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A VICTORIAN psychiatrist has revealed she felt “propelled” to attend programs run by the Gawler Foundation after being diagnosed with cancer.
In a Reflections article in the latest MJA, Dr Tanya Hall (pictured left) said she was drawn to the program, founded by cancer survivor Ian Gawler, because she found it difficult to adopt the passive stance that patients were expected to take in Western medicine. (1)
“With my very survival threatened, I needed to believe that I could play an active role in my own recovery; Gawler provided me with this sense of autonomy, for which I remain grateful”, Dr Hall wrote.
She said she particularly benefitted from some aspects of the program, such as learning meditation, which was taught well and which had a reasonable evidence base.
“However, other aspects of the program are troubling”, Dr Hall wrote.
Her main concerns were the low-fat, essentially vegan diet with no added salt or sugar and no caffeine, and the idea that those with a certain psychological profile were more likely to develop cancer.
“Depriving people of the pleasure of tasty and satisfying food, inducing guilt every time we transgress the dietary straitjacket, condemning us to highly time-consuming activities, suggesting that our illness has been brought on by our own faulty characters — these are not benign interventions, especially for those whose conditions are terminal”, Dr Hall wrote.
Dr Hall’s article follows recent controversy about Gawler’s diagnosis and treatment for advanced cancer, and his claims that his recovery stemmed from adopting major lifestyle changes rather than conventional medical practices.
In an article published earlier this year in the Internal Medicine Journal, two leading Australian cancer specialists, Associate Professor Ian Haines and Professor Ray Lowenthal, offered an alternative hypothesis for Gawler’s recovery from advanced and incurable metastatic sarcoma. (2)
They suggested that the patient, having been cured of localised high-grade osteogenic sarcoma of the leg by amputation surgery, then developed advanced tuberculosis alone without metastatic cancer.
The hypothesis was vigorously disputed by Gawler. (3)
In her article, Dr Hall said the accuracy of Gawler’s medical history was not relevant to her experience with the Gawler Foundation.
“I accept that Gawler, and his staff, are well intentioned and appear to be motivated by what they perceive to be the best interests of people with cancer”, she wrote.
“No one would disagree that addressing lifestyle factors is important for cancer patients; my concern is that in my opinion the Gawler program goes too far, making far reaching suggestions that do not appear supported by evidence.”
Dr Hall wrote that while criticism of conventional medicine was accepted as part of the program, “there is an almost complete lack of critical analysis among participants of Gawler’s methods”.
“Surely one can argue whether spending your limited days juicing and meditating is a ‘better’ use of one’s time than, say, indulging in one’s passion for fine wine, coffee, or even a roast lamb dinner”, she said.
– Kath Ryan
1. MJA 2012; 196: 598-599
2. Internal Medicine Journal 2012; 42: 212-216
3. Internal Medicine Journal 2012; 42: 472-474
Posted 21 May 2012
Dr Hall raises some important dietary issues that our patients also tell us. Most patients following the Gawler regimen are suffering from dietary induced cachexia and other nutritional problems. These issues were highlighted in Saturday’s Melbourne Age 9 June 2012 – “Doctor denounces Gawler program’s ‘harsh’ healing.” Although Dr Hall says the accuracy of Gawler’s medical history was not relevant to her experience with the Gawler Foundation, in reality it is hard to separate the two. If Gawler’s ‘cure ‘has influenced large numbers of patients to follow his cancer cure regimen often foregoing chemotherapy, and if indeed he was misdiagnosed – is that not relevant? Given recent evidence by Haines and Lowenthal in their 2012 IMJ, including disclosure that there had been no biopsy of Gawler’s metastases; claims relating the “curative” value of a vegan diet (Gawler didn’t have), meditation and positive thinking require proof and validation. Another important point discussed by Dr Hall is concerns regarding the Gawler Foundation’s attitude to the effectiveness of chemotherapy. She refers to study quoted and commented on by Ian Gawler in a readily available PDF on the Gawler Foundation’s website – Opinion piece: ‘Chemotherapy’ April 2006 ….”Increased survival only 2.8% after 5 years!” This much quoted paper by cancer patients and integrative GP circles is very misleading and has unfortunately deterred many patients from taking chemotherapy. The study Gawler quoted from was seriously questioned. A letter by four prominent Melbourne medical oncologists challenged the study’s methodology and conclusions. It was published by the same journal a few months later: Mileshkin L, Rischin D, Prince HM, Zalcberg J. Clin Oncol (R Coll Radiol). 2005 Jun;17(4):294.
I do not see the issue of diagnosis to be the central factor here. Ian Gawler claims to have had mature bone resected from his lung, and this would seem to be evidence of a metastatic osteosarcoma (see https://www.mja.com.au/journal/2008/189/11/thirty-year-follow-pneumonect…). However, if this is so then it would prove little as case reports are low level evidence.
A PubMed search on the terms (osteosarcoma metastatic spontaneous regression) reveals a number of similar cases, so Gawler’s circumstances are not unique.
Moreover, the 5 year survival in a recent case series of 323 osteosarcomas with resectable lung metastastes treated with chemotherapy was 9%.
See http://www.ncbi.nlm.nih.gov/pubmed/19515554
In order to determine if diet and meditation actually influenced the course of osteosarcoma one would need to publish at least a case series with historical controls.
Osteosarcoma, however, is one of the tumours with the lowest level of geographical variation around the world (except in the elderly) which would suggest that it is one which is less likely to be subject to major dietary influences. See http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048853/?tool=pubmed
Tanya Hall’s insightful article (MJA 21 May 2012) raises relevant issues for cancer patients who practise the Gawler program. I am the ex-wife of the Gawler Foundation’s found – and it’s co-founder (also published in the MJA) – and therefore more than qualified to comment given my 22 years involvement. The dietary concerns raised by Hall are real. In my current practice I often see emaciated patients due to veganism; feedback tells us it is often mistaken for cancer-related cachexia by oncologists. If patients are led to believing that Ian Gawler adhered faithfully to a vegan diet after his 3-month Gerson diet, and that it was a significant factor in his recovery – then they are severely misled. A December 2008 MJA story about the patient’s ‘remission’ incorrectly reported Ian Gawler’s vegan diet as fact. However, Ian Gawler never practised veganism as a part of his recovery; he later stated this on his blog. The original Gawler program that I co-founded in the mid 1980s until I resigned in 1996, encouraged patients to seek medical treatment in combination with lifestyle change, initially recommended lacto-ovo vegetarian diets short term often with addition of fish and other good protein sources on an ongoing basis, and, the organisation did not claim that meditation and lifestyle changes could cure cancer.
There were changes in the organisation after I left and there have also been changes in the story of Ian Galwer’s recovery – as Haines and Lowenthal state in their 2012 IMJ hypothesis; cross checking with past public records is revealing. The latter led to their investigation of this previously un-investigated case. Was there a misdiagnosis as Haines and Lowenthal suggest?
Hall chooses not to go there.
It is unfortunate that the links provided to MJA readers of this article do not relate to significant comments made by the IMJ authors Feb 2012 on a subject so imperative to the Australian cancer public…Haines and Lowenthal state: ” We stand firmly behind our hypothesis that Gawler developed progressive multifocal tuberculosis from late 1975 and was eventually diagnosed with, and cured of, advanced tuberculosis in 1978 by standard drug therapy. We do not believe that there is any evidence that he ever had metastatic osteosarcoma.” Is this issue of misdiagnosis important or not? Do cancer patients have a right to know, or should they go on blindly believing in and making life and death choices based on a highly questionable case history? Exceptional claims require exceptional evidence, so in this case, may science and medicine keep probing for the evidence.
While I agree that the Gawler approach does overinterpret the evidence, a recent review concluded that that there was some evidence that a low-fat, high-fibre diet as well as physical activity might be protective against cancer recurrence and progression in breast, colorectal, and prostate cancer. (See http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3251953/?tool=pubmed.)
A more intriguing question is what role diet plays in the initiation and promotion of these cancers in the first place. According to the WHO’s International Agency for Research on Cancer (IARC) Australia has the highest age-adjusted rates of prostate and bowel cancer and the second highest rate of breast cancer after Western Europe.
Interestingly there are regions of the world such as East Asia which have (until recently) had one tenth of the age-adjusted rates of these cancers that Australia has. This difference has been correlated in epidemiological studies with saturated fat and fibre intake. See the Globoscan data at http://www.iarc.fr/
It is ironic that Gawler and his devotees call out conventional medicine for being paternalistic and encouraging passivity in patients, and yet their method is more paternalistic than most – calling for strict obedience under the guise of self-empowerment. Health is not all about diet. We all know there is a complex interplay of genes and lifestyle, from smoking and obesity to chemical exposure. People crave simple, directed advice when they are vulnerable, and Gawler clearly gives it.
It would assist this debate if Ian Gawler published the long term results of his interventions
My (dead) mother was a devotee of Gawler’s – in my view the constant guilt about an impossibly stringent diet coupled with denial did considerble harm to her well-being.
How long will it be before our profession understands…!
Humans are BODY, SOUL (Mind, Will & Emotions) and SPIRIT…!!
Therefore if we are to treat sickness and disease in humans
we must ‘minister’ to each aspect appropriately!!!
Shalom…Shalom
The concept that in modern medicine we are encouraged to take a passive stance is not true and certainly is not my experience. Activity is not always treatment whether it be by an oncologist, radiotherapist, surgeon or alternative therapist. Having a positive but realistic attitude is the way to go and keeping away from true believers, either medical or alternative, is the safest bet.
Tanya Hall makes a good point in that conventional medical treatments expect patients to be completely passive. If the same happened to me I would consider a “Gawler”approach.
At least it does no harm!
So guilt and self denial are added to the cancer, which will continue its course anyway.