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.
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