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The Current Transcript for June 8, 2017

Host: Anna Maria Tremonti

Listen to the full episode

Prologue

[Music: Theme]

SOUNDCLIP

For a tech company, do you want to be part of the future or do you want to resist the future? We feel that in many ways we want to not be like the taxi industry before us.

ANNA MARIA TREMONTI: Travis Kalanick made it clear a couple of years ago that he would be in the driver's seat and it would be quite a ride into the future. But the co-founder and CEO of Uber has visions far beyond taxis from Alford's to hone in on public transit to autonomous cars even flying cars. He is accelerating corporate plans and he's got the app for all that thanks to his lesser known co-founder, the Canadian software designer who was inspired by his anger at San Francisco's taxis. In half an hour, our project The Disruptors summons Uber. And later, diagnosing illness through the eyes of a child.

SOUNDCLIP

Most of the kids I was seeing had experienced such severe trauma that it felt like something else was going on. Somehow I was missing something important.

AMT: Doctors are realizing that to treat ongoing illness in adults they need to ask about life as a child. As many as 32 percent of adults have experienced some form of childhood trauma physical or sexual abuse that history can influence how they react both physically and emotionally to later illnesses. We're talking about the links between childhood trauma and health care, in an hour but we're starting with a shifting vision of Canada.

SOUNDCLIP

Mr. Speaker is Canada an essential country at this time in the life of our planet.

[Music: Theme]

AMT: The view from the Hill. I'm Anna Maria Tremonti. This is The Current.

Is Canada well-positioned to take lead in the world?

Guests: Emily Tamkin, Christian Leuprecht, Stephanie Carvin

SOUNDCLIP

The fact that our friend and ally has come to question the very word of its mantle of global leadership, puts into sharper focus the need for the rest of us to set our own clear and Sovereign course for Canada. That course must be the renewal. Indeed the strengthening of the post war multilateral order.

AMT: While it was a speech that left a lot of people on both sides of the Canada US border stunned. Foreign Affairs Minister Chrystia Freeland outlining Canada's new position on international affairs. Her speech in the House of Commons Tuesday promised to bring good manners and strong muscles to the international negotiating table. She also said Canada must be willing to use military power in defense of our values and our allies and that new muscle will need money. Yesterday defense minister Harjit Sajjan delivered the government's defense policy review. Echoing many of the themes of Ms. Freeland's speech

SOUNDCLIP

As the Minister of Foreign Affairs said this is a time when Canada must be engaged in the world. We have much to offer. The cause of global peace, stability and prosperity doing our part is the right thing to do and it is also in our interest.

AMT: And to back up that engagement Canada will increase defense spending by 70 percent over the next decade to explore Canada's new effort of assertiveness out of an effort at assertiveness on the world stage and what it could mean for the Western alliance. I have three people ready to join me. Stephanie Carvin is an assistant professor at the Norman Paterson School of International Affairs at Carleton University. She is in our Ottawa studio. Emily Tamkin is a staff writer at Foreign Policy magazine. She is in Washington D.C. and Christian Leuprecht is professor of political science at the Royal Military College of Canada and Queen's University he is in El Paso, Texas today. Hello everyone.

GUESTS: Hello. Good morning. Hello.

AMT: Stephanie Carvin Let's start with you, were you expecting that speech from Chrystia Freeland?

STEPHANIE CARVIN: I was not. It was really astonishing to hear a foreign minister state with such clarity the changing shifting global environment and to basically state that you know in her opinion, the United States is basically questioning if not dropping its quote mantle of global leadership. And in that sense it really is astonishing because Canada is so dependent and has traditionally been so dependent on the United States for its basic thriving in the international system. So to recognize that is was a bit of a shock.

AMT: Christian Leuprecht, Harjit Sajjan followed up with a vision for Canada's defense. Do you see a change in direction?

CHRISTIAN LEUPRECHT: The missions set for the Canadian forces haven't changed, defend the country, defend the continent and defend our allies and so far as that enhances our national interest. I do think that this is a fairly detailed well-thought-out document in the sense that we're all focusing on the big ticket items, things that fly and things that float. But there's a lot in here for instance about emerging threats such as building a cyber-force. There is a lot here about some [unintelligible] the busiest in the Canadian armed forces the Special Forces. So I think overall there are many elements here that will make the Canadian armed forces more effective to deal with, on the one hand a rapidly changing security environment and on the other hand as the minister laid out a capability to deploy in a couple of missions at a time, and given that our interests we might have to pander to a number of interest both in terms of bilateral relations with you with the U.S. as well as with collective defense with the European allies. NATO missions other types of collective defense missions and reassurance and [unintelligible] missions, well that's in the air or at sea or at land. Certainly the government have to reinvest in the Canadian armed forces to do that. And there is a good deal of thinking around how this needs to be done. The question is can we hold the government's feet to the fire.

AMT: Christian I wanted to ask about two things that he talked about as well. So he's going to add 5000 troops regular reserve forces and modest increase in special forces, so more literally more boots on the ground or more boots able to get on the ground?

CHRISTIAN LEUPRECHT: Right. So that's a significant commitment right there because that's you [unintelligible] salary of about a billion dollars more or less a year right there to pay for all those troops. It's a significant interest to the special forces the special forces have been extremely active in a number of parts of the world, in that light of that sort of conflict that we've been engaging in which has been largely domestic type strife and we're trying to do a lot of preventive type work. The challenge around this is that the Canadian Forces have been struggling on the recruitment front. And so will The Canadian Forces recruiting group actually be able to step up and deliver on those 5000 people especially with the sort of quality of individuals that The Canadian Armed Forces will be looking for. And I think there's also recognition of The Canadian Armed Forces perhaps will need to do a lot more on the training, education, professional development piece especially to build the special operators and the cyber force that the Canadian government is looking for.

AMT: And you mentioned the cyber forces also armed drones for surveillance and combat. Is that new, armed drones? Do we already have that?

CHRISTIAN LEUPRECHT: So there certainly seems to be a shift in the recognition that a Canada needs to be able to do more of both on cyber and on the drone front than simply doing surveillance and defense. And the military will need to develop a doctrine around this and the government will need to provide instructions as to how offensive measures in cyberspace and from unmanned aerial vehicles are to be used. But I think this is a prudent way forward because ultimately when that challenge comes where we'll need to deploy these sorts of assets. That's when it's too late as democracy to have a conversation around what we want the armed forces to be able to do or not to do. So it is a development in which many countries around the world are engaging including our adversaries and it's probably inevitable it's, also if you want to pare back on the number of fighter jets that you're going to buy them the obvious substitute is unmanned aerial drones.

AMT: The drone. Right. Okay, so let's get the view from D.C. Emily Tamkin. What do you make of the timing first of all of these statements coming from Canada?

EMILY TAMKIN: Yeah I think it's interesting because while both speeches and particularly Chrystia Freeland speech did as you said stand on the side of the border. The reality is that what people are talking about in Washington D.C. today is not either of these speeches it is former FBI Director James Comey’s testimony before the Senate. And I don't actually think that that is accidental or coincidental and I think it sort of goes to underscore both minister's points which is that the United States has in its current administration in the United States has its mind on other things that it has distracted with domestic politics that it has turned inward that it's focused on anything but its role in the global order and that therefore in the Ministers mind and in the Canadian government's mind this is a time for Canada to step up. Right so I think that the timing actually goes to sort of serve what they're saying. There's an argument to be made that maybe it could have made it could have gotten more attention here had it been time differently. But I think that if you're looking at... I mean I don't think that would have as that would have been as effective.

AMT: Do you think they wanted to be under the radar, Emily?

EMILY TAMKIN: I don't think it's under the radar but I mean it was still it's still been covered. I'm still here talking about it the New York Times and ABC still had articles on it. People are still discussing this. But I do think and certainly I should say that experts who, are focused on this, it did not go under their radar. Right. That that one of our the one of the strongest traditional allies of the United States is saying in no uncertain terms that we need to sort of change the rules of the game here with the United States. But again it does go to prove their point which is that the United States is not being so attentive to its role in the world right now because we're talking about what went down between the president of the United States and the now former head of the FBI.

AMT: This week?

AMT: But not just this week, right? Because this has been an ongoing story and it Donald Trump's first foreign trip this is what we were talking about, while Donald Trump was abroad on his first foreign trip. This is what we were talking about so it is you know I heard the foreign minister say if you are so focused on this chaos at home you can't possibly play your role abroad. And I think that this is an example of that.

AMT: Hmmm. Has there been reaction from the Pentagon on this?

EMILY TAMKIN: Do you know. You know what I've heard so far from the United States government I think I believe it was Secretary of Defense James Mattis who came out after the speech yesterday and said we support this, we are you know we are glad that Canada is doing more to boost defense spending. I don't think that this is out of keeping with the Pentagon's aims. I think probably more concerned would be the State Department although perhaps not the State Department under Secretary of State Rex Tillerson who I think U.S. allies and perhaps a different way than some of his predecessors did.

AMT: Stephanie Carvin, Do you agree with the assessment that the U.S. is withdrawing from its role as a global leader?

STEPHANIE CARVIN: It seems that way in the sense that the Trump administration has made a point of stating that it sees its traditional relationships now in transactional terms. And by that I mean it sees the value of the relationships with its allies not so much in terms of you know history or shared values, but in terms of what are the very real short term material gains that the United States is making from these relationships. So that is a huge shift and that is a huge change. And the minister pointed out quite rightly that this is actually what 50 percent of the American population wants. This is not a temporary thing. This does not go away with Trump that you know there could very well be Trump 2.0 in the future maybe a little bit more smooth maybe a little bit more nice. But the fact is that Americans no longer seem to uniformly want a global leadership role. There was a time where you know we talked about politics stopping at the water's edge because you know there was a kind of a bipartisan consensus over U.S. foreign policy and that’s no longer there. And as a result the world can no longer depend on stable American leadership that's willing to bear the costs of that role. And as a result I think the minister's assessment was in fact correct.

AMT: And we heard some of this from Angela Merkel not that long ago, Emily Temkin. There's something that sort of is echoed in that in the Canadian statements, is there?

EMILY TAMKIN: Absolutely yes. I actually Chrystia Freeland speech reminded me very much of Angela Merkel's speech in that it wasn't a direct censure of the United States but it was more saying we have to realize that we cannot rely solely or largely on this one ally anymore, which is you know I think the American reaction , for those who are paying close attention the American reaction was one of two things; either there were people who were shocked and distraught and saying this is how one of our closest allies in both cases right. This is how one of our closest allies speaks of us. How disheartening how embarrassing. What a shame on this country. There are other people who are saying this is what Donald Trump said he was going to do right he said that he was going to get other countries more engaged that he was going to make them spend more. And look that's what they're doing. And isn't that a good thing and why should we bear the cost. I think that you're seeing it you're hearing both of those reactions in Washington and not just this week.

AMT: Christian Leuprecht, how do you think other militaries within the alliance, the Western alliance will see what Canada is planning?

CHRISTIAN LEUPRECHT: Well, there are three things that Canada needs to be able to deliver on. It’s cash, capabilities and commitments, and to be able to continue to have a strong influence over the means and ends up missions. Canada has always been able to be a strong player on the collective defense table because when the hands go around about who is going to be able to pitch in can it has always had very robust abilities it has been willing to make those commitments. And so this is also a relative question about making sure that Canada continues to be well positioned, to be able to contribute in an effort to be able to have an influence and to assert our interests around the collective defense table. And in that sense I mean the relationship with the United States that you just talked about, it's always been us unilateral. The differences with Obama it was unilateral and with a smile with trumpets unilateralism with frown. But really this is about collective defense has been about trying to make sure that the U.S. does not become too ally isolationist, because there's always been that risk and so it's trying to solve these collective action problems. And this is always oscillated between more and less U.S. engagement [unintelligible]. I think fewer immediate existential threats. And so, It is engaging in what's known as offshore balancing. Pulling back some of those capabilities from abroad and engaging on those levels where it sees [unintelligible] an existential threat.

AMT: Right. Right. But Christian, Canada is a big country with a small population relatively and our Army our military overall is very small compared to what the U.S. has. How does that affect how we move forward? Where Canada might get involved in something, like thousands and thousands where we would have hundreds some places, where we have thousands they have tens of thousands.

CHRISTIAN LEUPRECHT: Right so it's a question I think that the government is trying to answer here. What does Canada want to do and there's always this sort of argument Canada wants to punch above its weight. But I'm not familiar with the boxing category of punching above your weight. You're either feather weight, light weight, medium weight, heavy weight. And so what Canada is trying to signal here is that we continue to be a medium sized player and try to bring disproportionate energy to the table. Canada has identified some of those in the policy here. We've already talked about Special Forces but also intelligence, surveillance, reconnaissance, capabilities because we are part of the five eyes community and so we can do things with the U.S. and with the UK that for instance other allies cannot do. And if you think of NATO as sort of your Europe variety pack at the beer store, Canada is a flavor that everybody tends to like and I think the minister is here signaling we want to make sure we remain that flavor.

AMT: You are so Canadian you're using a beer analogy in the summer when we're talking about defense [laughs]. Emily, I want to ask you how this might be viewed elsewhere by two leaders Mr. Putin and Xi Jinping. What's he thinking as he watches this?

EMILY TAMKIN: You know I think the question on Xi is really interesting because we've been speaking about defense but defense is not the only thing that Chrystia Freeland identified in her speech, right? I believe she also spoke to, and that the Canadian government in general has been speaking to Canada playing a bigger role particularly in terms of the environment and trade. Those are two things where you know sort of the fear from some was that if the United States will back China would be writing the rules of the game. Canada is very clearly saying we can we can help write the trade rules right. We can take a leading role on making sure that we are combating climate change and actually Canada I think is quite well poised to do both of those things both because of its trade agreement with the European Union. It's still a NAFTA. It has already you know it's already made such progress in combating climate change and also works with the United States in terms of clean air clean water, it can in terms of hydro power. So if I were Xi Jenping, you know I don't want to try to read the Chinese leader’s mind, but I would say that I would be looking at this and saying oh it's not going to be, you know do not pass go do not collect 200. Great. We are now writing the rules of trade and environmental regulation. It's China’s year. No, there are other parties that are stepping up and playing that role.

AMT: But also that this is a signal from a NATO country that they have to step up more on defense because the U.S. might not. Surely if you're running the government of China and its military there's a message in there on how others see the superpower the U.S. and interrelate But there's an underlying message in there, right?

EMILY TAMKIM: So, on the one hand perhaps you know I think this also speaks to you asked what Putin thought. You know I again I'm loathe to try to read Vladimir Putin’s mine but I would say that on the one hand you say oh this is good. This organization in which I have explicitly said I want to sow discord is now question itself turning on itself. On the other hand you look and you see there are other countries here that are committed to this. Now granted 1.2 or 1.4 percent of GDP on defense spending is not what the United States pays on defense, right? But on the other hand clearly there are other countries in the world that are looking and saying no we still believe in this alliance too. We're still committed to all of these things too. We are not ready to turn over the car keys to Russia just yet. And so it's, you're right there are a few messages, on the one hand there is chaos and on the other hand there are those who are still committed to keeping calm.

AMT: Stephanie Carvin, what do you think?

STEPHANIE CARVIN: I would agree with that. What actually surprised me in the speech was Freeland speech, was that there was actually no mention of a free trade agreement with China. In fact there are very little policy specifics so you know it's interesting when you wonder how this is going to be received around the world. Actually if you look at both the speech and the defense policy review which is very you know, they're very complementary with each other. They actually I speak to the same threats, and the defense policy reviews is very clear eyed and it actually it's for the first time in a long time I've seen the words Russia and China specifically identified as concerns globally. We haven't seen that in any of the CS's documents or the threat environment documents. So there was you know they're fairly bold in the way that they are actually looking at the world so you know they clearly wanted to put out a vision that you know identified the problems but what's really interesting is that also Freeland has made a point of saying you know yes China, a rising China is a problem. We think the solution here is hard power but also soft power that we want to basically try to accommodate you know, this shift in the nature of global politics through multilateral institutionalism which is kind of a big word for this time of the morning, but is basically ..

AMT: Oh, it’s okay. We are caffeinated.

STEPHANIE CARVIN: [Laughs] There you go, but basically the idea of working through institutions to try and work through problems before they start. But in that sense I think the bigger picture here is you know we're still lacking some of the very specific policies, we still don't know what a peacekeeping mission is going to be if that's even going to happen now.

AMT: Right. Right. We're going to have to leave it there. But yes more questions to ask of our ministers. Thank you all for being part of this discussion.

GUESTS: Thank you. Thank you. Thank you.

AMT: That's Stephanie Carvin assistant professor at Carleton University. She's in our Ottawa studio. Emily Tamkin staff writer at Foreign Policy magazine she's in Washington D.C. Christian Leuprecht professor of political science at the Royal Military College of Canada and Queen's University. He's in El Paso Texas today. Stay with us. The news is next and then tracking Ubers route to ride sharing dominance.

SOUNDCLIP

There is no question what they were doing was illegal at some level and yet they were delighting a lot of people at the same time.

AMT: Author Adam Lashinsky talking about Uber as a Disruptor when we come back. I'm Anna Maria Tremonti. This is The Current

'Founded in controversy': Author's inside look into Uber's success and scandals

Guest: Adam Lashinsky

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

[Music: Theme]

AMT: Still to come people who experience early childhood traumas have to carry the mental and emotional wounds later into life. Doctors now say those adverse experiences also affect us physically and knowing what we've been through can help them help us hear what they have to say, but first from humble beginnings to a ride sharing revolution.

[Music: The Disruptors Theme]

SOUNDCLIP

When we first launch, first of all, like, you go wow it's successful. It's so obvious, I call it the palm to forehead moment when they learn about Uber, they're like I had this idea or I should have had this idea. When we first launched guys, it wasn't easy getting our angel around. People thought we were crazy, limos in San Francisco? What?

AMT: That is Uber CEO Travis Kalanick on the idea that would become a multibillion dollar industry that circles the globe. Uber is a disrupter. The app and its league of drivers have changed the way a lot of people get from here to there. But following closely behind Uber success since hitting the roads in San Francisco, is a drumbeat of controversy that continues to dog the company. As part of our project The Disruptors, I'm joined by Adam Lashinsky. He's the executive editor of Fortune magazine. He takes a look under the hood of Uber in a new book, Wild Ride, inside Buber's Quest for World Domination. Adam Lashinsky is in our Toronto studio. Hello.

ADAM LASHINSKY: Hello. Thank you.

AMT: Can I ask how you got to the studio today?

ADAM LASHINSKY: [Laughs] Yes. In a in a limousine that was hired by my publicist.

AMT: No Uber.

ADAM LASHINSKY: Correct.

AMT: OK.

ADAM LASHINSKY: Not today.

AMT: Are you are you an Uber user?

ADAM LASHINSKY: Yes I am.

AMT: Give me an idea just how big it is today.

ADAM LASHINSKY: Uber is in, I believe something like 600 cities in about 80 countries. It is literally all over the world. And interestingly went global very quickly for a young company I believe in its second year of operations.

AMT: It was quite spectacular. Just like from zero to 60, as they would say. Yeah.

ADAM LASHINSKY: And that was a function of the fact that that Uber was built on the iPhone and the App Store and so Uber as an app was able to do something that start-ups couldn't have done even 10 or 15 years ago which was that, because they got their customers through the App Store through Apple's App Store they were able to start up relatively quickly wherever the App Store was available which is everywhere.

AMT: So the main player is Chief Executive Officer Travis clinic. Who is he?

ADAM LASHINSKY: He's a 40 year old from Los Angeles who dropped out of UCLA and was involved in start-ups his whole young adult life. And he's somebody who was involved in two relatively unsuccessful technology start-ups. Before about 6 7 years ago he became the CEO of Uber.

AMT: And what's he like?

ADAM LASHINSKY: Oh he's, he is things. So, he has a reputation for being ruthless and lacking empathy and these things are true. In my book I tell the story about when I first approached him to work on the book. We knew each other a little bit, and he threatened me and he told me that if I persisted in this project which he didn't approve of he would hire somebody else to write an Uber book that would torpedo my project. He changed his mind obviously and we can talk about that if you like. I'll tell you he also is someone who is curious and intellectually demanding. Quite fun to be around if he's in a good mood. He's playful argumentative and interesting.

AMT: And what kind of access did you have to him?

ADAM LASHINSKY: About two years went by between the time that he threatened me and the time that he agreed to work with me on the book. And once that happened I had very good access. I traveled with him in China for the reporting on the book. I walked around the streets of San Francisco for an interview once with him which I recount toward the end of the book, and I had multiple interviews in the office with him and with many other Uber executives.

AMT: You went on bike rides with him. No we walked.

AMT: Oh. You walked, okay.

ADAM LASHINSKY: This is something he likes to do.

ADAM LASHINSKY: Oh that's interesting. Like a power walk kind of thing?

ADAM LASHINSKY: Well there's two things. That's become a thing in Silicon Valley of course, to have walking meetings and he does like that, but he's a pacer. He paces up and down this one particular hallway in the Uber headquarters in San Francisco he likes to talk on the phone or talk to other people while he's pacing. He doesn't sit still very well and so, for this final interview we had last summer, it was in the evening, which was unusual for me 7:30 in the evening, not unusual for him. Those are normal work hours for the San Francisco entrepreneurs and he said to me and I won't use the curse word that he used. He said: We can sit in that room right there and I'm going to pace back and forth the whole time or we can go for a walk. Which would you prefer?

AMT: OK so you write that Uber might never have happened if an amiable Canadian software designer hadn't pissed off San Francisco's two biggest taxi companies. There's a great story there tell us what happened. What's that story?

ADAM LASHINSKY: Garrett Camp who is from Calgary, or studied in Calgary at least, and then founded an Internet company called Stumble Upon back in the early days of e-commerce essentially, was living the young entrepreneurs life in San Francisco where the taxi service is terrible, and it has been terrible for years. And he would order a taxi you call the taxi company ask for a taxi and maybe it would come maybe it would not, and he would get in the first one that he saw. Wasn't necessarily the one that was called for him? This annoyed the dispatchers. They had his telephone number the way he tells the story was he got blacklisted by these taxi companies. So, well you know you don't you don't get in the cab when you call for one anyway. So we're going to stop sending you cabs. This was how he fell out with San Francisco's taxis and eventually had the idea to do something different which was a smartphone based way to hail a ride.

AMT: And it's great how much anger can drive a successful business. So he gets angry and he creates this system to use on a smartphone but then Kalanick takes it another step. What does he do?

ADAM LASHINSKY: That's right. Camp figured out that through the semiconductor chips, the GPS chip and the accelerometer in the in the smartphone, that he could design a way to figure out how fast you were moving and where you were. He developed a system to help limousines. He had an idea he was going to buy limousines he was going to lease a garage and he was going to hire drivers because he really liked riding around in limousines. Kalanick said to him, they were friends, and he said Interesting idea but what you really should do is enable limousine drivers to drive four U.S. contractors give them a phone and make that your dispatch system. Don't hire them, that's expensive. Don't buy cars, that's expensive. Don't lease a garage. That's ridiculous. This was Kalanick’s first contribution to the idea.

AMT: So you make the point that it breaks out internationally within two years.

ADAM LASHINSKY: Yes.

AMT: Okay. And it's the subject of constant controversy. Why do you think that is?

ADAM LASHINSKY: The company was founded in controversy. In its in its earliest days it received a cease and desist letter from the city and county of San Francisco who marched into its offices and said you're operating an illegal taxi service. In fact it was called Uber cab originally. Uber's response was twofold. One we aren't a taxi service. We're a technology company enabling transportation or whatever. You know mumbo-jumbo.

AMT: We're a ride sharing company right now. That was the line they used in Toronto.

ADAM LASHINSKY: Yes, that was later, but yes. And secondly we're going to remove the name cab from our name we're just going to be Uber. So don't call us a taxi service, we aren't one. And my point for telling that story is that, that established a pattern everywhere they went. Most reasonable businesses would go to City Hall metaphorically and say we're here we intend to operate this business what do we need to do? Uber took a totally opposite approach it went. It started and it waited for City Hall to come to it. So it was grounded in controversy , and it is sometimes that went relatively smoothly. More often than not it didn't.

AMT: So in other words, the taxi industry in almost every city in country where it's shown up has accused you of undermining it. But essentially that was part of the business plan.

ADAM LASHINSKY: Absolutely. So initially Uber was focused on limousines. It only later came to normal cars driven by normal people, as opposed to beautiful town cars driven by licensed professional chauffeurs. But disrupting taxis was part of the plan from the beginning. And Uber took quite a confrontational approach to these taxis. Uber would say repeatedly out loud, these taxi companies and the taxi systems and the taxi commissions are corrupt. They would use that word. They would say they exist to limit the number of cars on the streets and to keep prices high. And we're going to do the opposite. We exist to have as many cars as possible because that's what's better for consumers, and we're going to drive prices down because that's great for consumers. This was very controversial and disruptive and that was the point.

AMT: Well and certainly we saw we saw taxi companies and taxi drivers protesting in the streets in cities all over the place. We saw great debates in municipal governments. All of that, right? It was all part of the introduction of Uber. Make the news all the time.

ADAM LASHINSKY: Yes. And on the one hand there's no question what they were doing was illegal at some level. And yet if you think back to when started, they were delighting a lot of people at the same time. They were delighting riders who loved this. This ability to get something quickly to remove the anxiety of how quickly, how soon is going to come, I know from looking at my app. How long it's going to take and by God it would arrive when it said it would arrive. And then I get to get out without fumbling with my wallet and computing a tip and do you take credit? None of that was an issue. And secondly when they started drivers loved Uber, because from nowhere they gave them an opportunity to make money and initially good money, because Uber was subsidizing the rides at the beginning. So I point all this out to say that they started from a position of being quite popular. And they had support when there were these protests against them they had a lot of support. Now a lot of that has evaporated. But that's water under the bridge.

AMT: Uber has been accused of collecting and keeping data on people who use their app. What do you know about that?

ADAM LASHINSKY: They well they collect data as part of their daily business. They absolutely do that itis part of their secret sauce. Now I write about one episode, a handful of years ago where they bragged about it in a very inappropriate way. They did a blog post where they said to people we've noticed that many of you take a ride to a certain location late at night, and that you're then getting a ride in the wee hours of the morning from the same location. They said, in college we called that the walk of shame. Now it's called rides of glory. You don't need to have the walk of shame anymore. They didn't have the maturity or the presence of mind to realize that people who are concerned about privacy would be shocked by this. You're essentially saying that you are accumulating data about people's sexual activity, and Uber quickly took down took down the post. But this is an example not only of what they're capable of doing but what they are doing now. Their response would be well we're using this data to make the service good. We want to anticipate where people want rides and so on. You can see the good product uses of this data accumulation and you can see the negative potential.

AMT: That's right people don't like people predicting all their movements especially if they're doing the quote unquote walk of shame.

ADAM LASHINSKY: Correct.

AMT: And you took a turn as an Uber driver?

ADAM LASHINSKY: I did.

AMT: Good research?

ADAM LASHINSKY: Yes I did it for research purposes. And you know I am not sure if it says more about me or about driving, it's not necessarily Uber but I really didn't like it. I had this romantic vision that I would enjoy being a taxi driver. I'd always wanted to try that because I thought would be neat to drive around town.

AMT: Meet new people and just talk.

ADAM LASHINSKY: Exactly. Well guess what? I don't know about you but I very often don't talk to my driver, because I'm either on the phone or looking at my e-mail, and a lot of people ignored me and I didn't like that. And I didn't like being stuck in traffic on somebody else's time schedule, and I didn't like the wear and tear on my car, and little things. I didn't like it when somebody got out of my car and didn't realize that they didn't close the door and I had to stop at the next street and get out and walk around and close my door. It's a small thing but it is cumulative, exactly. And the money's not very good. Anyway again I just want to say that it made me realize that I love what I do and I feel privileged to do what I do and not that. This is a lifeline to people who are looking for ways to pick up some cash and who want flexible hours. There's all sorts of problems with it but anyway I didn’t particularly care for it.

AMT: But you learned a lot, by doing that?

ADAM LASHINSKY: Oh sure. It gave me a worm's eye view into the company that I was writing about. It was really the first time in my career as a business journalist that I was able to do the thing that the company I was writing about does. And so yeah I had a more intimate knowledge of the driver app for example which is something that the riders don't see. I had a more intimate knowledge of how surge pricing or dynamic pricing works and things like that. I could understand what the company was accomplishing better.

AMT: How long did you do it?

ADAM LASHINSKY: Oh I did it off and on for a few months. And I had the decal in my window and I found that that decal was stressing me out, because it was reminding me that I wasn't finished writing the book yet. So I had to take that decal out. I took that decal out once I was sure I wouldn't drive again.

AMT: So it is possible to make a living as a Uber driver?

ADAM LASHINSKY: Well it's possible it depends what your definition of a living is of course. But it is possible if you are willing to go long hours and you know all the tricks. So the tricks involve or include understanding the highest volume potential areas. This happens to be you know, Saturday night in areas where young people are going bar hopping for example, or early morning in neighborhoods where business people are going to be going to the airports. You also need to be very tuned to the incentives that Uber and its competitors like Lyft in the United States are offering, because they'll essentially pay you to drive and the people who are trying to make a living know all these tricks.

AMT: I have a clip I want to play of a confrontation between Travis Kalanick and the Uber driver. This is from February of this year.

SOUNDCLIP

I bankrupt because of you.

Look.

Yes, yes. You keep changing every day. You keep..

Hold on a second. What have I changed about Black.

You changed the whole business.

What, What?

You dropped the prices.

On Black.

Yes, you did it with $20.

You know what?

How much is the mile now? 275?

You know what?

What?

Some people don’t like to take responsibility ..

I take responsibility.

They blame everything in their life on somebody else

But you send an email for [unintelligible]?

Good luck.

Good luck to you, too, but I know you are not going to go far.

AMT: So they have a billionaire CEO telling one of his bankrupt drivers to accept responsibility for his plight. How did that go down with Uber drivers?

ADAM LASHINSKY: Not well. Uber's relationship with its drivers had already soured at that point. Now remember these people aren't employees and that's been a bone of contention for years now. And Uber drivers are all over the map I would say on their attitudes toward Uber. You will find a Uber driver who will in the same ride tell you that you know they hate Uber for the following reasons, and they will continue driving for the following reasons. But that was a good encapsulation of what has happened over the last several years with Uber drivers, not just.. When he said black he is referring to Uber Black. Their limo service, as opposed to UberX. The prices they paid drivers were higher at the beginning. The commission they paid was higher at the beginning. The prices have come down and the commission has come down, and so for these drivers like this fellow who made that recording who were around at the beginning, things have deteriorated significantly.

AMT: There's been a lot of concern that they do not vet drivers properly how do they get vetted?

ADAM LASHINSKY: So that's another thing that I experienced firsthand. I had to submit that I was a licensed driver and that I had auto insurance, and then they ran me through a criminal background check. They hire a third party that ensures that searches public records to make sure that I am who I say I am and that I don't have a criminal record. They do not do a drug test which in the United States or at least in San Francisco I believe limousine drivers have to take. And that's basically it.

AMT: And last month in Toronto a driver was arrested allegedly for kidnapping a young woman by locking her in his car, trying to take off with her. It's not the first time Uber has been accused of being unsafe for women. How does it respond to accusations like that?

ADAM LASHINSKY: Well and of course years before this Toronto case there was a horrible instance of a rape in Delhi in India. This person was a criminal who was out on bail I believe for another crime and was convicted was convicted for that rape. Uber’s response is with statistics. They will, then I don't have them in front of me, but they will tell you that they do millions and millions of rides and these horrible tragedies are a tiny fraction of them.

AMT: And I guess in fairness some there have been charges against taxi drivers in many cities as well, the more sort of the traditional cab companies.

ADAM LASHINSKY: Yes, whatever the regulations are and whatever the window. Whatever the photo and the medallion and the window, you're still getting in a car with somebody who you don't know. Both sexes actually are taking a risk. And that of course also has been going on for years. It's interesting about women who would for a period of time trumpet the fact that some women felt like Uber was safer than getting in a taxi, for the simple reason that the ride was being tracked and could be traced. So this broad subject has gone has gone both directions.

AMT: What's the percentage of women who drive for Uber?

ADAM LASHINSKY: I don't know off the top of my head. I can only, I can judge San Francisco best and I would guess it's something like 20 percent maybe 15 percent.

AMT: Uber has a reputation for playing hardball with its competitors. Tell us about Operation Slog?

ADAM LASHINSKY: Operation slog was a time where Uber had its own people use, you know what drug dealers called burner phones. Phones that have no identity connected with them, to call to request rides with Lyft which is Uber's competitor in the United States and then cancel the rides. So they were doing this to harass Lyft and also to... In other instances they would go ahead and take the ride with the Lyft driver and try to convert them to become Uber drivers while they were while they were in the ride. It got exposed. And Uber tried to put a spin on it, well we're just trying to get information, we're trying to recruit. This was a recruitment effort. And they stopped doing it. And there have been things over and over over the years that they were called on the carpet on and stopped doing.

AMT: How much of a stronghold does it have on the type of service it offers? Because there are competitors there's Lyft, there are others.

ADAM LASHINSKY: Well you know Uber had this grace period where they had become a verb and everyone thought they had a lock on everything. But what it really takes to compete in this market is the right technology and money, and so Lyft for example with money with backing from venture capitalists has been able to give Uber a ride for its money in multiple markets. So for example in San Francisco in Los Angeles and a few other places, their market share has gone back and forth because they can subsidize the rides. And if you can subsidize the rides you know most people will take the cheapest most convenient ride. Now Uber has the dominant market share still in the United States. They do quite a few Latin American countries. The opposite is true in China where they were being beaten so badly that they just gave up. They're fighting it out in India and in multiple countries in Europe. And so that's how this story goes market by market.

AMT: And they gave up in China except that they allowed, what was the name of the company that bought them?

ADAM LASHINSKY: DD.

AMT: DD. But they still own a portion of DD, do they not?

ADAM LASHINSKY: That's right. That's what they took in exchange for closing down their business.

AMT: So even when you lose you win.

ADAM LASHINSKY: Well it worked out very well as an investment, but it didn't work out well if your goal is to be a global brand to be excluded from the world's most populous country.

AMT: There's an Ontario town called Innisfil and it wants to use Uber as an alternative to public transit.

ADAM LASHINSKY: Yeah I read about that.

AMT: Is that like the thin edge of the wedge there, where is that going?

ADAM LASHINSKY: Yes, yes. If this works this is the sort of thing that is Uber's grand vision around the world, that it can be more than just replacing a taxi service. That it can do almost anything with regard to transportation. It has experimented in other places; it already has a carpooling service. It is experimented with fixed routes which is what this town is trying to do. It has a service where to try to match people who are commuting from the suburbs to the city center and all of these things are efforts by Uber to say we have this technology that utilizes maps and matching users we can utilize it in different ways.

AMT: You've written about Apple?

ADAM LASHINSKY: Yes.

AMT: You see a lot of companies in your work who start and grow. Where do you put Uber? Like, 20 years from now what are we going to think about what Uber has done here? Where does it fit in the firmament.?

ADAM LASHINSKY: Uber is seven years old and Uber has had the kind of success that Apple had with the Macintosh at roughly the same age actually. So Uber is one of these.. Uber is a phenomenon. It's a global phenomenon. It has a charismatic leader who has a strong vision and a cranky personality. For now that's where the comparisons end, 20 years from now. Well a lot of things have to go right for Uber to be something that we're talking about 20 years from now.

AMT: Fascinating stuff. Thanks for your work.

ADAM LASHINSKY: Oh. Thank you. Thank you for your great questions.

AMT: Adam Lashinsky His book is called Wild Ride inside Uber’s Quest for world Domination. And he is also the executive editor of Fortune magazine, knows a few things about business. He tracked Uber. We contacted Uber to see if it wanted to respond to anything in Adam Lashinsky book. We have not heard back. Stay with us. Coming up in our next half hour, childhood trauma is not always something we just get over as we get older. It can not only affect emotional development it can make us more susceptible to serious physical illnesses such as lung cancer or heart disease. Coming up, two doctors say it's time to start asking adult patients about their childhood trauma because it just might save their life. I'm Anna Maria Tremonti. This is The Current on CBC Radio 1 Sirius XM Online on cbc.ca/thecurrent and on your radio app.

How childhood trauma can have a life-long impact on health

Guests: Robert Maunder, Howard Ovens

AMT: Hello I'm Anna Maria Tremonti and you're listening to The Current. In a moment we're asking about long term health impacts of childhood trauma. But before that we want to share some feedback. Yesterday we looked at the issue of migraines. More than one in 10 people will get a migraine at some point and yet migraines and those who get them are often misunderstood. According to Statistics Canada women in this country are more than twice as likely to report a migraine.

SOUNDCLIP

My migraine started when I was a little girl, when I was about five. And one of the first things that I remember is going to a pediatrician and that doctor telling my parents that I had a Type A personality. And that treatment from physicians continued on for decades.

AMT: Well that is Joanna Kempner She's an associate professor in the Department of Sociology at Rutgers University. She's also the author of Not Tonight: Migraine and the Politics of Gender and Health. After that conversation we heard from a lot of you. Joelle Hansen of Rothesay, New Brunswick writes: My mom had migraines for 20 plus years. I don't have many memories of her treatment or prognosis as a kid. All I knew was that my mom was never available. I do remember a few times when she would be dismissed by healthcare professionals. When your guest was told at 17 that she had migraines because she didn't have a boyfriend. I thought I would be sick. It seems shameful that a doctor can so easily dismiss something so serious. Lynda Van Lewen of Chatham Ontario shared this story. I suffered from migraines for years until menopause changed my hormonal balance. As a substitute teacher racing to an unknown classroom each morning, a migraine was a frequent result. I recall returning to a grade one classroom after a break, suffering from a migraine, walking over to the classroom sink and throwing up immediately. I was certain that would be the story of their substitute teacher the students took home that day. Going home with a migraine and heading straight to bed was a normal occurrence. Sandra Chatterton of Ottawa adds I've been having migraines, I began having migraines when I hit menopause. Before that I sadly thought they were just headaches for whiners. Talk about stigmatising. My first one took me to the hospital. I have a wonderful female doctor who has helped me. Apart from childbirth migraine pain is the worst. Unah Holmes in Ottawa shared her remedy. I had debilitating migraines for two or three years in my late 30s. Pills didn't work but acupuncture did. needles into the base of the skull over several sessions. Migraines never returned. Probably won't work for everyone but worth a try. And finally Dorothy Lindsay of Vancouver writes: I have experienced everything the guests described from dismissive doctors to having to leave a career I loved. But the neurologist actually made me cry with relief when she described people with migraines as brave and resilient, rather than weak and whiny somebody gets it. Well if you missed that discussion on migraines find it on our website cbc.ca/thecurrent. Listen on the CBC radio up free from Google App or from the App Store from Google Play or the App Store. As always we want to hear from you. You can find us on Facebook. Go to Twitter @thecurrentCBC. Go to email cbc.ca/thecurrent, click on the Contact link.

[Music]

AMT: You are listening to the current on CBC Radio One. I'm Anna Maria Tremonti.

SOUNDCLIP

In high doses it affects brain development, the immune system, hormonal systems and even the way our DNA is read and transcribed. Folks who are exposed in very high doses have triple the lifetime risk of heart disease and lung cancer and a 20 year difference in life expectancy. And yet doctors today are not trained in routine screening or treatment.

AMT: That is American pediatrician Nadine Burke Harris in a TED talk. And the exposure she's talking about is not to pesticides or chemicals. It is to childhood trauma. She's part of the growing medical movement pushing to understand the emotional scars created by abuse or neglect while growing up. It's a standard procedure in any health clinic to ask patients about their past physical medical history, to gain insights in how to treat them. Now doctors say those screenings should go deeper to explore the possibility of childhood trauma. They say this critical information can change treatment plans and even improve the odds of healing. Dr. Robert Maunder is a psychiatrist at Toronto's Mt. Sinai Hospital. He's a professor and the director of brain body integration for the medical psychiatry Alliance at the University of Toronto and he and his colleague Dr. Jonathan Hunter have written a book called Love Fear and Health: How are Attachments to Others Shape Health and Health Care. Dr. Robert Maunder is in our Toronto studio. Hello.

ROBERT MAUNDER: Good morning.

AMT: So how closely linked are childhood trauma and chronic illness?

ROBERT MAUNDER: Well, the very closely linked. It actually goes beyond abuse neglect to other kinds of adversity that kids experience, having a parent with a mental illness, having a parent with addiction witnessing parents.. witnessing violence in the family. And there is a kind of step wise gradient so the more types of adversity that a child is exposed to the greater the risk of most of the most common chronic diseases that fill our hospitals and most of our most common causes of mortality.

AMT: So we often think of trauma that could manifest in adulthood as a psychiatric illness but we don't think about it as a physical illness. And you're saying it could be either or, or it could be both?

ROBERT MAUNDER: It's both. And it may be both in the same person, or it may be either or. But the risk for mental illness and for addiction is quite substantial. But the risk for chronic physical diseases is much less recognized and pervasive.

AMT: How do you measure something like childhood trauma?

ROBERT MAUNDER: Typically when it's measured even just with a checklist. So there are 10 or 12 categories of child adversity that are the most common that have the greatest effect on health. We can just ask if they're present or not and essentially count up the check marks and the more that are present the greater the risk.

AMT: What kinds of things do you ask?

ROBERT MAUNDER: We ask certainly were you hit as a child? Was there any physical abuse in the family? Were you ever touched in a way that felt inappropriate or frightening, in a sexual way? But we also ask was there anybody in the house with a mental illness? Or with an addiction? Was there anybody in the house that went to jail? Did you have a parent die? Or did you lose a parent when you were young? So we asked specifically about each of the things that bring risk.

AMT: So it's a real range of what can traumatize a child. Some of it intended and some things unintended like the death of apparent.

ROBERT MAUNDER: Some of it's just the environment in which kids live and so that's one of the ideas that I think we need to move away from, is that there's a kind of.. there's good parents and bad parents and that adversity for kids comes from a kind of malevolence on the part of the parents. That's most often not the case.

AMT: And so I've got some statistics here there was a study that said basically almost a third 32 percent of Canadians have experienced some kind of trauma as a child?

ROBERT MAUNDER: Yes so those numbers are really consistent. There's been a lot of studies done they all generate essentially the same numbers that there is, just looking at physical abuse and sexual abuse not even the broader categories. Somewhere between a quarter and a third of kids are exposed to that while they are growing up.

AMT: How can the trauma that is experienced in early life also affect someone's relationship with the health care system?

ROBERT MAUNDER: Well that's the kind of the double whammy right. So on the one hand it puts you at risk of becoming ill but once you're ill and once you're in the hospital it complicates health care. Let me give you an example. Imagine there's a woman with a chronic disease, Crohn's disease. So that's an abdominal disease and a flare of the illness might come about, show up as pain. So this woman that is in terrible pain and the next step is that she needs a test and the test she needs is a colonoscopy in order to figure out how to treat that best. But that woman at the last minute cancels the colonoscopy and refuses to go. And if you know both the trauma you know that that's because it's a trigger for her that it's linked to a sexual trauma in her past, and that it's too frightening an experience for her. If you don't know about the trauma, then at the best case scenario that's just accepted as her preference, that she doesn't want the test. Worst case scenario is it's misinterpreted as her being difficult to resist, what used to be called not compliant.

AMT: Right.

ROBERT MAUNDER: And then the relationship kind of becomes poisoned with mistrust.

AMR: So once you learn that a patient has experienced a childhood trauma. Let’s take that case then how would how would that knowledge allow you to give them better care or treatment? What would you do differently?

ROBERT MAUNDER: Well it can directly affect the choices that are available in that moment but it also changes the relationship. Like all of health care takes place in relationships. And when you understand what's going on with a person in it's fullness and not just in the organ system that you're trying to treat at the moment, it's more supportive in their care improves. But specifically if you knew that that woman was not able to have that procedure because of trauma you might look for other tests that would provide similar information or you might provide her more support going in so that she was actually able to tolerate it. Maybe he would invite her partner in if that was something that made her feel more secure and it allowed her to get through the test more successfully. So the options depend on the circumstances, but more options appear once you actually understand what's going on.

AMT: Okay. Well we have someone else ready to join us in this conversation Dr. Howard Ovens is chief medical strategy officer for Sinai health system. Until April he was the chief of emergency medicine at Toronto's Mt. Sinai Hospital. And using your research, Dr. Maunder over the last five years Mt. Sinai has changed how it treats what it calls complicated patients by involving psychiatrists early in the intake process. Welcome Dr. Howard Ovens.

HOWARD OVENS: Good morning.

AMT: So let's talk about this a little bit more. First of all what's a complicated patient?

HOWARD OVENS: Well that research refers to generally people who are frequent or returned visitors to the emergency department, and usually part of the challenge in dealing with them is that there's some behavioral aspect of their presentations that's challenging for the staff, and they need some support or direction in figuring out how to kind of break this pattern of return visits that never seem to lead to any progress in the patient's problems.

AMT: So what we're talking about is a wider general way to maybe start asking patients more questions. But when it comes to the emergency room and specific kinds of patients this kind of questioning how does that translate? Why is it so important?

HOWARD OVENS: First of all there are more general ways that our relationship with Bob and John and the work that they do has informed our practice. Many patients who come to the emergency department whether they're presenting with mental health illness and a manifestation of that directly, or in addiction or whether they have a physical complaint related to a chronic disease, that's related to as Bob was talking about increased risk from childhood experience or sometimes they're presenting with pain and we can't find anything wrong to cause it. Or they have an increased anxiety about a relatively minor problem. Often the unstated subtext is the impact on their personality and development from childhood abuse. And if you know that again it informs your whole perspective and philosophy. In many cases it will inform your communications with the patient your history taking. You'll not only ask about serious medical illnesses but you will ask some of the questions Bob refer to. And beyond that in these individual cases where the staff have been struggling, we developed an approach in a collaborative research model where we develop care plans for patients. Bob and John were part of the team that discussed these patients, their behavior and in some cases we had not only discuss the strategy they actually made an effort to have somebody from the psychiatric team meet these patients in the emergency department. In a way that wasn't the traditional consult model where we asked for a consultation because of an acute crisis. But we kind of plan next time so and so is in the emergency department if it's day time please page John or one of his team to come see the patient.

AMT: So you have patients who show up frequently?

HOWARD OVENS: Every emergency department has patients who show up frequently.

AMT: Why? Is it because they don't have a general practitioner? Isn't that they can’t? Are they marginalized? What's happening?

HOWARD OVENS: So, it's multi-factorial. Most importantly people who have chaotic lives have trouble following through, in maintaining relationships, keeping appointments, and the emergency department is open 24 hours a day every day. And although it's usually portrayed as not such a welcoming place because it's busy and you have to wait and you don't know who you're going to see. In fact for a certain kind of patient it's very welcoming because we'll never turn them away. They can always come in and we're almost like a modern day sanctuary for a lot of people in terms of where can they turn when they feel that they're in a crisis and they end up with us.

AMT: How willing are people to share their childhood background when you ask?

HOWARD OVENS: So I'll take it first. In the setting of the emergency department it's variable of course, it should seem like it's natural, just a normal question as Bob indicated. We ask about whether you smoke whether you drink. What surgeries have you had. What drugs are you on? Have you ever been exposed to trauma for instance? And if you get a positive response you go into more detail if you don't get a positive response you put it aside or leave it.

HOWARD OVENS: Yeah so I think one of the things that need to change is that health care providers need to ask more often. By and large we don't as a group, we don't ask all the time when we should. And if you ask patients whether they want to be asked or not the majority will say yes they want to be asked. They understand that it's relevant and most people don't mind talking about it. Some people want to talk about it. Some people don't. Every once in a while a patient needs you to justify why it's relevant. It feels like your question out of left field sometimes. And so you need to be able to talk about why it matters.

AMT: And what about it's on a scale right. There could be severe physical sexual abuse. It could be a form of neglect that they might not even have recognized as such, could it be, or not?

HOWARD OVENS: Yeah yeah. Well very much so. And so asking about abuse for example is a poor way to ask the question because if you frame it as abuse most many people don't consider these kinds of exposures to be abuse or necessarily neglect. But if you ask them about specific things that have actually happened to them they can tell you yes that happened, or no that didn't happen or if you ask them if they've had experiences that have been very frightening for them. People can talk about that.

AMT: It's interesting because intellectually they may not recognize it but their bodies and their minds have recognized it on another level and that's what you're trying to deal with. Are you able to actually provide psychiatric care for those people who show up on a regular basis and might have that underlying issue? How easy is it to get them that kind of help as well?

HOWARD OVENS: So just one other point about the questioning. Another way into the story is to ask them about their current relationships. Are your parents alive? Do you have a relationship with them? Do you maintain contact with your siblings? And depending on the answer you can follow up on that because many of these patients are not just isolated in the healthcare system they're socially isolated cut off from their families. And the most important thing about getting them engaged in ongoing health care is to have some sort of intake process that's flexible, whether it starts with a visit in the emergency department from a social worker or a psychiatrist, or a follow up that's very easy for them to make. A kind of walk in appointment, something soon within the next couple of days is crucial. And for our most difficult patients as I said we adopted a strategy of creating a written plan that the staff had in advance so that if the patient showed up at a convenient time we would ask one of the members of the specific team not just a psychiatrist on call but a member of the liaison team that works with Bob and John to please come down and just meet them no matter why they're there that day. And that gives them a chance to engage them and hopefully start to develop a relationship that they can follow up on.

AMT: And you've been doing this for how long now? It's a very concerted effort.

HOWARD OVENS: We've been doing it informally for many years we formalized it in a research protocol starting about 2011. And once the grant ran out it was so important to the staff. We just kept doing it.

AMT: And what difference did you see.

HOWARD OVENS: One big difference was that.. so we've created probably three or four hundred separate individual care plans since the inception of the program. And one of the big issues is just making care for these people consistent. If you come in frequently with common presentations but the react differently each time that really is difficult for the staff and difficult for the patient. Because the next time the patient comes in they said well Oven's did this last week why are you not doing this for me. So it's much better if there's a consistent response.It also supports the staff who find many of these people very upsetting challenging. It's a source of burnout for a lot of our staff. But if they feel that they are supportive that we've given them some direction and will stand behind them in employing a particular approach, it really makes them feel like they're part of a team and has been a very important morale booster for the staff.

AMT: Robert Maunder do you want to add to that? What do you see changing?

ROBERT MAUNDER: Yeah. So that's been a really useful endeavor. And so there are changes, really fundamental changes. You go into the emergency department for some of the patients who have care plans. If a person came in previously with say self-harm and appeared to be of some danger to themselves then that could be a chronic issue for that person. The first response of somebody who doesn't know them very well is to just try and manage that risk. And often we have to do that in ways that are… that show some authority or you know exert some power over the patient with a care plan understanding the situation differently. We can allow the patient more autonomy allow them to kind of take more responsibility for their ongoing care. And give permission to the care providers to kind of rely on the care plan so that they don't have to overcorrect on the side of being too controlling.

AMT: Are you telling me then that you see real physical improvement by treating patients this way as opposed to treating their whatever illness they show up with by itself?

ROBERT MAUNDER: Maybe Howard can speak to that. I would go elsewhere than the emergency department for looking for evidence of real physical improvement probably because of the same issues apply on a kind of less severe or less dramatic level.

AMT: That is going to be my next question. So talk to me a little bit about what's going on. Obviously you think that this should go on in every doctor's office as well, then, that it gives context.

ROBERT MAUNDER: A family physician is that is the best example of those are ongoing continuous relationships. They're not always about traumatic problems they're often about prevention and kind of identifying things early. And if a person you know on the one hand a person is kind of very anxious has lots of symptoms, needs a lot of reassurance, a lot and kind of depend on their health care providers they show up a lot but there's off. It's often not clear what to do about that. And then we see people on the other end of the spectrum who are self-reliant to a fault really don't like being vulnerable don't like the idea of being sick or counting on somebody else and they don't show up very much at all. And so they arrive at the doctor's office with an illness, like diabetes or heart disease or something that's been going on for a long time undiagnosed and untreated, because they have been reluctant to come whereas that other person is coming essentially all too often. And both the patient and the provider are walking away from those interactions frustrated. So there's a lot of opportunity for change there to kind of optimize that. So everybody's moving a little bit closer to what keeps them most healthy.

AMT: I just want to make sure we were talking on several levels here. Are you suggesting as well then if you have a childhood trauma that you could be more susceptible to not only psychiatric illness but physical diseases?

ROBERT MAUNDER: Absolutely. And that you can trace back like well, what are you saying like chronic diabetes could be related to your treatment as a child?

ROBERT MAUNDER: Yes so we know that that those links are. We know that those links are true because there's evidence for the links, the more trauma that you have the greater the risk of illnesses like that. We don't know the mechanisms in between. Don’t know how it gets from A to B.

ROBERT MAUNDER: Yes.

AMT: But what you're saying is if you understand it's there then you can start to look at almost everything with a little more depth and with another angle?

ROBERT MAUNDER: Yes, we can certainly treat everything more thoughtfully in terms of what early adversity causes, I would be reluctant to say everything a theory of everything is usually a theory of nothing. But it certainly is an important risk factor for a lot of common and serious chronic illnesses.

AMT: Gentlemen thanks for talking about this. Thanks for coming in.

Guests: Thank you very much. Pleasure.

AMT: Dr. Robert Maunder psychiatrist at Mount Sinai Hospital and co-author of Love Fear and Health How our Attachments to others Shape Health and Health care. Dr. Howard oven's is chief medical strategy officer for the Sinai health system. They were both in our Toronto studio.

SARA EVANS: Hello, I'm Sarah Evans one of the producers here at The Current. This week the show was produced by: Idella Sturino, Howard Goldenthal, Ines Colabrese, John Chipman, Lara O'Brien, Shannon Higgins, Sujata Berry, Kristin Nelson, Karin Marley, Liz Hoath, Samira Mohyeddin, Catherine Kalbfleisch, Willow Smith, Eunice Kim, Pacinthe Mattar and Graeme Steel who was filling in as writer this week.Special thanks to our Network Producers: Susan McKenzie in Montreal and Anne Penman in Vancouver. The Current's writer is Peter Mitton. Lisa Ayuso is our web producer and Ruby Buiza is our interactive producer. Transcriptions by Rasha Shehata. Our technical producer is Gary Francis. Our documentary editor is Josh Bloch. Our senior producers are Richard Goddard in Toronto and Cathy Simon in Vancouver. The executive producer of The Current is Kathleen Goldhar.

AMT: That's our program for today stay with Radio 1 for Q. Comedian Kevin Hart opens up to Tom Power about his meteoric rise to fame warts and all. Remember you can take The Current with you by using the CBC Radio app, browse through past episodes of our show start listening in a few seconds. Free from the App Store or Google Play. Earlier you heard Adam Lashinsky telling us about his experience as an Uber driver as part of the research for his book on Uber. He is not the only one who has tried it. U.S. talk show host Jimmy Kimmel also got behind the wheel for Uber in 2014 to show for people across L.A. Some of his passengers’ reactions are worth a five star rating. We will give Uber driver Jimmy Kimmel our last word today. I'm Anna Maria Tremonti. Jan Wong is here tomorrow. Thanks for listening to The Current.

SOUNDCLIP

[Music]

Oh I got one. Well this is exciting, my first pick up.

[Sound: Phone ringing]

Hello.

Hello, is this Eric?

Yeah.

Hey I'm right outside 8920. How is it going?

Good.

Jimmy. How are you, Eric?

Good.

Oh my God.

What's happened? No [beep] way.

[Audience laughing]

I am your driver today.

Really?

Yeah, yeah, yeah. You’re ready?

I'm ready.

All right.

Is that for real?

This is for real. This will be the weirdest Uber ride you've ever had.

[Audience laughing]

[Music: Theme]

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June 8, 2017 Full Episode Transcript

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