It’s not often that a scientific article in a learned medical journal becomes front page news but that was the case recently when a paper I co-authored with Dr Ian Haines of Melbourne’s Cabrini Hospital was published in the Internal Medicine Journal (IMJ) just before the new year.
In very prominent “exclusives”, Fairfax newspapers, including The Age in Melbourne, called our paper explosive. What was the fuss about? Ian Haines and I are experienced cancer specialists and had published a paper with the rather unexplosive title “Hypothesis. The importance of a histological diagnosis when diagnosing and treating advanced cancer. Famous patient recovery may not have been from metastatic disease.”
In this technical report, we analysed the very public case of Melbourne cancer guru Ian Gawler whose claims to have cured himself of advanced cancer by a series of unorthodox treatments have passed into Australian folklore. His methods included herbal remedies, meditation, coffee enemas and diets.
After careful evaluation of the publicly available case details (mostly made public by Gawler himself), we came up with an alternative theory. We suggested that rather than suffering from advanced cancer, Gawler had been afflicted by tuberculosis, which was appropriately treated with antibiotics and cured.
Gawler vigorously disputes our theory and there will undoubtedly be a lively series of exchanges in the correspondence pages of the IMJ. Both Ian Haines and I have received a number of unpleasant communications from Gawler supporters for having gone public the way we did, often with questions about our motives. Although, to be fair, we also received a considerable number of supporting messages from colleagues.
The obvious question – why did we do it? Why put our reputations on the line to query the diagnosis of a man who is seen by many in the community almost as a saint, as someone who (according to one correspondent) “has helped thousands of cancer patients”.
Although we didn’t appreciate it at the time we prepared our report, the publication of our paper coincided with increasing stirrings amongst scientists and orthodox medical practitioners against what’s seen as promotion of “pseudoscience, anti-science, dodgy science, bogus science, balderdash, claptrap…”. This description comes from Dr Simon Singh, a British science journalist who recently successfully defended himself in the United Kingdom against a libel action mounted by the chiropractic fraternity for harsh criticism of their philosophy.
So our work hasn’t occurred in a vacuum. The newly formed Australian organisation, Friends of Science in Medicine, is currently campaigning strongly against universities that are seen as sullying their scientific reputations by running courses in alternative and evidence-poor philosophies of medical practice, such as chiropractic and homeopathy. In only a few weeks since their launch in late 2011, FSM has attracted hundreds of supporters and garnered international attention.
Although alternative practitioners have always been with us, they became much more prominent during the 1970s and 1980s. Initially, at least, the attitude of the orthodox medical profession was to ignore them and hope they would go away. Orthodox clinicians often adopted an attitude of “at least their treatments can do no harm”; an attitude has been shown to be mistaken in many cases.
But the increasing emphasis in medical teaching and practice on a solid “evidence base” for everything clinicians do is starting, finally, to encourage the profession to challenge the proponents of these alternative philosophies and indeed to be harsher in their criticisms of treatments considered bogus or worse.
So to return to the Gawler story. Ian Haines and I, and many of our medical colleagues, have been distressed over the years to see large numbers of our cancer patients adopt some of his unproven ideas – often to the exclusion of proven orthodox treatments.
We asked the question, how well supported by evidence are Gawler’s claims? We based our enquiries on a quote from the late Carl Sagan that “extraordinary claims require extraordinary evidence”. Gawler’s claim to have cured his cancer by meditation, herbs, coffee enemas and a vegan diet is surely extraordinary by anyone’s interpretation.
If cancer sufferers and other ill people are to follow his advice, which is not an easy thing to do, they need to be sure that it is based on rock solid evidence without there being a possible alternative explanation.
Our motive, pure and simple, was to point out that there’s at least one other highly plausible explanation for his survival. Cancer patients should think carefully before following down the path that Gawler has mapped out.
It’s time science fought back.