Ian Gawler Blog: Research, daily life and cancer

Groups, mushrooms, CD47, surgeons, PSA tests, mistletoe and coconut oil.
What do they have in common? They all feature in important research that throws light on what might make for a good choice if you or someone you love has cancer – or wants to avoid it. So this week, some compelling reading that just might help to save a life.

Plus Ruth and I start our tour of New Zealand next week, so more details of the talks and retreats, but first

Thought for the day
If I die
I want to be the healthiest person ever to die of this disease
                           One of the women in my Friday cancer group

Yes, that dot in the middle is me speaking at the Happiness and its Causes Conference in Perth last week; some highlights next week.

1. Attending a therapeutic group halves the risk of recurrence and the risk of dying from breast cancer
This study is a few years old now, but very significant all the same.

After a median of 11 years of follow-up, this study involving 227 women showed that those women provided with a psychological intervention via small groups that included strategies to reduce stress, improve mood and alter health behaviours, were found to have around halved the risk of both breast cancer recurrence (hazards ratio [HR] of 0.55; P=.034) and death from breast cancer (HR of 0.44; P=.016).

Follow-up analyses also demonstrated that women in the groups had a 50% reduced risk of death from all causes (HR of 0.51; P=.028) during the time of the study.
The authors concluded that psychological interventions can improve breast cancer survival.

Reference: Andersen BL et al, Psychologic Intervention Improves Survival for Breast Cancer Patients - A Randomized Clinical Trial.  Cancer. 2008; 113:3450-3458

2. Psychological and behavioural variables can have profound effects on cancer. 
In a related study, a meta-analysis (analysis of a large number of studies) revealed stress-related psychosocial factors to be associated with a higher cancer incidence in initially healthy people, poorer survival in patients diagnosed with cancer, and higher cancer mortality.1

Reference: Chida Y, Hamer M, Wardle J, Steptoe A. Do stress-related psychological factors contribute to cancer incidence and survival? Nat Clin Pract Oncol. 2008;5:466–475. [PubMed]

3. CD47: The cancer breakthrough I believe may really happen
Many of those who attend my workshops may remember I have been speaking hopefully of CD47 for some time. Here is an update.

CD47 is a kind of protein that is found on the surface of many cells in the body. It tells circulating immune cells called macrophages not to eat these cells. The body uses the CD47 protein to protect cells that should be protected and to help dispose of cells that are aged or diseased.

Unfortunately, some cells that should be destroyed are not. Researchers at Stanford discovered that nearly every kind of cancer cell has a large amount of CD47 on the cell surface. This protein signal protects the cancer against attack by the body's immune system.

Stanford investigators have discovered if they block the CD47 "don't-eat-me" signal through the use of anti-CD47 antibodies, macrophages will consume and destroy cancer cells. Deadly human cancers have been diminished or eliminated in animal models through the use of anti-CD47 antibody.

For the last year, many people have been working to make clinical trials in humans possible. Stanford is hopeful that the first human clinical trials of anti-CD47 antibody will take place in mid-2014, and clinical trials may also be done in the United Kingdom. Stay tuned; this one just might work!

4. Mushrooms – cook them and reap the rewards!
Some will know that mushrooms have been under something of a cloud (OK – bad pun ) and even on the Gerson banned list. I have never been able to find a satisfying rationale for this avoidance and more recent research indicates that maybe the problem was eating them raw, while cooking them seems quite beneficial.

In 2009 a study of 2,018 women correlated a large decrease of breast cancer in women who consumed common white button mushrooms (Agaricus bisporus). Women in the study who consumed fresh mushrooms daily were 64% less likely to develop breast cancer, while those that combined a mushroom diet with regular green tea consumption reduced their risk of breast cancer by nearly 90%.

Some studies have revealed that raw A. bisporus - along with some other edible mushrooms - contain small amounts of carcinogens. However, this research also noted that when cooked, these compounds were reduced significantly.

Reference: Zhang, M et al;  "Dietary intakes of mushrooms and green tea combine to reduce the risk of breast cancer in Chinese women". International Journal of Cancer 124 (6): 1404–1408.

HERE IS THE INVITATION

Pause,  focus on the scene below,  take a deeper breath or two,  bring yourself into this present moment     :-) 

then read on

Photo taken near the river at the Gawler Foundation's Yarra Valley Living Centre where we conducted the training /retreat with Dr Nimrod Sheinman recently and where Ruth and I will lead next year's pre-Easter retreat Meditation in the Forest

5. Would you travel to save your life? Surgeons and survival
A fairly well kept secret is that when it comes to cancer surgery, particularly the more complex, complicated surgery, your surgeon’s experience levels can drastically affect your chances of long-term survival. This is an excellent thing to know BEFORE you might ever need it. Tell anyone you care for about it!

This proposition has been further validated recently by a well-funded Swedish prospective cohort study in which all patients who underwent eosophagectomy between 1987 and 2005 were followed until 2011.

Results demonstrated that surgeons who performed above the Swedish median number of operations per year had a 20% reduction in mortality. The median number was about 10 operations per year. What that means is that if you had been operated on by a surgeon who was doing more than 10 esophagectomies per year, you would have had a 20% reduction in mortality.

What should we make of this? Seek an experienced surgeon if you need a tricky operation.

Reference: Derogar M et al. Hospital and surgeon volume in relation to survival after esophageal cancer surgery in a population-based study. J Clin Oncol. 2013;31:551-557.

6. Are PSA tests more trouble than they are worth?
Here we go! This is really going Out on a Limb! PSA testing for prostate cancer seems to ignite untold passions in many of those involved, but speaking in The Age recently, health reporter Julia Medew pointed out

“PSA tests are controversial because they can cause "overdiagnosis" of prostate cancer that is so slow-growing it was never going to cause men harm. It is now estimated that for every man thought to be saved by the test, another 12 to 47 will be diagnosed with cancer that will not kill them. Many will have surgery and other interventions that can lead to sexual impotence and incontinence.”

A recent Australian review has called into question one of the major studies that is used to support PSA screening and in doing so, adds more caution to taking that test.

Here is the Abstract of the paper so that if you are interested you have some facts.

Major clinical trials using prostate-specific antigen (PSA) as the screening test to detect localized early-stage prostate cancer and to attempt to change its natural history with early intervention have yielded conflicting interpretations.

The US Prostate, Lung, Colorectal, and Ovarian (US PLCO) cancer screening trial concluded that PSA-based screening conferred no meaningful survival benefit, whereas the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the GOTEBORG clinical trial (GOTEBORG) trials claimed statistically significant life-saving benefits.

These divergent outcomes have not provided physicians with clarity on the best evidence-based treatment. To determine the extent to which these divergent outcomes are clinically meaningful, we evaluated these data and those of a long-term prospective cohort study in the context of the clinically documented harms of androgen deprivation therapy (ADT) (hormone treatment).

We noted the unheralded fact that in both European trials far more patients received hormonal treatment in the control than the prostatectomy arm, whereas hormonal therapy in the US trial was balanced between arms. We examined this imbalance in ADT treatment and prostate cancer–related deaths in the contexts of contamination, stage migration, and attribution of cause of death, all of which impinge on data interpretation.

The ERSPC and GOTEBORG data are compatible with the hypothesis that ADT treatment contributes differentially to an increase in prostate cancer deaths in control patients. If so, the claim of a reduction in prostate cancer deaths in the screened cohort requires reappraisal.

The conventional interpretation that PSA screening and radical treatment intervention are the major contributors to the results of these two studies needs more rigorous scientific scrutiny, as does the role of ADT treatment of nonmetastatic disease.

Reference: Haines I, Miklos G et al; Prostate-Specific Antigen Screening Trials and Prostate Cancer Deaths: The Androgen Deprivation Connection JNCI J Natl Cancer Inst, Vol 105; 20, 1534-1539.


To read The Age report: CLICK HERE: 

7. Mistletoe doubles survival in advanced pancreatic cancer
Advanced pancreatic cancer is a tough disease and while over the years I have seen a number of people actually survive for long periods following our approach, often the side-effects of any medical treatments are outweighed by any benefits. This then is an interesting study as although the times were still disappointingly short, the mistletoe injections almost doubled survival. Also, mistletoe has been one of those controversial treatments often labelled as "alternative", so it is good to see it being evaluates scientifically and that it does seem to have some efficacy.

Abstract: The unfavourable side-effects of late-stage pancreatic cancer treatments call for non-toxic and effective therapeutic approaches. Over 12 months, we compared the overall survival (OS) of patients receiving an extract of Viscum album Mistletoe (VaL) or no antineoplastic therapy.

Findings: We present the first interim analysis, including data from 220 patients. Patients in both groups received best supportive care. Median OS was 4.8 for VaL and 2.7 months for control patients (prognosis-adjusted hazard ratio, HR = 0.49; p < 0.0001). Within the ‘good’ prognosis subgroup, median OS was 6.6 versus 3.2 months (HR = 0.43; p < 0.0001), within the ‘poor’ prognosis subgroup, it was 3.4 versus 2.0 months respectively (HR = 0.55; p = 0.0031). No VaL-related adverse events were observed.

Conclusion: VaL therapy showed a significant and clinically relevant prolongation of OS. The study findings suggest VaL to be a non-toxic and effective second-line therapy that offers a prolongation of OS as well as less disease-related symptoms for patients with locally advanced or metastatic pancreatic cancer.

Reference: Tro ̈ger W. et al., Viscum album [L.] extract therapy in patients with locally advanced or metastatic pancreatic cancer: A randomised clinical trial on overall survival, Eur J Cancer (2013), http://dx.doi.org/10.1016/j.ejca.2013.06.043
 

RELATED BLOGS
Let your food be your medicine - more dietary research

Multi-vitamins and cancer

Who needs prostate surgery?

NEWS UPDATE
I am being asked in workshops why coconut oil melts at room temperature, around 22 -24C, yet Prof George Jelinek in his guest blog on coconut oil (Coconut oil- are you nuts?) says the simple, obvious reason not to use coconut oil is that it contains saturated fats that are solid at body temperature - 37C.

At first glance this may seem confusing, but here is the detail, and again, I quote George:

The explanation for this melting point of the oil is pretty simple. Coconut oil is a complex mixture of fats; while 88.7% is saturated fat, there are also mono- and poly-unsaturated fats in the oil, as with other oils.

So the melting point of the oil depends on the relative proportions of the various fats making up the oil, and is lower than the individual melting points of the saturated fats referred to in the blog because of the lower melting points of some of the other shorter chain saturated fats, mono-unsaturated fats, and poly-unsaturated fats.

However, coconut oil does not get absorbed whole, but rather as the individual fatty acids, and it is the melting point of each of those individual fatty acids that is the important factor when they are incorporated into cell membranes.

By way of example, butter melts at 32-35C despite being composed of 63% saturated fats, most of them with melting points higher than body temperature, yet no-one would recommend it for good health.

NOTICEBOARD
Ruth and I will be presenting a range of public talks, workshops and retreats around New Zealand
in November/December.

There are a range of events in Auckland, Rotorua, Christchurch and Nelson.

We are delighted to be including our first meditation retreat in New Zealand (which quite a few Aussies have also booked for already!) - December 2 -8.

Please do let anyone you may know in NZ about the visit -  all the details are on my new public Facebook page: Dr Ian Gawler,    or the website.

Meditation’s 3 great gifts

For some reason most probably to do with those delightful but mischievous creatures known as computer gremlins, this blog dropped out of the ethers, so I am re-posting. Apologies for any inconvenience to those who have read it already, I think it one of the better ones for those yet to read it!

Why do so many people meditate these days? What is really on offer? Are you missing out? Or are you experiencing meditation’s 3 major benefits?

This week, we go Out on a Limb, go to the heart of meditation and seek to understand why it is so reliable as a stress-free way to manage stress.

Also, more details on the tour of New Zealand that starts with an evening public talk in Auckland on Thursday 14th November and includes workshops and retreats around the country – details CLICK HERE.

Then breaking news with a very important piece of research examining the effects of taking multi-vitamin/mineral supplements on the lifespan of women with breast cancer, but first

Thought for the day:
In meditation the mind keeps wandering.
We keep bringing it back, and it wanders again.
And we bring it back again, and so it goes on,
Maybe for months and years, until at last the mind becomes stabilised . . .
Thoughts go roving around in the head,
But if we bring them down into the heart, that is, the centre of the person,
They come to rest.
Fr Bede Griffiths. River of Compassion: A Christian Commentary on the Bhagavad Gita.

Being asked to speak at the Happiness and its Causes conferences in Brisbane and Perth this week on the topic of stress and anxiety set me to think deeply about why meditation is such a reliable and all-encompassing antidote to both. This led to understanding meditation's 3 great gifts.

Now to be clear, when I speak of meditation, I speak of learning to relax deeply in a physical sense, and then to go beyond the activity of the thinking mind into a deeper stillness.

In fact, meditation introduces us, or perhaps just makes abundantly clear, that the mind does have these two aspects; there is the active thinking mind and the still mind.

The thinking mind is the domain of stress – how we perceive things, how we interpret things. Clearly a great deal of stress is to do with how we think. To a large extent it is the thinking mind that determines the stress we may or may not experience.

The still mind is beyond all this. The still mind is calm and clear. The still mind is highly creative, highly productive, but it is the domain of deep, natural peace.

How then to help the thinking mind let go of stress, to become clear and calm, to become stress free?

First an analogy. If we were interested in the true nature of the sky but had never seen it before; and went outside on a cloudy grey day, we could form the view that the sky was this grey fluffy stuff that filled the space above us.

However, those of us who do have a little more familiarity with the sky; we know of course that clouds as we call them are only one part of the sky. There is a second part, a second aspect – that big blue canopy we are so familiar with and that is so evident on a cloud-free day.

Those of us that are more familiar with the sky know that clouds come and go, the blue canopy is always there. So even on the cloudiest, stormiest, wildest of days, sooner or later the clouds do clear and there it is. It was always there of course, that clear blue sky, it is just that sometimes the clouds obscure it from our direct sight.

So, the analogy is good. With our minds, thoughts come and go all the time; they are ever-changing and impermanent. Happy thoughts, stressful thoughts. They come and they go. But sooner or later they will clear, and reveal this deeper stillness, the more fundamental enduring, stable aspect of our mind.

So there is the active and the still mind. Meditation provides a reliable way to go beyond the activity of thinking mind and directly experience the stillness of the more fundamental or true nature of our mind. And in doing so, meditation offers 3 major benefits: Profound Peace, Natural Balance, and the View.

Profound Peace speaks for itself. There is a natural ease, an inner clarity and confidence that comes with meditation that provides a profoundly effective antidote to stress.

But more, this profound peace, coupled with deep physical relaxation brings Natural Balance to our whole being. Physically our body chemistry and physiology regains its natural balance. It is like meditation resets our factory settings and recalibrates the physiological changes we know accompany adverse stress, and over time becomes our default setting.

So this is how meditation diffuses stress and anxiety – with a return to a natural, healthy balance. But there is still more! This natural balance flows on to be experienced as emotional balance, mental balance; there is even a deep sense of connectedness and a natural rise of love, compassion and altruism – a spiritual balance.

And perhaps even more profoundly, meditation offers a new perspective. We begin to see the world, and our life, not just from the perspective of the ever-changing “thinking mind”, but also from a more profound vantage point – that of the still mind, the true nature of our mind.

The View is a word that is used to encapsulate how we view the world, how we interpret our life. What meaning and purpose we experience in this life. Our View is tied up with our values, our ethics, our habits, and our beliefs. How we live our life.

Now, our View of course is radically affected by our perspective. For those whose perspective does happen to lead them to think that all they are is just this body, it is easy to imagine how they “over-identify” with their body image and their physical health and in doing so become highly stress-prone.

For those whose perspective or View is such that they conclude life is all about relationships, and in so doing over-identify with their partner or children, or even their community, it is easy to imagine how the ups and downs of life will make them particularly vulnerable to chronic stress.

For those whose View is that life is all about mental reason, and as a consequence over-identify with the rational, logical, scientific aspects of their mind, it is easy to imagine how the mysteries of life, the unexplainable, the new, the challenging makes them significantly prone to stress.

So, one elegant definition of stress is “over-identification with the wrong part of our self”.

Body, emotions and mind are very important, but they are not who we really are. Over-identifying with them will mean we are bound to be stressed, maybe even full on anxious.

When we change our perspective, everything changes. If we have a problem, as we see it, and we fixate on it, it is like holding an egg to our eye – we can see nothing. It is a big problem and it obscures everything. However, if we hold the egg at arms-length, we recognise it for what it is. It is an egg with loads of possibilities, loads of potential.

So meditation introduces us to who we really are, what is in our heart’s essence. And in doing so, meditation offers three great gifts Profound Peace, Natural Balance and the View.

Truly meditation offers a unique pathway to stress free stress-management.

RELATED BLOGS
Meditation in 4 easy steps

NOTICEBOARD
Ruth and I will be presenting a range of public talks, workshops and retreats around New Zealand
in November/December.

We start with an evening Public Talk in Auckland on Thursday November 14th (which will be followed up by a weekend in Auckland on November 30th and December 1st), then there are a range of other events.

We are delighted to be including our first meditation retreat in New Zealand (which quite a few Aussies have also booked for already!) - December 2 -8.

Please do let anyone you may know in NZ about the visit -  all the details are on my new public Facebook page: Dr Ian Gawler,    or the website.

NEWS
An important new study has shown that taking a regular multivitamin and mineral supplement (MVM) significantly reduced mortality for women over 50 with breast cancer.


Given how contentious the supplement issue has been in cancer medicine for years, and how often people tell me that their oncologists have told them MVM will reduce the benefits of treatments and give advice not to take them, this study adds weight to a growing body of research that does support their use.


Here is a short summary of the abstract and the reference for the full article.



This prospective study followed the effects of MVM use on breast cancer mortality in postmenopausal women diagnosed with invasive breast cancer. It included 7,728 women aged 50-79 at 40 clinical sites across the United States and followed them for a mean of 7.1 years after breast cancer diagnosis.



In adjusted analyses, breast cancer mortality was 30 % lower in MVM users as compared to non-users (HR = 0.70; 95 % CI 0.55, 0.91). This association was highly robust and persisted after multiple adjustments for potential confounding variables and in propensity score matched analysis (HR = 0.76; 95 % CI 0.60-0.96). 



The results suggest a possible role for daily MVM use in attenuating breast cancer mortality in women with invasive breast cancer but the findings require confirmation.



Wassertheil-Smoller S et al, Breast Cancer Res Treat. Multivitamin and mineral use and breast cancer mortality in older women with invasive breast cancer in the women's health initiative; 2013 Oct; 141(3):495-505. doi: 10.1007/s10549-013-2712-x. Epub 2013 Oct 9.

For the full reference, CLICK HERE

Ian Gawler Blog: Portrait of the survivor

What image do you have of a long-term cancer survivor? What have their stories to offer? What can we learn from them about life and about survival?

This week we find out, as well as having the extraordinary opportunity to view amazing portraits taken by world-class photographer Robbie Merritt of long-term survivors. These portraits will form a truly remarkable exhibition You Are Beautiful coming soon in Perth, and to celebrate I have asked the CEO of Cancer Support WA (CSWA), Mandy BeckerKnox to share an insight that came courtesy of one of these survivors.

Each portrait is linked to that persons story - very inspiring and informative - and a fundraising initiative for CSWA, so if you want to support a great organisation, link here to donate.

Also, a small request. I have been asked to help set up a public Facebook page to promote the workshops I will present in Auckland in a few weeks. Apparently it helps to be “Liked”!!! So please go to the new page, (I will now be adding interesting and topical new info there too from time to time) and “Like” me! Link here.

All the New Zealand events for the tour Ruth and I head off for in a couple of weeks are featured on this new Facebook page, so if you do know anyone interested, please share the link with them.






But first


Thought for the Day
People are like stained-glass windows.
They sparkle and shine when the sun is out,
But when the darkness sets in,
Their true beauty is revealed
Only if there is a light from within
               Elizabeth Kubler-Ross




Geoff Barbour
Long term survivor of advanced lymphatic cancer
First diagnosed 1997, no medical treatment




How asking yourself a simple question could save your life by Mandy BeckerKnox

A wise friend told me about a very simple method she used for healing herself of secondary melanoma 25 years ago. She was in a difficult predicament, given a few months to live with no medical treatments available to her. Not ready or willing to die, she realised her life was in her own hands.

Willing to do whatever it took to be well again, she asked herself a profound question before eating or drinking anything. She asked the same question of her thought processes, of her relationships, before undergoing any treatment, and in fact before she did anything.

 The question was simply “is this life-giving, or life taking?’ If the answer was life-giving, then she would wholeheartedly embrace that choice. If the answer was life taking, she found the strength and willpower not to follow through on that choice.







Father and daughter team, Ross and Lisa Taylor.









Ross diagnosed with secondary melanoma over 20 years ago.
Lisa also had her partner diagnosed and die of a brain tumour - an extra-ordinary caring role.


There were only two possible answers to this question … there were no maybes, buts, this times or I don’t knows – it was either yes this is life giving, or no this is life taking.

In addition to following through on her life-giving choices, she was willing to explore as many healing modalities as possible, to make sweeping lifestyle changes, to meditate, to develop intuition and to give it a voice.





Mike Sowerby - whom I first met when he was a 3rd year vet student in 1979, just diagnosed with kidney cancer. 

Mike became the first new therapist I worked with in the early '80s, and now he works with the CSWA.

Mike had no medical treatment.











It was her soul’s journey to survive cancer and to become a healer and facilitator herself, inspiring and giving hope to many other people facing the same devastating prognosis.


In case you are wondering who this wise friend is,
it is the wonderful Cathy Brown,
Cancer Support WA’s wellness facilitator.

                    Cathy Brown was diagnosed with metastatic 
                    melanoma 20 years ago. Cathy was one of 
                    our co- facilitators on our recent 
                    Meditation in the Desert retreat.

Cathy and the team of wellness and healing professionals at CSWA understand what it takes to be well and have developed a program and many resources to support people on their healing journey. That team is there to guide you through the program and to help you find the inner resources to be well and to heal.

We wish you all the best and hope to see you soon!

Mandy BeckerKnox
Chief Executive Officer, CSWA


YOU ARE BEAUTIFUL – the exhibition, is Australia's first 100% glass photographic exhibition celebrating the inner beauty, resilience and strength of West Australians touched by cancer.

Organised by Cancer Support WA in partnership with celebrity photographer Robbie Merritt, Panther Graphics and other sponsors, the purpose of You are Beautiful is to bring awareness to the untold stories of people with cancer, and to raise funds for Cancer Support WA.

​The YOU ARE BEAUTIFUL exhibition features large scale portraits of 100 West Australians who have been touched by cancer. Each portrait reveals the story of each person by drawing out their unique beauty and emotion. Each portrait is accompanied by the personal story of each person featured.

The YOU ARE BEAUTIFUL Photographs are being displayed at Central Park Building, 152-158 St Georges Terrace, Perth from 2nd to 8th November, Central Park  and a smaller selection will be displayed from 18th to 29th November at Brookfield Place, 125 St George's Tce, Perth WA. Entry to the exhibitions is free.

RESOURCES
1. Refer to my website where there is more related research and suggestions on how to manage a cancer diagnosis.

2. My book: You Can Conquer Cancer

3. My CDs (also available as downloads)
The Gawler Cancer Program
What to do when someone you love has cancer

RELATED BLOGS
Cancer survivors? Cancer thrivers!!!

Cancer survivors come to Today Tonight

Recovery from cancer is possible

NOTICEBOARD

Ruth and I will be presenting a range of public talks, workshops and retreats around New Zealand
in November/December.

We start with an evening Public Talk in Auckland on Thursday November 14th (which will be followed up by a weekend in Auckland on November 30th and December 1st), then there are a range of other events.

We are delighted to be including our first meditation retreat in New Zealand (which quite a few Aussies have also booked for already!) - December 2 -8.

Please do let anyone you may know in NZ about the visit -  all the details are on my new public Facebook page: Dr Ian Gawler,    or the website.

Ian Gawler Blog: Key medical terms - What is in a name?

When I began one of the world's first cancer self help groups in 1981, what I was doing was often described as "Alternative Medicine". Back in those early days, this seemed fair enough.

What I was teaching was new and it was different to what the mainstream doctors were doing. However, it was not meant to involve a choice as in "do one alternative or the other; do the medical stuff or the self help stuff". It was just different.

But then things began too shift. Somehow, some key people in mainstream medicine decided there was a conflict between what the doctors could do for people with cancer and what those people could do for themselves. Perhaps they were worried people would make the choice to not go with the medical stuff.

Whatever the thinking, instead of seeking to combine the best of what the doctors could do with the best of what the patients could do for themselves, they adopted a combative, exclusive view. They began to strongly express that when it came to recovery from cancer, the only hope lay in what the medical system could do for its patients. The self help options were denigrated.

While this always struck me as a weird and most unfortunate misunderstanding, it sadly led to what some now interpret as a very unhelpful turf war, initiated by those same medical authorities. To be clear about this, I have done all possible to avoid such a conflict. I have maintained constantly since 1981 that in my view the best results for people with cancer will always be achieved by a collaborative approach that combines the best of what is available. However, it is also true that I regard the contribution of the patient, their families and friends as crucial and I have no doubt that frequently this combined contribution has made the difference between life and death.

One way that the self help movement was put down was to brand the word "alternative" as a pejorative. That means "alternative" become a term of medical derision, and all too frequently it is still used as such. The way the word "Alternative" is used these days, it  smacks of quackery and danger.

To attempt to brand people working hard to help themselves as being involved in "quack alternatives" is clearly very unhelpful. In my view it is actually irresponsible as well as being an extremely inaccurate way to describe what I advocate and teach.

In response to all this, more balanced doctors and self help advocates use far more constructive terminology. So we have moved on to "Holistic Medicine", "Complementary Medicine" and "Integrative Medicine". Currently, the best and most accurate way to describe what I advocate and teach - the self help approach - is "Lifestyle Medicine".

However, it seems to me we are now in a position where all of these medical words tend to be bandied about a bit recklessly - in the media, amongst the professions and privately. So this week it seems useful to clarify the definitions. But first

Thought for the day
A joyful heart is good medicine
But a broken spirit dries up the bones
              Proverbs 17:22









1. MEDICAL DEFINITIONS
Currently there are many terms used to describe different ways of offering healing and wellbeing: Conventional Medicine, Traditional Medicine, Complementary and Alternative Medicine, Lifestyle Factors and so on. Often these words are used in a loose way that can be confusing.

What follows is an attempt to draw together the best and most widely accepted working definitions for these different modalities. The hope in that this may bring more understanding and help with the words being used more accurately and more clearly.

1. Orthodox or Conventional Medicine and/or therapies1
Orthodox or conventional medicine generally describes medical interventions taught at medical schools, generally provided at hospitals, and meeting the requirement of peer accepted mainstream medicine and standards of care.

2. Evidence Based Medicine2
The conscientious and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise is meant the proficiency and judgement that individual clinicians acquire through clinical experience and clinical practice.

3. Allopathic Medicine3
The system of medical practice that treats disease by the use of remedies that produce effects different from those produced by the disease under treatment.

The term ‘allopathy’ was coined in 1842 by CFS Hahnemann to designate the usual practice of medicine (allopathy) as opposed to homeopathy, the system of therapy that he founded based on the concept that disease can be treated with drugs (in minute doses) thought capable of producing the same symptoms in healthy people as the disease itself.

4. Integrative Medicine4
The blending of conventional and natural/complementary medicines and/or therapies with the aim of using the most appropriate of either or both modalities to care for the patient as a whole.

Integrative Medicine considers the person’s body, emotions, mind and spirit. Integrative Medicine is open to integrating the services of a wide range of health practitioners and modalities in a way that is often described as Holistic Medicine.

5. Holistic Medicine and/or therapies5
These combine complementary and conventional approaches that support the physical, social, psychological, emotional and spiritual wellbeing to help achieve optimal health. The holistic or health model looks at maximising or supporting all aspects of a person’s health that may lead to the disease being healed by the body. Health promoting and lifestyle advice, such as advice in dietary changes, stress management, exercise, and the environment, are integral to holistic medicine.

6. Lifestyle Medicine6

The application of environmental, behavioural, medical and motivation principles to the
management of lifestyle related health problems in the clinical setting.

7. Lifestyle Factors7
These come under the umbrella of Integrative Medicine and are concerned with what a person can do for themselves in the context of their daily life. Lifestyle factors contrast with complementary therapies which better describe a therapy provided by a therapist, or a compound taken by the patient. (eg. Supplements/herbs)

Lifestyle factors or therapies include physical factors such as nutrition (food/juices), exercise, exposure to sunlight and creative activities.

They also utilize Mind-Body Interventions which can include psychosocial activities, group therapy, mind training (positive thinking, affirmation, imagery etc), meditation, Yoga, Chi Gong, Tai Chi, healthy emotions: (relationships, communication, laughter, forgiveness, etc) personal development and transformation.

Lifestyle factors also encompass spiritual pursuits such as exploring meaning and purpose in life, prayer, spiritual healing, religious practice and spiritual development.

8. Complementary & Alternative Medicine8
In the United States, the National Centre for Complementary and Alternative Medicine (NCCAM), defines CAM as a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine, as defined by our medical peers.

Unlike in America, in Australia, Complementary Medicine and Alternative Medicine tend to be spoken of quite separately.

9. Complementary Medicine9
Any therapeutic practice that does not satisfy the standards of the majority of the orthodox medical community in Australia, that is not taught widely at Australian medical schools and that is not generally available at Australian hospitals.

According to Dr Vicki Kotsirilos10 this definition varies cross culturally with more medical schools – both in Australia and overseas – offering courses in complementary medicine.

Dr Kotsirilos goes on to say that the diversity of these therapies makes them difficult to categorise as a group, yet they are often collectively referred to as ‘complementary’, ‘alternative’, ‘integrative’, ‘unorthodox’, ‘unconventional’, ‘unproven’, ‘natural’, ‘traditional’ and ‘holistic’ medicine, and are contrasted with ‘conventional’, ‘mainstream’, ‘allopathic’, ‘orthodox’, ‘conventional’ and ‘scientific’ medicine.

According to the NCCAM, CAM can be grouped as:

i. Alternative Medical Systems: include naturopathy, Traditional Chinese Medicine, Ayurveda and homeopathy.

ii. Mind-Body Interventions: include patient support groups, cognitive-behavioural therapy, meditation, prayer, mental healing, and therapies that use creative outlets such as art, music, or dance.

iii. Biologically Based Therapies: include herbs, foods, vitamins, minerals, and dietary supplements.

iv. Manipulative and Body-Based methods: include therapeutic massage, shiatsu, chiropractic, and osteopathy.

v. Energy Therapies: include acupuncture, therapeutic touch, reiki, Chi Gong, electromagnetic fields, magnetic fields, kinesiology.

10. Alternative Medicine11
Alternative medicine has two aspects:
i) Proven Alternative Medicine which includes alternative medical systems such as Traditional Chinese Medicine and Ayurveda. These alternative medical systems represent a different paradigm of health care when compared to Conventional Western Medicine.

ii) Unproven Alternative Medicine – sometimes described as Unorthodox or Unconventional or Unproven Medicine and or therapies. This generally describes medical interventions that are not widely taught at medical school, not generally provided at hospitals, and are outside peer accepted mainstream medicine and standards of care. Examples include aromatherapy, intravenous chelation and ozone therapy.

11. Traditional Medicine or therapies12
Well documented or otherwise established medicine or therapies according to the accumulated experience of many traditional health care practitioners over an extended period of time.

The Therapeutic Goods Administration (TGA) provides a specific definition: ‘traditional use refers to documentary evidence that a substance has been used over three or more generations of recorded use for a specific health related or medicinal purpose’.
Traditional therapies include traditional Chinese medicine, traditional Ayurvedic medicine, western herbal medicine, homeopathic medicine, indigenous medicines, and aromatherapy.

12. Natural Medicine or therapies13
Substances or therapies that work with the natural processes of the body by restoring or correcting organic functions; or modifying organic functions such as modifying those functions in a manner that maintains or promotes health. They generally support the body’s healing mechanisms rather than taking over the body’s processes.
Examples of pharmaceutical medication originally derived from natural medicine include digitalis from the herb foxglove (Digitalis purpurea), and asprin(salicylate) from willowbark (Salix alba), which contains that active ingredient salicin.

COMMENT
Using these definitions, Integrative Medicine can be understood as an umbrella term which includes current Western Orthodox Medicine and Complementary Medicine. Alternative Medicine is posed as a choice to Conventional Western Medicine. This may be a well founded, proven alternative therapy such as whether to use Western Medicine or Traditional Chinese Medicine to treat a specific condition (where two quite different approaches are established as having good results) via different and therefore alternative methodologies; or an unproven alternative therapy such as using shark cartilage to treat primary cancer.

2. THE AIM OF TREATMENT 
Curative Treatment14
Aims to render the person clinically free of detectable cancer and to restore the person to their normal life expectancy.

Palliative Treatment15
Palliative care is an umbrella term for assisting those approaching death. It is a fundamental need and right. This term is generally used in the context that death is imminent and inevitable; and the application of palliative care aims to make dying as easy and comfortable as possible.

Palliative treatment is non curative by definition. It aims to extend life, eg. increase survival time, ameliorate symptoms, and increase quality of life.

REFERENCES
1. Medical Benefits Schedule, Item Statistics reports

2. Sackett DLR, Rosenberg WM. Gray JA, Haynes RB, Richardson WS. Evidence based
medicine: what it is and what it isn’t. BMJ 1996;312:71-2.

3. Webster’s New World Medical Dictionary

4. The RACGP-AIMA position paper on Complementary Medicine, available on www.racgp.org.au/advocacy/position-statements

5. Kotsirilos V Complementary Alternative Medicine AFP 2005;34: 1-3

6. Egges G North Ryde:McGraw Hill (2008) Lifestyle Medicine.

7. Gawler I.J. 2009 Presented at RACGP Annual Conference 2006.

8. National Center for Complementary and Alternative Medicine, National Institutes of Health,
Bethesda, Maryland 20892 USA. Available at: www.nccam.nih.gov

9. Easthope G Alternative, complementary, or integrative? Complement Ther Med 2003: 11:2-3C
10 Kotsirilos V. – ibid

11.Gawler I.J ibid

12.Therapeutic Goods Administration. Levels and kinds of evidence to support indication and
claims for non-registrable medicines including complementary medicines and other listable
medicines. TGA, October 2001

13.Kotsirilos V. – ibid.

14. Caociato DA. Manual of Clinical Oncology 5th Ed 2004
15.Gawler IJ ibid


Other Useful References:
1. Kotsirilos V. Complementary & Alternative Medicine – Part 2 AFP 2005; 34:689-691

2. Kotsirilos V. GP’s Attitude toward Complementary Medicine AFP 2007: 36: 1-2

3. Complementary Medicines Information Use and Needs of Health Professionals: General
Practitioners and Pharmacists December 2008 – National Prescribing Service Ltd.
4. Model guidelines for the use of complementary and alternative therapies in medical
practice. A Policy Document of the Federation of State Medical Boards of the United States. Dallas: Federation of State Medical Boards of the United States, Inc. 2002.
5. Marc S. Micozzi. Fundamentals of Complementary and Alternative Medicine. Churchill Livingstone Inc. 1996.

RESOURCES
1. Refer to my website where there is more related research and suggestions on how to manage a cancer diagnosis.

2. My book: You Can Conquer Cancer

3. My CDs (also available as downloads)
The Gawler Cancer Program
What to do when someone you love has cancer

RELATED BLOGS
The Cancer Council, the survivors and the book

Recovery from cancer is possible

NOTICEBOARD
Ruth and I will be presenting a range of public talks, workshops and retreats around New Zealand in November/December.

We start with an evening Public Talk in Auckland on Thursday November 14th (which will be followed up by a weekend in Auckland on November 30th and December 1st), then there are a range of other events.

We are delighted to be including our first meditation retreat in New Zealand (which quite a few Aussies have also booked for already!) - December 2 -8.

Please do let anyone you may know in NZ about the visit - a link to last week's blog gives all the details - Colour therapy and New Zealand - or go to my new public Facebook page: Dr Ian Gawler, or the website. So much technology!!!

Ian Gawler Blog: Colour therapy and New Zealand

This week some extra-ordinary colour therapy courtesy of a flourishing garden, along with details of the meditation retreat in, and tour of New Zealand Ruth and I will embark upon in November and December. Plus reminders of impending talks in Melbourne, Brisbane and Perth, along with a small request and a treat!

If you do know anyone for whom these events may be useful, please do share this post with them. I am still convinced that helping someone else to learn or deepen their meditation is one of the most useful things we can do.

But first
Thought for the Day
It takes dedication, hard disciplined work, and intensive training
Before a dancer can move with unearthly grace
And perform feats that are impossible for an untrained body.
In the same, way, people have found when they practice compassion assiduously,
All day and everyday,
They achieve new capacities of mind and heart
                   Karen Armstrong

Ruth and I love going to New Zealand. Great country, great people, great reception. There seems to be a real openness and enthusiasm for Mind-Body Medicine, Complimentary therapies and Lifestyle Medicine. My sense of this is that both the public and the professions, including the doctors, are more open and embracing than in Australia.

It would be interesting to get comments/impressions from any of you who do move back and forth across “the ditch”; what is your experience of this?

We have been invited to present a range of programs – from retreats to a free public workshop in Christchurch for those affected by all the devastation that has come to that city.

So we hope to be able meet up again with those we have met on previous visits, and to continue to make new friends along the way. The events begin in

AUCKLAND: Evening Public Lecture: Medicine of the Mind - Thursday November 14th.
Here the conversation will be around how to let go of stress, activate healing and maximise performance in all you do. The latest research findings will be presented, along with how they can be applied. The power of the mind at work in everyday life. Time to relax and meditate together as well! There will also be a weekend workshop in Auckland Nov 30, Dec1 - see below.
Full details, CLICK HERE

Next comes
ROTORUA: Health, Healing and Wellbeing - November 16th
Here the focus will be more on the prevention and recovery from illness. I will aim to present the essence of what I have found most helpful over the 30 plus years I have worked in this field. Given we have a full day together, there will be plenty of mindfulness and meditation practice interspersed throughout. Full details, CLICK HERE

WANAKA RETREAT – Cancer and Beyond -  November 18 – 22
This five day follow-up cancer program is specifically for people who have attended a CanLive program in NZ, or Gawler Foundation program. This program is currently fully booked, but there may be a cancellation. Full details, CLICK HERE

CHRISTCHURCH Inner peace, Outer health. Sunday November 24th.
A free day workshop made possible by CanLive. An offering to all those affected by the traumas that have beset Christchurch and surrounds in recent times. I will speak of stress management in the conventional sense, as well as what I find to be the more profound possibilities with mindfulness and meditation. We will discuss recovery from major trauma and how it may be possible to find peace and clarity amidst troubled times. Full details, CLICK HERE

NELSON: Mind-Body Medicine in daily Life - Evening of November 26th.
Ah, Nelson. Now there is a place! And the chance to speak about relaxation, meditation and creative imagery for health, business, healing and wellbeing, with a focus on how to deepen the experience of meditation – and some practice together.
Full details, CLICK HERE

AUCKLAND: Weekend workshop: A New Way of Living
A way of living that generates good health, profound healing and long-term wellbeing.
Saturday November 30th: Meditation and the power of the mind
Meditation has a long history at the heart of spiritual practice. Then there is a more recent and rapidly evolving modern, scientific history.

Currently, astute leaders in all fields are recognizing that the mind is pivotal in whatever field of expertise you care to examine. In sport, business, relationships, health, healing, wellbeing; the mind decides what we do, how proficient we become and how much enjoyment we experience. Train the mind and everything gets better.

Meditation provides the key to training the mind and as such is the key to the future. Support it with the practices of relaxation, mindfulness, imagery and contemplation, and we can directly and reliably tap into the incredible power of the mind.

This day will gently blend facts and experience, knowledge and wisdom. I love it!
Full details, CLICK HERE

Sunday December 1st: Living Well, Being Well –
We all want to be healthy and happy. Many people have heard stories of people who have recovered against the odds from cancer and other major illnesses. Many know of, or are dealing themselves with major illness. Carers and Health Professionals are always thinking of how they can be most useful.

What to do? What works best? How do complementary and natural therapies work with conventional medicine? And what about prevention? What is best to eat – for good health and for recovery? How can we be really well and experience long-term good health and happiness?

Today the focus is on presenting the evidence, sharing years of experiences and providing practical answers. Learn how our lifestyle can powerfully affect our health and our capacity to heal – and how to get the best from our own potential.
Full details, CLICK HERE

MANA RETREAT CENTRE on the COROMANDEL PENNINSULA
Meditation Under the Long White Cloud. December 2nd – 8th.
This seven day meditation retreat will be the first Ruth and I will have presented in New Zealand. We love these retreats. A wonderful time to be amidst like-minded people, to assist with deepening your understanding and experience of relaxation, mindfulness and meditation; and then guiding you into the direct experience of inner peace.

Some may join us from Australia and places further afield, but if you are thinking of coming, it will make sense to book soon as all our retreats of late have been fully booked.
Full details, CLICK HERE

THE REQUEST
The organisers for the Auckland talks have requested me to help them set up a public Facebook page that they can use to help promote the events there. As time goes on, I will be able to use this to send out other interesting info and event news and all the things people do on Facebook – God help me!!! – but it seems “Liking “ the page is helpful.

So, if you care to, please pause for a moment, smile, and like me! Now you are laughing a little, please do the liking by CLICKING HERE! Then please send it on to anyone who may be interested.
Many thanks!




Here is the blank canvas 
The veggie garden
prepared over winter
awaiting the Spring planting




NOTICEBOARD
i) MELBOURNE: Mind-Body Medicine in daily life - Sunday October 20th, 10 – 4.30pm
Day seminar with Ian Gawler and Dr Nimrod Sheinman
Be inspired, be informed, deepen your experience of mindfulness, creative imagery and meditation.

Nimrod is a world authority in Mind-Body medicine and an expert with creative imagery and mindfulness. A healthy lunch is included in the modest fee for the day.
Full details, CLICK HERE

ii) BRISBANE November 4,5 and PERTH November 7,8
The famous Happiness and its Causes conference is going on the road and I will be presenting keynote addresses and half day workshops at both venues. My keynote topic is dealing with stress and anxiety; the workshops are on meditation.

Full details,  BRISBANE CLICK HERE  ,  PERTH CLICK HERE

NOW FOR THE BONUS TREAT
Try clicking on this: The pause that refreshes - the wildest way yet to encourage people to meditate!