer. They may never come into place, but who knows? Do you think this buy Canadian focus is going to last?

FRED NELSON: You know, we went through the pandemic where everybody jumped on board and, well, not everybody, but a whole lot of us jumped on board, and where we could, we got our, we wore our mask and got our shots and that kind of thing. And slowly over time, things wane. But, you know, instead of just having an invisible virus, we've got an orange plague that is going to continue to come back and haunt us. You know, it's going to be a constant reminder, and I think it's going to last. I think people are going to continue to say, no, no, no, we can do something. We can stand up to you in our own little way. And one of the best ways we can do it is by purchasing our own products, something with the Maple Leaf on it before we purchase anything else from the United States.

MG: Fred, good to talk to you. Thank you very much.

FRED NELSON: Thanks for having me. Appreciate it.

MG: Fred Nelson runs the Facebook group Buy Canadian First. He was in Vernon, British Columbia. Michael Von Massow is a professor of food, agriculture and resource economics at the University of Guelph in Ontario. Mike, good morning to you.

MICHAEL VON MASSOW: Good morning, Matt. Thanks for having me.

MG: Thanks for being here. What do you make of what's happening now? It's not just in local grocery stores. You see this all over online. You talk to people. I was just surprised in walking into the shop, how many people were looking at labels and paying very close attention to where things are coming from. What do you make of that?

MICHAEL VON MASSOW: Well, I think it's interesting. And I think Canadians as consumers have a right to buy what they want. I think that it's not always easy to buy Canadian. I think if you look at some of those lists, there are things that aren't true and that are actually Canadian. And where the line is really is difficult to determine, is something we need to determine individually. The other thing I think, Matt, if I may, is that you talked about, oh well, these products are, you know, we bought blueberries from Peru. We don't have a fight with non-US products right now. And, you know, Canada is an exporting nation. And I have no problem with trying to, we're trying to buy local as much as we can. But as you said, we're pissed at the Americans. We're not pissed at avocados from Mexico or blueberries from Peru or beans from Peru. And so I think we have to decide as individuals if we're buying Canadian or if we're expressly just not buying American.

MG: Fair enough. Can you help? One of the things that was difficult is trying to understand some of the language here. The label might say made in Canada. It might say a product of Canada. It might say prepared in Canada. What's the daylight between all of those?

MICHAEL VON MASSOW: Okay. Product of Canada means it's made in Canada by Canadians and with Canadian ingredients. There may be, you know, a little bit of spices or things that come from other places. So product of Canada is 100%. Made in Canada or prepared in Canada says it's made by Canadians, but it isn't necessarily made with Canadian ingredients. And so made in Canada might have Canadian ingredients in it, but it might have more, for example, while we grow sugar beets in Ontario, most of those get exported for processing. So sugar isn't considered a Canadian product. So if you have something that says more than a couple of percent of sugar, it can't necessarily be a product of Canada because part of those ingredients are coming from outside the country. So there's, you know, when people talk, Matt, about American companies versus Canadian companies, I've seen some of those lists. And, you know, we have American companies, take Lay's potato chips as a subsidiary of PepsiCo, they are producing potato chips with Canadian labour, with Canadian potatoes right here in Cambridge, Ontario. And so, you know, we have to decide individually where the line is and what we're willing to accept.

MG: It was interesting in looking at the vegetables that, you know, the tomatoes I used in my salad were grown in Ontario. But it was hard, as we heard, to buy lettuce. So you end up with cabbage instead that might be raised and grown here in Canada. This is a time of the year where local fruits and vegetables could be hard to find in many parts of the country. What impact do you think the push to buy Canadian is going to have on those items?

MICHAEL VON MASSOW: Well, I think, you know, we need to decide two things. The first is are we willing to be flexible? As Canadians, we're very much creatures of habit. And if broccoli was in my basket last week, it's likely to be in my basket this week.

MG: Plus, you're also used to, part of the habit is also that you have access now to everything all the time, right?

MICHAEL VON MASSOW: Exactly. Exactly. So if it's important to you to buy Canadian, then think about perhaps you can’t eat broccoli right now. You know, we went much like you to the grocery store over the weekend and we bought carrots. We bought some of those cherry tomatoes that are hothouse. We bought beets which were Canadian, so those were storable. We also looked at buying frozen vegetables, which isn't our preference, but we could get Ontario frozen vegetables. We could get varieties that we might not have been able to get fresh. So we have to make those sorts of decisions, whether we're willing to be flexible. We also, like we also bought some green beans that were produced in Peru and said, well, we're not mad at Peru. Let's buy some green beans. So it depends, again, where your line is and what your individual priorities are.

MG: And what you can afford as well, because sometimes, that can be more expensive, right?

MICHAEL VON MASSOW: Yeah, for sure. I think there are definitely cases where domestic product will be more expensive, which is why we've gotten into the habit of buying non-domestic products. And that's one of the beauties of trade, frankly, is that we export what we're good at and we import what we're not good at. And in the winter, that's often fresh fruits. That's often fresh fruits and vegetables. But it doesn't always need to be more expensive, Matt. You know, we bought as I said, we bought bagged carrots the other day. They were Ontario produced. They were stored, and they weren't more expensive than some of the alternatives. They were just different. So it can be more expensive, but it doesn't have to be.

MG: Do you think this is going to have any impact on President Trump's strategy? I mean, there's something that's happening and people feel good about this. But from your perspective, is this going to move the needle at all?

MICHAEL VON MASSOW: I think it has the potential. We have to remember that we're a pretty small part of the American economy. But just because it's not sort of swinging the needle at the national level, there will be companies who feel it when we change our choices. And if we, and if they are making noise up the value chain, remember, agriculture is a big part of the Republican base. So if we're changing what we're buying and individual firms are feeling that, I think there is the potential, there is the potential to move the needle a little bit. I also think that I have never seen, or maybe never is a bit, I haven't in a long time seen Canadians as united as they are now. And so doing some of these things that close the gaps between us, there's something positive about that as well.

MG: Is this the possibility to move the needle on, I mean, I'm old enough to remember endless discussions on interprovincial trade. We've been talking about this as long I think as high speed rail in this country. Is this the opportunity for us to be able, we were just hearing about things that are available in in British Columbia, for example, that might not be available elsewhere in the country, to be able to move things seamlessly across this giant country of ours?

MICHAEL VON MASSOW: Well, I think we can. I mean, we have some work to do on interprovincial barriers. But it's not a silver bullet in this instance, right? We've seen the evolution of these supply chains which have been focussed more north south than they have east west. We can move things east west. That might get a little bit more expensive. Some of the interprovincial barriers are a regulatory rather than actual barriers or tariffs. And I think we can make progress, but it's not a silver bullet in this instance. It's sort of incrementally, things we can do to reduce this pressure.

MG: I'll let you go, but do you think this will stick? This feels, to your point, that there is a sense of, you know, shared purpose among many Canadians. People feel, you know, whether it's the flag, they're rallying together around something. Is this going to stick beyond this moment, do you think, the idea of trying to support domestic industries and support the people who are making things here in this country?

MICHAEL VON MASSOW: Well, I think there will be, it will lose some momentum as these movements do all of the time. You know, a year ago, we saw a grocer, we saw grocer, people avoiding certain grocers, and that didn't continue. But I think some people will change their habits. And we are very much creatures of habit. And I think we'll see people change what they're buying and continue that because they've liked it and it's worked out well for them. So yeah, I think there is some staying power here.

MG: Mike, good to talk to you. Thank you very much.

MICHAEL VON MASSOW: Thanks for having me, Matt. Have a great day.

MG: And you. Michael Von Massow is a professor of food, agriculture and resource economics at the University of Guelph. Are you planning to buy more Canadian? How are you doing that? Are there things that you're willing to go without because you want to support local producers here and perhaps want to cut out those in the United States? Let us know what you're doing and how the news of tariffs is impacting your shopping. Email us, thecurrent@cbc.ca. You CBC news is next, and then.

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ELDRED ALLEN: I had blinders on to the beauty that was all around me. But when I got started in photography and got my first camera, it gets you to slow down and just look at something specific that you probably just glazed over.

MG: That beauty that Eldred Allen saw was in his community in Labrador. He will tell us about what he has come to appreciate through the camera and the story he wants to tell about his community to the rest of this country. That's coming up in six minutes here on The Current. Stay with us.

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INUK PHOTOGRAPHER

Guest: Eldred Allen

MG: Hello, I'm Matt Galloway, and you're listening to The Current. When you think of Labrador, you might picture dramatic coastlines, sweeping barrens. The landscape in that part of this country is a wonder. But for Eldred Allen, the place where he grew up is more than that. Eldred Allen is an Inuk photographer from Rigolet, and he wants to show the people, the lifestyle and the wildlife scenes of his community to the rest of Canada one photo at a time. His solo exhibit, Scenes from Labrador, is on now at the Stephen Bulger Gallery in Toronto, and Eldred Allen is with me in studio. Good morning.

ELDRED ALLEN: Good morning.

MG: It's a real pleasure to meet you. Describe the place that you live in.

ELDRED ALLEN: I'm from a remote community in northern Labrador. We're one of five communities in Nunatsiavut, which is an Innuit self-governed region in northern Labrador. And my community is called Rigolet. And it's a very small community of 300 people. We're completely isolated in that we don't have road access, so it's only ferry and airplane to arrive in the summertime. But it's a beautiful place we live. Our community is right on the water. Very intimate community. Of course, everybody knows each other. And we have amazing wildlife and scenery and people and culture and all beautiful things that, you know, are right on my doorstep and allow me to capture them in photography.

MG: What do you love about the place? I mean, you've given us a lot there, but what do you, why is that the place that, you know, you can't bear to leave?

ELDRED ALLEN: It's where I grew up. I've lived there all my life. And it's just the slow pace and the connection with nature I think is most enjoyable. We lived, myself and my wife lived for a year in Ottawa, and it was just so completely different. It was such a fast hustle. You work all day, get home and cook your supper. And by the time all that’s done, you're ready for bed to get up and do it again the next day. And, you know, we'd spend our Saturdays just walking downtown Ottawa and we'd sit on a curb eating an ice cream, and we'd look at each other and say, we could be sitting on the shoreline next to the water having a fire and enjoying beautiful scenery. And it's just something, you know, that once it's in your blood, having grown up there, you just can't leave it. It's so beautiful. The lifestyle, the disconnectedness from technology and nature and just being so close to nature all the time, it's something that once you experience and once you love it, it's just something that you can't leave.

MG: The work that you're doing now is photographing the community and kind of sharing it with the rest of the world in many ways. Tell me how this started. You’re a self-taught photographer.

ELDRED ALLEN: Yes, it all started in 2016. I had an interest, a personal interest in drones at the time. And I just went online and thought, you know, I was at a point in my life where I could afford one. So I ordered myself a drone. And I was working at the time doing GIS work. So computer mapping. And I only had my drone for maybe three days. And because we live in such a remote part of the world, a lot of my GIS work, I would be looking for aerial imagery and data of this remote projects going on in Labrador, but we couldn't, you know, it wasn't available. Google Earth had terrible coverage of Northern Labrador. So I had the idea that I could use the drone to start a business and offer that as a service to clients.

MG: That’s smart.

ELDRED ALLEN: To be able to offer them high resolution imagery and data of project sites in remote locations. So I started a company, Birdseye Inc, in 2016 offering those services. And it was in 2018 when I was working for a client, they asked if I could supplement my drone pictures with handheld pictures from the ground of their project. And I had no experience in photography. Just using automatic settings on my drone was sufficient for, you know, commercial client work. But when I ordered my first camera in 2018, I'm the type of person when I want to be proficient at whatever I'm doing and using. So I took a deep dive into photography while I was waiting for my camera to arrive by the mail, which usually takes a couple of weeks. So I taught myself, you know, how to use the camera, how to expose images correctly. And once I got the camera, prior to using it in any client work, I would take it with me everywhere because I wanted to practice with it. And I quickly found that photography was something that I was really interested and passionate about, and in 2018, kind of sparked my photography career, I guess you could say. I’m completely self-taught. You know, we live in such a remote place that I learned everything that I learned about photography from YouTube and the Internet.

MG: So that answers a couple of questions. One is YouTube is what you were looking at before the camera arrived.

ELDRED ALLEN: Yes.

MG: This is the first camera that you’d owned?

ELDRED ALLEN: Yes, other than just a point and shoot camera, right, that everybody can purchase at a Walmart or something. You just turn it on and use it. But this was what I deemed, quote unquote, a professional camera because you could take the lenses off, change the lenses. And when I got my camera cam, I had been studying how to expose images correctly. And right from the get go, from the first image I took, I used manual settings only on the camera because I wanted to understand what changing certain settings like your shutter speed or your f-stop would do to the image. So right from the beginning, it was almost like learning how to drive a standard. I started there. And so, you know, I've become proficient enough now that I can just switch between, you know, fully manual or change some automatic settings on my own.

MG: What did you love about it? When you started playing around with this and then got out to take images of your community, what did you love about it?

ELDRED ALLEN: I always give the example of wherever you live in your day-to-day life, you kind of operate with blinders on because you become so accustomed to your daily routine that you go through activities in your daily life that you just don't pay attention to.

MG: You see it every day.

ELDRED ALLEN: You see it every day. It’s like for yourself here in downtown Toronto, you might walk four city blocks and then you look up and you're at where you wanted to get to, but you don't remember at all those city blocks you passed. And that's what I found was like for myself. I lived in a beautiful place, and we have amazing activities and scenery. But because it was something I’ve seen, just it was, you know, my daily scene of what I always look at, I never really fully appreciated it. So I had those blinders on to the beauty that was all around me. But when I got started in photography and got my first camera, you become directed, right? You look through the viewfinder and through the lens of your camera and you're looking at certain aspects of the scenery, the wildlife or the landscape that surround you, and you're trying to compose images and take something out of it and present it in a beautiful way.

MG: Give me an example of that, something that you walked past, something that you saw but you never saw until you pointed the camera at it.

ELDRED ALLEN: Even very simple things like, you know, as coming from an Innuit culture, we hunt and fish and gather as part of our daily life. So, you know, in the wintertime, we go out and shoot partridges, white ptarmigan. And, you know, it was always a matter of I want to kill this bird to feed my family, so it would be as fast as I could get my gun to shoot it. But I've never really seen it other than it's there, I've got to shoot it. But when I started photography, I would go, I would find a partridge, and I would take out my camera and I would just sit and watch it. I would watch it feeding and, you know, eating off of the willows and walking through the snow and just going through its normal activities. And I'd never, ever seen that before because I never stopped to watch.

MG: Because you were looking at it in a different way.

ELDRED ALLEN: In a different way. And so now, when I go with my camera to go out and find a partridge, oftentimes, I'll just watch it, take photographs and video of it and just appreciate it and what it's doing and then just leave it and let it go on its way. And it's just something I would never, ever have seen or witnessed without photography because it gets you to slow down and just look at something specific that you probably just glazed over, you know, in your regular life.

MG: Can I ask you about, I'm just looking at some of the photos that are on display here. And I mean, the interesting thing about this is you are shooting from a couple of different perspectives.

ELDRED ALLEN: Yes.

MG: One is at ground level and the other is from these drones up above.

ELDRED ALLEN: Yes.

MG: How does the landscape that you live in change when you can look at it from above?

ELDRED ALLEN: It started and it was made apparent to me quite early when I first got my drone because we live right on the water and there are always lots of seals that are in the water. And, you know, having grown up there and we're always on the water and speedboats and stuff like that. And you only ever see the head of the seal as they poke out to look around and breathe. And so for 40 years, that's how I'd seen a seal, unless it was, say, on the ice or on the land. But one day, I had my drone out and there's what we call a skull of seals. So, you know, a flock of birds, but a large group of seals. They're all swimming together. And I had my drone flying over them and I'd never seen that perspective before. But looking straight down, you can see their entire bodies as they’re swimming through the water. You can see the way that their flippers move, and you can see the breath coming out and spraying in the water. And it was just so amazing to get that different perspective on something I had seen from, you know, the ground perspective all my life. It just really opened my eyes that drones offer this new and interesting perspective. And that's one thing that I always try to accomplish with my photographs, is take everyday scenes from home and not only have people from a way that have never seen them before to be excited about it, but for people from home who probably had never seen it from that vantage point before as well to be just as excited about it as someone from away. So I really enjoy that when people from home also get excited because they're seeing things in a new way they'd never seen it before.

MG: Tell me about this photograph I'm looking at called Support.

ELDRED ALLEN: It's a drone photograph.

MG: It's a drone photograph. And it is, I mean, I guess an ice sheet, but there's a couple of different tracks on this ice sheet, right?

ELDRED ALLEN: Yes. And that's one of the things I enjoy about photography as well, is I enjoy abstract photography and quite minimalist photography at times where you don't fully understand what you're looking at. And so you have to kind of study the image and get in close and dissect it and kind of feel with it as well.

MG: But there’s a story behind what I'm looking at.

ELDRED ALLEN: Definitely. Near my community, just to the north, there's a body of water called Double Mare. And of course, we depend on ice in the wintertime and snow to travel. So it becomes our ice highway, so to speak. And in the fall, that has to freeze up for people to travel across that ice, to access cabins and hunting grounds and go off fishing. And it's usually about the same time of the year, late December or early January, when that freezes up in recent years. And it's always the same family members who are the first one to go over and test it to see if it's safe to cross or not. So they, you know, once they safely cross, they come back and everybody's all excited because now you can cross over safely. But in this image, if you notice, on the top of the image was a single track.

MG: Yeah.

ELDRED ALLEN: And that's a single snowmobile track. So this was the gentleman from the community who had driven out onto this ice during a time when it should be frozen up and safe. But he got out so far on his snowmobile and he fell through. And he lost his snowmobile, and it sunk in probably 100 feet of water. But when he jumped off, luckily, he never broke through. And in the bottom of the image, if you look in closely, it's all footprints.

MG: That's why there's all these tracks that go out.

ELDRED ALLEN: Yeah. So my father and another gentleman were on the shoreline. Watching him as he was out testing the ice. And when he broke through, he jumped up and was walking back to shore. And my father and the other gentleman walked out to meet him. So you can notice some of the footprints are going in one direction, but then they all turn around and come back. So I call it support because, you know, when things happen in small communities, everybody is always there for each other. And the gentlemen that were on the shore walked out onto the ice to meet him to walk back with him and give him support because he had lost his snowmobile. And so really, it's a, you know, it's an abstract image, but it's really a depiction of climate change and the effect it's having on our region.

MG: One of the other, and maybe this is connected to another incredibly beautiful photograph of yours is Broken Road, which looks, I mean, again, it's the break up of ice.

ELDRED ALLEN: Yes. And it's another image speaking to climate change. When I started photography, of course, I'm still, I consider myself a new photographer. I only started in 2018. And when you start, you're always interested in kind of the single image, just things that excite you. But as you become more proficient, you start looking at themes and looking at projects and stuff like that. And of course, climate change is having such a dramatic impact on our region. I'm always looking at certain aspects of the environment that are becoming affected or ways to capture an image and compose it in a way that kind of speaks to climate change. And as I mentioned, ice I say is our highways, right? We travel on it to go to other communities or hunt and fish. And I call this one Broken Road because ice becomes our road. But in this image on the right hand side of the picture, it's all broken up into smaller ice bands.

MG: These little fragments of ice.

ELDRED ALLEN: It's all fragmented. And that's what's happening. It's becoming unpredictable. Our ice is not forming the same way that it used to. I call it Broken Road because it looks like a highway of ice, but it's all broken up. And it’s of course the effect of climate change.

MG: As somebody who, I mean, as you said, you live off the land, you grow up in that land. When you see that land changing, when you see the climate changing, what does that do to you?

ELDRED ALLEN: It's pretty terrible because, of course, you know, I'm only 46 years old. And even in the last 10 or 15 years, the changes are happening so rapid and so quickly that, you know, I've got two kids, a seven-year-old and a nine-year-old, and I want them to be able to enjoy the lifestyle, the traditional lifestyle of getting out and harvesting from the land and going out and enjoying the land that I'm used to and generations before me are used to.

MG: Do you worry about that, that they’re not going to be able to do that?

ELDRED ALLEN: But I’m worried about that because they’re not going to be able to do it. This year At home is the worst year that I've ever seen or people can remember on how late the ice is in freezing up because we've had such, our temperatures are well above, 20 degrees above normal for this time of the year. It's only within the last week that we've had good freezing temperatures. So it's really worrying because the lifestyle that we live is going to be completely changed because the climate change is having such a drastic and quick impact on everything around us.

MG: Let me ask you about one other photo. This is a photo called Tickle.

ELDRED ALLEN: Yes.

MG: And there is a cabin. It's in the dark. There's some lights on, but the cabin isn't what you're really paying attention to. It's the northern lights that are in the background. There's astonishing display of the aurora. Tell me a little bit about the story that surrounds that photograph.

ELDRED ALLEN: It's a photograph that just depicts. And what I'm trying to capture in my photography is everyday life of what we enjoy and presenting it in a beautiful way. And so everyone at home always travels on the weekends to their remote cabins or in the community to get away and disconnect and hunt and fish and spend time with their family. And we often get amazing aurora borealis, northern lights. And everyone always says, you know, from where I learned all my photography on YouTube, save your money and travel to these, all these locations and take amazing pictures. But fortunate for me, I just have to go out on my doorstep and it's all, you know, we live in such an amazing landscape that, you know, I was there with my family at that remote cabin and, you know, go out in the Night-Time and look up at the sky and you can see the aurora borealis happening. So it's just a matter of picking up my camera, walking 20 feet and being able to capture scenes like this.

MG: This is the thing that people travel again all over the world just to go and see. But for you, I mean, the ordinary becomes the extraordinary.

ELDRED ALLEN: Yes, exactly. And so if you look closely in that image and look at that cabin window, you can see the foot of my son. He's just there sleeping on his bed in a bunk bed.

MG: There he is.

ELDRED ALLEN: Yeah. So, you know, my family is just in the cabin. My kids are. They're asleep. My wife is in the cabin reading, and I'm just outside at night with my camera and taking pictures. And, you know, we've got this beautiful inukshuk in front of the cabin that you can see in the image as well. And there's, you know, so many amazing scenes that is right on my doorstep, and it's great to be able to capture it.

MG: You were part of this Pulitzer Centre project called How Inuit Want to Protect Their Arctic Home. Tell me a little bit about that.

ELDRED ALLEN: Yes, that was a collaboration with a journalist from the region as well, Ossie Michelin. And he now lives in Montreal, but he was born and raised in Northwest River, which is a community near Rigolet. And he's a colleague and a friend. And he approached me and said that he was working with the Pulitzer Centre and The Guardian, and they were wanting to tell the story about how climate change is affecting our region and our lifestyle. And he had a story, of course, that he wanted to depict through his words in the article he was writing, but he needed a photographer to be able to capture it to express, you know, the words that he was, because of course, they say a picture is worth a thousand words. So if you can kind of tell it in a nice image and composition, you can really get your story across to your audience. So I think it was quite amazing that, you know, he came into my community and told that story there. But I'm from the area as well, so I've got that inside access. So we're out on a small 16 foot speedboat in the ocean hunting seals. And so kind of, you know, if you're not from the area, it's kind of graphic content, and you might not be as comfortable capturing and how to safely, you know, move in a boat and get around and take images and stuff. So to be a photographer from a small place like that involved in telling a story like this, I think the access that I have and being there, being a childhood friend of the person that I was photographing, it just gives you that intimacy, and you're able to express and see that through the photographs.

MG: I mean, part of this is also about, this is your first solo exhibition, the one that we're talking about.

ELDRED ALLEN: Yes.

MG: West of Newfoundland and Labrador.

ELDRED ALLEN: That's correct.

MG: What does it mean to you to be able to show your community to the rest of the country?

ELDRED ALLEN: It's pretty special. I'm very, very thankful for Stephen Bulger Gallery here in Toronto. They represent my artwork and they sell my artwork as well. And to have such esteemed and established galleries such as Stephens here showing my artwork and, you know, the clients that he has and the network that he has, to be able to bring that to an audience further outside of Newfoundland and Labrador, it's really, really special and quite surreal as well.

MG: There’s a bit of responsibility that comes with that as well, though. You're also, you're representing your community.

ELDRED ALLEN: Yeah. And it's great because, you know, I've got so much support from my community. As I mentioned, I'm trying to capture photographs in ways that even my community members enjoy them. So I'm not trying to do anything and make it fantastical or trying to do fancy things or Photoshop. It's realistic. It’s documentarian. It's, you know, showing everyday life and everyday activities. So for, you know, the Stephen Bulger gallery to want to display that and show it on a wider stage outside of Newfoundland and Labrador and my small community of Rigolet is very, very special. And my exhibition scenes from Labrador is currently on display now at the gallery, and it's on until February 22nd.

MG: What do you think those of us from away get wrong about your community? We might have impressions of what life is like there. You have a little smile on your face as you’re about to answer. Go ahead.

ELDRED ALLEN: I think, you know, it's small. It's remote. It's often difficult. There's lack of access to a lot of things that people, I think, from urban areas take for granted. You know, such easy access to food, easy access to shopping. And through the photographs, you see the beautiful things. But, you know, we have so many mosquitoes and black flies that I'm often tormented half to death while I'm out on the land trying to capture these pictures because they're hounding me and, you know, biting me all over and stuff. But no, I think through the type of photography that I do, which is, you know, documenting where I'm from, everything that you see there in those images is real. If you come there, you can see those things for yourself as well. But yeah, we're very remote. You know, you got to fly in on a small 18-seater Twin Otter airplane and stuff. So it's not easy to get to. It's very expensive to get to. So yes, everything there is beautiful, but we have just quite a few challenges and stuff there as well.

MG: If there's one place that you love in your community to take a photo of, what would it be?

ELDRED ALLEN: Oh, I think it's a little bit of the entire region. But oftentimes, in the image that you referenced earlier, Tickle, which is our summer cabin, it's very, very small island. It's, you know, you can walk around the entire perimeter of the island in less than 10 minutes. But with that inukshuk out front often, with the aurora borealis that you get in the summertime, there's whales probably 10 feet from the shore because the water is so deep. And there's wildlife. And in another image there in the exhibition with that same inukshuk, you can see the Milky Way behind it. It's called stargazing. It's just such a beautiful place. It's there's minimal flies on there as well. For me as a photographer, because it's so small and there's no trees or anything on it, that it's great. You don't have to go far. And there's just so, so many different opportunities to get different photographs in such a small location. It's one of my favourites.

MG: People are going to see this, and your community is going to be overrun with those of us from away who want to come and see what you've seen. These are beautiful pieces of work.

ELDRED ALLEN: Thank you.

MG: And it's just the story that you have is fascinating about telling, learning how to do this and telling the story, but also, what we will learn about your community I think is really powerful as well. Thank you for coming in and telling us about it.

ELDRED ALLEN: Yes, thank you for the opportunity.

MG: Eldred Allen is a photographer from Nunatsiavut in Northern Labrador. His solo exhibit is called Scenes from Labrador. It's on right now at the Stephen Bulger Gallery in Toronto through the 22nd of February. And if that conversation whet your appetite for travel, tune in tomorrow. We'll speak with Rick Steves, the legendary travel guide and writer. Rick Steves has a new book coming out tomorrow. And what he's done is pull out his travel journals from 1978, from a trip that he took back then that changed his life.

SOUNDCLIP

RICK STEVES: It's some kind of freaky anthropological dig into the past of looking at a 23-year-old me. I'm exactly three times that old right now. 69. And when I go back to that, and it was me before I was a travel writer. I was a piano teacher. And I was just on vacation in the summer. I have not travelled in such a footloose and fancy free way since because I've got the burden, the wonderful burden of running my business and updating my guidebooks and leading my tours and making my TV shows. But on that trip, it was purely a chance just to get out there and get to know the world. It was travel with abandon. It was travel celebrating the idea that you can learn more about your home and yourself sometimes by leaving it and looking at it from a distance. And I have all these kind of philosophical approaches to travel now. But back then, there was no philosophy that I knew of. I was just a green, naive kid with a few bucks in my money belt and going for the end of the rainbow as far as hippies were concerned. And that was Kathmandu.

MG: You can hear my conversation with Rick Steves about his adventures on the Hippie Trail from Istanbul to Kathmandu. That's coming up tomorrow here on The Current. And coming up in days ahead, this kind of connects with the buy Canada thing. What about travel in Canada? Your suggestions on where we should go in this country. We asked, and you delivered at great length on the places that we should go and visit in this country, hidden gems and more. We'll tell you about them coming up in days ahead here on The Current. Well, coming up after your regional update.

SOUNDCLIP

TERRY MCRAE: The extension of my life is pretty important, but I also want to have a decent quality of life. So that's the most important thing. I think that's what everybody would say.

MG: Terry McRae is living with advanced colon cancer. His treatment goals are simple, live longer and feel well enough to do the things that he loves. In a study that's coming out today, physicians are calling for those same simple goals to guide that treatment. And it's not as common as you might think. We will find out why coming up in 90 seconds. I'm Matt Galloway, and this is The Current on CBC Radio and the CBC Listen app. Stay with us.

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CANCER CARE

Guests: Rachel Koven, Ian Tannock

MG: Hello again. I'm Matt Galloway, and you're listening to The Current. Terry McRae was diagnosed with colon cancer in the summer of 2022. After surgery and six rounds of chemo, he thought he was in the clear. But last year, he learned that cancer had returned.

SOUNDCLIP

TERRY MCRAE: After my Pet scans, I had multiple places the cancer was. So it was not, they were not able to surgically remove what I had. There's multiple places and the only option I had was chemotherapy. And I was given at that time two to three years to live. So that was quite a slap in the face.

MG: Terry is 69. He gets chemotherapy every two weeks to delay the spread of that cancer. He wants to live longer, but it's just as important to him to be well enough to enjoy the life he has left.

SOUNDCLIP

TERRY MCRAE: When you're looking at the big picture things, you know, being able to be there watching your grandkids grow, being with your kids. And my wife and I, we’re, you know, 46 year married. And, you know, we do a lot of stuff together. And it's pretty scary to think that that could end. But, you know, as long as we extend it as long as I can and I'm able to do stuff, that's great

MG: Stuff like spending time with his grandkids at their cottage by the lake just north of Kingston, Ontario, or enjoying a few days of downhill skiing with his son between treatments. It is a balance between extending life as long as possible and maintaining a decent quality of life. And now, a paper published today in the Lancet Oncology Journal is calling for standards in clinical trials that would ensure that new treatments emphasize quality of life. We'll hear more about that study in just a moment, but first, I'm joined by Rachel Koven. She is a patient advocate with the cancer program at Kingston Health Sciences Centre. Rachel, good morning to you.

RACHEL KOVEN: Good morning, Matt.

MG: A diagnosis of cancer can be terrifying for many people, and immediately, they will turn to any number of things. One is to try to figure out what the treatment is that could help alleviate the things that they're facing. What are you hearing from patients with a diagnosis like Terry’s about what they want most in the face of that news?

RACHEL KOVEN: I think everyone wants something different. Everyone has an individual experience. And I think what Terry talks about is truly, what people are looking for is a balance between the time that they have left and the quality of the time that they have left. It's really two different ideas, I would say.

MG: I mentioned you’re a patient advocate. This is also something that you know personally because you went through this with your late husband.

RACHEL KOVEN: Yes, I did.

MG: Tell me about his diagnosis and what followed.

RACHEL KOVEN: My husband was diagnosed with metastatic gastroesophageal cancer in the fall of 2014. We had a young family then. My daughter was nine and my son was six. And it was a catastrophic point in our lives that we never thought we would see. How do you prepare for something like that? You believe that as Terry is doing, you grow old with your spouse and live to see your children meet so many incredible milestones. And we just weren’t going to have that. And he got very sick very quickly. So it wasn't anything that we saw coming.

MG: What was the approach that he took to his treatment?

RACHEL KOVEN: My late husband found his strength in the idea of treatment at any cost. And so he took any kind of option there was without a lot of regard for perhaps what the consequence of that would be in terms of the time it would take away from doing the small things with his family. He was entrenched in a fight narrative, and that was where he found his hope and his strength.

MG: Tell me more about that in terms of the, this is hard to talk about, I know, but the consequence of that and what that meant for your family. And as you mentioned, your kids were still young at the time.

RACHEL KOVEN: The consequence of that was spending an awful lot of time at the hospital, either having treatment, getting tests before the treatment, attending medical appointments. And in a lot of cases, beyond the first line of treatment, the ones that came after that really, I would say, didn't necessarily contribute positively to the quality of the time that he had. Oftentimes, we ran into complications and he was sicker. And it really didn't allow us to enjoy the small things in life. And my daughter now, looking back as she's 20 years old, she and I've had that conversation that she wished her dad at a certain point would have just been content to enjoy the time that he had without treatment and spend time with her at home.

MG: I mean, that's in some ways almost an impossible thing to wrap your head around because the instinct for so many people, including your late husband, is to fight like hell. But as you said, there can be a cost or a consequence to that as well. How does that shape what you say to patients and their families who are making these decisions in the work that you do now as a patient advocate?

RACHEL KOVEN: I think the best approach to take really is to look at the person as someone with cancer and that the pathology of their tumour is really secondary. And it's really important to get to know the family and what their goals are as a family and to try and help them navigate all the choices that are available, both treatment and non-treatment. Unfortunately, I feel like sometimes, with this battle narrative that's perpetuated, people see not having treatment as giving up, and they're really not giving up sometimes. Really, they're just choosing a path that's a different perspective. They may be giving up a few days or a few weeks or a few months, depending on the treatment. But if the quality of the days and months that you have are better, then perhaps maybe you're really not giving up as much as you think.

MG: What are the kind of questions that you think families should be asking doctors as they work through this?

RACHEL KOVEN: There's three groups of questions, I would say. First and foremost, it's around the diagnosis and understanding the diagnosis. Is it curable? What stage is the cancer at and where the cancer is located. Is it in other places? So that's the first group of questions. The next group of questions is around treatment options. And as I said, maybe some of those options are not having treatment, but understanding the treatment, what the side effects will be. And then thirdly, I would say, how is their decisions going forward going to impact the life they have with their family? And I think that really for me is the most important thing. It's understanding who they are as a family, what their goals are, what they'd like to do with the time that they have in a palliative cancer situation, and really helping them to choose treatments that are aligned with what they would like to do with the time they had left.

MG: For those of us who aren't doctors, how easy is it to get that information in a way that we can actually understand what's coming at us?

RACHEL KOVEN: It's not that easy, I would say. I am an epidemiologist by training, so I had that background when my late husband got sick. And even I struggled in trying to find research that would support us making a good decision. Science does an excellent job of using the quantitative aspect of time as it relates to medical intervention and treatment. They can look at how long it will take until a tumour progresses or how much additional time you have in survival and that sort of measuring numbers of days. But it doesn't do a great job in looking at the quality of the person's life within those days. So the qualitative aspect of it. It wasn’t a lot in the literature. Although they can find a statistically significant relationship, it doesn't actually tell you what that means in the real world and how it can make a difference.

MG: Just before I let you go, we're going to speak in just a moment about this idea of common sense oncology, something that we've talked about before on the program. But based on what you've gone through and what you're talking about, just briefly, what does that phrase mean to you?

RACHEL KOVEN: Common sense oncology?

MG: Yeah.

RACHEL KOVEN: I think it's outcomes that matter to people. That's really what the essence is about, and helping people figure out what those outcomes are by giving them the knowledge to make the best decision they can for their loved one and their family and for themselves.

MG: Rachel, I'm glad to talk to you about this. Thank you very much.

RACHEL KOVEN: Thank you so much for having me. I really appreciate the opportunity.

MG: Rachel Koven is the co-chair of the Patient and Family Advisory Council for the Cancer Program at Kingston Health Sciences Centre in Kingston, Ontario. Dr. Ian Tannock is an emeritus professor of medical oncology at Princess Margaret Cancer Centre and the University of Toronto, and a leading author of a paper published in the Lancet oncology today. He is calling for improvements in clinical trials for new cancer treatments, and Dr. Tannock is with me in studio. Good morning.

IAN TANNOCK: Good morning.

MG: You're part of a growing number of doctors who practice this idea of common sense oncology. We've talked about this before from a medical perspective. We spoke with a patient who had decided, facing a serious diagnosis, that she was going to stop her treatment, to live the life that she had and live it as full as possible, rather than see that life interrupted by and perhaps derailed by treatments. What does that phrase mean to you, common sense oncology?

IAN TANNOCK: Well, I think Rachel said it very well. I think it's a grassroots organization which has doctors, patients, nurses and so on. And I think we've come together because we recognize, as Rachel said so well, that we want to champion treatments that really help patients. But unfortunately, we also have out there, a number of treatments have been approved that don't do a lot for patients. And so we're trying to improve both the way that the evidence is gathered so that we have good evidence for the treatments that really work and not to support the treatments that sometimes do very little for the patients. We're trying to improve education of young oncologists so that they critically look at that. And we're trying to improve communication. Rachel said it very well that sometimes, in communicating with doctors, the patient doesn't get a real view of what will really help them and where treatments might add toxicity without a great deal of benefit.

MG: Can you help me understand that? Why is it that people would be getting treatments that wouldn't help them? I mean, the assumption is that the treatment that you're getting is a treatment that is meant to help you in the situation that you're in. Why is that not happening?

IAN TANNOCK: Well, there are many complex reasons, but most of the evidence comes from cancer clinical trials. And the gold standard for clinical trials is where patients receive, by random choice, by the toss of a coin, if you like, either a new treatment or a standard treatment. And then in those trials accrue, many hundreds of patients often participate, there is an analysis at the end. And these trials, which has changed over the last 20 or 30 years, are now run entirely by pharmaceutical companies. Almost entirely. 90% of them. Some of those have led to very good drugs. So we really have had some new drugs that have made a huge difference to both the survival and its quality. But unfortunately, there are also a number of drugs out there that have been put forward by companies, and because of a variety of biases and so on, that the evidence is not very strong. But nonetheless, those drugs or new treatments have often been approved by the registration agencies, the FDA in the US, the EMA in Europe and Health Canada here.

MG: These are treatments that would, reading the paper, suggest that these are treatments that perhaps would reduce tumour size but not make the patient feel any better, for example.

IAN TANNOCK: Yes, that's very true. Quite a few years ago, there was a concentration on really the outcomes that matter. As Rachel said, there's only two things that we ultimately want to do. We either want to make the patient live longer for have a longer survival and preferably as well, make them live a life that is of higher quality. And there's been a tendency in the clinical trials to use alternative outcome measures. So delay in tumour growth, which is obviously something that patients like to hear. But if that's confounded by added toxicity, that doesn't really help them. And unfortunately, that particular outcome measure in general doesn't predict very well for either longer survival or for better quality of survival.

MG: Are there examples of treatments that you've seen that would have minimal benefits to patients?

IAN TANNOCK: Absolutely, yes.

MG: Like what?

IAN TANNOCK: Well, there are several types of drugs that have been approved, drugs for a variety of different diseases, that have led to improvements in delay, to progression of their tumour, but have not improved when there is a later analysis of the length of survival, that haven't led to a meaningful improvement in the length of survival and haven't led to a meaningful improvement in the quality of life. You want me to name some drugs?

MG: Well, no, but I mean, people would know the drugs, but I'm just curious as to if you could immediately say yes, that's the case, what's leading to the bias that would allow those drugs to be available, but also to have that treatment kind of directed toward the patient? What's at the root of that bias?

IAN TANNOCK: The root of the bias is that the clinical trials that are done, often they are not done very well. And the pharmaceutical industry will use whatever methods they can to bring drugs to market. And as I say, they've done some good trials that's led to some good treatments. But otherwise, there's a variety of, if you like, dodges that are used that can lead to a false impression of benefit. And some of those dodges, you always compare a new treatment with the best current standard. That's what you should do. But some trials have used an older standard that is not the optimal treatment at that time. So that obviously gives a bias towards the new treatment looking better that may not be there. Often, companies will use a treatment that has been shown beneficial in a late stage of the disease and try to move it earlier in the disease. And sometimes, that's a good thing to do, but sometimes, it's not. And one of the things that's happened is that trials have become very big. They've become sometimes global. So the people who get the this treatment earlier, all of those will get it. The people who are in the other group that don't get it should be able to get it later if it's been shown to be beneficial. But if you live in a middle-income country, and many of the trials are recruiting patients in China, Brazil, Russia, Argentina, etc., the patients can't afford it. And the companies should actually be providing that, but they're not. So those are a couple of things. Another is patient dropout. I mean, obviously, when you recruit patients into a clinical trial, they have the perfect right to say, I've had enough of this. I don't want anymore. And if patients drop out randomly, that isn't a problem. But in some of the trials, up to 20% of the patients drop out. And one of the things that happens is that new drugs usually not only they hopefully might bring benefit, but they usually also add toxicity. And so the patients who drop out tend to be those who aren't doing very well. If you've got a, if you're having a new treatment and you're feeling sicker, you’d say, I've had enough of this. I don't want to have any more of this. And if those patients drop out, those are the patients who usually will have poorer outcome measures. And so you drop them out of the experimental group and the group that are receiving the new treatment. And that leads to a bias in favour because the ones who are left are those with better outcome measures. So there are various types of biases that are a little bit hidden, but which can confound the outcomes or the reported outcomes of the clinical trial.

MG: What's the better way forward? Again, this matters because the patient and their loved ones want that patient to have those goals. I mean, you want to live longer. You want to enjoy those, that time that you have. You want to feel good. You want to feel better. So what's the better way forward here?

IAN TANNOCK: Well, absolutely, you're right. The better way we think is to establish some firm principles for people who are both designing trials, analyzing the trials and reporting the trials. And in the paper that you mentioned at the outset, we have a couple of checklists that are relatively simple lists of a few things that need to be done, and they address some of the problems that I've just talked about. What we're hoping is that we will obviously give these checklists and alert people who are editors of journals, reviewers of journals, people analyzing trials, clinical trialists, and the companies that are often designing them to try to get them to improve the way they design, analyze and report the trials.

MG: Is this corrupted by money at the centre of it? I mean, there's a lot of money that's sloshing around here.

IAN TANNOCK: There's huge amounts.

MG: And corrupted is a strong word, but I mean, if you're trying to get the cleanest, at most accurate outcome possible.

IAN TANNOCK: It's definitely money plays a huge part. When I was a young oncologist several decades ago, most of the trials were supported by government grants, charities and so on. And that's changed dramatically over the time. So as I said, 90% or more of the large practice changing clinical trials are now supported by companies. I'm not saying they don't do some good trials. They've done some very good trials, and we've had some good products of that. But along with that, there are other trials that are not of the same calibre, and they're tested treatments that aren't of the same calibre. But the company is beholden to its shareholders. It's trying to make a profit. And sometimes, the goals of making a profit and the goals of making patients, helping patients to live longer, live better, come together. They’re cohesive. But sometimes, they're not. And that I think is a fault. So yes, you're right that finances play a big part in it.

MG: Just in the last couple of minutes that we have, can I go back to what I started with, which is if you are a patient and this is a diagnosis that you don't want, but you've received this diagnosis, what should you be thinking about? What should your families be thinking? What should you be asking?

IAN TANNOCK: Well, I think that's something we're trying to tackle as well. We have a lot of patients involved with our group and we're trying to, one of our colleagues who's a member of the group is coming up with a patient charter and trying to come up with a list of reasonable questions. But some of them were exactly those that were voiced by Rachel just before I started speaking. You know, is this treatment likely to both, is it likely to prolong my life by a reasonable amount? Is it a treatment that even if I accept that the drugs may add a little bit of toxicity, is it thereafter going to lead me to have a better life where I can do the things that she so nicely described?

MG: Those are hard conversations to have.

IAN TANNOCK: They are hard conversations. And it's often easier just to prescribe something than take the time to have the conversations, but the conversation is very important.

MG: Dr. Tannock, thank you very much.

IAN TANNOCK: It's a pleasure.

MG: Dr. Ian Tannock is Emeritus Professor of Medical Oncology at Princess Margaret Cancer Centre and the University of Toronto. As I mentioned, we've talked about this a couple of times. And the response that we've gotten back from people has been really powerful, this idea of common sense oncology and what you are looking for in the wake of a diagnosis and what that path might be for you in trying to figure out how to get and achieve those goals. If you have gone through this yourself or with a family member, we'd love to hear from you. You can email us, thecurrent@cbc.ca. That is The Current for this Tuesday. It's the 4th of February. Q is up next on CBC Radio One. Big night of music on Sunday. It was the Grammy Awards. Beyoncé took home album of the year as well as best country music album for Cowboy Carter, a record that features the work of several Canadian artists, including Dave Hamelin, who is from the Montreal band The Stills, worked as producer, engineer and mixer on this record. First time Grammy winner on Sunday. Congratulations, Dave. Here's Beyoncé and RIIVERDANCE. I’m Matt Galloway. Thanks for listening to The Current. We'll see you tomorrow.

[Song: “RIIVERDANCE” by Beyoncé]

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Tuesday, February 4, 2025 Episode Transcript

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