23 July 2018

Ruth-and-Ian-Gawler's-history-How-we-met-and-the-insight-that-followed

Many people have asked over the years how Ruth and I met. Our story began amidst tragedy and its telling offers a profound insight into the role of the mind in healing.

Ruth has been inspired to share this story and it reveals personal aspects of her own life, so another guest blog - read on… you are in for a treat; but first




              Thought for the day 

     It is just purely a stillness of the mind.
     Not asleep, not unconscious, not drowsy;
     Quite clear, but just a stillness.

                       Dr Ainslie Meares
         Australian pioneer of therapeutic meditation








RUTH’s DEMISE
Many years ago when I was in my mid thirties I had a complete physical and mental breakdown. A doctor living and working in Alice Springs at that time, I was a mother of 2 young boys. My difficulties centred around severe intractable backpain which radiated down my right leg causing weakness and numbness in my right foot; rather mundanely referred to as sciatica.

Diagnostically my back pain was supposedly related to “bulging discs” – an all time rubbish diagnosis because often the cause of backpain is so hard to find. However, there was no denying the pain was severe, restrictive and intermittently excruciating.

There had been a previous episode of severe backpain in my life, the first had come 9 months after the birth of my first child - whilst I was in a full-blown major postnatal depression and had not had a decent night’s sleep in 9 months.

So, this second bout was like a re-run, and as a consequence I became depressed once more, with regular experiences of panic and negative thoughts about what my future held. Despite this, I was reluctant to recommence the antidepressants that I had taken for years after that first episode in my late twenties.

So I found myself lying on my bed, writhing around, trying to find a comfortable position to
breastfeed my healthy 5 month old baby son, and trying to work out how I could manage the day.

There were all the necessary chores of cooking, washing and tidying up, along with entertaining and engaging his 4 year old brother.

Doing this with determination and resolve; whilst trying to stop my mind sinking into despair.

Unable to sit for more than 5 minutes and doing exercises that the physiotherapist at the Alice Springs hospital had recommended – swimming laps and walking in the shallow end of the pool - as well as gentle stretching which came from my yoga practices which had helped my back to be pretty good for the previous 3 years.

But, try hard as I did, I was faced with the fact that I was having a complete breakdown and these methods were not working. Physically, mentally, emotionally; I was a wreck.

RUTH DESCENDS INTO THE DEPTHS

All the ways I had learnt to survive, thrive and cope with life were no longer working… and I did not believe in much beyond what science offered. And worse than this, from my perspective, into the mess of my inadequate functioning - I had brought a new baby.

My partner who was a loving father to the children was a busy Flying Doctor in Rural Health working around 60 hours/week, and although he was away a lot, he was providing for us all and engaging when he could. We had no extended family in Alice Springs to help, and sure our friends were helping us as much as they could, but we had no sense of when this misery would end, or even if it ever would.

Guilt grew that my baby and my little boy would feel abandoned. I took indefinite leave from my part-time general practice work at the Family Planning Centre. And took the various anti-inflammatory medications, stayed off opiates, and recommenced small doses of amitryptiline.

Although I started to become used to being chronically ill, at times life seemed almost unbearable. However, I did keep my ears open for help by consulting orthopaedic specialists and new GPs; as I saw it in those days, “anything that might help”.

In desperation, I even tried Reiki - on the recommendation of a kind friend who was a nurse helping me with childminding.

It worked like paracetamol and gave welcome relief for 4 hours.

However, me being a conservative doctor in those days, it left me very perplexed as to what had happened.

I knew I had been pain free for 4 hours but had no belief that anything like that should or could work.

My mind was starting to crack. But the Reiki was too challenging for me with my existing paradigm and I did not keep going for it. I had become one of those “sickly” people who was coping with a rather miserable situation.

RUTH FINDS PEACE of MIND
Then one day a book eased itself into my line of vision. Did someone give it to me? Who? I have no memory of how this book actually came into my life, but my best guess now is that I had probably bought it myself a bit earlier when I had thought meditation may help my chronic struggle with depression. It had sat unread on the bookshelf at home.

The book was Peace of Mind by Ian Gawler!

I started to read it and as I continued, developed a strong feeling that the author really knew what I was experiencing in my life.

It was like Ian was talking to me personally - and he described a methodology through which I might find comfort and ease.

I read the book in a couple of days and started implementing the techniques described there.


And then the miracle! Over a matter of a couple of weeks my pain began to diminish, some real flexibility returned, and most importantly I had hope that I would be OK, and my mood started to lift.

Moreover, the author seemed to believe that complete healing was always possible, no matter what the cause or the prognosis. He dared to suggest that all the doctors who had told me that I would need to be on medications intermittently for the rest of my life may well have been wrong. And the combination of his confidence – which came through his words and the way he phrased things - and the technique of the Progressive Muscle Relaxation based meditation were working for me.

RUTH’s RESTORATION
My recovery was gradual and consistent; and did not take very long. Within 2 months I was back to being how I had been prior to the breakdown. Sometimes, I actually felt that I had escaped a lifetime prison sentence and was elated!

Of course I was told by my GP that the problem would return and I should expect that. I had kyphoscoliosis and lumbar disc problems and manic depression (now called bipolar). How could something so simple work on something so complex?

My intellect went into overdrive trying to understand why I was getting better, but could find no satisfactory explanation. I was unfortunately a scientific fundamentalist and had no belief in any reality apart from what science had discovered and supposedly proven. In those days, science and psychology were my gods. They had both shaken their heads at me in the plight I was in and their faces had been somber.

Why did I dare to believe in something so unrealistic? Why did I choose to believe in something so unrealistic? Well, how that all unfolded is another story for another time!



SO HOW DID RUTH AND IAN MEET?

Often I respond to this question with a cheeky smile and say with a twinkle in my eye “what do you call meeting?

Are we meeting the person when we read their book?”, because if so, this has been the story of that first meeting.



RUTH’s INSIGHT
And what I really want to communicate in telling you all this is that the doctor, or the healer, or the therapist you are seeing will greatly influence your own beliefs about what is possible when it comes to your recovery. When we consult someone in their office we are often in a kind of a trance, and our mind is quite child-like and obedient. The possibilities of our own future are quite naturally limited or expanded by what the therapist thinks and expresses.

We are only as well as what we think, and our doctors/therapists/healers have a profound influence on what we think. If their view is that we have a poor prognosis and are doomed to a bleak future, it deeply affects our own mind and the nature of what is possible, and thus our own vision of what our future holds. Of course, the opposite applies equally.

So we need to make decisions very consciously about who we consult, what we read and what we listen to when you are dealing with major illness and recovery.

My wish is that you have the courage and clarity, and are supported to make wise choices…


Ruth Gawler's 
next meditation retreat - with Julia Broome

Meditation - Pure and Simple

Whether burnt out, dealing with physical or mental issues, this retreat provides a unique opportunity to be led and supported by a doctor well versed in Mind-Body Medicine who has a particular expertise with deep relaxation and healing.

Ruth will focus in this retreat upon the meditation techniques of Dr Ainslie Meares and Ian Gawler. 
The only meditation retreat Ruth is leading in 2018 that will be specifically focussed on meditation's therapeutic healing benefits.  

Combine deep relaxation techniques and mindfulness meditation to release the stress we carry in our bodies in this busy and complex modern world. Ideal for healing, rejuvenation and opening our awareness.

Ruth’s teaching style is one of openness and authenticity, and there will be plenty of opportunity for questions and discussion. Techniques covered in this retreat will be accessible and engaging for both beginners and more experienced meditators. This retreat is well suited to all Health Professionals. Certificates of Attendance for CPD points issued, on request at the end of this retreat.

DATES                                    September - Monday 10th to Friday 14th September 2018
VENUE                                   Yarra Valley Living Centre, Rayner Crt, Yarra Junction, Victoria
ENQUIRIES, BOOKINGS     The Gawler Foundation ClientServices@gawler.org
                                                 and 1300 651 211 - Call Mon-Fri 9-5pm

WEBSITE LINK CLICK HERE


09 July 2018

Cancer-treatment-Is-it-OK-to-say-no?

Guest blog from Dr Ruth Gawler
My dear 82 year old mum told me this week that following a mammogram she has been diagnosed with probable breast cancer and she does not want a biopsy or any treatment. 
Being her oldest daughter and a doctor, all this came as a bit of a shock; and it raises questions around the right and sensibility of refusing treatment.
Now mum told me her news in a matter of fact, unemotional way; as if she just wanted me to understand this was her decision and she was simply informing me. She has also told the family and is quite open about her diagnosis and choice. 
As it happens, I have another elderly patient who also is saying no, so this week let us examine what is behind these powerful choices - and their wider implications, but first,

                      Thought for the day - mid winter style


       An elderly American Indian was asked by a white man
       How it was he managed to wear so few clothes in Winter.
       “You white people,” he replied
        “Does your face get cold in winter?”
        “No.”
        “We Indians… all face!”  




My mother has been living in an aged-care facility for over 3 years due to relentlessly progressive immobility from a number of causes including longstanding kyphoscoliosis and arthritis, reflex sympathetic dystrophy, chronic muscle atrophy etc etc. 
Yet mum’s mind is clear as a bell, she has a formidable memory and the kind of well-informed, original conversation that has a string of visitors - family and friends - almost queuing to be engaged and entertained regularly. My mother is what they call a real live wire; well-informed, gregarious and with a great sense of humour. 
So, after she had called me with “the news” I went to visit her in her room on the 5th floor of her aged care residential facility overlooking St Kilda Rd. To my pleasant surprise, from her usual sitting position on her bed she greeted me with a big smile; obvious delight to see me all over her face. Her arms extended for a hug and a kiss; I put the shopping I had done for her on the floor, and we embraced. 
Now mum had also made it clear to me that she did not want my medical advice, and I was to refrain from giving my opinion on her medical situation. Not an easy call for someone like myself who has worked intensively with people managing cancer for nearly 2 decades. But, I could do it and had resolved just to talk about other things unless she raised the topic. 
Being a regular meditator makes this kind of plan relatively doable. After all, when we meditate we learn how to place our attention where we want, and to be aware when we are distracted. So it was just a matter of deciding to talk about other things and remembering the plan. 
As it happened, we did talk about many things, including the blanket she was knitting, her conversation on Skype with her sister in Israel, the potato latkes (fried classic Jewish potato cakes) that had been brought for her dinner, and the funny weather we were having.  
Then, at one point she repeated that although her mammogram had shown probable breast cancer she did not want a biopsy or any treatment. 
Like any daughter I was initially surprised and upset. 
Mum told me that she would not cope well with the medical procedures and it was not her wish at this time in her life to be going through more suffering than she already had. 
What would you call that? 
Stupid? Sensible? Crazy?  Self-aware? 
In shock? Denial? Depressed? Rebellious?  
Some would analyse her reaction as “scared of the medical system”, or “ill-informed”. 

Others may say that she has so many other health problems, her life may just be too hard to manage any longer. Mum has a “frozen foot” with severe constant neurogenic pain, recurrent digestive problems and a big swollen tummy, great difficulty walking and needing to shuffle along in a walking-frame, failing eyesight, and so on and so on. Maybe this recent “breast cancer diagnosis” just slipped into the list of all her other physical challenges.
And another factor - my dear mum has been pretty overtly rebellious since she divorced my dad when I was 15 (and had then exploded the lid of her life as a virgin-bride, hardworking mother of 3, and piano teacher who had cooked and cleaned for her family for 16 years). 
But given all this, it may still be quite possible mum is making a very reasonable, rational personal choice to not engage further with the medical industries on this matter. Mum is a double degree, university educated, highly intelligent, well-informed elderly lady with human rights. And here she is telling us all clearly in sound mind that it is her wish is to curtail further medical investigation and treatment.  
So many ways of looking at an old lady saying “No thanks!”
Now in my medical practice is a 78 year old highly educated Swiss lady who was diagnosed with Ovarian Cancer about 4 years ago. 
On medical advice she received chemotherapy that was not deemed to be curative but would “prolong her life and improve her quality of life”. 
She described this treatment to me as “a nightmare” of misery that left her with neurological deficits – numbness in her hands and feet, extreme tiredness, weakness and depression. 
Yet, she told me “it may have done some good because her cancer marker went down” and “maybe it was worth it” at the time.
Now a couple of years later after reading You Can Conquer Cancer and attending a cancer residential program she feels wonderfully well once more, and describes her life as “better than it has ever been”. 
She is eating a clean (organic) wholefood-plant-based meals, she is meditating regularly, using an infra-red sauna regularly, taking certain specifically recommended supplements prescribed by an expert and exercising regularly. 
Her mood and energy levels are excellent she tells me, and her relationships with her daughters and grandchildren are good. 
She has no sense of being unwell. 

However, her cancer marker CA125 is slowly going up. Very slowly going up. This means that she is regularly advised to have “more chemotherapy” albeit something slightly different than the last course. 
It is with great personal effort, courage and resolve that she says “no thank you” to the “very compassionate and caring oncologist” who has been regularly taking care of her. She has had incredible difficulty doing this. 
This great, mature lady has studied the efficacy (effectiveness) of the treatment offered and she has had personal experience of similar treatment. This woman too is university educated and by the by, was a leader in her field of childhood education in her middle years. She is aware that her body is actually doing a good job of minimising the growth and impact of her metastatic cancer with all she is already doing to stay well. She also has the resources and support to manage this lifestyle long-term. 
Both my mum and my Swiss patient are old dames who have left the countries of their birth and childhoods, have seen wars come and go, families grow up and leave and make lives of their own, and been engaged, hardworking members of the communities they live in. 
Of course they are different in many ways but here they are in their twilight years saying “No thanks” to their doctors. 
Do they have this right?  
And could they be right to do so ? 
And if the answer is yes to both these questions, then why is it that we do not make it easier for them?


       Ruth's mother second from left with her two daughters on the right celebrate a milestone birthday.


Ruth Gawler's 
next meditation retreat - with Julia Broome

Meditation - Pure and Simple

Whether burnt out, dealing with physical or mental issues, this retreat provides a unique opportunity to be led and supported by a doctor well versed in Mind-Body Medicine who has a particular expertise with deep relaxation and healing.

Ruth will focus in this retreat upon the meditation techniques of Dr Ainslie Meares and Ian Gawler. 
The only meditation retreat Ruth is leading in 2018 that will be specifically focussed on meditation's therapeutic healing benefits.  

Combine deep relaxation techniques and mindfulness meditation to release the stress we carry in our bodies in this busy and complex modern world. Ideal for healing, rejuvenation and opening our awareness.

Ruth’s teaching style is one of openness and authenticity, and there will be plenty of opportunity for questions and discussion. Techniques covered in this retreat will be accessible and engaging for both beginners and more experienced meditators. This retreat is well suited to all Health Professionals. Certificates of Attendance for CPD points issued, on request at the end of this retreat.

DATES                                    September - Monday 10th to Friday 14th September 2018
VENUE                                   Yarra Valley Living Centre, Rayner Crt, Yarra Junction, Victoria
ENQUIRIES, BOOKINGS     The Gawler Foundation ClientServices@gawler.org
                                                 and 1300 651 211 - Call Mon-Fri 9-5pm





WEBSITE LINK CLICK HERE





25 June 2018

Top-Ten-Reasons-to-Meditate

Many people these days are meditators. Many who read this blog are even regular meditators! Others? Part time. So what motivates us to make time to meditate; to take time to meditate? And how does that compare to others?

This week a top ten list of reasons to meditate, and a question … What motivates you?, but first



         Thought for the day


Learning to focus our attention 
And suspend the stream of thoughts 
That normally occupy our mind


             Definition of meditation 
from the National Centre for Complementary and Alternative Therapies in the USA




People make time in their busy lives to meditate for many and varied reasons.

For some, it is an essential element in their spiritual practice; for others, a far more mundane reason. Here is a suggested the top ten list with an invitation to comment…

Regaining balance
Meditation is a modulator. It brings things into balance. Actually, it brings many things into balance - body, emotions, mind and even spirit. It does this by helping us to let go of the stresses of life and re-establish our own natural, healthy, balanced state. Meditation leads to deep physical relaxation and deep mental calm and peace, and with these two - a natural state of balance.

Relaxation
Most meditation techniques lead of themselves to a good degree of physical relaxation. However, the technique I have found most useful over the years emphasizes and starts with deep physical relaxation.
This leads to a relaxed, healthier, more active, energetic body. This physical relaxation quite effortlessly can flow on to bring relaxation to the mind. And it feels great!

Stress relief
Meditation is well known for it stress relieving properties. Through a combination of relaxing the body and helping us to react differently in our mind to potential stressors, meditation provides rapid relief. This reduces the risks from the many stress related illnesses, has a direct positive benefit with relationships and leads generally to greater efficiency and wellbeing. Again, this also feels great!

Increased concentration
At the heart of good meditation practice is concentration. So as we practice meditation, we develop our concentration. This then flows into all aspects of life, meaning we can apply our minds to better effect.

Increased mindfulness
We all know how good it feels when someone gives us their full attention. And how unsatisfying it is when they do not. We all know how bad feeling judged by others feels; how good it is to be listened to, accepted and worked with collaboratively. All the positives here are to do with mindfulness - another of the core practices we develop as we meditate regularly. Mindfulness - giving whatever we do our full attention free of judgement or secondary commentary.


Increased energy
If we are stressed out, we are burning heaps of energy in the process.

If we are physically tense we are wasting heaps of energy in that tension.

As we meditate and learn to become more relaxed, calmer and clearer, a good deal of the effort goes out of whatever we do.

Things just seem to get easier, and there is more energy available within us for the things that really matter.





Better health
Prevention? Meditation is well proven to assist in preventing most of the things you would rather not have.
Healing? Better Immunity? Faster recovery from injury? Remember, meditation is a modulator, it helps to create the ideal conditions within the body and mind that enable good health - prevention and recovery.

Better decision making
Doubt, confusion, worry, indecision; all these things go hand in hand with stress. Meditation leads to a calm and clear mind. Many people notice once they begin meditation that choices seem easier to make. With a calm and clear mind we are able to think more clearly, what to do seems more obvious, we develop more confidence in the choices we do make and so we follow them through and get good results. This is a key to what we know as “positive thinking”.

Heightened intuition
The active thinking mind and emotions can combine to become a real double edged sword - could be really good, could be really bad - for us and for others. Yet we all know there is this deeper aspect to our mind that has an innate wisdom; that can be relied upon for good advice. When we learn to meditate, slow down the chatter within the thinking mind and allow our emotions to settle a little, we naturally come within closer contact of this inner wisdom. It is as if a veil lifts and that wiser part can speak to us - and be heard. This too can feel really good! And lead to great decisions about all aspects of life.

Heightened spiritual awareness and connectedness

So many lonely, disconnected people these days. So many people seeking some deep relief or inner high through drugs or destructive behaviours.

Many then are turning to meditation as they seek to find meaning and purpose in their lives.

Many seek answers to the great philosophical questions - Who am I?, Where did I come from?, and where am I going to? And What is life?

And the fact is that over millennia meditation is a proven pathway to personally satisfying answers to these questions.

Perhaps we left the best reason to meditate to last? 
What is it that motivates you? Maybe time for a comment below?





12 June 2018

The-Jade-Buddha-in-Bendigo-Home-at-last

Imagine this… A Buddha carved from a million dollars worth of top quality jade now residing in regional Victoria! What a story… Well worth telling…

For those unacquainted, this giant Buddha was carved from one massive piece of pure polar jade found in the Yukon - the far northwest of Canada - 18 years ago.

I had the good fortune to be invited to attend its inauguration when the Jade Buddha arrived at its new home - the Atisha Centre outside Bendigo on Friday 18th May.

So this week, this incredible story and encouragement to visit, plus details of Ruth's upcoming meditation retreat in the Yarra Valley, but first

Thought for the day (a longer poem in honour of the Jade Buddha …)

The Journey

One day you finally knew

What you had to do, 
And began,

Though the voices around you

Kept shouting

Their bad advice-
-
though the whole house

Began to tremble

And you felt the old tug

At your ankles.

"Mend my life!"

Each voice cried.

But you didn't stop.

You knew what you had to do,

Though the wind pried

With its stiff fingers

At the very foundations,

Though their melancholy
was terrible.

It was already late

Enough, and a wild night,

And the road full of fallen

Branches and stones.

But little by little,

As you left their voices behind,

The stars began to burn

Through the sheets of clouds,

And there was a new voice

Which you slowly

Recognized as your own,

That kept you company

As you strode deeper and deeper

Into the world,

Determined to do

The only thing you could do-
-
determined to save

The only life you could save.

Mary Oliver

Some of us may have been fortunate to see the Jade Buddha during its travels or buy a small piece made from the offcuts.

The Jade Buddha is 2.5 metres high and sits on an alabaster throne of close to 1.6 metres. Weighing in around 4 tonnes, it is considered to be priceless and is shown here in its uncut form with Ian Green (on the right), the man behind the whole project.




The Jade Buddha was modelled upon the Buddha inside the Mahabodhi Stupa in Bodh Gaya (India).  This Buddha was chosen because it is recognised by most Buddhists as the closest likeness to the Buddha himself.




The Jade Buddha project 
In early 2003 Ian Green heard about the massive piece of jade known as Polar Pride.



Ian then spoke to his spiritual master, Tibetan Lama Zopa Rinpoche (whose organisation FPMT has a major centre in Melbourne, the Tara Institute - along with many other centres around the world).

That night Lama Zopa had a vision that the boulder would become a Buddha that would illuminate the world.

Lama Zopa then told Ian “you must turn this jade boulder into a Jade Buddha as a holy object to offer to the world”.

            Lama Zopa with the Dalai Lama


The next 5 years were devoted to raising the necessary funds, selecting the best jade master carvers, shipping the boulder to Thailand, preparing a total of 4 prototypes, carving and polishing the Jade Buddha. Completion?  December 2008.

World tour
Commencing early in 2009 the Jade Buddha for Universal Peace toured the world with the objective of inspiring everyone who sees it to find peace in their family; peace at work; peace at school, peace in their community and most importantly peace in their heart.

The Jade Buddha tour travelled to over 120 cities in 20 countries and an estimated 12 million people spent time in its presence.

Atisha and the stupa
The stupa in which this remarkable statue is now the centrepiece, is nearing full completion but already stands 50 metres high and 50 metres wide at its base, making this $20 million building the largest of its type in the western world.



Atisha had its genesis in the advertising career of its now President, Ian Green. Turning his back on the “rat race” and looking to India for solace and meaning, Ian found Buddhism before returning to Melbourne; whereupon his father offered him 50 acres in Myers Flat, near Bendigo.

Over the past 38 years, Ian has supported the Atisha Buddhist centre as it has expanded to over 210 acres and now includes a monastery, a retreat centre and an inter-faith peace garden. There are also plans to create a school and an aged-care facility.

"A little town that runs on Buddhist values of harmony and cooperation and, you know, peace — but that also runs on the grounds of sustainability," Ian said.

Highly recommended for a visit
No doubt the Jade Buddha and the incredible stupa will be a draw card for serious pilgrims and curious tourists - who may just make a connection or have their curiosity aroused and turn towards the dharma.

For any of us; what I do suggest is that whenever you can, make a visit - it is quite extra-ordinary and the atmosphere in the stupa, when you sit in front of the statues of the Jade Buddha and Guru Rinpoche, plus a huge White Tara thangka is quite something.



Well worth making time for…

Jade Buddha    WEBSITE


Ruth Gawler's 
next meditation retreat

Meditation - Pure and Simple

Whether burnt out, dealing with physical or mental issues, this retreat provides a unique opportunity to be led and supported by a doctor well versed in Mind-Body Medicine who has a particular expertise with deep relaxation and healing.

Ruth will focus in this retreat upon the meditation techniques of Dr Ainslie Meares and Ian Gawler

Combine deep relaxation techniques and mindfulness meditation to release the stress we carry in our bodies in this busy and complex modern world. Ideal for healing, rejuvenation and opening our awareness.

Ruth’s teaching style is one of openness and authenticity, and there will be plenty of opportunity for questions and discussion. Techniques covered in this retreat will be accessible and engaging for both beginners and more experienced meditators. This retreat is well suited to all Health Professionals.

DATES                                    September - Monday 10th to Friday 14th 2018
VENUE                                   Yarra Valley Living Centre, Rayner Crt, Yarra Junction, Victoria
ENQUIRIES, BOOKINGS     The Gawler Foundation ClientServices@gawler.org
                                                 and 1300 651 211 - Call Mon-Fri 9-5pm





WEBSITE LINK CLICK HERE



28 May 2018

Are-parachutes-useful?-Evidence-Based-Medicine-and-a-plea-for-common-sense…

We are all making decisions every moment of the day. Some big. Some inconsequential.

So how do we decide what to do?

Current mainstream medicine loves describing itself as “Evidence Based”. The implication is that all decisions are made based upon “good scientific evidence”, with randomized trials being the “gold standard”.

But would you volunteer for a randomized controlled study into the efficacy of parachutes?

Maybe not; so this week, an exploration of what really does constitute “good scientific evidence” - and where does common sense fit in; but first



       Thought for the day

Simple can be harder than complex :
You have to work hard
To get your thinking clean
To make it simple.

But it is worth it in the end
Because once you get there,
You can move mountains.

                         Steve Jobs






To quote the authors of a landmark research paper published in the prestigious British Medical Journal (BMJ) way back in 2003, “As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials.



Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. 

We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.”




Simple really! We use the best available evidence for any decision we face.

In medicine, drugs are one type of intervention that often can be evaluated well using double blind, crossover trials.

But let us not even go into how often drug companies and researchers under all sorts of pressures (both external and internal) have been proven to falsify results.

The truth is that it is estimated around 75% of all recommendations made in common medical practice do not have high level scientific evidence to support them.

A good example is the treatment of early bowel cancer. Everyone accepts surgery is the best option; yet there has never been a randomized trial to confirm this - probably never will be; the fact remains this option is based entirely on clinical experience.

So it may be helpful to point out what the definition for “Evidence Based Medicine is. The commonly accepted definition first appeared in the BMJ, this time back in 1996 :

Evidence based medicine (EBM) is the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. EBM integrates clinical experience and patient values with the best available research information.

Key points? 
Not just “best available research”, but “clinical experience and patient values”. This is the definition. This is EMB. Clinical experience is important. And the patient and what is important to them needs to be taken into account. You need a good clinician!

The problem? 
Current medicine in my opinion has been railroaded by those who overly value scientific research.

My sense of it is that many current practitioners have lost confidence in their own abilities.

It seems that unless a test confirms something for them, they are unable to trust their own clinical acumen.

Rather than examining their patients, they send them off for tests - blood tests, XRays, CAT scans; and often it seems the more complex the tests the better.

And this reliance on investigations is certainly driving and being supported by big business in medicine. An MRI costs a lot more than palpating an abdomen.

And the lawyers have a lot to answer for as well. If challenged - as in sued - a doctor has a better chance of defending themselves these days if they can refer to the evidence of pathology and other tests rather then clinical examinations.

So what to do?

Firstly be aware that evidence has a hierarchy.
There is good evidence and bad evidence, or should we say evidence with greater or lesser weight. In science and medicine there is what actually is called “The Hierarchy of Evidence”. This describes the quality of evidence as follows…

1. Systematic reviews and meta-analyses of "Randomised Controlled Studies (RCTs) with definitive results".
2. RCTs with definitive results (confidence intervals that do not overlap the threshold clinically significant effect)
3. RCTs with non-definitive results (a point estimate that suggests a clinically significant effect but with confidence intervals overlapping the threshold for this effect)
4. Cohort studies
5. Case control studies
6. Cross sectional surveys
7. Case reports

No need to bother with the detail of the above unless you are really into it; where a read of Wiki on this matter may be useful (3).

Clearly when it comes to evaluating research evidence, this hierarchy has some use; the implication being that the higher up the hierarchy you go, the better the quality of evidence.

But be aware that even when the research evidence is good, it still needs to be personalised for you as an individual and there may be several if not many other factors to take into account as well as the scientific research.

An example?

It is summed up by what in the definition of EBM was described as “patient values”.



Finally, note how the hierarchy of evidence starts with case reports (reports in journals of individual or similar case histories with details of diagnosis, treatments and outcomes, but no systematic research)- which scientific types commonly describe as “anecdotes” and demean.

However, case reports often are the best evidence available - as in the only evidence available -  and as such they constitute the basis for correctly informed EBM.

An example?
For many years it could well be argued that the best way to treat cancer nutritionally was to follow the diet as recommended in You Can Conquer Cancer (4).

The reason for this assertion is that for many years there was no better evidence; the Foundation through the clinical experience of myself and all my colleagues had amassed more clinical experience with treating cancer with nutrition than anyone else in the country, so to be Evidence based, we had the best evidence!

How do you like that idea???

Anyway, what to do now? 
Now there is more formal research evidence for cancer nutrition, as well as so much bogus stuff floating around the net and in the press. How to make the best decision we can in any circumstances - medical or elsewhere???

So a push for common sense.

That is it.

That is where this post ends.

A push for common sense.

And more trust in, and support for doctors who do actually talk with their patients and do actually physically examine them.



And avoid any suggestion you take part in a RCT to do with parachutes.

REFERENCES 
1. Smith GCS and Pell JP : Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. BMJ 2003; 327:1459

2. Sackett DL et al : Evidence based medicine: what it is and what it isn't. BMJ 1996;312:71

3. Greenhaigh T : How to read a paper. Getting your bearings (deciding what a paper is about)  1997  BMJ. 315 (7102): 243–6.

EDITOR’s NOTE This is a very useful paper if you are interested in reading original research papers and interpreting their qualities.

4. You Can Conquer Cancer : First published 1984, revised current edition 2015, Wilkinson Publishing, Melbourne. Also available as a spoken book - from my website...

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Just give me the facts


Ruth Gawler's 
next meditation retreat

Meditation - Pure and Simple

This particular retreat will be ideal for everyone seeking deep healing
Whether burnt out, dealing with physical or mental issues, this retreat provides a unique opportunity to be led and supported by a doctor well versed in Mind-Body Medicine who has a particular expertise with deep relaxation and healing 
Ruth will focus in this retreat upon the meditation techniques of Dr Ainslie Meares and Ian Gawler

Combine deep relaxation techniques and mindfulness meditation to release the stress we carry in our bodies in this busy and complex modern world. Ideal for healing, rejuvenation and opening our awareness.

Ruth’s teaching style is one of openness and authenticity, and there will be plenty of opportunity for questions and discussion. Techniques covered in this retreat will be accessible and engaging for both beginners and more experienced meditators. This retreat is well suited to all Health Professionals.

DATES                                    September - Monday 10th to Friday 14th 2018
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