Donald Trump’s FDA and the ‘United States of Oxy’

How will the pharmaceutical industry be impacted under the Trump administration? Who’s the new FDA Commissioner? How will e-cigarettes be effected? How will the opioid crisis be impacted?

Trump’s FDA and “the United States of Oxy”

By Lucas Richert

The US Food and Drug Administration (FDA) may be headed for a major overhaul under the Trump presidency and the agency’s new head, Scott Gottlieb. At a recent meeting with pharmaceutical industry leaders, President Trump asserted that “we’re going to be cutting regulations at a level that nobody’s ever seen before.” His most recent statements, made at a White House confab, echoed loudly throughout the medical and pharmaceutical industries.

Just talk? It’s tough to say, yet supporters of pharmaceutical deregulation have long wanted to reduce bureaucracy and lessen oversight of drugs and devices. Critics, by contrast, contend the drugs market could be destabilized and public health undermined. The tricky task will be to strike the proper balance of speed and safety, as well product innovation and consumer protections.

An American drugstore, circa 1963. Courtesy of Library of Congress.

Scott Gottlieb, a physician and regulator recently approved to lead the agency by the US Senate in a 57-42 vote, pledged he would lower prices, reduce approval times, and fight the widespread abuse of opioid painkillers. This kind of addiction, said Gottlieb, was “a public health crisis of staggering human and economic proportion.”

This rhetoric and attempted reforms at FDA are not new, but the devastating painkiller crisis certainly is.

Opioids

Gottlieb’s critics noted that he was too closely tied with the pharmaceutical industry to tackle the opioid epidemic. “We are suffering this public health epidemic because big pharma pushed pills they knew were dangerous and addictive, the FDA approved them, Senator Ed Markey (D-Mass) told reporters. The United States had been turned into the “United States of Oxy,” Markey added.

The FDA approved OxyContin, a powerful opioid to treat severe pain, such as in the case of patients with terminal cancer. With mild pain, though, the FDA deemed the dangers of addiction too great, and has not allowed the marketing of Oxy for such pain.

Not able to solve the opioid alone, the FDA nonetheless will play an important role. He has made this case quite forcefully. However, Gottlieb’s critics (mainly Democrats) have pointed to his past views on the regulation of opioids. In particular, he has suggested that policies restricting pharmacies and drug distributors might burden innocent patients.

This will be one of the defining issues of his career.

E-cigs

The Food and Drug Administration’s move in May, 2016 to crack down on e-cigarettes brought regulation in line with existing rules for cigarettes, smokeless tobacco and roll-your-own tobacco. This had been highly anticipated after the FDA issued a proposed rule over two years ago.

“Millions of kids are being introduced to nicotine every year, a new generation hooked on a highly addictive chemical,” U.S. Secretary of Health and Human Services Sylvia Burwell stated during the announcement of the new rules. She asserted, too, that health officials still didn’t have the scientific evidence showing e-cigarettes can help smokers quit, as the industry asserts, and avoid the known ills of tobacco.

The Trump administration recently approved a delay in the FDA’s e-cigs guidelines. It was a decision that divided officials in the public health establishment. And it’s undoubtedly true that several Trump administration officials, including FDA chief Gottlieb, have connections to the e-cig and tobacco industry.

From March 2015 to May 2016, according to Bloomberg, Gottlieb was a director of Kure Corp., a Charlotte, North Carolina-based firm that distributes e-juices and vaping pens in coffeehouse-style lounges known as vaporiums. Of course, he had a financial interest in the company as of March, according to financial and ethics disclosures, and promised to sell his stake if confirmed as head of the FDA.

“How to regulate e-cigarettes is one of the most critical questions on tobacco regulation that the FDA is going to be facing in the coming years,’’ said Vince Willmore, a spokesman for Washington-based Campaign for Tobacco-Free Kids.

Vaping will also be a significant issue for Gottlieb and the FDA. Getting the regulation right matters – not just in the U.S., but places like Glasgow and Vancouver.

FOR MORE ON E-CIGARETTES:

Why aren’t we regulating e-cigarettes?

Do We Regulate E-Cigs, Ban Them, or What?

Red Tape

The writer Matthew Herper suggested recently how “talk of speeding up [drug] approvals for serious diseases first gained traction in the early 2000s.” Actually, the trend extends much further back. Debate about quickening drug approvals has a complex and compelling history.

The FDA under President Ronald Reagan, for instance, offers a useful tool to evaluate the Trump administration’s approach to the FDA and the drug industry.

In mid-January, as Mr. Trump awaited his inauguration and the transition team worked furiously to establish his cabinet and select suitable agency nominees, the FDA generated serious debate. Trump met with Jim O’Neill, a venture capitalist, and a close friend of PayPal’s Peter Thiel. He met with Balaji Srinivasan, a cofounder of genetics testing firm Counsyl.

Both men subscribed to the idea – now conservative doctrine, according to Forbes – that the FDA prevented a flood of new drugs from hitting the market. Neither held an M.D., which has been for years a prerequisite for the FDA’s top job. Yet, by 20 January the frontrunner for the Commissioner’s job was Gottlieb, who had made it known publicly he believed the FDA should trim bureaucratic red tape and approve drugs in a speedier fashion.

Trump ultimately settled on Gottlieb, whose selection was welcomed by the pharmaceuticals sector. His ties to industry were questioned by Democrats, but the vote wasn’t close.

The Gipper’s FDA

Ronald Reagan, whether as a candidate or later President of the United States, did not desire the dismantling of the FDA, but neither did he trust it. In his optimistic view, its authority, like that of many other regulatory agencies, simply needed curtailing.

In 1975, he told an audience at the American Enterprise Institute, a conservative think tank, that the FDA was hurting Americans, yet also made clear he did not wish to totally “eliminate the responsibility of the FDA…”

The problem, as Reagan saw it, rested in the restriction of freedom of choice for American consumers, since the agency had established itself “as the doctor and decided that they will tell us what medicines are effective.”  He felt that a degree of regulation was necessary to protect Americans from each other, but the FDA had overreached and, as bureaucracies do, went beyond “protecting us from poisonous or harmful substances…”

In 1980, the Republican presidential ticket of Ronald Reagan and George Bush promised to change Washington. President Jimmy Carter represented failure, Republicans argued, be it botched rescue attempts and helicopter crashes in the desert, the loss of the Panama Canal, or an impotent economy. The jaunty and upbeat Reagan succeeded in shifting the policy discourse about the size and scope of federal government programs; harkening back to halcyon days, he moved the conversation about which government program to launch (or expand) to how much of a program’s or agency’s budget ought to be cut.

In 1981, the debate about drug regulation continued to polarize people; finding a middle ground was often difficult, and as the new administration took power, the outgoing FDA Commissioner Goyan articulated a consensus-oriented, centrist approach to drug regulation. Think tanks such as the Heritage Foundation and American Enterprise Institute promulgated changes to the FDA’s mission as a means of unleashing the once-mighty American pharmaceutical industry. This would fuel the U.S. industry and the greater economy.

For some, the FDA transcended presidential politics and ideology.  It protected all Americans – conservative and liberal – as it carried out its duties. “My view,” said the bearded, grey, and somewhat feisty Jere Goyan, “is that government regulation needs to strike a balance between preserving the maximum freedom for individuals while at the same time establishing the rules that are needed for us to live together, to survive as a society.”

Jere Goyan and President Jimmy Carter. Courtesy of Library of Congress.

By voting for Reagan, Americans indicated they wanted “modifications” to the current models – reform rather than removal. “It would be a mistake,” Goyan argued, “a tragic one, to interpret the election results to mean that the public wants a lessening of the standards that provide the foundation for the food and drug industries in this country, standards that make our food and drug supply the best in the world.”

Often, his approach went unheeded, overwhelmed by disputes about individualism and consumer choice and bureaucratic incompetence. One the one hand, many Americans regarded FDA staff members “as a bunch of demented bureaucrats running amok,” even though the agency’s “balanced” regulation of drugs was both “socially valid and moral.”

On the other hand, the president of the Pharmaceutical Manufacturers Association illustrated an alternative. Lewis Engman felt that taking medicines, like smoking cigarettes, was a matter of personal choice. “Any time you interfere with the basic market system,” he said in 1981, “you’re in trouble…the consumer is his own best guardian.”

Impossible as it was to know how the new president would transform the FDA in early 1981, political pundits, economic analysts and pharmaceutical industry insiders suggested that Reagan meant less regulation, which meant industry growth. The President of the National Association of Retail Druggists (NARD), Jesse M. Pike, sent a congratulatory letter to Reagan. It emphasized how delighted NARD was to see him in the White House and just how his regulatory reform beliefs would be good for business. In Pharmaceutical TechnologyJames Dickinson wrote, “everyone expects life to be easier for industry under the new Reagan Administration.”

Apparently, the Washington cocktail circuit was rife with speculation about the new administration repealing the Kefauver-Harris 1962 drug efficacy requirements – a move that would further enhance prospects for industry growth. This was nonsense, according to knowledgeable policymakers and reporters. Still, the fact that the notion was even bandied about, however fancifully, represented a substantial change in the debate about drug regulation.

Reagan promoting Chesterfield, circa 1952

The press envisaged a pharmaceutical industry boom in the near future. Newspapers reported how “The Drug Business Sees a Golden Era Ahead” and that pharmaceutical associations were positively giddy. Rep. James Scheuer (D-NY) publicly denounced the agency’s over-cautiousness and emphasized the need for immediate reform. It was risk averse, to the detriment of sick Americans. Moxalactum, he argued, was an American-made antibiotic for pneumonia used by Marshal Tito in Yugoslavia – yet it was not available in the United States. The narrative Scheuer framed was that the FDA was protecting Americans to death – and this before the onset of the HIV/AIDS crisis.

Mounting enthusiasm about pharmaceutical growth in the wake of the Reagan election was palpable. Reports indicated that the pharmaceutical industry and investors were confident about the future – a golden era – in this new regulatory climate. There was bullishness about drug stocks in general, and many predictions that pharmaceutical companies would start to generate more and more earning in 1981 and 1982. Overall, these stories proved to be accurate.

Ronald Reagan, however, had pledged in 1980, with trademark sincerity, not to gut the FDA. Rather, he made oblique references to the agency’s storied history and resorted to prosaic comments about the danger of hidebound power-hungry bureaucracies. “There’s a certain amount of regulation that is always necessary to protect us from each other,” he told CBS’s Walter Cronkite. “And that I recognize. We don’t want to, for example, eliminate the responsibility of the FDA…”

Much can be gleaned from Reagan’s public statements about the Food and Drug Administration, but they fail to reveal the entire picture. On May 20, 1986, Reagan described a meeting between Paul Laxalt, Jack Dreyfus, and himself. Dreyfus, who had “spent $50 mil. of his own money” was attempting to have the epilepsy drug Dilantin approved and found a roadblock in the form of the FDA. According to Reagan’s personal diary: “The villain in the case is the Fed. Drug Admin & they are a villain.”

 Red Herrings and Empowered Patients

Under the Trump administration, will the FDA play the villain role? President Trump will build on earlier Republican efforts to streamline the agency, whether these took place during Reagan or Bush presidencies. He has promised to remove barriers for overseas drugs and support ‘Right to Try’ laws, which will attempt to provide access to unapproved drugs. Indeed, some of these measures may help patients. And the Trump administration will be the right track if it can safely accelerate drug approvals, promote production and use of generics, and lower drug prices through increased competition.

Gottlieb and others have suggested they would radically restructure the drug approval process –  even if that remains something of a red herring argument. QuintilesIMS Institute, among various other organizations, have determined that the total time between patent and approval has dropped 31% since 2008. Yale researchers hold that the FDA is already considerably faster than Europe and Canada when it comes to approving drugs.

Another area of regulation that ought to be monitored closely is advertising. Every other nation besides the US and New Zealand has concluded that advertising powerful drugs for treating complex illnesses makes no sense when your target market lacks the qualifications to fully grasp the risks. How will powerful painkillers be regulated in the years ahead.

The drug industry wants to empower patients, to invest them in the writing of prescriptions. Looking ahead, it will be important to watch the administration’s and FDA’s role in faciliating this.

FOR MORE ON PATIENT ACTIVISM

Quarrelsome cannabis in the UK

Trimming Down: The Debate over Weight Loss Drugs and the Push for a Leaner FDA, 1979-2001

“The [industry] idea is that consumers are central players in their health management and therefore have a right to be informed of different drugs,” Lewis Grossman, a specialist in food and drug law, told the Los Angeles Times.

Yet, the practice of medicine should not be placed in the hands of amateurs and junk scientists. In the post-truth era, however, when an opioid epidemic soars and drug prices are hitting Americans in the pocketbooks, these “facts” could be lost in the noise.

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Thanks for reading. For more, please follow the blog.

Lucas Richert is a Lecturer in History at the University of Strathclyde (Glasgow, UK). He is the author of Conservatism, Consumer Choice, and the Food and Drug Administration during the Reagan Era. He’s currently at work on a second book, tentatively called Strange Medicines: Drugs, Science, and Big Pharma in Culture.

LSD: Insight or Insanity?, 1968

From the NIH. A post by Professor Erika Dyck on the history of LSD.

Circulating Now from NLM

Circulating Now welcomes guest blogger Erika Dyck, PhD, Professor and Canada Research Chair in the History of Medicine at the University of Saskatchewan. Today, Dr. Dyck shares some insights on a recently digitized film in the Library’s collection highlighted in our Medical Movies on the Web project.

For Rebels, it’s a Kick…

It’s the late 1960s. Teenagers, a hip voice clues us in, are always looking for kicks, and today’s teens express themselves with cool fashions, groovy hairstyles, and kooky pranks. Not so long ago, our narrator played the character of “Plato,” a troubled teenager, in the 1955 classic Rebel Without a Cause. In that film, Plato idolizes the reckless machismo of young Jim Stark (played by James Dean). In an epic display of bravado, Jim and another boy play a game of “chickie run” in which they drive their cars in parallel directly toward a cliff. Jim leaps…

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Cannabis ‘Policy Brief’ Announcement

It’s my pleasure to promote the publication of an important Policy Brief on Cannabis by Kathleen Thompson. Over the past few years she has helped drive conversations about the consumption and control of marijuana. Her recent Policy Brief ought to be read by anyone and everyone! Here’s an extract.

LEGALIZATION OF CANNABIS: THE POLICY CHALLENGES AND OPPORTUNITIES

By Kathleen Thompson, PhD, MSW, RSW, BA (Hons)

“The commitment by the Government of Canada to legalize cannabis
and cannabis products presents a complex range of socio-economic
challenges and opportunities. Creating the right legal and regulatory
framework to address the implications, both good and bad, will be
key in determining whether legalization is deemed successful public
policy.
The federal government plans to introduce cannabis legislation in the
coming spring session of Parliament. The legislation will be based on
the recommendations contained in a report issued on November 30 by
a Task Force of experts who studied the issue for the past year. The Task
Force received input from more than 30,000 Canadians, organizations
and professionals. Entitled “A Framework for the Legalization and
Regulation of Cannabis in Canada”, the report recommends allowing
more flexibility in the current federally controlled cannabis cultivation
model. Specifically, the federal government would regulate a safe and
responsible supply chain of cannabis.”

The full document, which has been sent to law enforcement and government officials across Canada, can be read on the Johnson-Shoyama website or downloaded here thompson-policy

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Large Indoor Marijuana Commercial Growing Operation With Fans, Greenhouse, Equipment For Growing High Quality Herb. Cannabis Field Growing For Legal Recreational Use in Washington State
Large Indoor Marijuana Commercial Growing Operation With Fans, Greenhouse, Equipment For Growing High Quality Herb. Cannabis Field Growing For Legal Recreational Use in Washington State

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ABOUT KATHLEEN THOMPSON

Dr. Thompson has worked in health policy analysis and research as a bureaucrat and as a consultant for the last 25 years, specializing in the mental health, disability and corrections sectors.

In 2015, Dr. Thompson created the Cannabis Regulatory Research Group. The focus of the policy research group is on promoting collaborative public policy processes and evidenced-based research with the cannabis industry, governments, academia, civil society and at the United Nations. Additionally, Dr. Thompson consults with individuals and organizations on how to enter the legal cannabis industry.

 

 

Weed in the Workplace

The newest issue of Canadian HR Reporter discusses ‘weed in the workplace’ and focuses on drug screening. There are some vital ideas here about on-the-job safety, the legalities of drug testing, and impairment. Basically – drugs during ‘9 to 5.’ Also, I get my two cents in there! Check it out at Increasing use of marijuana could cause problems on the job

 

Crackdown? Regulating E-Cigarettes

In the Regina Leader-Post today I write about Canadian e-cigarette rules. Both the U.S. and E.U. have moved ahead with new rules. Should Canada?

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Why Aren’t We Regulating E-Cigarettes?

Recently, the regulation and use of e-cigarettes in Canada, the U.S. and European Union has raised serious challenges for consumers, politicians, and health officials. Now, the U.S. and the EU have moved forward with new policies and Canada is being left in the dust.

In the U.K., an estimated 2.6 million people use e-cigs, prompting more calls for regulation. And this week, new regulations go into effect.

These include rules that limit the size of refill containers and the potency. All packaging must be “child proof.” Manufacturers will be asked to submit to government scrutiny. Finally, if three EU member states express a willingness to ban e-cigs, it will be possible to start a process banning them across the whole of the union.

Last week, the U.S. government also took broad steps to crack down for the first time on e-cigarettes, which have been growing in popularity among teens and are projected to be a $4-billion industry this year.

The Food and Drug Administration’s move brought regulation of e-cigarettes in line with existing rules for cigarettes, smokeless tobacco and roll-your-own tobacco. This action had been anticipated after the FDA issued a proposed rule two years ago on how to supervise the e-cigarette industry.

“Millions of kids are being introduced to nicotine every year, a new generation hooked on a highly addictive chemical,” U.S. Secretary of Health and Human Services Sylvia Burwell said. She suggested that health officials still don’t have scientific evidence showing e-cigarettes can help smokers quit, as the industry asserts, and thus avoid the known ills of tobacco.

In Canada, considering that both the Harper Conservatives and Trudeau Liberals have dithered on crafting any meaningful policy, perhaps it would be easiest simply to follow the lead of the EU or U.S.

First, e-cigarettes have not been proven as a legitimate and conclusive aid in quitting smoking. Anecdotally, many believe they are a useful harm-reduction tool. Many former smokers praise the devices, while many physicians and public health experts also support their use. Yet, there is anything but scientific or medical consensus on the e-cig.

Second, the flavoured liquid that substitutes for nicotine lacks proper regulatory standards, so the safety is problematic. Business owners either can craft the liquid themselves or purchase it from anywhere they wish. This raises questions of security. It’s basically a “wild west” market. Without appropriate controls over the liquid mixing process or the supply and distribution chain, consumer protection is weakened. It is unthinkable that a pharmacy down the block could operate in an unregulated, unstandardized environment.

Also, a recent report in the U.S. found that e-cigs have “sickened rising numbers of young children,” and in most cases this involved swallowing liquid nicotine. In Lethbridge, an e-cig exploded in the face of young Ty Greer. It “lit his face on fire,” knocked out teeth and seared the back of his throat. The young man will bear the scars of this accident forever.

Do such examples mean we ought to crack down hard and regulate this market out of existence? No. Does this mean we should think proactively? Yes.

Alberta, Saskatchewan and Newfoundland and Labrador are the only provinces that have not banned sale of electronic cigarettes to minors, according to the Non-Smokers Rights Association.

Les Hagen of the group Action on Smoking and Health said what happened in Lethbridge is another reason why e-cigarettes must be regulated federally and provincially. By contrast, Jesse Kline of the National Post has told us, “Don’t believe the fear campaign — e-cigarettes can save millions of lives.”

It is time for federal leadership. We need rules that meet the needs of consumer protection and business owners, and balance health concerns for children with harm reduction for adults. According to federal Health Minister Jane Philpott, “Health Canada is actively reviewing health and safety data and scientific studies on vaping products, including e-cigarettes.” She noted a report will be issued reasonably soon.

It will be a tricky task, especially with the marijuana file looming large.

Lucas Richert teaches the history of pharmaceutical and recreational drugs at the University of Saskatchewan.

Clarify Pot Policy for Veterans

Today I wrote a short viewpoint for the Star Phoenix. The article is on medical cannabis for Canadian veterans.

Auditor General Michael Ferguson has raised important questions about the increasing use of medical marijuana by Canadian military veterans.

As authorities contemplate enforcement actions and zoning bylaws relevant to marijuana dispensaries, and the federal Liberal government prepares for legalization in 2017, Ferguson is urging the Department of Veterans Affairs to address the amount of medical cannabis being prescribed to veterans. He found the quantity prescribed was “poorly documented” and not always evidence-based.

Ferguson focused more broadly on how Veterans Affairs has been managing drug benefits for former servicemen and women, some of whom have complicated health issues and suffer from mental health conditions such as post-traumatic stress disorder. The AG made it plain that it’s time to cut through the haze and clarify marijuana policy for veterans.

The core problem rests with the amount of cannabis veterans are authorized to take. In 2014, Veterans Affairs doubled the amount to 10 grams per day for eligible veterans. Yet, for Health Canada this is twice the amount it considers safe. An internal Health Canada document showed that more than five grams has the potential to increase risks to the cardiovascular, pulmonary and immune systems, as well as psychomotor performance. It has a chance of increasing the risk of drug dependence.

Ferguson’s office could not find any evidence to support this decision to increase the threshold. Veterans Affairs Minister Kent Hehr expressed shock in March that his department lacked an “informed policy” on the use of medical cannabis, even as number of claims by veterans for medical marijuana grew more than tenfold over the past two years.

According to figures provided by Veterans Affairs, 112 veterans were reimbursed for medical marijuana in 2013-14, The following year, it was 628. By March 2016 that number has risen to 1,320.

Mike Blais, president and founder of Canadian Veterans Advocacy, has been abundantly clear about veterans’ consumption of medical marijuana: “I think there should be no cap, and that every case should be judged on individual merit and that the doctor’s prescription is paramount.”

At the same time, Canadian Forces have taken an alternative stand. In 2014, H.C. MacKay who was then the deputy surgeon general of the Canadian Forces, made clear that “with respect to marijuana use for medical purposes, we have identified what appears to be a very significant policy divergence between Veterans Affairs Canada and Canadian Armed Forces.”

In short, even though Veterans Affairs was funding medical marijuana, the military’s health service did not recognize it for medical use. With respect to PTSD, the Canadian Forces have also suggested there is insufficient evidence to authorize marijuana use and could even be detrimental to veterans’ health.

Marijuana remains a highly contested medicine for various scientific, political and social reasons. That is obvious. However, the auditor general report reaffirms how it and the policies surrounding the medical treatments for Canadian veterans require significant clarification.

Lucas Richert teaches the history of pharmaceutical and recreational drugs at the University of Saskatchewan.

Below the CBC covers the story.

Rebranding: Justin Trudeau and Canadian Coffee

For millions of Canadians, there is no icon in business more collectively beloved than Tim Hortons. “Tim’s” – as the franchise is affectionately called – long ago transcended the humble domain of doughnuts and coffee. Instead, it is now a part of the Canadian national identity – one of those rare brands by which individuals and societies categorize themselves.

Forget beer. Tim Hortons coffee is Canada’s drug of choice.

beer

And it is a fascinating historical and political development that Stephen Harper’s Conservative Party cleverly latched onto this when pitching itself to the masses. The Tories held photo-ops inside Tim Hortons outlets across Canada and made sure to be photographed delivering Tim Hortons goodies around various communities.

In 2009, one researcher felt that the Tim Hortons X factor was essential enough to warrant asking voters which party leader was more likely to buy their coffee at Tim’s. No surprises here, the Conservatives edged the Liberals in this category. Canadians had, in short, developed a culture of conservative coffee.

With the recent election of Justin Trudeau and a new Liberal government (which promised hope and change), the time is right to take a step back and assess the relationship between Tim Hortons and politics.

trudeau-family-halloween-20151031
Trudeau family at Halloween. May the 4th be with you.

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Tim Hortons opened its first location in 1964 in Hamilton, Ontario. It was co-founded by NHL player, Tim Horton, who played for the Toronto Maple Leafs, among other teams. In succeeding decades, thousands more popped up across the country, making it more successful in Canada than McDonald’s. Sure, the arrival of the coffee chain in a small town sometimes meant the end of local ‘mom-and-pop’ shops, but its presence produced more excitement than resentment. Getting a Tim Hortons was a sign that a community – however small – had made it.

tim horton
Tim handles the puck

Over the course of 50 years, Tim Hortons caught and surpassed the big-name American burger chains to become the undisputed champion of Canada’s “quick service restaurant” market.

By 2004, the term “double-double” entered the Oxford dictionary of Canadian English, signifying recognition of its importance to everyday speech. Ordering a drink of this kind represented, at least for some commentators and scholars, more than just habit. It was and remains an act of solidarity within the national body politic. According to the Globe and Mail, one estimate suggests Tim’s sells nearly eight in 10 cups of coffee sold in Canada.

double doublealways fresh

Most pharmaceutical companies would kill for that kind of market share.

This road to dominance was chronicled in Ron Joyce’s Always Fresh, an insider’s account of Tim Horton and the business named after him.  At times, it is a devastatingly blunt account of the chaotic and complicated personal story behind one of Canada’s most successful businesses.

joyce

Ron Joyce, one of the co-founders of the franchise, chronicles the drugs, the infidelity, an epic court battle, and one spectacular, fatal car crash – that of Tim Horton himself, which was booze-fuelled and largely overlooked until recently.  Joyce, in short, takes his readers behind the counter, into the kitchen, and demonstrates the inner-workings of the company.

The tone of tenor of the book are inherently and recognizably free-market. It is a Horatio Alger, pull-yourself-up-by-your-bootstraps, local-boy-makes-good narrative. First, Joyce settled in Hamilton and worked menial jobs in factories, scraping together enough to get by. Later, he joined law enforcement and increased his measly pay by taking on a variety of odd jobs, including: a produce truck driver, construction worker, and then Brinks guard. Finally, he simply fell into the restaurant business in his mid-thirties and then, through sheer hard work and force of will, he went on to become one of the wealthiest businessmen in the country.

We have all been exposed to this upwardly mobile narrative before, and it surely one that resonates with free-market advocates and, more generally, economic conservatives. Yet, Joyce’s story is intriguing because it showcases how success can tear at the fabric of friendship and family. According to Maclean’s, “It’s as much about jealousy, greed and betrayal as it is about cash flow and marketing.”

According to Douglas Hunter, politicians, especially the Conservative Party, saw tremendous value in the legend of Tim Hortons and seized on the idea that the company, as well as the hockey player founder, was representative of the average Canadian.

When Condoleezza Rice visited Canada in 2006, Foreign Affairs Minister Peter MacKay was photographed taking her to Tim’s. Newspapers referred to this as “double-double diplomacy,” even though she chose to have her coffee black with one sweetener, rather than two creams and two sugars.

Prime Minister Harper also used the Tim Hortons logo as a political stage, including a 2009 speech that welcomed the company back to Canada after it relocated its corporate headquarters from the U.S. To make this political statement, Harper declined an invitation to speak at the United Nations General Assembly, much to the chagrin of the national press.

Harper explicitly referenced how the company was an “essential Canadian story,” which included “success and tragedy,” as well as “big dreams in small towns,” “old fashioned values and tough-fisted business,” “hard work and hockey.” To use David Farber’s phrase, this muscular nationalism, an unshakable patriotism that was popularized by Harper.

Similarly, as Canada prepared to go to war in Afghanistan, the Canadian Chief of Defence Staff, General Rick Hillier, contended that troops should have a Tim Hortons at Kandahar Airfield. It would cost the public at least $4 million, but access to Canada’s drug of choice was a boon to morale. “There’s nothing more Canadian than sipping a double-double in Kandahar airfield while you’re watching a hockey game,” noted Gen. Hillier.

According to Hillier’s Afghanistan commander, Brigadier-General David Fraser, when asked what he thought about the idea: “Tim Hortons better get its ass over here, as far as I’m concerned.”

* * * *

The identity crisis Canadians have suffered since Confederation in 1867 has helped Tim Hortons achieve its emblematic status. It doesn’t help that Canadians are so close to the United States and struggle with what makes us distinct.

Essentially, this means we have been desperate to clasp on to everything that helps delineate and comfort us, particularly in a post-1980s globalized world in which national culture has become so tangled with acts of consumption.

Tim Hortons has seized on that and the Conservative Party seized on that, too. “The worst thing a company can do is tell you straight up ‘We are important to your identity,’” says Douglas Hunter. Instead, the politicians made that point. Tim’s was used as a prop and a backdrop. And the coffee formed part of a political strategy, which has helped reinforce the iron grip of a gentle brand.

And while Justin Trudeau, Canada’s new prime minister, promised hope and change on the campaign trail he made sure to stop in to Tim’s for a cup of coffee. Some drugs, it seems, are hard to kick.

Are you an Anti-Vaxxer?

Why do we question vaccines? And who are the thought leaders involved? Are they respectable, or are they hacks? And, more importantly, what can we glean from past debates about vaccines? In Elena Conis’s new book, we get a sense of this – and so much more.

conis book image

In the newest edition of Social History of Medicine, I review Elena Conis’s new book, Vaccine Nation: America’s Changing Relationship with Immunization.

In tracing over 50 years of vaccine controversy, we get to know the key institutions, opinion leaders, and major ideas that have driven debates. We are exposed to federal law, feminism, and, oh yeah, Jenny McCarthy and the mass media.

She began her career in 1993 as a nude model for Playboy magazine and was later named their Playmate of the Year. McCarthy then parlayed this fame into a television and film acting career. She is a former co-host of the ABC talk show The View.

McCarthy has also written books about parenting and has become an activist promoting research into environmental causes and alternative medical treatments for autism. In particular, she has promoted the idea that vaccines cause autism and that chelation therapy helped cure her son of autism.

Both claims are unsupported by medical consensus, and her son’s autism diagnosis has been questioned. McCarthy has been described as “the nation’s most prominent purveyor of anti-vaxxer ideology”, but she has denied the charge, stating: “I am not anti-vaccine…”

jenny_mccarthy

In Conis’s book, we get a better understanding of how someone like McCarthy can drive the policy process and shape our View on vaccines.

Here is a brief excerpt from the review:

“Vaccines are significant medical interventions that naturally induce powerful economic, social, and political reactions. Vaccines have helped shaped narratives about American scientific and technological ingenuity, as well as therapeutic progress, yet they have also been ‘cast in the image of their own time’ (p. 10), The pathway to effective, accepted vaccines has been neither simple nor straightforward.

In Elena Conis’s penetrating new book, Vaccine Nation, this fluid negotiation over vaccines for polio, pertussis and Human papillomavirus (HPV), among others, is on full display. We are exposed to a ‘wildly diverse set of influences, including Cold War anxiety, the growing value of children, the emergence of HIV/AIDS, changing fashion trends, and immigration’, that have shaped vaccine acceptance—as well as resistance (pp. 2–3). Conis, a former journalist, offers punchy and accessible prose as she skilfully traces the ebb-and-flow of vaccine history from the 1960s to the present.”

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If you’re interested, PBS has done a great job covering anti-vaccination in the U.S.

Tories, Turmoil, and Marijuana Legalization

THE CBC reported yesterday that there is tremendous turmoil within the Conservative Party over the legalization of marijuana. Without Stephen Harper, the issue has created controversy. The story below is by Stephen Dyer.

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As candidates for the Conservative Party’s leadership race continue to line up, an issue has emerged that many thought the Tories had put to bed a long time ago — the legalization of marijuana.

Former prime minister Stephen Harper called marijuana “infinitely worse” than tobacco. “If we sell marijuana in stores like alcohol and tobacco, that will protect our kids? No one believes that,” he said.

But last week Maxime Bernier injected a slightly unexpected element into the race when he suggested he was leaning toward supporting a Liberal motion to legalize possession of marijuana for recreational use, as has already happened in four U.S. states and the District of Columbia.

“I think it must be time to have a discussion with that,” he told Rosemary Barton, host of CBC News Network’s Power & Politics. “I am happy that this government will bring a bill.”

“I am more for it” than against it, he said. “It depends how the government will do it. At the end I will decide whether I will vote for it or against it. But I am more toward — for — that.”

That position sets Bernier at odds with his party’s long-held opposition to loosening the laws against recreational use of marijuana.

Law unpopular with Tory voters

According to Vote Compass, CBC’s voter-engagement survey, about 37 per cent of Conservative voters in the last election said they supported the full legalization of marijuana.

Another 38 per cent of Conservatives supported the NDP’s position of decriminalization of marijuana — a step short of legalization that would treat pot possession similar to a traffic offence.

Only a quarter of Conservative voters agreed with Harper’s position that marijuana possession should remain a criminal offence —  a number that drops to 14 per cent across all voters.

These numbers suggest there is an audience within the Conservative Party for a more libertarian viewpoint — like the one Bernier is pitching.

On the other side of the debate is Bernier’s only other declared rival, former minister of labour Dr. Kellie Leitch. She is one of the few Conservatives who have continued to thunder against the impending legalization of marijuana since the party’s electoral defeat in October 2015.

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“Health Canada spends hundreds of millions of dollars every year to encourage Canadians to stop smoking. Now the government wants Canadian kids to have access to a drug to smoke, marijuana,” she told the House of Commons in February. “Parents are scared and concerned for their children. The government is sending out mixed signals.”

Indeed, the Liberals have been criticized by advocates of marijuana reform for maintaining the current criminal penalties while they take their time drafting a legalization plan, rather than moving immediately to decriminalize as an interim measure.

Not clear where leader stands

Also sending out mixed signals is interim Conservative Leader Rona Ambrose.

As Harper’s health minister, Ambrose often found herself fronting the party’s anti-legalization approach, including the “reefer madness” strategy of linking marijuana use to mental illness.

So an interview she gave in January to Vancouver radio station CKNW caused considerable confusion about her position.

“The bottom line is there’s a huge faction of people in this country that want — that are mostly adults, to be frank — that want access to pot and they want it legalized and it’s for recreational purposes.”

Ambrose then said she hoped the Liberals would push ahead faster to regulate storefront pot dispensaries that have sprung up around Vancouver.

“I hope the faster they move on this the better, because the proliferation of pot dispensaries is quite large, so it has moved now not just in Vancouver but across the country, and they’re unregulated. So the sooner they can move on that, the better to protect kids.”

Conservatives later explained that Ambrose was merely recognizing the inevitability of legalization, and encouraging the Liberals to get on with it. But government supporters jumped on what they saw as another Conservative post-election reversal.

“Health minister who spent millions of your $ on misleading ads against pot wants us to legalize faster,” tweeted Trudeau’s principal secretary Gerald Butts.

Will the vote be whipped?

It remains to be seen whether marijuana will become an issue in the Tory leadership race, or if members who dissent from the official party line will be able to express those views in Parliament.

Asked whether the party intends to allow a free vote when marijuana reform finally comes before the House, Ambrose’s director of communications Mike Storeshaw told CBC News no decision has been taken.

“Decisions on caucus positions for legislation aren’t made until there’s actually legislation to consider, and we don’t appear to be anywhere near that point yet.”

The Rise of Big Cannabis on Shaw TV

The Rise of Big Cannabis Symposium that I recently aired on Shaw TV in Saskatoon, Prince Albert, Moose Jaw and Swift Current stations.

The first airing was this weekend on March 19th @ 9:30pm

Other dates to follow:
March 21st – 11pm
March 23rd – 9:30pm
March 24th – 10pm
Bonus airing in Saskatoon on March 27th – 11pm