Jan 04 2012
Dr. Ian Gawler, a veterinarian, suffered from osteogenic sarcoma (a form of bone cancer) of the right leg when he was 24 in 1975. Treatment of the cancer required amputation of the right leg. After completing treatment he was found to have lumps in his groin. His oncologist at the time was confident this was local spread from the original cancer, which is highly aggressive. Gawler later developed lung and other lesions as well, and was given 6 months to live due to his metastatic disease.
Gawler decided to embark on an alternative treatment regimen, involving coffee enemas, a vegetarian diet, and meditation. Eventually he was completely cured of his terminal metastatic cancer. He has since become Australia’s most famous cancer survivor, promoting his alternative approach to cancer treatment, has published five books, and now runs the Gawler Foundation.
At least, that is the story he believes. There is one major problem with this medical tale, however – while the original cancer was confirmed by biopsy, the subsequent lesions were not. His oncologist at the time, Dr. John Doyle, assumed the new lesions were metastatic disease and never performed a biopsy. It was highly probable – the timing and the location of the new lumps following a highly aggressive cancer. But even a diagnosis that is 95% likely will be wrong in 1 patient out of 20 – which means a working physician will have patients with the 5% diagnosis about once a week. The standard of practice today would be to do a biopsy to get tissue confirmation of the diagnosis, and rule out the less likely alternatives.
Recently oncologists Ian E Haines and Ray M Lowenthal published a paper in which they advance a plausible alternative theory to the story Gawler has been telling for 30 years. Another part of Gawler’s history is that, at the same time he was pursuing alternative treatment for his presumed metastatic cancer, he was diagnosed and treated for tuberculosis. He was having night sweats, losing weight, and coughing up blood – all symptoms that can be explained by disseminated TB. Gawler acknowledges that he had TB and was successfully treated for it, but contends that he had cancer and TB. Haines and Lowenthal propose their alternate hypothesis, and point out that all of Gawler’s symptoms (following successful treatment of his sarcoma) could be explained by TB.
Haines and Lowenthal conclude in their paper:
This hypothesis is advanced for two reasons. The first is to underline the modern recognition of the need to consider diagnostic investigations, including biopsy, before assigning the diagnosis of advanced cancer to any patient. This principle is especially vital in cases where two diseases can present in the same way. The second is that there a risk that if diseases are incorrectly labelled, incorrect treatments may be given. This can lead to misleading interpretations being made about non-traditional treatments providing “cures,” which can influence the decision-making of patients seeking answers and even lead them away from potentially curative traditional treatments.
As oncologists they want to emphasize the point that biopsy is necessary in such cases – that is a fairly accepted position. They go further to point out that incorrect diagnosis is one source of misleading stories that could convince many cancer patients that an ineffective “alternative” treatment is effective, and therefore interfere with their informed decision making. This is an excellent point.
No one is doubting the sincerity of Ian Gawler himself, although even if sincere he can still be profoundly mistaken. It is easy to understand how someone who was given a terminal diagnosis and then survived would credit whatever they did to treat themselves. This is a profound personal experience, and certainly affected the course of the Gawler’s subsequent life. It is a powerful story that will resonate with anyone facing a cancer diagnosis.
All the more reason to set the story straight, or at least point out that Gawler’s interpretation of his own story is not the only possible interpretation. This points to the fallacy of relying on anecdotes in medicine – 37 years after the fact we have no way of determining whether or not Gawler had metastatic cancer or TB. This means that his case cannot be used as evidence for the efficacy of diet and meditation in curing cancer. But that is exactly how Gawler is using it.
In his latest book, The Mind that Changes Everything, Gawler writes:
It is our mind that regulates our present and our future. Do you imagine a happier world with better health? More vitality? More success with the ability to fulfil your potential when it comes to sport, business, relationships, healing and peace of mind?
This is a typical New Age, Chopra, The Secret type of claim – if meditation can cure cancer, then the mind can do anything. It is pure wish-fulfillment fantasy, but can sound compelling when backed up by an apparent dramatic story.
In a news report on their new article, Haines is quoted as saying:
”I’ve seen beautiful young girls with their whole lives ahead of them and they go into these holistic therapies and spend hundreds of thousands of dollars and then in the end we have to look after them. They all eventually get to us.”
I need to point out that while Haines’ experience is important, it is also anecdotal. He is only seeing those patients who come to him after CAM treatment failure. It is possible that there are those who are cured that he is unaware of because they don’t “get to” him. All we can say is that there are cases of patients who pursue alternative cancer cures, they do not work, and then they present to an oncologist in an advanced stage of their disease. What we need are controlled studies of any proposed treatment to see if they are safe and effective. Of course, there are no such studies supporting the use of alternative cancer cures – that’s why they are alternative.
Gawler has believed for the last three decades that diet and meditation can cure cancer. He has spent that time writing books and promoting his personal story, convincing many others of his beliefs. While he may mean well, the far better course of action would have been to study the hypotheses that stemmed from his dramatic experience, not to conclude that he must be correct and proceed with premature conviction. That is the difference between a crank and a scientist.
In medicine well-meaning (and not-so-well-meaning, for that matter) cranks can do a lot of harm. It’s good to see mainstream doctors recognizing the risk and doing something about it.
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