Ian Gawler Blog: Twenty years and what has changed?

What if you were to read something, thought it to be from current time, and then found out it was 20 years old? I have to confess with being a little down-hearted with the place of the “patient” in current cancer management. And the slow pace of progress.

I had occasion to re-read a piece I wrote for the Australian Doctor (the main newsletter of GPs in Australia) 20 years ago - in 1993. As far as I can tell, there is only one significantly different detail after all these years. See if you can spot it!

But first

Thought for the Day
“Science progresses not because scientists change their minds,
but rather because scientists attached to erroneous views die,
and are replaced”
                                Dr. Otto Warburg, Nobel Prize winner in medicine in 1931,
                                    quoting from Dr. Max Planck, originator of quantum theory, 1858~1947

Cancer patients find strength in self-help approach. Ian Gawler

Quoted from the Australian Doctor, 3rd September, 1993.

How can doctors best help people affected by cancer? How much can cancer patients do to help themselves? What should they avoid and what reasonable options are open to them? What should you recommend?

If a new anti-cancer drug was shown to double the lifespan of women with advanced breast cancer, would it be negligent not to recommend it?

The Lancet in 1989 reported Spiegel’s (1) well designed, widely acclaimed study that proved that attending a support group once a week for a year doubled such women’s survival time, so how can it be ignored?

People affected by cancer can be helped to learn how to become long-term survivors. Many are missing out on this opportunity.

As a veterinarian and a recovered cancer patient I have spent the past 12 years conducting cancer support groups. During this time more than 10,000 people have attended the weekly and residential programs that my wife Grace and I founded and continue to develop at the Gawler Foundation in rural Victoria.

We never say we can cure cancer. Our self-help program’s stated intention has been to help cancer affected people improve their quality of life and contribute wherever possible to their own survival. People learn to live well and to die well.

The self-help approach augments conventional therapies and, at the very least, plays a vital role in meeting the human needs of patients.

There is a widespread feeling that doctors need to attend better to the psychological and spiritual needs of their patients(2). We have a system that has been doing this effectively for more than 12 years and happily share it.

When we began our work in 1981, this whole area was unexplored. Now support groups are coming into most cancer hospitals and patients are seeking the self-help options.

Our approach is to encourage cooperation and communication between doctors and patients. Best results are obtained when doctors work with patients and their families in partnership.

The patient has the right to remain at the head of this partnership. They also have the right to give away this authority away if they choose. A doctor does not have the right to assume this authority without the patient’s conscious permission.

Similarly, people affected by cancer have the right to informed debate and choice. We do not recommend unproved remedies. We are convinced the community is best served by reasoned debate.

Many patients feel that elements of the medical profession – more often specialists than GPs – are inordinately biased against innovative or alternative therapies.

The furious and often emotional debate over vitamin C is a great example. While many patients report its benefits, the debate rages(3) .

The Foundation’s aim is to provide information that is available in a balanced way, encouraging individuals to take responsibility for their own decisions.

The crucial question is: why do some patients recover when others with the same illness do not? I am confident that this is more than just good luck. It is what I am most interested in studying and what new patients are interested to learn about.

We can learn from successful patients, just as we would learn from successful sporting or business people.

My own history, which is often misquoted, offers an example of the complex history of a long-term survivor.

In 1975, as a young veterinarian, and athlete, aged 24, I had my right leg amputated because of osteogenic sarcoma.

Later that year, inoperable secondaries were confirmed in the right inguinal and mediastinal lymph nodes. In those days, I was told available chemotherapies were of no value and radiotherapy would be palliative at best. The prognosis of 3-6 months was considered reasonable.

I turned to diet and meditation.

Importantly, my wife fully supported my view that cancer could involve a failure of my body’s immune system. If we could find a way to re-activate it perhaps I could recover.
We initially followed the Gerson diet(4) . This was exceedingly rigorous and created many problems.

These days, we advise against using the Gerson diet as it is far too demanding in a home setting. However, I do believe it has enough merit to warrant serious study.

I feel sure that nutritional factors helped me a great deal. Many patients report the positive benefits associated with changing their diet.

There is a good body of evidence to indicate that nutrition can alter the outcome of cancer. Numerous animal studies confirm the proposition, but studies in humans have been more limited.

I also began meditation with Dr Ainslie Meares. Dr Meares believed that prolonged meditation could reduce cortisol levels, improve immune function and so lead to recovery(5).

For that first 3 months my tumours remained static. Then severe sciatic pain forced me to try acupuncture (2 treatments only), then palliative radiotherapy, (3 treatments to my lower lumbar region only). The pain continued to be severe but was then relieved by injections of a mistletoe extract administered by a GP interested in natural therapies.

By March 1976, I was suffering severe weight loss (though 1.8m I weighed 54 kg), jaundice, night sweats and hydronephrosis of the right kidney (on IVP). The pain was again severe.
At this point my surgeon considered my prognosis to be a couple of weeks.

My wife and I then left for 4 weeks with faith healers in the Philippines. This was a truly extraordinary experience which challenged all my preconceptions and experience of surgery.

Importantly I came home 6 kg heavier, with no pain and feeling “I had turned the corner”.
In the next 6 months, while my general health improved, the cancer itself continued to spread and grow. I maintained the modified diet and meditation while my wife did many hours of massage for me. We also investigated many natural therapies.

By late 1976 I had massive secondaries on my sternum, my left lung, lumbar spine, mediastinal and inguinal lymph nodes. Remarkably, I was free of pain and otherwise unaffected by this widespread cancer. However, I reconsidered the medical options.

I was offered experimental chemotherapy based on “Adriamycin”, Vincristine and methotrexate.

I completed the first round of this protocol in 2 and a half months but there was little change in my tumour sizes. I then elected to cease treatment despite warnings of a rapid rebound.

We returned to the Philippines for 3 months, travelling then to India. In May 1977, the holy man Sai Baba told me: “ You are already cured, don’t worry”.

This was another major turning point, as it helped me to dispel doubts and be fully confident of recover.

I had no more medical treatment but continued, fully committed, to the self-help regimen as described.

By June 1978 all visible lesions had subsided. Tests in Adelaide confirmed that there was no evidence of active cancer, but I did have TB.

I responded rapidly to standard TB treatment, and my case was reported by Meares(6).

Grace and I moved to Yarra Junction, Victoria in 1980. We have had 4 children since chemotherapy.

Obviously this is a complex history. I am often asked what cured me, and I reply that it was a combined result.

I have no doubt that the medical treatment on its own would have been unsuccessful. My recovery demanded a great deal of effort from both myself and my wife.

In 1981, my wife and I began an innovative cancer support-group based on our experiences. At that time little was being offered to people affected by cancer who wanted to help themselves. Patients were being left to fend for themselves. Hope was often denied and the myth of cancer as a death sentence prevailed.

We were keen to redress these painful problems and felt we had something important to offer. The main ingredients of our approach were (and still are) good nutrition, developing a positive state of mind, meditation, and mutual support.
Our patient-based programs gained wide interest.

In 1983 we founded the non-profit non-denominational charitable organization The Gawler Foundation to extend this work and left our veterinary practice.

 In 1984 I detailed our approach in You Can Conquer Cancer(7).  The book was launched by Sir Edward “Weary” Dunlop who remained a strong supporter of our work.

In the same year, being keen on scientific evaluation, I unsuccessfully approached the Peter McCallum Cancer Institute in Melbourne and the Victorian Anti-Cancer Council for help with research. Like many self-help groups, our resources were limited and we could get no outside assistance at that time.

In 1987, we began developing our own extensive in house database with a view to follow-up research, In the same year I was awarded the Order of Australia Medal for services to the community and published a detailed account of our meditation and positive thinking methods in Peace of Mind(8).

In 1988 on the ABC Couchman across Australia, Professor Ray Lowenthal challenged us to present our fifty best cases for assessment. We readily agreed, but the proposal lapsed when Professor Lowenthal was unable to secure funding for the research from The Australian Cancer Foundation.

We are now cooperating on research projects with Monash and Deakin Universities, have helped fund a major study with the Royal Melbourne Institute of Technology and continue with our own in-house research projects.

We welcome medical visitors to our programs and many have attended as patients, partners or observers. These people see what can be accomplished.

Remarkable transformations occur when people attend an active cancer support group. We focus first on living well and peace of mind. The hope, energy and vitality in our groups is truly amazing and quite inspiring.

People learn to communicate, to balance their lives, to clarify their goals and to work effectively towards them.

We use strategies in our programs to help people avoid guilt and find the peace of mind that is the focus of our work.

Many doctors, often unintentionally, place potentially damaging pressures on patients and, importantly, on their partners and families. We experience this often when people complain that their self-help efforts receive no support from their doctors or, worse, are attacked by them. They feel misunderstood, unsupported and alienated.

If doctors are noticing negative feelings being directed towards them by their patients, it is often because they do not listen. They would do well to sit and take an interest in them as people.

This is another key ingredient to a successful support system. We provide the time to speak and to be listened to.

Spiegel’s study shows meditation and a positive attitude help patients cope with the consequences of their disease. Doubling the lifespan by attending a support group is a powerful effect.

A good summary of the mass of literature on this subject is in The Psyche and Cancer(9).

After a 10 year study of women with breast cancer, Pettingale (10) found survival was best predicted by the patient’s attitude.

After a 7 year study, Levy(11)  found cancer survival time was best predicted by the expression of joy at baseline testing.

On the basis of psychological interviews before biopsy, Wirshing(12)  was able to predict accurately when women’s breast lumps would be proved to be benign or malignant.

Ramirez(13)  found life-threatening events were significantly associated with recurrences of breast cancers.

Another excellent series of review articles is contained in the report “Can psychological therapy improve the quality of life of patients with cancer?”(14)

In another controlled prospective study, Fawzy(15)  reported on 6 weeks of structured group intervention for patients with malignant melanoma. Distress decreased, coping increased, and, significantly 6 months later, immune function was measurably enhanced.

Professor Lowenthal says that in my book You Can Conquer Cancer I do not provide evidence for the claim that cancer patients have a typical psychological profile and are unable to cope with stress appropriately. But the cancer personality is widely recognised by many patients and scientists. (16, 17)  It certainly warrants further major study.

Professor Lowenthal says that “ taken overall science has made only a modest impact on the problem of cancer…Even where effective treatments can be offered, to many patients the potential side-effects of surgery, radiotherapy, and chemotherapy are perceived as unacceptable relative to their possible benefits.” He says doctors should “offer cure in some cases, comfort in all”.

Clearly patients being recommended orthodox treatments need more psychological support to cope with both the disease and the treatment.

The argument would seem to be about how to provide comfort effectively. There is a need to investigate new areas and techniques for solutions to cancer.

Hope is the starting point and it needs to be backed by effective techniques.

A normal progression in science is for observation to precede evidence. Having recovered personally from such a critical condition, having observed our techniques transform the lives of so many others and being aware of the bulk of recent supportive, scientific evidence, my wife and I know that our self-help approach has a lot to offer.

Many doctors do encourage their patients to include self-help techniques as part of their healing equation. We believe good doctors always have done so, and hope more doctors will have the confidence to support patients and families effectively in these self-help efforts.

References

1. Spiegel et al, The Lancet, 1989, ii:888-91.
2. Lowenthal R M, The Medical Journal of Australia, 1989, 151:710-15.
3. Pauling & Moerte. Special Report, Nutrition Reviews, 1986, 44:1, 28-31
4. Gerson, M. A Cancer Therapy – results of 50 cases, The Gerson Institute, Bonita, 1958.
5. Meares, A. The Medical Journal of Australia, 1983, June, 583-84.
6. Meares, A. The Medical Journal of Australia, 1978, 2:433.
7. Gawler, I. You Can Conquer Cancer, Hill of Content, Melbourne, 1984.
8. Gawler, I. Peace of Mind, Hill of Content, Melbourne, 1987.
9. Kune, GA and Bannerman, S. The Psyche and Cancer, University of Melbourne, 1992.
10. Pettingale et al. The Lancet, 1985, 1:750-751.
11. Levy et al. Psychosomatic Medicine, 1988, 50:520-28.
12. Wirshing et al. Journal of Psychosomatic Research, 1982, 26:1-10.
13. Ramirez et al. British Medical Journal, 1989, 291-293.
14. Greer, S. British Medical Journal, 1989, 59:149-51.
15. Fawzy et al. Archives of General Psychiatry, 1990, 47:729-35.
16. Bagenal et al. The Lancet, 1990, 336:606-10.
17. Bagenal et al. The Lancet, 1990, 336:1186-88.


Lovingly typed by my wife Ruth Gawler.

So there it is. After 20 years one thing has changed but not much else. Maybe there is more research to quote. Maybe the community is keen for a more Integrated approach to the management of cancer. Maybe there are more groups, more centres offering some form of self-help program; but I suggest I could have submitted this same article to the Australian Doctor last week and they would have taken it to be reasonably fresh. What do you think? Any comments?

So in the next few weeks I plan a series of posts to examine what is going on in oncology, and what is the place of the patient in the management of cancer. Next week, Surviving Cancer - a tribute to the long term survivors and a feature to mark the inspiring event coming to melbourne on March 5th - see below.

RELATED BLOGS
Recovery from cancer is possible

RESOURCES
You Can Conquer Cancer. Fully revised/re-written edition now in the bookshops or available on-line from the Gawler Foundation.

NEWS

1. Surviving Cancer
Hear, learn and be inspired as four remarkable cancer survivors share their stories and insights

Date: Tuesday 5th March. Light supper and book signing from 6.30pm; 7 – 8.30pm

Venue: St Michaels on Collins, 120 Collins St, Melbourne

Cost: $20, with concession for Health care cards and students $15

Enquiries: St Michaels: 03 96545120

Bookings: Not necessary; pay at the door on the night

All proceeds from the evening will support the work of The Gawler Foundation.

To download the flier, click here

2. Meditation in the Forest: Yarra Junction; March 22nd - 28th, 2013
Ready to join Ruth and myself, take some time out and experience deep natural peace - amidst the majestic forests of the Upper Yarra Valley.

This retreat will take you deep into the essence of meditation - the direct experience. As well as being restful and regenerative, in this retreat I will be introducing and guiding a structured series of breathing exercises that enhance concentration, deepen meditation and facilitate healing and wellbeing. There are only a couple of places left.

For details and to book, click here

Ian-Gawler's-cancer-diagnosis : If it looks like a duck…

There are 11 strong pieces of evidence that confirm I had secondary cancer complicated later by TB. So this raises a good question - how many pieces of evidence do you need to tell the difference between a duck and a dog?  I would have thought the old saying holds, so first

Thought for the day
       If it looks like a duck
      Swims like a duck
      And quacks like a duck
      Then probably it is a duck
                                      James Riley

PLEASE NOTE : This post was updated 22 April 2014 when a further key piece of evidence came to light - taking the original number of pieces of evidence quoted in the piece from 10 to 11. The new piece is number 11 below.

This then is a call to action. The Age newspaper has revealed that the Gawler Foundation has suffered a major drop-off in attendances at its cancer programs this last few months. Linking the downturn to the financial crisis, there is the imputation that it has also been related to the hypothesis raised by doctors Haines and Lowenthal that I did not have secondary cancer, but only TB and their suggestion that my “famous recovery” was not from cancer.

This extraordinary claim was made despite the doctors not consulting my original treating doctors or my original records which were extensive and conclusively prove the fact that I did have the secondary cancer.

In this latest article, Chris Johnston of the Age chose to ignore six compelling new pieces of evidence that have come to light confirming that I was diagnosed with secondary cancer followed by the complication of tuberculosis (TB).

This new evidence came out of a rigorous review of my case by Dr Jonathan A. Streeton, a recognized senior authority on TB and my Chest Physician for over 30 years. The new evidence, collated in a letter from Dr Streeton, includes clinical references, histology, pathology and photography. This adds to the existing evidence and brings to ten the individual points that confirm the original diagnosis.

Unfortunately, Dr Streeton has chosen to neither speak to the media or to publish his conclusions in the journal where the original hypothesis was published – the Internal Medicine Journal. He tells me this is because he does not want to discuss a patient's details in public or become involved in a public controversy. Disappointing! However, he has given permission for me to use the letter, so I summarize the findings below and am happy to share it with anyone who requests it - you can do this via info@insighthealth.com.au.

This new evidence adds to the details confirming the basis of the secondary cancer already published in the IMJ, and was published in letters to the IMJ by Ruth and myself - see the related blog below.

In the light of this new evidence, I call on Haines and Lowenthal to publically concede their hypothesis was incorrect. There is a need to put the record straight. If they are interested in the truth of this matter, they need to respond. 

Why is this new evidence so significant? Well, thirty six years after I was originally diagnosed with secondary osteo-genic sarcoma (bone cancer) in 1975, the oncologists Haines and Lowenthal published an hypothesis that I may have been misdiagnosed. They speculated that my symptoms may have been explained by TB alone, and that maybe I never had secondary cancer.

They then implied my “famous recovery” was in question and somehow this was extended to question the validity of the lifestyle-based self-help cancer programs I have conducted for over 30 years. This suggestion concerns me deeply as whatever the intention of Haines and Lowenthal, the effect has been confusing and damaging. The controversy surrounding their hypothesis and the resulting publicity may result in some needy cancer patients and their families being led away from valid lifestyle- based, self-help and support options being offered by many good practitioners and organisations.

THE NEW EVIDENCE

1. X Rays of the spine were specifically diagnostic for cancer, not TB.
An X Ray from my spine from 16/1/1978 shows marked destruction of the body of the 4th lumbar vertebrae with the intervertebral spaces well preserved. This finding is almost unheard of for TB. In Streeton’s words, this “would tend to be a specific excluder of a tuberculous process involving the lumbar vertebrae… as tuberculous infection would normally involve the intervertebral discs in the first instance”.

2. No psoas abscess
Streeton points out that TB in the lumbar vertebrae normally evolves into what is called a psoas abscess that commonly leads to an open discharge via the groin. Despite large masses being involved in my case, there was no such abscess and no discharge.

3. The strain of TB that I contracted indicates I almost certainly contracted TB well after the secondary cancer diagnosis.

Streeton was able to obtain my medical records from the South Australian Government’s Adelaide chest clinic where I was treated for TB in 1978. These records confirm the strain of TB that I contracted was resistant to the TB drug, Isoniazid. Such drug resistance was uncommon in Australia at that time, almost unheard of; whereas drug resistance was the usual in the Philippines and other parts of Asia at that time.

I had never been outside Australia prior to developing secondary cancer late in 1975, but did travel to the Philippines in March of 1976 and again after chemotherapy later that year. I have always believed it most likely that I contracted the TB in the Philippines, probably on the second visit.

4. Key photographs have dates printed on them and further prove a response occurred with chemotherapy. This makes sense for cancer, but not TB.

While the photographic evidence in my case is crucial, it has been debated. Here is why. In October 1976 I underwent chemotherapy for my cancer for 10 weeks. If I had had just TB not cancer, there is no rationale to explain how the visible masses on my chest could diminish in size. If I had had cancer, it would make sense.

Perhaps because of my veterinary training, I am a keen documenter. So I had my chest photographed before commencing chemotherapy and took serial photographs each month until the lesions had disappeared in April 1978.

Being fairly spectacular, those initial photographs, along with the “all clear” photos, have been reproduced widely in the medical and popular press. Unfortunately, early on the initial photos were miss-labeled as being from October 1977 – well after I had chemotherapy. Without checking with me, Haines and Lowenthal used the incorrect date to assert that the chemotherapy had not impacted on the course of my disease and claimed this indicated it was TB not cancer.

However, as well as having the original photo album with the full sequence of photos and their dates recorded, only recently I discovered the photos actually have Kodak dates printed on their reverse. These dates confirm the correct timelines and show there was some reduction in size of the cancer in response to the chemotherapy.

This response had also been confirmed in two letters I retained from the oncologist involved at the time, Dr Ivon Burns. On 13 August 1976 Burns writes, ‘the masses on the anterior aspect of the chest wall have increased in size’ and on 2 September 1976, ‘it measures 14 cm in diameter’. Then on 16 December 1976, he states that ‘the mass on his chest wall has decreased in size from 13cm ¥ 13cm to 10cm ¥ 10 cm’.

5. Histology of bone spicules coughed up from my chest support the cancer diagnosis.
At the height of my illness I coughed up many small spicules of bone from my chest. These have been examined recently and the histology of these bone spicules, while not definitive, does clearly support the cancer diagnosis.


The report states “the appearance are those (of) modified osteoid fragments and would be in keeping with the clinical history (of osteo-genic cancer), however, due to the obscured nuclear details of the lining cells, the histopathology findings are equivocal”.

6. A review of the numerous X Rays states that they are “typical of cancer” not TB.
The initial radiology reports regarding my case clearly confirmed secondary cancer (metastases). This is a direct quote from the first report: “Mottled calcified areas of varying size from 1.5 to 3 cms in diameter are demonstrated overlying the right sacroiliac region, the appearances of which are those of glandular metastases”.

However, recently Streeton had all of my available X Rays re-examined with expert radiologists and states “I reviewed these films with my radiology colleagues here at the Mercy Private and the general consensus was that these are typical of an evolving osteogenic sarcoma metastasis”. There was no support for the TB only hypothesis.

These six new findings strengthen the four separate pieces of evidence already in the public domain and together provide an overwhelming confirmation of the original diagnosis of secondary cancer later complicated by infection with TB, and clearly refute Haines and Lowenthal’s hypothesis that I only had TB.

THE PRE-EXISTING EVIDENCE:

7. The clinical picture. Eight independent specialists all confirmed the diagnosis of secondary cancer followed by TB.

Eight medical specialists investigated my case with a view to treating me. All examined me and my records thoroughly and ordered whatever diagnostic tests they considered necessary; all of which I complied with.

The specialists were Mr John Doyle, surgeon with cancer expertise; Dr Robin Kerr, radiotherapist at Peter MacCallum Cancer Hospital; Dr Ivon Burns, oncologist at St Vincent’s Private; A Gold coast doctor whose name has been lost, but the X Rays he ordered remain; Dr Alastair Robertson, oncologist with TB experience; Dr Rosemary Walker, head of the TB clinic in Adelaide; Dr Jonathon Streeton, chest physician and TB authority; Prof Peter Clarke, chest surgeon with TB expertise and experience.

All of these experts investigated my case thoroughly and none suspected my symptoms could be explained by TB alone. All confirmed the initial diagnosis of secondary osteo-genic sarcoma, bone cancer.

8. The visible chest masses looked nothing like TB, acted nothing like TB and were fully consistent with a cancer diagnosis.

Streeton comments on these “numerous chest wall masses which appear to be metastatic disease, and certainly quite unlike anything which would be seen in a generalized systemic (and invariably fatal) case of tuberculosis infection”.

9. Chemotherapy did reduce the size of the tumours, as might be expected with cancer and not TB: and also, did not kill me as might be expected if I had TB.

The evidence that supports that the chemotherapy did reduce the visible tumour masses has already been reviewed.

Of equal significance, it is known that the combination of chemotherapeutic agents I was treated with is highly immune-suppressive. As a consequence, even modest exposure to colds or scratches could result in massive, often fatal infections.

If my condition had involved only TB, the chemotherapy could be expected to have at least created these side-effects, but it was more likely, to have killed me. In fact, I suffered few side-effects, the lesions diminished and I have always acknowledged that the chemotherapy I received did play some part in my holistic recovery.

10. Histology on bone removed from my lung is consistent with cancer not TB
No biopsy was performed at the time of the initial diagnosis of secondary cancer for two reasons. Firstly, the clinical picture, the X Rays and other tests so clearly confirmed the cancer, none was deemed necessary. Secondly, a biopsy of the lesions I was initially diagnosed with would have necessitated an unwarranted general anaesthetic and significant surgery in my abdomen or chest.

However, in 2004, my left lung was removed subsequent to complications created by the TB. A large piece of bone was evident within this lung.

TB can lead to calcification, but not the formation of bone. As Streeton said “one gets calcification from TB, but nothing remotely of the appearances of your calcification”.

Further, the histological report on the lung reports extensively on the TB lesions in other sections of the lung. Then, commenting on the histology of the bone removed from my lung, it states “the latter appearance in particular is recognized as a change which may occur in osteosarcoma after chemotherapy”. There is no suggestion this bone could have had anything to do with the TB that was so evident throughout the rest of the lung. Clearly, both conditions existed.

11. When treatment for TB commenced, all visible masses had already resolved
Haines and Lowenthal claimed that the TB treatment cured my condition. However, photographs with the dates from Kodak on their reverse establish that all the visible lesions on my chest had fully resolved before the TB treatment commenced in July 1978.

This is a very powerful, very clear piece of evidence that the Haines and Lowenthal hypothesis is incorrect, yet no one thought to put this together until now. ( April 2014)

How could a treatment cure something that was not there? What I have always maintained - and the evidence confirms - is that I had the 2 conditions - secondary cancer and TB. The cancer was located in various places around my body, most visibly on my sternum (or chest). The TB had infected my chest and initially was not diagnosed given the very obvious presence of the cancer. It was only when the cancer had resolved (which included all the cancer masses on my chest and in my chest disappearing) that the TB became evident within my chest.

So back to the duck. 
Eleven major pieces of evidence are difficult to dismiss. Most reasonable people would conclude eleven was more than enough to differentiate a duck from a dog.

So again, while I appreciate it is not an easy thing to do, I respectfully call on Haines and Lowenthal to publicly concede their hypothesis was incorrect and to put the record straight.

What to do 

Consider a letter to the Age. You could write to a letter to the editor: letters@theage.com.au, or directly to the journalist Chris Johnston at cjohnston@fairfaxmedia.com.au. A letter of support to the Foundation: info@gawler.org. Those of us that know the work at the Foundation know how valuable it is and this is a time to support its existence and good work.

RELATED BLOGS

Nobody expects the Spanish Inquisition

The Age gives me a voice

TB or not TB – The Age gives me a voice

After another article printed in The Age Monday 16th debating whether I did or did not have secondary cancer, or whether it actually was TB all along, happily they accepted and printed my reply as an Opinion piece. Here is the link. They called it "Article an insult to doctors who diagnosed my cancer'.

But there is more! I am being interviewed again today for another feature on the story scheduled for the Saturday Age. It is amazing how much interest this is generating.

This is a good time to be sending letters to the editor as they are taken seriously and can help to inform opinion. Also, maybe this is a good link to share with your friends on Facebook and Twitter - if you are on it!

This is an extra blog for this week; scroll down if you have not already seen the main blog that explains why you may be paid to meditate.

Also, I have added with permission a comment that seems to warrant wider readership than maybe just in the Comment section:


I recently saw the report on ACA featuring cancer survivor and integrative medicine advocate, Ian Gawler and a Dr Lowenthal, an oncologist.

I have to say that I am dismayed and appalled at, as I understand it, the apparent lack of acceptance by too many allopathic practitioners of all that cancer patients can do for themselves beyond allopathic medicine.

When I was diagnosed over 3 years ago with systemic metastatic renal cell carcinoma, I felt very much in an information vacuum. Treatment options open to me included neither surgery nor radiotherapy, and whilst chemotherapy had in the past shown mediocre success with mRCC, a relatively new drug, Sutent, albeit with unrelentingly unpleasant side effects, was showing promise. The options are few, and 'unfriendly'.

Oncology offered me at that difficult time no advice of integrative therapies, of the importance of taking control, emotional health optimization (especially combating fear and demystifying cancer), the importance of relaxation techniques, meditation, healing visualization/imagery, exercise and breathing, spiritual connection, vegetarian & optimization of diet (beyond a 'balanced' one - whatever that is??), nutritional juicing, eradication of toxins (dietary and emotional), consultations with empathetic 'holistic' GPs, positive hope (in recognition of the real evidence of many thousands of 'spontaneous' remissions of diverse cancer types and stages within Australia and around the world), and the valuable literature and audio bank out there describing how greatly cancer patients can assist themselves! I had to find that out myself over the past 3+ years.

I began my quest with Ian Gawler's program and follow it to this day, plus some refinement appropriate to my personal circumstances. Suggesting that Ian Gawler's recovery was due to fringe procedures such as coffee enemas and psychic surgery is like saying Easter is actually about chocolate eggs and Christmas is about Santa - it completely misrepresents the true story.

I cannot fathom the purpose of detractors of integrative treatment models. Bolstering public faith in traditional allopathic medical treatments? Pointless, unless cancer patients are voluntarily opting out, which, since options are limited and their hopes are sky high, would not be so. Dismantling 'false hope'? No such thing. So why deny cancer sufferers tentatively hopeful confidence invested in an integrative treatment model, and benefits that may derive from it. Why discredit Gawler's vital work and its proven benefits, and, thereby, that of others like him (witness the books, 'Surviving Cancer - Inspiring Stories of Hope and Healing'; 'You Can Conquer Cancer'; 'You Can Beat The Odds'; 'Living Simply with Cancer'; 'Life, Happiness and Cancer' and many other survivors' accounts - in which the common theme is patient willpower, control, determination, open-mindedness, and, ultimately, success!). Allow us the hope, if not of complete remission, if not of tumour regression, if not even of stability, at least allow us the hope of the human spirit in trying!

Neither oncology, not its allopathic god, indeed nobody, yet has a cogent answer for the occurrence of so-called 'spontaneous' remissions. That traditional allopathic medicine could be still so rigidly shackled to its marvellous yet limited science, and allow absolutely nothing beyond it (actually, I suspect many allopathic practitioners are swaying toward integrative mind-body wisdom) including by cancer patients themselves, is more than, as Gawler said in the ACA report, 'disappointing', it, in my opinion, is disturbingly myopic. Certainly, it is terribly disheartening to vulnerable cancer sufferers needing to, with great hope, courage and determination, put all options, allopathic and otherwise, 'on the table' for intelligent scrutiny. Easily accessible patient information is vital.

Cancer treatment, it seems to me, needs to go beyond the current traditional linear model of assessment–diagnosis–treatment–outcome. A more collaboratively linear/lateral approach, embracing integrative treatment strategies would actually support conventional treatment models and, more importantly, would markedly benefit patients.

Nobody expects the Spanish Inquisition

For the Monty Python fans, remember their skits where in daily life situations the Grand Inquisitor would dramatically sweep onto the scene while the soundtrack trumpeted “Nobody expects the Spanish Inquisition”?

It was the scene that came to mind when one of the most surprising propositions of my life was put to me recently. At first the suggestion seemed laughable.

“Would you like to put your name to a scientific paper with me that will claim you never had cancer and that what you really recovered from so famously was widespread TB?”

Think about this. How would you respond if what you believed in deeply were to be questioned? Would you simply dismiss it? Would you investigate, or would you attack it? Maybe just stay silent and let it all blow over? Or observe who else may like to take up the argument?

This is the situation I found myself faced with back in March 2011 when Associate Prof. Ian Haines put the suggestion to me that I never had secondary cancer. I feel some explanation to my readers is warranted, and have submitted an edited version of this piece to The Age as an Opinion Piece.

Haines had approached me as a friend. He had spoken at a Gawler Foundation Conference, we had worked on other projects together; he had even been in charge of treating my father who had died of bowel cancer.

But then to confuse the matter further, the article was already written and the co-author was Prof. Ray Lowenthal, a long-term critic of my work. What to do?

In my experience, the mind is like a parachute; it works best when it is open. I have always had a deep commitment to seeking the truth and to responding to the best evidence available. There was no choice.

I checked with all my original doctors. All were confident all the necessary tests had been performed to confirm the clinical signs that the boney masses that appeared around my body were secondary cancer and not TB. A biopsy was not included in these tests as it was deemed unnecessary and to biopsy a bone cancer can necessitate a surgical procedure under general anaesthetic (as it did for my original diagnosis).

All my specialists confirmed I had both secondary cancer and TB. Two had expertise with TB. Dr. Alistair Robertson said
“I certainly do not think that it is at all likely that you just had TB”.
Dr. Jonathan Streeton said
“One gets calcification from TB, but nothing remotely of the appearances of your calcification”.

Furthermore, in 2004 my left lung was surgically removed due to damage caused by the TB and the cancer. The lung contained a large boney mass and the examining pathologist reported its histology was consistent with “osteosarcoma after chemotherapy”. There was no suggestion that this cancellous bone could be from TB, just cancer.

Another crucial point is that I did have a course of heavy chemotherapy after the secondaries were diagnosed. Such treatments are well known to severely depress immune function, thus making even minor infections potentially life-threatening. If I did actually only have widespread TB, not only would my oncologist Dr. Ivon Burns have been negligent, but the chemotherapy would have killed me.

So, for Haines and Lowenthal to contend “unequivocal evidence that the patient was cured of widespread metastases is lacking” insults the doctors who established my diagnosis. The article was not based on speaking with the treating physicians or examining the large number of X rays and pathology reports. In my view their theoretical speculation is scientifically sloppy and mischievous.

It attacks me personally and they clearly aim to imply that if my case history was invalid then my work is invalid. In my view this makes their article dangerous, as it could lead vulnerable and needy cancer patients away from self-help measures that could improve their quality of life and their chances of survival.

So, I said “no” to Haines and the Medical Journal of Australia refused to accept it without my permission. However, Haines and Lowenthal went ahead and published it (against my expressed wish) in the Internal Medicine Journal, which must have different standards.

And then came the front page of The Age and a few other newspapers. Last time I was on the front page of The Age was in 1981, 30 years ago when it announced my plan to start the first Melbourne Cancer Support Group.

What has changed since? A paradigm is a particular way of thinking about a subject. It is common to accept things that reinforce and to reject everything that conflicts with our point of view.

What would you do if you were a cancer specialist who had an experience that did not match your paradigm?

I know that for me one of the biggest obstacles I needed to overcome to recover was my Veterinary training and the belief that secondary osteogenic sarcoma, the bone cancer I had was uniformly and rapidly fatal.

But what if you were a busy oncologist and somebody did do just that; recover from advanced secondary bone cancer? Would you dismiss it? Would you investigate? Would you attack?

I have been attacked quite a deal over the past 30 years.

Of course I believe in good diagnosis. Of course I believe in appropriate medical treatment. Of course I believe that people can influence their own wellbeing and the course of their disease.

What I recommend is best described as Lifestyle Medicine. It is to do with what you eat and drink, your exercise and emotional health, the power of your mind and techniques like meditation. This is not “alternative” medicine. It is good medicine. It is safe medicine.

There is a need to make it clear my life is not work. My work started with my life and my recovery, but 30 years later that work has evolved in response to new experiences and research and now stands in its own right.

Happily my life is fully congruent with what I teach. Anything I recommend I either did or more likely, continue to do. I have never heard of an oncologist trying a course of their own chemotherapy to find out what it is really like. That would be absurd, but to claim that what I do is dangerous or risks taking people away from effective treatments is equally absurd.

No one I know of ever died from eating well or meditating too much. However, are we allowed to say that people do sometimes suffer inordinately and die from chemotherapy and its complications?

There needs to be a realistic and balanced perspective and patients need to be helped to make well informed decisions.

My understanding of science is that it advances by observing unusual events and investigating them. Thirty years later I have observed many people recovering from cancer against difficult odds.

Around 20 years ago on ABC TVs Couchman show Lowenthal challenged me to present my 50 best cases for evaluation. I readily agreed but he subsequently claimed that he was unable to gain funding for the research. My feeling is that project would have been a much better use of energy.  Maybe it is time for a cooperative investigation and a real sense of everyone working together.

If you feel motivated, letters to the Editor of The Age or The Sydney Morning Herald would still be useful.
Or add a comment below.

Happy New Year. May 2012 be a year of peace, good health and deep seated happiness.

Link to The Age article

          to Monty Python and the Spanish Inquisition

Resources

My biography which documents my case: The Dragon's Blessing by Guy Allenby

You Can Conquer Cancer which documents my cancer work

The Gawler Cancer Program: the CD that presents the paradigm I work with

Mindbody Mastery: online meditation program

It only has to be done once

This weeks blog is written in two parts. The first part is my weekly blog and the second is an article that I wrote and was published in Australian Doctor this week that is referred to in the blog.

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Part A

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There has been some discussion recently in the medical press regarding my case history; its accuracy and its relevance to others with cancer. It seemed to me that the matters raised had been satisfactorily answered but then Linda Calabresi, medical editor for Australian Doctor (the journal that goes weekly to all Australian GPs) suggested the record needed to be set straight, so my response has been published in AusDoc and is reproduced below.

The issues of contention revolved around the timelines for my illness and the dates on photos taken of my cancer, as reported my Dr Ainslie Meares way back in 1978, and the 30 year follow-up of my case in 2008; as well as me being described as having followed a vegan diet during my recovery.

The reality is that I was diagnosed with osteogenic sarcoma in January 1975, had metastases confirmed in December 1975 and was found to be cancer free in June 1978. What happened in between was quite complex. I tried most things you could think of and probably a few you would not!

When I recovered Ainslie Meares, who had introduced me to meditation, reported my case in the Medical Journal of Australia. While he acknowledged many of the things I had done, he felt the most significant factor may well have been intense meditation.

It is true he reported I had more severe disease when we first met than I did, however, he had not shown me his article before submitting it and this error seemed to me to be of no material significance. If a woman has a pregnancy confirmed, but the dates are wrong; unless there is major intervention, she will still have a baby. I certainly had a very poor prognosis when I went to Dr Meares; if there had been no major intervention, all the experts were sure I would have died within a few months. As it was, I did recover and I too felt the meditation was crucial.

The main photo in contention was of the rather large mass of cancer on my chest that was enlarged many years ago and then mis-labelled as being taken in July 1977. In fact it was taken before I began chemotherapy in October 1976. This again seemed of minor importance but I do have the complete series of photos taken once each month from then until the chest had cleared completely towards the end of 1977.

Because my history is so complex, when it came to having it told in book form, I decided not to do it myself as an autobiography, but to agree to a journalist, Guy Allenby writing it. Guy had full access to my medical records, the meticulous diaries I kept, and he interviewed my medical staff, family, friends and colleagues. In my opinion, the timelines in The Dragon’s Blessing are accurate, so anyone interested will find them there.

Regarding what I ate during my recovery, it was mostly vegan. If you eat meat once a week, you are not strictly a vegetarian but you certainly are not a rabid carnivore. It is hard to characterise diets in a few words, and anyway, I do not recommend people do exactly what I did. What I do recommend has been readily available since “You Can Conquer Cancer” first came out in 1984. Anyone really interested could come to the residential or non-residential programs I established, come to a workshop or listen to my CDs on food. I have also written some blogs on food and will do more soon, particularly on why it makes good sense to avoid dairy and adopt a relatively low protein diet.

The good thing about all this discussion is that it has provided another opportunity to present the merits of a therapeutic lifestyle for people with cancer in a medical forum.

Cancer is a lifestyle disease and the value of a therapeutic lifestyle needs to be discussed early for people diagnosed with cancer just as it is for people when they are first diagnosed with heart disease or diabetes.

If we really want to treat cancer best, we need to prevent it and the soundest way to prevent it is through a healthy lifestyle.

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Part B - Taken from Australian Doctor 17th Nov, 2010

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The case for lifestyle

Well-known cancer survivor Dr Ian Gawler presents his side of the story.

One of the good things about being described as a high profile alternative treatment story is that you are alive to engage in the discussion.

In referring to my recovery from metastatic osteogenic sarcoma and my work over 30 years with lifestyle-based self-help programs, Linda Calabresi’s editorial [i] “Providing hope comes with a duty of truth” (27 October) suggests “the record be set straight”.

First then, the term “alternative”, as used in some reports of the case, is misleading. Cancer management falls into three broad categories: conventional medicine, complementary and alternative medicine, and lifestyle medicine. My personal recovery involved all three, while my work focuses on lifestyle.

The facts of my case were thoroughly documented in 2008 by Guy Allenby [ii] in “The Dragon’s Blessing”. So while back in 1978 (psychiatrist) Dr Ainslie Meares [iii] reported that I had more severe disease when I first saw him than I actually did, and these timeline errors were carried over into the 2008 follow-up [iv], this has little material relevance to the important facts. On meeting Dr Meares, I did have metastatic disease. I did have a prognosis of 3 to 6 months. I am alive more than 30 years later.

My personal story has direct relevance to people with osteogenic sarcoma. It changes the landscape of that disease. The fact is at least one person has survived metastatic disease for over 30 years. It only has to be done once to show that it is possible, so my story offers real hope.

However, it is my work that has the most relevance to the wider body of people affected by cancer. The lifestyle I teach now goes well beyond what I did 35 years ago. Research and experience leads to ongoing development. While my story may inspire, I have never recommended others do exactly as I did. This was clearly documented in my book “You Can Conquer Cancer”[v],first published in 1984.

The evidence for lifestyle factors enhancing quality of life and cancer outcomes is growing steadily. Compelling examples are Dean Ornish et al’s [vi] randomised lifestyle intervention for prostate cancer and the evidence suggesting regular exercise halves the risk of dying for women with primary breast cancer [vii]

And consider that spontaneous remissions - improvement or recovery without clear medical cause [viii] - are thought to occur once in every 60,000 to 100,000 people [ix]

During a period when 8,400 cancer patients attended Gawler Foundation’s lifestyle programs, 43 people who fit the description of “spontaneous remissions”[x][xi] have been recorded. This equates to one in 195, which is 300 times more than the average.

While this data may be crude, it points to why the public is so interested in lifestyle programs, and surely warrants more research.

Lowenthal [xii] says “the speciality of psycho-oncology and the more recent development of 'integrative oncology' arose to some extent out of the work of Gawler and his followers.”

The next step is lifestyle medicine needs to have the same prominence for cancer as it does for heart disease and diabetes.

Dr Gawler OAM, BVSc, MCounsHS is retired founder of the Gawler Foundation.

References:

1. Calabresi L. Providing hope comes with a duty of truth. Aust Doct 2010: Oct 27:
2. Allenby G. Ian Gawler - The dragon’s blessing. Melbourne: Allen & Unwin, 2008.
3. Meares A. Regression of osteogenic sarcoma metastases associated with intensive meditation. Med J Aust 1978; 2:43.
4. Jelinek GA, Gawler RH. Thirty-year follow-up at pneumonectomy of a 58-year-old survivor of disseminated osteosarcoma. Med J Aust 2008; 189: 663-665.
5. Gawler IJ. You can conquer cancer. Melbourne: Hill of Content, 1984. Revised edition: Melbourne: Michelle Anderson 2001.
6. Ornish D, et al. Intensive lifestyle changes may affect the progression of prostate cancer. J Urol 2005; 174:1065-70
7. Irwin ML, et al. Influence of pre- and post-diagnosis physical activity on mortality in breast cancer survivors: the health, eating, activity and lifestyle study. J Clin Oncol 2008: 26(24): 3958-64.
8. Bakal. DA Minding the body: clinical uses of somatic awareness. New York: Guilford 2001.
9. Jerry LM, Challis EB. Oncology. In Rakel ED (Ed) Textbook of Family Practice, (3^rd ed., 1061-1081). Philadelphia: Saunders 1984.
10. Gawler IJ ( Ed). Inspiring people – stories of remarkable  recovery and hope from the Gawler Foundation. Melbourne: The Gawler Foundation, 1995.
11. Kraus P. Surviving cancer – inspiring stories of hope and healing. Melbourne: Michelle Anderson Publishing 2008
12. Lowenthal RM. Snake oil, coffee enemas and other famous nostrums for cancer – a recent history of cancer quackery in Australia. Cancer Forum 2005; 29: Issue 3.