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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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City to rebuild Maple Leaf Pool – Regina




Sharp public outcry has turned the tide for the embattled Maple Leaf Pool.

On Tuesday night, Regina city council voted unanimously to replace the 72-year-old facility in the Heritage neighbourhood. It had been scheduled to close in 2019.

“We know that the people of this city want  that pool replaced, and replaced in a hurry,” Councillor Bob Hawkins emphatically remarked.

Councillors cited a slew of emails and phone calls supporting the ageing pool in addition to a weekend protest and more than a dozen delegates presenting at budget.

“There’s a lot of newcomers in our neighbourhood,” Heritage Community Association executive director Shayna Stock said. “About 20 per cent are First Nations or Metis, and it’s a mix of lower income families and working class families, so the pool is really a hub for the community.”

Regina residents protest closure of Maple Leaf Pool

“We changed our minds. We’ve changed the focus back to a local pool that’s critical- the centerpiece of a community. We understand, we agree,” Mayor Michael Fougere said.

Hawkins pushed to have a new pool open by 2020- though administration felt that was a little too ambitious.

“2020 we would start construction. 2019 we’d do design. You can’t move any quicker than that,” City manager Chris Holden said.

Administration will report back with funding options early in the new year, though council discussed financing through debt and increasing the mill rate at Tuesday’s meeting.

A proposal from Hawkins to pay for it through a .45 per cent mill rate increase was squashed after much debate.

Maple Leaf pool the focus of Regina’s budget debate

Council heard there is almost $17 million in debt dedicated to replacing Wascana Pool with a new water park by 2021. While Maple Leaf Pool will be a priority, the proposed destination outdoor aquatic facility is not off the table.

“It may be a modified one, but I don’t think we’re going to be talking about the end of the destination (aquatic facility),”Fougere added. “I think we’re talking about moving forward on both projects.”

While details on construction and a price tag may be hazy, it appears the Maple Leaf Pool has a new lease on life.

© 2018 Global News, a division of Corus Entertainment Inc.

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Meng Wanzhou is out on bail — but could be in legal limbo for years




Meng Wanzhou says she hasn’t read a novel in 25 years.

As the lawyer for Huawei’s chief financial officer told B.C. Supreme Court Justice William Ehrcke Tuesday, the 46-year-old has been too busy raising a family and helping her father grow his company into a global telecommunications giant.

Defence lawyer David Martin said his client practically welcomes the constraints Ehrcke considered before granting her $10 million bail under strict supervision: more time to spend with her daughter, to catch up on her love of literature — and who knows, maybe even to consider getting her PhD?

Meng, who was arrested in Vancouver at the request of U.S. officials, is accused of violating international sanctions against Iran through a « hidden » Huawei subsidiary called Skycom.

U.S. prosecutors claim she put American banks in legal jeopardy by lying about the relationship between the companies, inducing them into « carrying out transactions that they otherwise would not have contemplated. »

Meng Wanzhou left B.C. Supreme Court in downtown Vancouver around 8 p.m. local time, nearly five hours after the judge delivered his decision. (CBC)

The U.S. wants to see her extradited.

But if the legal precedents Ehrcke considered in granting Meng her freedom are anything to go by, she may have time to finish War and Peace, Anna Karenina and the complete works of Marcel Proust before her extradition odyssey is done.

« This has been an unusual case, » the judge said as he wrapped up the day, which drew crowds so large the sheriff had to set up televisions in the lobby. 

The proceedings spoke to a number of Vancouver stereotypes: a part-time yoga instructor, a real estate agent, an insurance salesperson and a homemaker all came together as last minute sureties to guarantee the freedom of a woman whose father with an estimated worth of $3.2 billion US.

And all of this on a day with torrential rain.

Left holding the bag

In considering bail, Ehrcke had to balance Meng’s risk of flight against the guarantees of friends who put their own property on the line as sureties.

He considered the examples of Rakesh Saxena and Lai Changxing, two men who fought long battles against extradition.

It took 13 years before Saxena was deported to Thailand, where he was jailed for fraud.

And Lai — once considered one of China’s most wanted men — fought deportation for more than a decade before being sent back to face charges of bribery and theft.

Both men lived under house arrest and were eventually freed pending the resolution of their cases. Saxena was placed under house arrest again after violating the conditions of his release.

Lai Changxing fought deportation from Canada for years. His case was one of the examples the judge considered in granting bail to Meng. (Chuck Stoody/Canadian Press)

Ehrcke also considered the case of Michael Wilson, an accused fraudster, who — like Meng — was wanted for extradition to the U.S. and who — also like Meng — had multiple sureties step forward.

But Wilson fled to Vietnam with two of those guarantors in a bid to escape justice, leaving the other two holding the bag.

Wilson’s actions cost one of them $200,000. The friends who stepped forward for the Huawei CFO could be on the hook for as much as $3 million if she flees.

‘Myriad’ reasons to avoid the U.S.

Meng was arrested just over a week ago on a provisional arrest warrant as she passed through Vancouver International Airport en route to Mexico, Costa Rica, Argentina and France.

Prosecutors claim the fact she hasn’t stepped foot in the United States since 2017 is proof she’s avoiding possible arrest in that country.

But Ehrcke rejected that argument, pointing out that people have « myriad » reasons for avoiding the United States in the past two years.

U.S. President Donald Trump chats with Chinese President Xi Jinping during a welcome ceremony at the Great Hall of the People in Beijing. Tensions between the two countries have been rising. (Andy Wong/Associated Press)

The judge didn’t mention Donald Trump’s name — but the tense relationship between the U.S. president and China’s leadership has simmered in the background from the moment Meng first stepped foot in court.

« There’s a larger macro struggle going on between the United States and China, » Martin told the court during his client’s first appearance — proceedings to which the CBC News has since listened.

Many of the people who packed the courtroom for three days running questioned the timing and motive of the arrest. They applauded Ehrcke’s final decision and some congratulated Meng’s husband as he left the courtroom.

Supporters decried the allegations and one man walked outside the courthouse and shouted, « We love Huawei. »

Patience and time

The arrest of a Canadian in China on the same day that Meng’s release was to be decided increased the air of intrigue.

And Trump’s assertion that he might intervene in the case against Meng if it would help national security interests or close a trade deal with China only helped reinforce the sense that the case may ultimately be decided in Washington and Beijing, not Vancouver.

For now, though, Meng is confined to a strict radius of locations in Vancouver, Richmond and parts of North and West Vancouver.

She’ll pay for round-the-clock shifts of security guards to watch her every movement — sworn to arrest her if she breaches the terms of her parole.

She’ll swap her green prison sweats for an electronic monitoring ankle bracelet.

And she’ll finally get to pick up a book. To paraphrase War and Peace, she may learn that patience and time are the strongest warriors of all.

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My friend Michael Kovrig was arrested in China. Please, pay attention




VANCOUVER—This morning, when I heard that former Canadian diplomat Michael Kovrig had been arrested in China, I hoped it was one of those brief detentions officials routinely use to intimidate foreign researchers, charity workers and journalists.

I rushed to the Star’s Vancouver newsroom and got on the phone to see if I could find out anything more about my friend. It was past midnight in Beijing, and none of our mutual friends and acquaintances were getting back to me. I was starting to panic.

Finally, I reached the previous Canadian ambassador to China, Guy Saint-Jacques. He was Michael’s boss when he worked in Canada’s Beijing embassy from 2014 to 2016.

When Saint-Jacques told me he feared Michael could be charged with espionage, my heart sank.

It would not be unprecedented. In 2014, Canadian Christian aid workers Julia and Kevin Garratt were arrested by Chinese officials and accused of spying. Many believed it was retaliation for the arrest in Canada that same year of Chinese citizen Su Bin, who was accused of hacking U.S. military databases.

“In my view, this is part of China’s efforts to put pressure on Canada on the Huawei case,” he said, referencing the Dec. 1 arrest of the telecom company’s CFO Meng Wanzhou in Vancouver, which my newsroom has been busy covering.

In a state of shock, I filed the former ambassador’s quotes to our story as messages started pouring in from friends who had also learned about Michael’s detention. The Canadian government has since confirmed it.

Michael was one of the first people I met in Beijing four years ago when I worked as a foreign correspondent for European news agencies. A group of Western diplomats invited me to join them at a Chinese folk concert in one of the ancient “hutong” alleyways of the capital city.

We were all new to working in mainland China, though some of us (like me and Michael) had worked in Hong Kong. We were excited to explore Beijing’s night life and cultural offerings.

Michael reached out to me to grab lunch because both of us were interested in politics and human rights in China. We wanted to trade notes on these complex and overwhelming subjects.

After that, he always tried to make it to my gatherings, and he invited me to the fabulous bashes he threw in his apartment — including one party where he even hired a swing band and bartender.

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Despite the wonderful friends I made in my years covering human rights in China, it was depressing to write about the arrests or mysterious disappearances of lawyers, writers and activists.

It was exciting to run with Chinese human-rights lawyers down back streets to evade the police watching their every move — but also crushing to hear when yet another advocate had been arrested.

One attorney, Wang Quanzhang, has not been heard from since he was detained in 2015 during a police sweep on hundreds of lawyers and advocates. I sat with his wife as she cried in a restaurant. She, too, had been put under house arrest.

Last summer, I travelled to the northeastern city of Shenyang to try to find pro-democracy advocate Liu Xiaobo as he lay dying of liver cancer. He remained locked away in a hospital and was the first Nobel Peace Prize laureate to die in state custody since the days of Nazi Germany.

I moved back to Vancouver this July, where I soon got a job with the Star.

I last heard from Michael in the spring, when he told me he was loving his job as senior adviser on northeast Asia for the International Crisis Group, an internationally respected NGO that examines ways to prevent and resolve deadly conflict.

The job allowed him to travel widely, speak with many people and write for a wider audience to promote peace.

Michael is emotionally very open. Many in his social circle knew that he struggled with his decision to take a leave of absence from work as a diplomat in 2016. He chose to do so because he didn’t want another posting somewhere else. He wanted to stay in China and keep learning more about the country.

In short, he was a China nerd and eager to keep learning.

“He loved China,” said Saint-Jacques. “I told him you can take a leave of absence from the government and try to find something, and good luck with your plans. And that’s why he decided to stay and enjoy living and working in China.”

Michael could not have foreseen what would happen to him. I am still hopeful that he won’t be detained for long, even though I know that the outcome could be awful.

A foreign passport can provide little protection. Just look at the case of B.C. winery owners John Chang and Allison Lu, who have been detained in Shanghai since 2016, accused of failing to pay sufficient taxes on wine shipments.

Those who track human-rights cases in China worry that people around the world are becoming numb to their concerns.

Please, pay attention to what is happening with Michael’s case.

Joanna Chiu is assistant managing editor of StarMetro Vancouver. Follow her on Twitter: @joannachiu

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