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The Current Transcript for December 17, 2018

Host: Anna Maria Tremonti

STORIES FROM THIS EPISODE

Prologue

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VOICE: I have additional prescribing authority. I recommend to patients if they would like to have like antibiotics and then I can prescribe for them.

ANNA MARIA TREMONTI: Depending on where you live in Canada, your pharmacist can do a lot more than fill out prescriptions. In some provinces they can prescribe antibiotics, oral contraceptives or administer certain quick tests. In certain studies, patient satisfaction with this was extremely high and pharmacists were found to follow guidelines more than physicians. Some see this as a new wave of accessible, workable healthcare, others say they are blurring the lines for physicians. In half an hour, we're looking at the changing roles and responsibilities of pharmacists and how it might affect your health care. Also today, middle child blues.

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VOICE: All I hear all day long at school is how great Marcia is at this or how wonderful Marcia did that. Marcia, Marcia, Marcia.

AMT: Well from the Brady Bunch, a sitcom you may have thought you left behind, to the real world, the middle child has its own particular place in family dynamics. Perhaps, you are one. Perhaps, you have one. Perhaps, you're ignoring one. Just in time for the holiday season and the family dynamics that encourages, we are reprising our look at the triumphant and torments of the middle child. That's in an hour. But we're starting with the geopolitical fallout surrounding the extradition proceedings of Huawei's Meng Wanzhou.

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VOICE: In our Chinese community in greater Vancouver, everybody, every Chinese talk about it. She's just a suspect. Why Canada treat her in such ways.

AMT: From callers to Chinese language radio shows in Canada to the arrests of Canadians in China, the U.S. request that set this all motion is having domino effects on Canadair that appear to be neither predictable nor finished. I'm Anna Maria Tremonti. This is The Current.

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Conflict inevitable with Canada stuck in middle of U.S.-China row: expert

Guests: Steven Lee Myers, Lynette Ong

AMT: Meng Wanzhou, the executive at the Chinese tech giant, Huawei, may be out on bail, but the fallout continues after her arrest in Vancouver, earlier this month, on a U.S. extradition warrant. Last week's detention of two Canadians in China has struck many as retribution, plain and simple. Former diplomat, Michael Kovrig and entrepreneur, Michael Spavor, remain in Chinese custody. Canadian Ambassador John McCallum has now met with each of those men. A major Canadian brand, the jacket maker, Canada Goose, has postponed the launch of a flagship store in Beijing, citing construction delays and the whole situation has put a damper on the final weeks of this so-called Canada-China "year of tourism 2018." Our tourism minister, Melanie Joly's plans to cap off the campaign with festivities in China, have now been put on ice. Asked if the situation could get any worse, the editor of The Global Times in China a state run newspaper says, oh yes.

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VOICE: I personally believe that in Canada extraditing Meng to the US, China's revenge will be far worse than detaining a Canadian.

AMT: Well for a sense of how all of this is playing out inside China, I'm joined by Steven Lee Myers. He is a diplomatic and national security correspondent for The New York Times based in Beijing. He spoke with Michael Kovrig shortly before his arrest. Hello.

STEVEN LEE MYERS: Hello.

AMT: Can you tell me about the last time you spoke with Michael Kovrig?

SLM: You know Michael was well known in the diplomatic and journalistic community here in Beijing, as an expert on many aspects of China and its foreign policies and we had spoken by phone, specifically about new allegations of corporate espionage with the United States in particular and other countries as well, following a bunch of cases that were brought by the United States. He was a well-known expert, often quoted, often on TV, also on Chinese TV.

AMT: Were you surprised to hear he'd been arrested?

SLM: Of course, I think his arrest and then a few days later we learned of the second one, I think really had sent a chill through the community of expats here because you know you realize you stay here with the forbearance of the government, as a foreigner, especially as a journalist, but you don't expect it to suddenly end up in a situation like we have right now.

AMT: And how are people in China reacting to the arrests of the Canadians?

SLM: I think for most Chinese, what they know of the case, is if they know of them at all is what they've read in state media and as far as the state media is concerned, these are espionage cases and I don't think most Chinese would be surprised that there are espionage cases going on. But obviously, you know they come in retaliation to the Huawei case and issues playing out in the courts there. And you know I think most other people who are aware of it, in that level you know see it as a case of judicial vengeance or a bargaining chip.

AMT: And in terms of the wider Chinese public and the arrest of the Huawei CFO, what's the mood been, can you get a sense of the public, given the fact that the government controls some of that stuff?

SLM: You know it's probably a little bit more mixed than you'd think, in terms of the given the control of state media. You know most people you know digest a pretty consistent message from that's approved at least by the state, which is not to say there is not a divergence of opinion and there are people out there who have access to Western media, for example outside of the great firewall. And they can read the case and they can also make judgments themselves and some of the reaction you've seen on social media platforms here suggest just that people you know are at least willing to hear it the American concerns about Huawei. They see it as a political fight. A lot of people of course just instinctively rally around their company, kind of mild patriotism or what have you. But you know there is some talk of there being a boycott of Canada Goose for example, the flagship store that you mentioned earlier, is just around the corner from here and you see the sign and walking down the street of course, you see lots of people wearing the clothes. It's a very popular brand here. So these situations that’s happened with other countries, South Korea for example last year. So I think people tend to go with the flow if you will when these diplomatic crises erupt.

AMT: Now family and friends of course Michael Kovrig and Michael Spavor are worried about their detention in China. We have a clip here that I'd like you to hear. This is Benjamin Young, a friend of Michael Spavor's speaking to CBC's As It Happens.

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VOICE: I think they really do not like the fact that Canada detained Ms. Meng from Huawei and I think that this is really China trying to pressure Canada to not extradite her to the United States. I think China feels that it can bully Canada around because it's not the United States. I think Michael is an unfortunate pawn.

AMT: Steven Lee Myers, from your vantage point, how do you see this?

SLM: I mean I think there's no question that these two detentions are a bargaining effort by the Chinese government. I mean it's a very crude way of dealing with the situation and you know it lacks in the appreciation, as Canadian officials have pointed out, that there is a judicial process there that's independent of the political system, which is true in the United States as well. And so I think you know to arrest people essentially as hostages, to do you know depending on the resolution of the judicial process in Canada you know, is really a hardball tactic. The interesting thing is Donald Trump more or less said at least in one tweet that he would consider a trade, an extradition if it would help the trade deal, which is more or less what the Chinese are banking on. And you know it in both cases you know I think it politicizes, which should be an independent judicial system. Obviously the system here is hardly transparent, it's hardly fair and when people get caught in the system of course, they're not going to have bail hearings. So I think you're really seeing a crisis taking shape and what's hard to imagine now is how it resolves itself. Even if the court rule in favour of Huawei and let her leave and do not extradite her to the United States, I think people will see it as a politicized outcome and then we'll see what happens with the two men here, but it's a grave crisis and you could see it getting much worse.

AMT: And in terms of the Chinese newspapers and Chinese media then, do you see that politicization, is that the main thrust of the reporting?

SLM: Yes of course and in the in media, which is basically all media here, you know the message has been consistent that this is an under arrest, meaning in the Huawei case, that these charges are purely political, that the United States is going after this company because they fear fair competition from. And that's what people read, unless they're seeking out sources outside of China.

AMT: How worried are other Canadian expats in China right now?

SLM: You know I mean one hopes that there may be, these are the only two people can be detained, but it does show that if the Chinese authorities decide that you're a problem, you can be arrested and that doesn't apply just to Canadians, that applies to any advised to any foreigners here.

AMT: I was just going to ask you, do they worry you at all as an American journalist covering a story like this?

SLM: I mean I would hope that the Chinese do not resort to arresting journalists who are here and you know not breaking any rules. You know, but if they decide that you've broken a rule then it's you know you're here at their pleasure essentially and so at any moment you could be detained and you know accused of something, even if you haven't done anything wrong, which I think is the case in both of these situations.

AMT: So what are you watching for in this story now?

SLM: I mean I think the big question that we all have to wait for is the judicial process in Canada and depending on how that goes, you could see, as I said, the situation becoming much worse. As the editor of Global Times who you quoted earlier, you know he made it clear that it will be a lot worse and even mentioned the detention. As I said, there's very little pretense here that this was done in retaliation and it was a warrning that you know you can imagine it would be much more. And if they extradite her to the United States, where she's charged with bank fraud, you can see this expanding to Americans as well.

AMT: Steven Lee Myers, thank you for your insights.

SLM: It's my pleasure talking to you.

AMT: Steven Lee Myers is a diplomatic and national security correspondent for The New York Times. He's based in Beijing. That's where we reached him. Lynette Ong has been listening in. She's a professor of political science at the University of Toronto and she's an expert on China. She's with me in studio to help explain why China is reacting to the situation the way it is. Hello. Welcome.

LYNETTE ONG: Hi, thank you for having me.

AMT: Did you see this coming?

LO: No, not at all. I think we know that there has been tension between the United States and China for a long time with the trade war and the technological war and then until a half ago, there was actually a 90 the truce in terms of the trade war. And suddenly you heard the news of Meng Wanzhou being arrested in Vancouver. I think that came really as a surprise to everybody, including myself and at the beginning President Trump and Peter Navarro actually say that Trump wasn't aware of the arrest at all. It was a decision made by the Department of Justice. So it came as a surprise to everybody.

AMT: And you know the official line is that Michael Spavor and Michael Kovrig were threatening China's security. There's widespread belief that these are really detentions connected to the arrest of Ms. Mong. Why would China's leadership find Canada's arrest of Ms. Mong so offensive?

LO: Because I think her arrest is seen as a politically calculated act to get back at China. So in the background is a technology war between the United States and China, from the Chinese perspective it is seen as US' attempt to trying to contain the growth of Huawei's 5G technology and the U.S. attempts trying to put pressure on its allies to Five Eyes country including Canada, Australia, New Zealand and the UK to not to engage with Huawei's telecom infrastructure technology.

AMT: And why would China then not just to retaliate with the arrest of Americans, as opposed to Canadians?

LO: Right. To me this is a case of picking an easy, a weak target, right. So the U.S. has actually got quite a lot bargaining chips vis-a-vis China. China actually wants the trade war to end pretty soon because of its slowing economy, but you know we don't have much of a bargaining chip vis-a-vis China. We have a much smaller country, much smaller economy, so Canada is just so easy to pick on, compared to the U.S.

AMT: So it can send a message?

LO: Precisely.

AMT: And you talk about the Five Eyes, The Globe and Mail is reporting today that what they call spy chiefs from Five Eyes network, briefed Prime Minister Trudeau twice this year on Huawei and national security risks because under Chinese law, the Chinese, any Chinese company, must work with China's intelligence agencies, if requested. Is that like what do you think of that whole fight then?

LO: Right. You know I think until the arrest of the two Canadians, I mentioning not unsympathetic towards the view that you know Huawei is a great technology company. It is a step ahead of many of its competitors. It has invested a lot of resources on R and D and its products was actually widely used throughout Europe, one of its biggest market. So to make the statement that Huawei automatically pose a security threat to Western democracies because it is from China. I think that involves quite a bit of assumption because we could also say that about Google and a lot of technology firms from the United States. We know that they own a lot of our data and they do turn it in to the U.S. authorities right. So I'm not sure, I think you know Huawei is a great company and yes it could potentially work with Chinese authorities, but I think that is not an automatic assumption.

AMT: China's ambassador to Canada wrote an op-ed in The Globe and Mail last week, saying people are worried about giving Chinese companies access to the 5G infrastructure. Now because they have a stale cold war mentality and what they're really worried about is that China's catching up.

LO: Right. So I think the arrest of the two Canadians really doesn't help the Chinese authorities. I think it has actually played the game wrong. I think that is seen as very much a thuggish behavior. I think that is just going to lead people to further believe that Huawei is going to pose a threat to Western countries.

AMT: Because it shows them being too interested in a private company.

LO: Yes. Precisely.

AMT: And Mr. Trump's, it was more than a tweet of course, he told Reuters that he could see bargaining over the arrest of Ms. Meng. How does that colour all of this for Canada?

LO: Right. So I think we know that you know this is clearly a situation of an emerging power posing competition to an existing international power, right. So there will be conflict inevitably, but I think what is unique in this situation is the current leadership that we have in place, isn't going to help with the situation, which is President Trump often making decision on a whim. Tweeting that basically suggesting to the Chinese that we could use this as a bargaining chip, that is precisely the wrong message. The message that we shouldn't be sending to the Chinese because our court system is independent of the government. The government has no power to intervene, but suggesting there is a bargaining chip is saying that you please come use this to bargain with us, which is precisely not what we should be saying.

AMT: What further action could Chinese authorities take to pressure Canada?

LO: A range of things. So things could get a lot worse or it could get a lot better. It is very difficult to predict, but what I suspect is happening between now and February, which is Meng scheduled for another extradition trial is that leadership is going to talk, is going to have back room negotiation, either in Beijing or Washington D.C. If they are smart about it, I think they want to talk about things, which is not transparent to either you or me. They want to talk about things and negotiate things quietly for the release of the two Canadians.

AMT: And you know there are something like 531 locations in China where Canadian business operates, everything from energy to agriculture to education. How worried should Canadians working in China be right now?

LO: I think right now people should be very cautious. I mean China is a country that sets many, many stringent rules and people often have to kind of work, square around the rules, working grey areas just to get things done. And those are the areas that the government could come and get you, even when it is it is necessary. So if I'm a Canadian business operating in China, I would be very cautious about everything that I'm doing.

AMT: But what does that mean? Because there would be people flying in and out, they've got businesses to attend to, how do they do that?

LO: So we would just have to avoid you know risky activities for the time being. You know I think also some negotiations, if you are thinking about a merger, acquisitions, I think people should be putting that on hold for a minute because the greater political environment is just not conducive.

AMT: And tell me a little bit more then about the political climate in China right now.

LO: I think until the arrest of the two Canadians, I think there has been a lot of public fury against Canada because we are seen as really helping the United States arresting Meng, which is calculated to contain China's growth rate, right. But I think the two arrest, I mean I think any fair minded Chinese would be able to see that as a tit for tat strategy, Chinese authorities arrests of the two Canadians. So I think public opinion has turned slightly because they do realize that their government is actually playing retaliation against Canada.

AMT: And how free is the general public to actually say that in terms of social media?

LO: Well I've seen public posts in Chinese social media actually arguing for Canada and I've circulated them, but interestingly enough, half an hour later they get taken down by the authorities. So it is pretty obvious that the Chinese authorities is also trying to fuel nationalist sentiment over this issue, really to help with the government's actions.

AMT: So Canada is stuck between these two giants right now.

LO: It is very, very much stuck in between the U.S. and China unfortunately.

AMT: Okay, well thank you for coming in.

LO: Thank you.

AMT: That is Lynnette Ong. She's a professor of political science at the University of Toronto's Munk School of Global Affairs and Public Policy. We did request an interview with China's ambassador to Canada, we did not receive a response. Let us know what you think of this. You can tweet us @TheCurrentCBC. Find us on Facebook. Go to our website, cbc.ca/thecurrent. And stay with us, the news is next and then could empowering pharmacies to do more be the prescription for our overburdened healthcare system, the one that it needs? That discussion after the news. I'm Anna Maria Tremonti. This is The Current on CBC Radio One, Sirius XM, online on cbc.ca/thecurrent, on podcast and on your radio app.

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Could expanding the role of pharmacists alleviate pressure on health-care system?

Guests: Ross Tsuyuki, Kevin Pottie, Christine Hughes

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

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AMT: Still to come, when the stockings are hung by the chimney with care, is yours in the middle? We're talking about middle children in half an hour because believe it or not, as family size shrinks across North America, the middle child is becoming an endangered species. If you are a middle sibling or if you have one then you don't want to miss this discussion, but first empowering the apothecary.

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AMT: It is that time of year for sniffles, sore throats, fevers, but if the idea of scheduling a doctor's appointment for a prescription seems daunting, then how about a trip to your local pharmacist instead? If you are in British Columbia, Alberta or Nova Scotia your pharmacist may be of help, that may be able to administer a rapid strep test. That is one example of the way pharmacists are expanding their roles in the health care system. This Fall, Saskatchewan pharmacists were given the power to prescribe for many minor ailments, including urinary tract infections or to help with quitting smoking. Across the country, flu shots from pharmacists are very common, but back to the rapid strep test I mentioned because it's become the subject of debate in Nova Scotia. The province's College of Pharmacists maintains that if it is administered by a pharmacist only then it does not meet their standard of care, but a group representing pharmacy owners, the Neighbourhood Pharmacy Association of Canada is lobbying to expand those tests in two other provinces. Our producer Michael O'Halloran went to Shoppers Drug Mart pharmacy in Calgary to see how pharmacist Azita Rezaei uses those tests.

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VOICE 1: This sample could contain the bacteria, Group A is streptococcus bacteria. After five minutes we insert it into the analyzer and within three seconds we know if it's negative or positive.

VOICE 2: So roughly in five minutes a customer.

VOICE 1: In five exactly, they will see that.

VOICE 2: How confident are you that the test that negative is negative and positive is positive.

VOICE 1: This machine is 95 percent effective. If it's positive because I have additional prescribing authority, I recommend to patients if they would like to have like antibiotics and then I could prescribe for them. If it's negative then I'll definitely counsel on how to take care of the viral infection that they have.

VOICE 2: How do you handle a situation where you suspect that someone needs to see a doctor, but the test came back negative? What do you do?

VOICE 1: Exactly it all depends on because we do the assessment first. So I have to ask all the questions of the patient to assess them to see that how they are feeling. You have to use your judgment.

AMT: Well is empowering pharmacists a way to save unnecessary trips to the doctor’s office and reduce unnecessary antibiotic prescriptions or do we put patients at risk by bypassing physicians and their physical exams? We brought together three people who've been working on this issue. Ross Tsuyuki is a professor in the Faculty of Medicine at the University of Alberta. He is also a practicing pharmacist. Christine Hughes is a professor in the Faculty of Pharmacy and pharmaceutical sciences at the University of Alberta. They're both in Edmonton. Dr. Kevin Pottie studied how pharmacists in Ontario are being integrated into family health clinics alongside physicians and nurse practitioners. He is a practicing family doctor and a professor in the Faculty of Medicine at the University of Ottawa and he is in our Ottawa studio. Hello everyone. Welcome.

ROSS TSUYUKI: Good morning.

KEVIN POTTIE: Good morning.

CHRISTINE HUGHES: Good morning.

AMT: Christine Hughes, I want to start with you because your work involves the idea of point of care testing pharmacists who do some diagnostic testing. What do you think of the idea of rapid strep tests being available at pharmacies?

CH: I think the opportunity for patients to access care much more easily and definitely another choice for patients to be able to go to their pharmacist versus their physician. Certainly as has been brought up in the media before that there are limitations associated with the rapid test. So they're not as sensitive for example as the traditional method of taking a swab and the samples being sent to the lab. So that definitely needs to be incorporated into the counseling and patient follow-up .

AMT: Dr. Pottie, as a family doctor, how do you feel about one of your patients perhaps being diagnosed by a pharmacist?

KP: Well I'm definitely a supporter of rapid tests. I'm not sure about this one because I've done research on the HIV rapid test and it's allowed us to go into communities where we weren't able to get the testing for HIV. Now each time we use a rapid the test, we really should have the evidence behind it, to understand the harms and the benefits like Christine is saying. So I think we have to be, we can't just because a test exists, does not mean it gives a better outcome.

AMT: And I should just say, Christine Hughes you work with HIV tests. Why is that different?

CH: Think about the rapid HIV test as a screening test, so it's not diagnostic. It also is a lot more sensitive and specific. So again as Dr. Pottie pointed out, you do have to be aware of the limitations and have research and evidence and there's definitely been a lot of research with HIV rapid testing in practice.

AMT: Ross Tsuyuki, why do you think there is concern about pharmacists taking on more of a diagnostic role?

RT: Well I'm not sure I would call it a diagnostic role. I guess I would call it a primary care role and pharmacists have been doing this for some time. You know, as you know, the definition of primary care is first point of contact with the medical system and so pharmacists being so accessible, patients can you know can see a pharmacist without an appointment and so that's a part of primary care. So you know in terms of diagnosis, you know diagnosis isn't something that sort of comes with your license. It's a set of skills and as a professional you should be able to determine yourself if you have those skills or if you need to brush up on them. So you know it really depends on the particular area that you're talking about.

AMT: Kevin Pottie, I should say we reached out to the Neighbourhood Pharmacy Association of Canada to talk more about why they are pushing to expand tests across the country. No one was available for an interview. What do you think is driving the push to get tests into pharmacies?

KP: I guess I worked with pharmacists for many years and I'm a very big supporter on especially interdisciplinary care, where we kind of work with our complementary skills to provide the best outcomes for patients. And I guess when, I also see pharmacists as playing some innovative roles in the community, you know enlarging our health system and I would support that type of thing. I think each time they do take something, I mean for me the flu shot is a great example where I think we've had a lot of success in increasing the number of people vaccinated. So each time they decide to try to take on you know something that will help the system, I think this is great, but I just want to make sure that it's evaluated and I'm not sure why they wouldn't have come because we could have talked about the evaluation or the state it's in because I haven't seen any numbers at this point.

AMT: Ross Tsuyuki, I did mention that Alberta is really a leader in expanding pharmacists roles. Tell us a little bit more of what's going on in Alberta that maybe people outside the province would be surprised to hear about.

RT: Sure. I guess the thing in Alberta is that the scope of practice has expanded, compared to a lot of other jurisdictions, like other provinces and in fact like other countries. In Alberta you can apply, you have to go through a process, but once you can apply for a prescriptive authority and and also to order laboratory tests. So that is different from the rest of the country where prescribing activities are quite a bit more limited. Just like it is for physicians, you only prescribe in an area in which you're competent. And as a healthcare professional, you should know what areas you're confident in and for example, I don't prescribe outside of my area of cardiology because I don't keep up in those areas and in my practice I don't, you know I don't see patients outside of you know people with heart disease. So you know it's kind of a self-regulating thing.

AMT: And can you give me an example of how you would prescribe for cardiology?

RT: Well sure. Of course where I work is kind of a different situation, I work in the Mazankowski Alberta Heart Institute, so you know pretty specialized. I see patients with heart failure. So these patients are referred to our clinic, usually because they're poorly controlled and they have a lot of symptoms and there's concern. So when I see a patient I greet them, I ask them some questions about their current status and how well they're doing. I do their physical examination and then I come up with a plan. We work in a team where we have nurses and dietitians and cardiologists. So if I'm the first one in to see that patient then I'll do their full work up, their full assessment and then I will speak with other members of the team and say here's what I found, here's what I plan to do and we have that kind of dialogue. Often they'll come in and see the patient again with me and we'll discuss the plan of attack and then usually I'll stay behind and then execute that plan of attack, which might mean writing prescriptions, lab tests and then spending some time explaining to the patient so here's what we're going to do. You know are you okay with this and discuss it with them and get them on their way.

AMT: And the cardiologist would they, would you consult with cardiologists on the prescriptions?

RT: Yes, usually I do. Usually they ask me what do you want to do, but I when I say come up with a plan, that's what I mean is any changes to prescriptions. We'll discuss it because that's what we do as a team.

CH: And who actually diagnoses the heart problem?

RT: Well in our case, the diagnosis has already been made and you know that's why they've come to this very specialized clinic and that's why I say it's, this is not, this is one type of practice.

AMT: Where you're working in tandem, you're entwined all of you for comprehensive health care.

RT: Absolutely and none of us have any issue at all with saying hey come here, this is what I'm thinking, what do you think? That goes both ways. We all do that and that's the benefit of working in a team.

AMT: And now you have done some research on what happens when pharmacies treat patients with high blood pressure. What did you find?

RT: Absolutely. Well as you know high blood pressure is the leading risk factor for premature death and illness and control rates are only about between 65 and as good 35 percent, but still there's a lot of patients that are not well controlled. And so in our study, pharmacists screen patients and found those with uncontrolled blood pressure and these are pharmacists out in the community, both in the rural settings, as well as in urban, and we randomly assigned those patients to either usual care, usual care by their pharmacists, usual care by their physician or this enhanced care, which meant that the pharmacist prescribed and did follow-up with those patients. And after six months we compared the blood pressures in the two different groups and we found that the blood pressure was quite a bit lower in those where the pharmacists provided prescribing and follow-up care to those patients.

AMT: And why is that?

RT: Well I think it's the cause follow-up. I think it's engagement with the patient and I think probably also a good understanding of the medications that are used for high blood pressure and in some cases getting people to better follow their medication regimen. So they took their pills as prescribed.

AMT: And Dr. Pottie, what do you think of that?

KP: I'm with Ross on this one. I think a lot of people think of a pharmacist filling prescriptions. We even had that happen in our study when we were integrating pharmacies into family practice that physicians didn't necessarily understand the expertise and what the pharmacist could add to a team. And I think that's what Ross has just giving a great example of is it's really an asset for health care teams and I definitely feel really comfortable with that and Ross is kind of describing a very similar to what we do as well in family medicine.

AMT: And Christine Hughes, I want to talk a little bit more about your work on HIV and other STDs. Are pharmacists getting involved in treating patients with HIV?

CH: Not definitely a pharmacist in the community per se. I work as part of, similar to Ross, I work as part of an interdisciplinary team as a pharmacist in the area of HIV. So I think really what and Dr. Pottie had mentioned this as well, as is in terms of HIV, one of the problems that we face is people being diagnosed and coming for testing so that they can be engaged in care. So that's some of the work that I've done is trying to reach in the community and pharmacists are generally one of the most accessible health care professionals. So they offer an opportunity for pharmacists to do testing to identify patients or if patients are negative to actually counsel them about risk factors for HIV and how to reduce the risk of acquiring it. So I think that's one avenue for community pharmacists, but we certainly have a lot of community pharmacists that work very closely with our program to help support patients in taking their medications out in the community.

AMT: And management of all of that right? Again, sort of that community contact, right?

CH: Exactly. So you know again it's really being part of that team in collaborating with specialized clinics and other health care professionals to try to improve patient outcomes.

AMT: Kevin Pottie, how do physicians overall react to these kinds of teams and this, what seems like a shift?

KP: I'm not sure about all of the physicians, but within our project it was very, at the very beginning, the physicians really they hardly even talked to the pharmacists. The pharmacists would sit in the coffee room and the physicians would just walk by them and because we took, we had the pharmacists writing like stories of what it's like to be in family practice as a pharmacist. And it began very slowly, but at the end of it, even after one year and we actually went and interviewed all the physicians and the pharmacists, it was an absolutely different story. They'd get to know each other, they realized they had complementary skills and the physician said, I don't know, I don't think I could keep doing this job without a pharmacist helping me. So this is, I think this is where, this is a real positive thing in interdisciplinary care, when you really respect and you learn about the other skills, but you don't just do that on paper. Some of it has to happen in person with patients, you're having good experiences together and then I think that can change a lot.

AMT: And Ross Tsuyuki, you teach in the medical school, you're a practicing pharmacist. How do you see the attitudes of doctors?

RT: Well as you said, I work for a faculty of medicine and I guess what I can say is that those that I work with are extremely supportive and in fact actually, it's interesting that this model of getting care out into the community seems to have really caught on and actually some of my colleagues are saying I want to do, some of my colleagues that are physicians are saying I want to do that kind of research as well. I want to get this out into the community. Can you help me to you know engage some pharmacists out in the community to do this? And I think in particular, you know people understand that things need to have evidence really to be implemented and they understand the importance of that evidence then and so as a university, we're involved in trying to generate that evidence and apply it in the community. And so yes there's really very strong support, of course can't speak for everyone, but there does seem to be a trend towards you know really strong support. And I just want to bring up one other point and you know, we do get asked that question a lot and that relationship is really, really vital. The kind of care that we're talking about isn't excluding physicians and I want to make that point because this is not instead of physician care, but it's in addition to and in collaboration with and I think that's an important point.

AMT: Because we already see pharmacists who are because they are point of contact in a community, they can monitor actually patients who are on a lot of different kind of prescriptions, actually more efficiently.

RT: Well and kind of be a connector as well.

AMT: Christine Hughes you're ready to say something, go ahead.

CH: No I was just snickering with Ross that really pharmacists can help connect, sometimes be a form of communication either between the patients and the physicians or even sometimes between two physicians who may not necessarily know something that the other physician prescribed. So I think there's an important role and a gap in the system that the pharmacists can fill.

AMT: Kevin Pottie, I'm wondering about the issue that doctors are under a government controlled system for payments, pharmacists are under a completely different system. Is that a problem? Does that constitute conflict of interest at times in the views of anyone?

KP: Well that's not totally correct because the pharmacists often that have joined our teams could be being paid by the same way we're being paid say the Ontario Ministry of Health. So the community pharmacists, the ones that have their own businesses, yes they're operating in a different financial situation.

AMT: And Ross Tsuyuki, do you see that as a problem for those pharmacists who are operating their own businesses and dispensing drugs and prescribing?

RT: Well I think you can, that the issue of conflict of interest does come up and I think what people need to to understand is that as healthcare professionals, we all put patients first, in front of all of that. Now people have expressed concerns because of big corporations that run pharmacies, but even so, as Kevin said, a lot of people are actually under a system where they are being paid by government as well. So for example in Alberta, a community pharmacist can bill Alberta Health for services, for medication review, for follow-up visits, for high blood pressure or diabetes etc. So that is the public system and it's parallel to that of physicians and so it keeps getting brought up, but I don't think it's really that much, generally that much of an issue and I think you know this is something that comes up all the time. For example, you go to your dentist, your dentist prescribes a course of treatment, which involves usually procedure, they're benefiting from that and yet we don't talk about that as being a conflict of interest, you know in the same sort of way.

AMT: And Christine Hughes, I wanted to ask you, so given the expanded roles for pharmacists in Saskatchewan and in Alberta, how is it working so far?

CH: I think you know, I think we're still, even though it's been over 10 years here in Alberta, there is still more to learn and so I think initially it was maybe a bit slowly. I think now we're seeing a lot of really innovative practices and more research, including some of the work that Ross has done that's actually showing the benefit of what's happening. So I think from what we've seen with immunizations or blood pressure and other chronic disease management, there's definitely evidence showing that pharmacists can make a difference and I think there's still more to learn.

AMT: And I'm just wondering what you each think of who, what body should be responsible for seeing how this moves forward? Should there be more even expanded roles for pharmacists? Kevin Pottie, or expanded roles for pharmacists working with physicians?

KP: I feel like deflecting that question. I just want to bring up just some, Barb Farrell, who's a pharmacist has led this team prescribing evidence-based guideline initiative and I just I think that this is the type of initiative that we really need because sometimes taking less medicine is better for patients. And having pharmacists lead this and be part of this, for me is a really positive thing that kind of goes a little bit against this concern of conflict of interest because basically the idea is of stopping medicines. So I know that's just another example, but I think in terms of the other question, I think I'm not going to reply on that one. That is a fantastic program the prescribing program and you could argue, using that conflict of interest argument, that's a reverse conflict of interest. You know, if you were to follow that kind of logic. I think actually that what's going to drive this is patients. You know we've talked about what do physicians think? What do pharmacists think? What does government think? But of course the most important person in all of this is the patient and you know that's an important question. What do patients think and what do they want? And when we've evaluated this scientifically what patients really like is the accessibility the thoroughness and the communication skills of pharmacists for many of these chronic diseases.

AMT: Okay, we'll end it there with that answer. Thank you all of you for being part of this conversation.

KP: Thanks very much.

RT: Thanks a lot.

CH: Thank You..

AMT: I've been speaking with Ross Tsuyuki, professor in the Faculty of Medicine at the University of Alberta and a practicing pharmacist. Christine Hughes is a professor in the Faculty of Pharmacy and pharmaceutical sciences at the University of Alberta. They were both in Edmonton. And from Ottawa, Dr. Kevin Pottie, family doctor and professor in the Faculty of Medicine at the University of Ottawa. Let us know what you think of those expanded roles and how they work together. Tweet us @TheCurrentCBC. Find us on Facebook. Go to our website cbc.ca/thecurrent. Stay with us, we're talking about the middle child when we return.

[Music: Theme]

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

Guests: Bruce Hopman, Rodica Damian, Catherine Salmon

AMT: Hello. I'm Anna Maria Tremonti and you're listening to The Current. Since it’s that time of year that many families come together in celebration, we wanted to share a conversation we had in September, as a little reminder, to share the holiday spirit equally among your loved ones.

SOUNDCLIP

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

VOICE 1: Sweatheart.

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

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

VOICE 1: That's nothing new for Danny.

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

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

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

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

VOICE: Lisa can I talk to you?

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

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

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

AMT: Now because you're neglected right.

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

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

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

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

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

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

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

AMT: Now you have children, do you not?

BRUCE HOPMAN: Of course. Guess how many.

AMT: You have three.

BRUCE HOPMAN: Of course I do.

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

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

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

BRUCE HOPMAN: Thank you so much.

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

RODICA DAMIAN: Hello Anna Maria.

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

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

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

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

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

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

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

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

AMT: A small which?

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

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

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

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

RODICA DAMIAN: Sure.

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

RODICA DAMIAN: You're welcome.

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

CATHERINE SALMON: Hello.

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

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

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

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

AMT: Is middle child syndrome a thing?

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

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

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

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

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

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

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

AMT: So what do we do with this knowledge?

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

AMT: Thank you for your time.

CATHERINE SALMON: You're welcome. Thank you.

AMT: Catherine Salmon, professor of psychology at the University of Redlands, co-author of The Secret Power of Middle Children: How Middle Borns Can Harness their Unexpected and Remarkable Abilities. I spoke with her in September. What do you think? Are you a middle child? Do you have one? Do you ignore one? Let us know what you’re thinking. Tweet us @TheCurrentCBC. Find us on Facebook and go to our website, cbc.ca/thecurrent. Email us from that site. That's our program for today. stay with Radio One for Q. Director Adam McKay is on the show to talk about Vice, his new film about former US vice president, Dick Cheney. And remember, you can always take The Current with you to go on the CBC radio app. It lets you browse through past episodes of our show and start listening in just a few seconds. Finally, after revisiting our conversation with Bruce Hopman, of the International Middle Child Union, let’s end with some seasonal music that comes to us courtesy of Mr. Hopman. This is his rendition of a soon to be holiday classic, Melvin the Reindeer. Here you go. I’m Anna Maria Tremonti. Thank you for listening to The Current.

[Song: “Melvin the Middle Reindeer”]

Dec. 17, 2018 episode transcript

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