02 September 2013

Ian Gawler Blog: Cancer, Four Corners and hope

Anyone with advanced cancer who watched the recent Four Corners program Buying Time (ABC TV 26 8 13), could be forgiven for thinking they were in a pretty bleak position. For patients and families, as I suggest in the attached letter I sent to the Four Corners team, the message bordered on the hopeless.

The suggestion of Buying Time was clear – find a new drug, find a way to meet the incredible cost of the new drug – or die. No real mention of quality of life. No mention at all of other possibilities.

So this week we go way Out on a Limb and ask, why no options? Why no choices? Why does a great program like Four Corners focus on these new cancer drugs with their incredible price tags, multiple side effects and marginal benefits; and at the same time give the impression to the uninformed that there is nothing else on offer?

What do you think? What did you think of Buying Time? (Link below). What sort of program would you like to see? But first

Thought for the day

So long as you write what you wish to write,
That is all that matters;
And whether it matters for ages or only for hours,
Nobody can say.

        Virginia Woolf, A Room of One's Own

                                                                                        The daffodils are out in force - delightful!
Dear Four Corners
I have had the chance to speak or communicate in writing with quite a few people now who saw your program Buying Time and I feel it important to share the feedback and ask for your help.

The program did a good job of clarifying how the modern cancer drugs are offered as a new hope, yet cost vast amounts and produce incredibly modest gains at the additional price of serious side-effects.

I would love to be more positive, but I think you need to know a number of patients I spoke to turned the program off early into the story. Many others report feeling deeply despondent. Where was the hope?  In fact, for patients and families I suggest the message of Buying Time actually bordered on the hopeless. The suggestion was clear – find a new drug, find a way to meet the incredible cost of the new drug – or die. No real mention of quality of life. No mention at all of other possibilities.

Sure, what Buying Time did achieve was to accurately portray the modern cancer dilemma. Many new drugs are coming onto the market, often heralded with the words “significant new breakthrough” and building the hope of major benefits.

However, when the reality is examined, these drugs commonly improve survival times in terms of a few weeks; at best a few months. To achieve these modest gains, they have price tags that can run over $100,000 per person per year and they have even higher side-effect profiles than the old chemotherapeutic agents.

Obviously there is a limit to how many of these new, expensive drugs we the taxpayers can afford to fund. Already the real growth in healthcare spending over the last decade has gone up 5.3%, close to twice the average annual growth in GDP for that time of 3.1%.

As you now know, Yervoy, the new drug for people with advanced melanoma, adds 4 months to average survival times, has multiple side-effects and will cost the public purse up to $60 million dollars a year. Is this the best way to spend $60 million dollars? As a community, we are not very far away from needing to make difficult choices about how we spend our health dollars.

However, for people directly affected by cancer, the problem is more immediate, more dire. The program clearly portrayed these drugs as being out of reach financially and not very effective; yet people were still clinging to them anyway. What people affected by cancer need is realistic hope. They need genuine options. At the very least a good quality of life and a good quality of death. But more, they need to know that there are real possibilities available to them through things they can do for themselves.

In my opinion and from what I hear from others, this is where Four Corners failed. By focusing on the medical dilemma, the program omitted the imperative for modern cancer management to be more inclusive. A huge resource; an affordable, credible resource was overlooked.

There are constant reports in the media and the scientific literature of people surviving against the odds. At the same time, there is an impressive body of evidence for the quality of life and increased survival gains to be had through the application of nutrition therapeutically, through the generation of positive states of mind and the practice of meditation.

Lifestyle Medicine, the study and implementation of what people can do to help themselves, empowers the patient and their families. Lifestyle medicine offers the promise of dramatic improvements in quality of life – and the research establishes that it delivers on this promise. Lifestyle Medicine offers the prospect of significant increases in survival times – in a highly cost effective manner with almost no adverse side effects.

Maybe Lifestyle Medicine is complementary to the current mainstream cancer treatments. Synergistic. But what if the benefits of Lifestyle Medicine were actually more cost effective than these new high-powered cancer drugs?

What if as a community we had the basic common sense to push our cancer authorities to fund serious research to investigate this compelling question? Why not a three arm trial to compare one, the standard medical treatment with two, standard treatment plus the lifestyle options with 3, the lifestyle options on their own. If a super expensive, high side effect drug trial qualifies as being ethical, surely there is enough grounds to compare it to the cheap, almost side effect free lifestyle option. What does help a person with cancer the best?

I call on you all at Four Corners to prepare and screen the logical follow up to Buying Time. The public needs to know. What does the patient bring to cancer management? Why has mainstream oncology spent years blocking or even attacking the growing cancer self-help movement? When will researchers cast their nets wider and investigate the many, many stories of long-term survival? When will the patients and their families, the public and the doctors realise just how much lifestyle has to do with the successful management of cancer?

How many people do we need to watch suffer and die? How broke does the health budget need to become before Lifestyle Medicine is taken seriously?

As I said, I would like to have been able to be more positive about the program. It did open discussion around the cost/benefits of modern cancer drugs and that is a very good thing. The public needs to engage in the conversation around how the health budget is allocated. But as I mentioned to you when the decision was taken to drop lifestyle factors from the program, from the patient's perspective there was the risk of lowering hope, increasing despondency.

So now I look forward to when you are ready to do the next part of this story; the part that has the chance to be uplifting and foster evidence based hope as it focuses on the role and potentials of the patients and their families to contribute to their own health and wellbeing through the therapeutic application of Lifestyle Medicine.

Many people would offer to contribute to such a program. Many would welcome it. Many would be informed by it.

be well

Ian Gawler


Cancer, facts and fiction

Link to view Buying Time: CLICK HERE

The Gawler Foundation for Lifestyle Medicine information and programs

You Can Conquer Cancer - a comprehensive, integrated lifestyle based, self-help approach to cancer


Training/retreat for those interested in mind made healing – either for personal use or as a health professional.
With Dr Nimrod Sheinman, Ruth and myself in the Yarra Valley. Details: CLICK HERE

Ruth and I are leading our first meditation retreat in New Zealand in December at the beautiful Mana Retreat centre that has a similar high reputation for a good environment and great food as the Foundation. Details: CLICK HERE

Specifically for people who have attended a CanLive program in NZ, or Gawler Foundation program. November 18 – 22 at Wanaka out of Queenstown - one of the most beautiful environments there is. Details: CLICK HERE


               More daffies   

      A couple of early tulips 
      glistening in the sun


  1. Completely agree with your comments Ian. My husband and I both thought the Four Corners Programme raised very valid questions about the drugs and their cost versus benefits. But we both felt it was far from a balanced programme.
    Nothing was really mentioned on the (often long term) side effects. Nor was there any interviews with people who had chosen (like myself) not to start or continue with one of these new drugs, why we made those decisions and what we were doing instead.
    You are so right, there are other options available to us but so many people do not find out about them unless they know where to look or the right questions to ask. Kim A.

  2. For me it really made me realize just how cheap our telomere support product is and just how effective it is at 'Buying Time' when compared with the chemotherapeutic drugs discussed in the Four Corners report.

  3. Ian, Your letter hits the nail on the head!!
    More needs to be said in the public arena about a balanced view of ways to treat the cancer patient. In fact, the practice of Lifestyle Medicine is a preventative as well as a treatment of cancer and other ills.
    One can only hope that each one of us as individuals, can demonstrate through our living practices that this is the way to go!!
    Karen & Peter

  4. Hello Ian

    Thank you for your post on the Four Corners program.

    I was reluctant to watch the program as I am still deeply affected by my mother’s recent death due to pancreatic cancer - I knew the program would pull on some strings!
    I watched the program last night however and was blown away at what a bleak picture the program painted.

    I completely agree with you that it is a real shame the program did not look at complementary options and place more focus on quality of life, particularly where the disease is branded as terminal.

    I believe it is a mind-set across the majority of mainstream medicine that the only option for treatment of cancer is with harsh chemicals and drugs. And this way of thinking then flows down from the medical profession to the general public who become blinkered to any other possibilities including aiming to live a quality existence. And when a program such as Buying Time is aired it does nothing but cement this mind-set even further.

    The key is to shift this mind-set, starting from within the medical profession. Medical professionals need to be encouraged to also discuss lifestyle options with their patients and put a larger focus on living a quality life. There is no reason why medical professionals cannot also discuss with their patients things such as healthy eating, meditation, spending more time with loved ones and focus on quality. Let’s put some of the $60 million into helping medical professionals facilitate these discussions!

    Although my mum tried chemo she also embarked on many lifestyle changes including adjusting her diet, incorporating meditation into her daily routine, learning to be gracious and accept the things she could not control, and spending more time with her beloved family and friends. I can attest that these changes, although none of them encouraged by her medical oncologist or anyone else she encountered in the medical profession, made mum’s last 9 months of life probably the most fulfilling years of her 62 years of existence.

    Let’s hope that Four Corners produces another program soon, looking at the benefits of incorporating complementary options into treatment regimes for cancer. This would be a small step towards shifting the current mind-set about treatment options.


  5. Hi Ian, I so agree with the comments in your letter to Four Corners. I watched the program and was dismayed by the cost and horror of medical treatments for cancer. I am hoping that Four Corners will broaden their scope and look at the self-health revolution that's happening at the grassroots level all over the world.

  6. Good letter, Ian. I agree there needs to be more emphasis on what other things people can do, and on quality of life.

  7. Hi Ian,
    Yes I agree it certainly put me off. The program offered nothing but drugs or depression! I felt like one should just give up if the drug doesn't work. It's high time for more open media and also trials on the complementary/alternative/supportive options that are available to all.
    So glad I didn't go down the drug route.

  8. it was indeed a very difficult program to watch - dark, depressing, it felt fearful and desperate - promting a response of "I hope that never happens to me " - cancer = mega fear - I agree Ian so much more could be done to draw a much bigger picture around the issues and the cost effectiveness of lifestyle medicine is obvious -it makes me wonder why mainstream medical professionals want to have such a strong hold on such a dark world and appear to not really want to let any light in (what is the threat to them ???) - I noted with interest that Professor Ian Haines was a major interviewee in the program and that he had collaborated with Professor Lowenthall in the push to have the diagnosis of your secondary cancer discredited and disproved - did this have something to do with the final edit ????

  9. Yes, I was very depressed after seeing the program. I have tried all other "complementary" remedies - but find I have had to resort to chemo - again. The oncologist continually tells me I am wasting time and money on these othere remedies. Well, if that's all the medical profession can come up with - I'll keep trying the alternative "cures".What about putting some of the bilions raised for "Cancer research" into complementary cures.
    Denise Lieven

  10. Well done Ian! A wonderful article and oh so needed. Tragically, there is a social hypnosis when cancer treatment is discussed. It is blind faith misplaced. Lifestyle medicine IS the way but will never become mainstram because it is too cost-effective and therefore not profitable for the medico-pharma alliance.

    Cancer is now an industry in and of itself, and as such more people make a living out of it than who die from it.

  11. I agree with many of the comments. It was also interesting to note the portrayal of Dr Haines as The Great Rescuer, he of the stethoscope continually wrapped around his neck (was this just in case patients forgot he was a doctor? C'mon!). The other point to note is how patients are pressured (by fear & by the system), to hand over their hope, power and ability to heal to the Great-Doctor-who-will-try-to-fix-you. Maybe an examination of the egos of the medicos involved is also in order.