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He’s been called a ‘lethal force’ who’s not afraid to take on medical authorities. And it all started with pain week



Back in 2010, a handful of University of Toronto professors gave in to an “impertinent” first-year medical resident and consented to a meeting with him.

In a boardroom of the medical sciences building on King’s College Circle, Nav Persaud warned the group he had discovered some big problems with a course they ran on pain management.

The then-29-year-old doctor-in-training charged there were serious errors in the curriculum for “pain week,” which was taught annually, over the span of a week, to hundreds of students from health science programs, including medicine, dentistry, nursing and pharmacy.

What’s more, the course was rife with conflicts of interests related to inappropriate ties to the pharmaceutical industry, he argued, imploring them to fix it.

But the unsolicited advice — coming from a trainee no less — was most unwelcome, according to some in attendance.

“Who do you think you are? How dare you question these materials.”

That was the gist of the response, recalls Dr. Rick Glazier, a professor from the faculty of medicine and research director in the department of family medicine at St. Michael’s Hospital, where Persaud was doing his residency.

Even though Persaud was polite and respectful in asking tough questions, “he was treated as being out of his place, as being highly impertinent,” says Glazier.

The academics who organized the program shut Persaud down, denying his assertions, the senior doctor recounts.

But the harsh reception did not dissuade the young man from endeavouring to set right what he saw as a significant and potentially dangerous problem.

The pain-week battle would mark the first time in Persaud’s career he would take on authorities in the health world. He has since gone on to make a name for himself as a crusader for improved care, often with Big Pharma in his crosshairs.

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At only 38, he has also distinguished himself as an advocate for patient safety, social justice, transparency and pharmacare — not to mention a brilliant researcher and practitioner. With a reputation for being principled and persistent, he has not been afraid to rock the boat if that’s what it has taken to effect change.

In just under a decade, Persaud has helped expose and eventually get banned a Big Pharma marketing scheme that saw brand-name drug companies digitally insert vouchers into electronic patient records with the intent of boosting sales. He helped create the Health Justice Program, a partnership between St. Mike’s and legal clinics, which provides legal assistance to patients encountering difficulties that affect their well-being, for example, mould problems in rental housing. And spearheaded an effort at his family practice clinic to stop pharmaceutical reps from providing freebie drug samples, a marketing scheme aimed at boosting drug sales.

But it all started with the pain-week course and the problems that came to his attention in 2009 in the emergency department of St. Mike’s. A medical student had written an order for Percocet for a patient who had overdosed on Tylenol. It was an odd — and dangerous — choice, given that Percocet contains acetaminophen — the generic name for drugs such as Tylenol, which the patient had just OD’d on. It also contains oxycodone, an opioid.

Persaud caught the mistake in time. He then had a conversation with the student, who had already been through pain week, and learned she was unaware of what was actually in the drug.

“I started wondering how it was that medical students were being taught information that was misleading and potentially dangerous for patients, especially in the context of what by then had become the opioid crisis,” Persaud says.

So he started doing some digging.

He had taken the same course years earlier, but the problems didn’t jump out to him then. But to a more experienced and knowledgeable Persaud, they were glaring.

For starters, he discovered that a reference book provided to students free of charge was paid for by Purdue Pharma. That was the same drug manufacturer that three years earlier, in 2007, pleaded guilty in a U.S. court to misleading regulators, doctors and patients about the highly addictive nature of its drug OxyContin. It paid $600 million (U.S.) in penalties.

Persaud also learned that a course lecturer had previously received money from Purdue, as a member of its speakers’ bureau.

Course material wrongly described oxycodone as a weak opioid, less powerful than morphine. In fact, it’s at least 1.5 times stronger than morphine.

Also included in the material was a quote attributed to a 2006 Canadian Medical Association Journal article, stating that placebo-controlled trials showed “strong” and “consistent” evidence that opioids relieve pain and improve function for patients with chronic, non-cancer pain.

Persaud looked up the original article, but the quote was nowhere to be found.

After getting nowhere in addressing his concerns with the course organizers, Persaud took them up the ladder, to associate deans, vice-deans, deans and anyone else who would listen.

In navigating the daunting world of academic politics, he sought advice from two superiors at St. Mike’s — Glazier and Dr. Philip Berger, then chief of family medicine.

Dr. Nav Persaud was just a doctor in training when he noticed some big problems with a course the University of Toronto ran on pain management. He pushed to get the curriculum fixed — and succeeded.

Glazier’s research expertise is in the area of evidence-based medicine. He also has a personal interest in the opioid crisis. A year earlier, his 18-year-old son Daniel died from an accidental opioid overdose.

The highly respected researcher — a senior scientist at the Institute for Clinical Evaluative Sciences who was appointed in October as scientific director of the CIHR Institute of Health Services and Policy Research — was stunned by the dismissive response to Persaud: “It was such a flagrant denial of fact. (Persaud) was objecting to things that were clear and objective errors.”

But in time, Persaud’s tenacity paid off. The university launched an inquiry. The course was subsequently overhauled; the book dropped, the lecturer dropped, and the medical school’s conflict-of-interest guidelines strengthened.

Berger was mightily impressed by this trainee he had just come to know. He would later offer Persaud a full-time job as a family doctor at St. Mike’s.

The hospital — which has an international reputation for working with disadvantaged and marginalized communities — turned out to be a good fit for the forward-thinking doctor.

As a boss, Berger also turned out to be a good fit. The pair are much alike, with reputations for pushing the envelope on issues they care about and for being unafraid to speak truth to power.

Berger, who eventually became Persaud’s mentor, describes his protégé this way: “He is fearless, very smart and singularly stubborn, all of which makes him a lethal force when he takes on institutions, governments or anybody in power.”

Berger adds: “He’s probably the smartest person I’ve ever met.”

Persaud was born in 1980 in Toronto shortly after his parents emigrated from Guyana. He and his older brother were raised in the Keele and Wilson area, in a neighbourhood with many newcomer families.

His father, an engineer back in Guyana, found employment as a labourer in an insulation factory and eventually worked his way up to management in a medical testing company. His mother got a job as an X-ray technician.

In his last year at William Lyon Mackenzie high school Persaud decided he wanted to become a scientist. The inspiration came one evening when he took the TTC down to U of T to hear the renowned, late physicist Stephen Hawking speak.

Persaud obtained an undergraduate degree in physiology from U of T where he later studied medicine.

Before graduating, he took three years off to study at Oxford University — two years on a Rhodes Scholarship and another year on a scholarship from Oxford.

There, he met a fellow student who would become his wife. Today, he and Shateel are parents to two boys, ages 9 months and 2 years.

Early in his career, Persaud was recognized for his strong research abilities. Adalsteinn “Steini” Brown, dean of the Dalla Lana School of Public Health at U of T, took notice of him when he had just finished his residency and received his first academic appointment as a lecturer in the Department of Family and Community Medicine. Today Persaud is an assistant professor.

Back in 2011, Persaud also received a financial award from the department and a national fellowship to support his research.

“He stood out from the start,” Brown says. “He was identified early on by the (department) as an outstanding scientist with high potential.”

Today, Persaud spends more than 75 per cent of his time doing research as a scientist at the Centre for Urban Health Solutions at St. Mike’s and the remainder working as a family physician at the hospital.

He has so far been published in academic journals about 75 times, most recently in November. A study he is leading was among 19 included in a Canadian Medical Association Journal supplement on patient engagement in health research. Getting patients more involved in all aspects of health care is part of a major cultural shift now underway around the world.

It was a highly competitive process just to get a research project accepted for this initiative, which requires that patients be part of the research teams.

Persaud’s project was one of two selected for presentation at the launch of the supplement in Ottawa in mid-November. Titled CLEAN Meds, it explores the feasibility of providing free medication to patients who otherwise would go without because they cannot afford them.

If it proves feasible, a good case could be made to create such a program. It would also give a big boost to the campaign for a national pharmacare program, which Persaud supports.

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While many academics are happy just to be published, Persaud aims higher, observes Brown, board chair of the Ontario SPOR (Strategy for Patient-Oriented Research) SUPPORT Unit, which co-funded the initiative with the federal government.

“He’s a perfect representation of a new generation of leaders in research who are really, really committed to rigorous work, but who also are just as passionate about seeing it get into practice,” remarks Brown.

One such example of Persaud’s research effecting change is a 2016 study he led, which found that 1 in 10 people who died of an overdose had been released from a provincial prison within the previous 12 months. It led to the creation of a program to distribute the opioid antidote Naloxone to inmates returning to the community.

The media-savvy Persaud has become a go-to expert on issues of patient safety and transparency. In late-November, he was prominently featured in a series of CBC stories about patients being harmed by faulty medical devices. He has long called on regulators and industry to be more transparent about problems with such devices and to do more to protect patients.

Persaud achieved success on another transparency battle earlier this year with the publication of a study, which revealed the morning sickness drug Diclectin fell short of its manufacturer’s own threshold for effectiveness. He reanalyzed data — more than 9,000 pages of it — from an earlier clinical trial, funded by the manufacturer, and poked many holes in the findings.

He fought for years to get access to the data, filing numerous access-to-information requests to both the U.S. Food and Drug Administration and Health Canada, but with little success. The data was deemed confidential business information.

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It wasn’t until the 2014 passage of Vanessa’s Law (Protecting Canadians from Unsafe Drugs Act) that Health Canada agreed to show him the manufacturer’s original trial data. But he first had to sign a confidentiality agreement promising to destroy the documents.

Health Canada has proposed updating regulations that would make publicly available reams of previously confidential clinical trial documents about prescription drugs and medical devices.

Brown says Persaud’s growing list of achievements shows that taking calculated risks can have high-impact results.

“He is very good at using traditional tactics, but also guerrilla tactics. The guy has got a conviction of his principles,” the dean remarks.

As for what to expect next in the young scientist’s career, Brown says: “I think it will be more and more of the same in larger and larger leadership roles.”

The Star is profiling 12 Canadians who are making our lives better. Next week we talk to immigrant network creator Robyn Webb.

Theresa Boyle is a Toronto-based reporter covering health. Follow her on Twitter: @theresaboyle

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Sen. Bernie Sanders says he’s running for president in 2020




WASHINGTON – Vermont Sen. Bernie Sanders, whose insurgent 2016 presidential campaign reshaped Democratic politics, announced Tuesday that he is running for president in 2020.

“Our campaign is not only about defeating Donald Trump,” the 77-year-old self-described democratic socialist said in an email to supporters. “Our campaign is about transforming our country and creating a government based on the principles of economic, social, racial and environmental justice.”

An enthusiastic progressive who embraces proposals ranging from Medicare for All to free college tuition, Sanders stunned the Democratic establishment in 2016 with his spirited challenge to Hillary Clinton. While she ultimately became the party’s nominee, his campaign helped lay the groundwork for the leftward lurch that has dominated Democratic politics in the Trump era.

The question now for Sanders is whether he can stand out in a crowded field of Democratic presidential candidates who also embrace many of his policy ideas and are newer to the national political stage. That’s far different from 2016, when he was Clinton’s lone progressive adversary.

Still, there is no question that Sanders will be a formidable contender for the Democratic nomination. He won more than 13 million votes in 2016 and dozens of primaries and caucuses. He opens his campaign with a nationwide organization and a proven small-dollar fundraising effort.

“We’re gonna win,” Sanders told CBS.

He said he was going to launch “what I think is unprecedented in modern American history”: a grassroots movement “to lay the groundwork for transforming the economic and political life of this country.”

Sanders described his new White House bid as a “continuation of what we did in 2016,” noting that policies he advocated for then are now embraced by the Democratic Party.

“You know what’s happened in over three years?” he said. “All of these ideas and many more are now part of the political mainstream.”

Sanders could be well positioned to compete in the nation’s first primary in neighbouring New Hampshire, which he won by 22 points in 2016. But he won’t have the state to himself.

Sen. Kamala Harris of California, another Democratic presidential contender, was in New Hampshire on Monday and said she’d compete for the state. She also appeared to take a dig at Sanders.

“The people of New Hampshire will tell me what’s required to compete in New Hampshire,” she told shoppers at a bookstore in Concord. “But I will tell you I’m not a democratic socialist.”

Sen. Elizabeth Warren of nearby Massachusetts will be in New Hampshire on Friday.

One of the biggest questions surrounding Sanders’ candidacy is how he’ll compete against someone like Warren, who shares many of his policy goals. Warren has already launched her campaign and has planned an aggressive swing through the early primary states.

Shortly after announcing her exploratory committee, Warren hired Brendan Summers, who managed Sanders’ 2016 Iowa campaign. Other staffers from Sanders’ first bid also have said they would consider working for other candidates in 2020.

The crowded field includes a number of other candidates who will likely make strong appeals to the Democratic base including Harris and Sens. Cory Booker of New Jersey, Amy Klobuchar of Minnesota and Kirsten Gillibrand of New York. The field could also grow, with a number of high-profile Democrats still considering presidential bids, including former Vice-President Joe Biden and former Texas Rep. Beto O’Rourke.

While Sanders had been working to lay the groundwork for a second campaign for months, it was unclear whether he will be able to expand his appeal beyond his largely white base of supporters. In 2016, Sanders notably struggled to garner support from black voters, an issue that could become particularly pervasive during a primary race that could include several non-white candidates.

Last month, he joined Booker at an event in Columbia, South Carolina, marking the Martin Luther King Jr. holiday. In 2016, Sanders lost the South Carolina primary, which features a heavily black electorate, by 47 points.

Sanders also faces different pressures in the #MeToo era. Some of his male staffers and supporters in 2016 were described as “Bernie bros” for their treatment of women.

In the run-up to Sanders’ 2020 announcement, persistent allegations emerged of sexual harassment of women by male staffers during his 2016 campaign. Politico and The New York Times reported several allegations of unwanted sexual advances and pay inequity.

In an interview with CNN after the initial allegations surfaced, Sanders apologized but also noted he was “a little busy running around the country trying to make the case.”

As additional allegations emerged, he offered a more unequivocal apology.

“What they experienced was absolutely unacceptable and certainly not what a progressive campaign — or any campaign — should be about,” Sanders said Jan. 10 on Capitol Hill. “Every woman in this country who goes to work today or tomorrow has the right to make sure that she is working in an environment which is free of harassment, which is safe and is comfortable, and I will do my best to make that happen.”

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Trudeau government leaks support in wake of SNC-Lavalin, Wilson-Raybould matter: Ipsos poll – National




The Trudeau government is leaking political support in the wake of the resignation of its former justice minister, making its chances of re-election this fall far less certain than they seemed to be at year’s end, according to a new poll provided exclusively to Global News.

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Prime Minister Justin Trudeau’s personal approval ratings are down; a declining number of Canadians think his government deserves re-election; and Andrew Scheer’s Conservatives narrowly lead the Liberals on the ballot box question.

“This is the worst couple of weeks the PM has had since the India trip,” said Darrell Bricker, CEO of polling firm Ipsos. “The biggest problem is that it hits at what gives the Liberal Party its appeal: the prime minister.”

Charges against SNC-Lavalin explained — and how the PMO allegedly got involved

Ipsos was in the field last week, after revelations surfaced that, last fall, while she was justice minister, Jody Wilson-Raybould felt that unnamed individuals in the prime minister’s office were pressuring her to intervene in a criminal court case in favour of Quebec-based engineering giant SNC-Lavalin. Those allegations were first reported by the Globe and Mail, citing unnamed sources.

If she did feel pressured, she did not act and did not intervene on behalf of SNC-Lavalin. But a few months later, she was shuffled out of her job as justice minister and attorney general and into the job of veterans affairs minister.

Then, last week, as Liberals themselves seemed divided over the optics of seeing the country’s first-ever Indigenous justice minister being shuffled aside for what appeared to be craven political calculations, Wilson-Raybould stepped down from cabinet altogether.

WATCH: Jody Wilson-Raybould quits Trudeau cabinet

Meanwhile, all through the week, Trudeau and other Liberals struggled to explain what had happened while Wilson-Raybould announced she had retained a former Supreme Court justice to provide her with advice about what, if anything, she might say about the whole matter.

Voters took notice.

Ipsos found that, among the 1,002 Canadians it surveyed online from Thursday through to Monday, nearly half or 49 per cent said they were aware of this rapidly shifting story involving SNC Lavalin, Trudeau and Wilson-Raybould.

And it appears many are changing their opinion of the government as a result.

Justin Trudeau’s top adviser Gerald Butts resigns amid SNC-Lavalin affair

Support for the Trudeau Liberals is now at 34 per cent, down four percentage points, from a poll Ipsos did in December. In the 2015 election, the Trudeau Liberals won their commanding majority with 39 per cent of the vote.

Scheer’s Conservatives appear to have benefited from this slide. That party is now at 36 per cent support, up three points since the end of 2018.

“The big trouble spot is now Ontario, where the Tories have a six point lead over the Liberals,” said Bricker. “The way the vote breaks in Ontario suggests that the Tories are doing well in the 905, where the Liberals won their majority in 2015.”

The NDP and its leader Jagmeet Singh, meanwhile, continue to languish, with 17 per cent support right now versus 18 per cent at year-end.

The poll was out of the field before Monday afternoon’s bombshell news that Gerald Butts had quit his post as the prime minister’s principal secretary. Butts, one of Trudeau’s closest friends, had played a critical role in the revival of Liberal fortune and was, along with Trudeau’s chief of staff Katie Telford, central to Trudeau administration. Butts said he had done nothing wrong but was resigning to avoid being a further distraction to the government’s agenda.

WATCH: Justin Trudeau’s top adviser Gerald Butts resigns amid SNC-Lavalin controversy

In any event, Ipsos found that even before that additional turmoil, voter approval of the Trudeau government had dropped nine points since the beginning of the year down to 42 per cent in its most recent pulse-taking.

Trudeau’s own personal approval rating is now two points lower than it was after his disastrous trip to India this time last year.

“Those who strongly disapprove of his performance now outnumber those who strongly approve by a margin of four to one,” Bricker said.

Halifax artist apologizes for controversial cartoon of Jody Wilson-Raybould

And yet, Trudeau is still doing better than his two main rivals, Scheer and Singh, who continue to have lower approval ratings than Trudeau.

“All is not bad for Trudeau,” Bricker said. “When assessed head to head with his major rivals, Scheer and Singh, he still does well on specific leadership attributes. Although the gap appears to be closing now.”

And just 38 per cent of those surveyed believe the Trudeau Liberals deserve re-election, while 62 per cent agreed that it was time to give another party a chance at governing.

A margin-of-error could not be calculated for this poll as the sample surveyed was not drawn randomly. That said, Ipsos says the accuracy of its polls can be gauged using a statistical measure known as a credibility interval. Applying this technique to this poll, Ipsos believes this poll would be accurate to within 3.5 percentage points, 19 times out of 20, compared to a poll of all Canadian adults

Exclusive Global News Ipsos polls are protected by copyright. The information and/or data may only be rebroadcast or republished with full and proper credit and attribution to “Global News Ipsos.” This poll was conducted between Feb. 14 and Feb. 18, with a sample of 1,002 Canadians from Ipsos’ online panel. The precision of Ipsos online polls is measured using a credibility interval. This poll is accurate to within +/ – 3.5 percentage points, 19 times out of 20, had all Canadian adults been polled.

© 2019 Global News, a division of Corus Entertainment Inc.

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‘Canadians deserve answers’: Opposition to press on with parliamentary probe after Gerald Butts resignation




A day after the bombshell departure of Prime Minister Justin Trudeau’s closest adviser, the SNC-Lavalin affair shows no sign of abating as the opposition parties cast his resignation as a sign there may be more to the scandal than initially thought.

The House of Commons justice committee will reconvene today to continue its study of a report that senior members of the Prime Minister’s Office pressured former justice minister Jody Wilson-Raybould to help Quebec-based multinational engineering firm SNC-Lavalin avoid criminal prosecution on bribery and fraud charges in relation to contracts in Libya.

Gerald Butts, Trudeau’s principal secretary and right-hand man, resigned Monday stating definitively that neither he or anyone else in the PMO pressured Wilson-Raybould to direct the Public Prosecution Service of Canada to sign a deferred prosecution agreement (DPA) — a legal tool resembling a plea deal — with SNC-Lavalin.

« At all times, I and those around me acted with integrity and a singular focus on the best interests of all Canadians, » Butts said Monday.

Rather than wipe the slate clean, Conservative Leader Andrew Scheer said Butts’ departure « does not in any way settle this matter. In fact, it presents even more questions that must be answered. »

Scheer said the staff changeover is a sign the prime minister is « desperate to keep the truth hidden. »

« Conservatives on the justice committee will continue to demand a thorough and public investigation, and all other options remain on the table, » Scheer said.

NDP MP Charlie Angus, the party’s ethics critic, said Butts’ departure — he calls the former staffer the « architect of the Sunny Ways » Trudeau playbook — could provoke a « political revolution. »

« For Gerry Butts to resign shows how much damage [the scandal] has done inside the Prime Minister’s Office … If Mr. Butts is willing to take a jump for the prime minister, at this point, it shows that they’re in free fall and total damage control, » Angus said in an interview with CBC News Network’s Power & Politics.

« The best thing the prime minister could do to restore public confidence is come into the House and agree to an independent inquiry … or else these questions are going to continue. »

The prime minister has denied any wrongdoing. He has said he told Wilson-Raybould last fall that any decisions on matters involving the director of public prosecutions were hers alone.

The Liberal and opposition members of the justice committee are expected to squabble today over who should be called to testify at the committee and just how wide-reaching the parliamentary probe should be.

At the top of the opposition witness wish list is Butts himself, but also Wilson-Raybould, who resigned from cabinet last week after the Globe and Mail published its initial report.

Wilson-Raybould had been demoted from the high-profile justice portfolio to the Veterans Affairs ministry in January.

Wilson-Raybould has stayed silent, claiming solicitor-client privilege — as attorney general, she was the government’s top lawyer — prevents her from speaking publicly.

She has taken the highly unusual step of retaining Thomas Cromwell, a recently retired Supreme Court justice, as her legal counsel as the scandal enters a new phase.

While the Liberal-controlled justice committee has agreed to study the matter, Liberal MPs defeated an NDP motion that would have compelled Butts and Wilson-Raybould to appear.

Following normal parliamentary procedure with respect to committee planning, members will discuss who they will call to the committee and define the scope of its investigation in private. The opposition parties had demanded these proceedings be held in public, whereas Liberals successfully pushed for closed-door discussions.

The parliamentary probe itself is expected to be televised.

More to come?

Opposition members have pointed to one line of Butts’ resignation statement in particular as an indication that there might be more developments to come.

Butts said, « My reputation is my responsibility and that is for me to defend. It is in the best interests of the office and its important work for me to step away. »

Not satisfied with a committee study alone, NDP Leader Jagmeet Singh is calling for a public inquiry into the government’s handling — and allegations of political interference — of the SNC-Lavalin affair.

Singh is demanding Trudeau waive solicitor-client privilege to allow his former justice minister to speak freely. Trudeau has said the privilege question is complicated and he is awaiting advice from current Attorney General David Lametti on what he can say in public. He has also said some of the government’s handling of the case is protected by cabinet confidentiality.

Speaking to reporters in B.C. a week out from the Burnaby South byelection in which he is running, Singh said intransigence by Liberal members of the justice committee demands another forum for investigation.

He said a public inquiry is the best way to « get to the bottom of what’s happened. »

« The scandal cuts to the heart of our democracy, » Singh said. « Canadians deserve a government that works for them, not a powerful multinational corporation that has deep ties to the Liberal Party. »

In addition to the committee study, federal Ethics Commissioner Mario Dion is examining the prime minister personally for any potential ethics code violations.

Trudeau loses long-time political ally

​In a tweet Monday, Trudeau said Butts served Canada with « integrity, sage advice and devotion. » He thanked the former staffer for his service and « continued friendship. »

In addition to the political partnership, the prime minister is close friends with Butts — a relationship that dates back to their time as students at McGill University in Montreal where they were members of the campus debating club.

Born in Glace Bay, N.S., a coal-mining town on Cape Breton Island, Butts worked on public policy in Ontario before becoming a senior staffer under former Liberal premier Dalton McGuinty at Queen’s Park.

Butts then made the leap to federal politics and helped chart Trudeau’s political future as leader of the Liberal Party and later prime minister.

Trudeau chats with Butts after the Liberal leadership debate in Mississauga, Ont., on Feb. 16, 2013. (Chris Young/Canadian Press)

Praised by his allies as a brilliant mind, and vilified by foes as the political puppet master behind the prime minister, Butts said Monday he is proud of his time as Trudeau’s top adviser.

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