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TB or not TB? A second opinion on Ian Gawler’s cancer

Late last year, two oncologists went public with a theory that cancer survivor Ian Gawler’s secondary cancer may not have been cancer at all but tuberculosis instead. At the time, the story made front…

Ian Gawler recovered from secondary cancer after conventional and unconventional treatments, including meditation. Sebastien Wiertz

Late last year, two oncologists went public with a theory that cancer survivor Ian Gawler’s secondary cancer may not have been cancer at all but tuberculosis instead. At the time, the story made front page news but expert testimony recently reported in The Age strongly disputes the claim.

Gawler lost a leg to cancer in 1975. He was diagnosed with secondary cancer in his pelvis and chest at the end of that year and it was treated with an experimental course of powerful chemotherapy for a few months in 1976. Following conventional and less conventional treatments – including meditation and a strict diet – he fully recovered.

In 1984, Gawler wrote the bestselling book You Can Conquer Cancer. Gawler’s approach has found increasing support over the years, but he also has his critics. The TB hypothesis put forward by Ray Lowenthal and Ian Haines was based on information taken from the public record. While there’s no dispute that Gawler did in fact suffer from TB, it appears he caught it later than Drs Haines and Lowenthal supposed.

Retired thoracic surgeon, Professor Peter Clarke, told Guy Allenby the chemotherapy Gawler was treated with would have caused him to die “because it would have rubbed out all his defences against the TB.” Chemo disrupts the body’s immune system. That Gawler somehow managed to shrug off TB during this treatment is an exceptional claim.

But let’s suppose he did - what other pointers are there to show that TB wasn’t present at the time? Dr Jonathan Streeton has re-assessed records and X-rays taken of Gawler’s secondary tumours specifically for evidence of TB. Streeton is a highly-respected chest physician based in Melbourne, was advisor to the Victorian government on tuberculosis and treated Gawler for over 30 years.

Together with some of his radiology colleagues at Melbourne’s Mercy Private Hospital, Streeton examined an X-ray of Gawler’s pelvis from the time when Gawler was diagnosed with metastatic disease (secondary cancer). In a letter to Ian and Ruth Gawler, Streeton said the general consensus was that the X-rays showed what was typical of an evolving osteogenic sarcoma metastasis.

Streeton also scrutinised a later X-ray showing damage to Gawler’s lower spine, which Haines and Lowenthal also hypothesised was TB. Significantly, the disc spaces between the verterbrae were well preserved. Streeton writes that this “would tend to be a specific excluder of a tuberculous process involving the lumbar verterbrae” and a TB infection of the spine would also typically evolve into an abscess inside the back wall of the abdomen. Gawler had no such abscess.

Streeton also notes that when Gawler later contracted TB and was finally treated in 1978, he was found to be resistant to Isoniazid – a drug used to treat the local strain of the disease. Such a resistance was usual in the Philippines and other parts of Asia but almost unheard of in Australia at the time. Gawler had never been out of Australia when he developed secondary cancer late in 1975. He visited the Philippines in March 1976 and January 1977 and India in March 1977 and March 1978 and likely contracted TB on one of the trips.

Gawler’s website lists ten pieces of evidence that throw doubt on the TB theory put forward by Haines and Lowenthal.

So, a fit young veterinarian is told by medical specialists that his cancer has returned after the amputation of his leg, and that he will shortly die. He survives against overwhelming odds, writes a book about it to give people in the same situation hope that it is possible, and starts a program of providing holistic care and support for these people.

Over 30 years later, two specialists - without referring to him, his medical records, or his doctors - say that his recovery wasn’t from cancer at all. Then, to top it off, the media frame this as the patient “claiming” he had cancer. Indeed, the suggestion that Ian Gawler was claiming he had secondary cancer implies some deceit on his part.

And the controversy isn’t over. A few days ago, The Age reported Dr Ian Haines saying Dr Streeton’s new assessments are incorrect and should be tested in a peer-reviewed journal.

In the bigger picture, there’s no such controversy – large-scale integrative cancer support centres are opening up in Australia and the rest of the world, driven by enormous consumer demand.

Ian Gawler has always been respectful of conventional cancer treatments and he’s the first to acknowledge that his retreats are not just about surviving, they’re about living and dying well. He has now retired from The Gawler Foundation, which works according to his principle of offering optimal lifestyle-based approaches to complement conventional medical therapy. Tens of thousands of people have lived better and died better as a result of its work.

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30 Comments sorted by

  1. Grendelus Malleolus

    Senior Nerd

    Article needs a subtitle: "Muddying the waters by paddling your own canoe".

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  2. Mia Masters

    pensioner

    I find the article useful and needed (to restore balance into the 'Gawler-debate').

    I find the attempts to undermine the work of the Gawler Foundation and its founder pathetic and unhelpful.

    The question on validity of this 'approach' was answered by Dr Karl Kruszelnicki (not in reference to the 'Gawler'):
    "One study showed that a healthy lifestyle could act on the DNA in the prostate cancer and trigger genetic changes.

    In other words, information could flow from outside the cell (good diet and exercise) and modify the DNA to slow down the prostate cancer."
    http://www.abc.net.au/science/articles/2009/11/04/2733310.htm

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    1. Reema Rattan

      Editor at The Conversation

      In reply to Mia Masters

      Hi Mia,

      I was struck with the words "One study..."

      Thanks,
      Reema

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    2. Pip Cornall

      logged in via email @gracegawler.com

      In reply to Mia Masters

      Dear Mia - with respect. Nobody is undermining the work of the Gawler Foundation or it's co-founder, Ian Gawler. But there was another founder, Grace Gawler who spent many years of her life as 24/7 care giver to Ian when he was too sick to do anything. She was also co-director of the Foundation until she resigned in 1996.

      When this other founder has shown proof that an 2008 MJA article about Ian Gawler's remission written by Prof Jelinek and Dr Ruth Gawler has multiple errors - we should investigate.

      Grace undoubtedly helped save Gawler's life - surely cancer patients deserve the whole truth and nothing but the truth beforfe deciding to base treatment choices on Gawler's misreported story.

      If you peruse all the conversations about this topic you'll find no 'attacks' on the foundation or Ian Gawler - just attempts to clarify his remission story.

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    3. Ruth H Gawler

      Medical Practitioner

      In reply to Mia Masters

      Exactly Mia. Where is the discussion about all or the research that supports the Lifestyle Medicine taught at The Gawler foundation. The work of Prof Dean Ornish and Elizabeth Blackburn. It's there if you look. Plenty of evidence-based medicine. Maybe what the real aversion to here is actually not the lack of science but the heart in it, the care.

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    4. Sue Ieraci

      Public hospital clinician

      In reply to Mia Masters

      Dr Hall, in her MJA article, referred to a low-fat, essentially vegan diet with no added salt, sugar or caffeine"" (which she said lacked a solid evidence base and was particularly harsh for people suffering mouth ulcers and nausea" and was "combined with juicing vegetables six times a day ")

      I haven's heard anything but praise for the attempts to connect people with others experiencing similar things, to give them a sense of empowerment, and to teach meditation.

      It is possible, however, that…

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  3. Pip Cornall

    logged in via email @gracegawler.com

    Accuracy about the Ian Gawler story is crucial due to his profile and influence over treatment choices made by cancer patients. My comment should shed more light into ‘muddied waters.’

    The recent controversy about Ian Gawler’s secondary cancer or TB arose from a 2008 MJA article, ‘True Stories’ written by Ruth Gawler and George Jelinek and peer reviewed by Dr Sandra Neate.

    The article contained many errors noted by a former patient of Grace Gawler, who notified her in 2009. Grace had been…

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    1. Ruth H Gawler

      Medical Practitioner

      In reply to Pip Cornall

      Has any one asked the question about why it took Grace Gawler nearly 20 years or more to decide that her husband did not have secondary cancer. Surely one has to ask why it was such a slow and timely realisation. How come she worked for so many years at The Gawler Foundation in the very programs she now criticises. Where is the credibility here?

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  4. Grace Gawler

    Founder/Director the Grace Gawler Institute

    True , Gawler lost a leg to cancer in 1975. But then waters get very muddied indeed. I was Gawler’s companion then wife who was present 24/7 to attend to his needs. We were together from 1974 – 1997. In other words quite enough time to be a key witness to all that transpired, plus I was the record keeper who took all the photographs throughout Ian’s recovery. There are no quarrelling wives in this story; a smokescreen that almost successfully buried the facts and the science of Gawler’s recovery…

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  5. Sandra Neate

    Doctor

    In response to Pip Cornall
    I know Ian Gawler. He is a friend of mine. He is a gentle soul. At the moment I imagine him in his vegetable garden or something similar. I know Ian survived cancer and that he has done a life time's work trying to help others. I am not sure what Ian eats or how he would classify what he eats. He is a friend. I have never worked at the Gawler Foundation although it seems like it would be a lovely place to work. I have been to a couple of courses there. They were wonderful…

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  6. Comment removed by moderator.

  7. Sue Ieraci

    Public hospital clinician

    As a regular reader and commenter on this site, I find the exchange on this thread so far very curious. On health topics, we are not normally debating who said what or what happened when, but whether health claims are based in evidence, and the various issues related to health care ethics, economics and science.

    So, the essential questions that we would normally discuss in relation to Gawler's approach (or "regime", some might say), would be:
    - What evidence is the approach based on?
    - Does…

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    1. Edward John Fearn
      Edward John Fearn is a Friend of The Conversation.

      Hypnotherapist and Naturopath

      In reply to Sue Ieraci

      Thanks Sue
      The few people I know who attended Ian’s meditation retreats were all continuing conventional medical treatment. All found the experience a largely positive one, however I would be interested to see if this result is a valid representation of the majority of participants attending these retreats.
      Supporting evidence for the use of mindfulness meditation in cancer can be found here.
      http://www.cam-cancer.org/CAM-Summaries/Mind-body-interventions/Mindfulness/Does-it-work
      A copy of the article by Dr Tanya Hall can be found on Grace Gawler’s website;
      gracegawler.com/Institute/wp-content/uploads/2011/03/Perspective-on-Gawler-Foundation-program-by-course-participant-psychiatrist-Tanya-Hall-MJA-2012.pdf

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    2. Ian Haines

      Adjunct Clinical Associate Professor & Senior Medical Oncologist and Palliative Care Physician at Monash University

      In reply to Sue Ieraci

      ..Hear hear Sue! You have identified the issues here and separated them from the distractions and 'red herrings.' You expressed yourself eloquently.....as you so often do.on these important discussions.
      Dr Streeton's statements about :
      1. Spinal TB always sparing intervertebral discs
      2. Being able to distinguish evolving TB of bone from metastases from osteosarcoma on plain xrays.
      3. Being able to properly assess intervertebral discs anyway on old plain xrays
      4. Only catching the less common…

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    3. Grace Gawler

      Founder/Director the Grace Gawler Institute

      In reply to Sue Ieraci

      Back to Basics - Evidence or No Evidence – : Sue - I agree. I can only endorse psycho oncology including relaxation methods to enhance the lives of cancer patients. Pre 1996 patients were supported in their medical care while partaking of the Gawler approach. This changed after 1996, as stated in my response letter on this blog.
      The questions you bring forward need to be addressed. I will focus just on one crucial journal abstract about this case.
      What evidence is the Gawler approach based on…

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  8. Luke Weston

    Physicist / electronic engineer

    Know what they call "integrative medicine" that only "integrates" healthcare modalities that have been assessed in a scientific fashion and found to have a good evidence base?

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  9. Pip Cornall

    logged in via email @gracegawler.com

    Dear Sandra (apologies Sue) since this conversation article was co-authored by your husband let’s stick to the medical implications and science indicating Ian Gawler likely had TB instead of secondary cancer and not whether Gawler is a nice chap meditating in his vegetable garden.

    Of concern is why your husband continues to write on this topic having co-authored that 2008 MJA article about Gawler later shown to contain multiple errors. Grace Gawler’s 2010 MJA letter tabled these errors.
    Thanks…

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  10. Ruth H Gawler

    Medical Practitioner

    There is a whole other aspect to this discussion which is best summed up by the points that Dr Kathryn Irving made in the IMJ in December 2011.
    "It relates to whether we can place our emphasis on protecting vulnerable patients from exploitation - advocating some degree of paternalism and asserting the superiority of biomedicine - a "doctor knows best" approach. Or we can remain agnostic about the limits of knowledge- biomedical and otherwise and place greater faith in the capacity of our fellow…

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  11. Edward John Fearn
    Edward John Fearn is a Friend of The Conversation.

    Hypnotherapist and Naturopath

    Thanks Ruth
    I was hoping that the discussion would move more towards the Gawler methods instead of just the Man.
    I have been quite interested in Blackburn’s experiments with diet and lifestyle changes in promoting telomere integrity and length.
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2599779/
    I am also aware of the 1-year randomized controlled clinical trial of 93 patients with early-stage prostate cancer which included a low-fat, plant-based diet that Dean Ornish was associated with and…

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    1. Ruth H Gawler

      Medical Practitioner

      In reply to Edward John Fearn

      I agree that it's a good question of "how much is the advice tailored to the individual cancer histology" that Sue asks, is also relevant to all the treatments people are offered - chemotherapy, radiotherapy and trial drugs. And thi question can be extended to asking how much is the advice tailored to their ages and personalities and circumstances. There is a kind of blindness in many oncologists to some of the consequences of the treatments. They are often called "side effects" when they are often "known common effects" and many people are pushed by their frightened families to "just do it" when it involves a lot of hardship and genuine suffering for minor gains. The Foundation attracts many people with common sense and intelligence who think deeply about their situations.

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  12. Ray Lowenthal

    Professor of Oncology at University of Tasmania

    The point needs to be made that Dr Jelinek’s "criticism" of Ian Haines and me—that we didn't consult Gawler's doctors or his original medical records—is no criticism at all. Indeed it is surprising that Jelinek, a medical practitioner himself, should make such a charge. We did not act in such a way for very good reason, that to have attempted to do so would have been a serious breach of medical ethics and would have amounted to interference with doctor-patient confidentiality. Rather, we relied entirely on the comprehensive details of Gawler's medical illness that were on the public record, almost all made public or endorsed by Gawler himself.

    Gawler chose to make his medical history public as a basis for certain quasi-scientific claims. Like any other public statement, it is thus a legitimate topic for fair commentary.

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  13. Edward John Fearn
    Edward John Fearn is a Friend of The Conversation.

    Hypnotherapist and Naturopath

    Thanks for the reply Ruth;
    There is a growing body of evidence that supports the view that dietary interventions may lead to improved patient survival rates and may be protective against cancer progression.
    For example;
    Increasing vegetable and fruit intake and may lead to an increased survival rate in non-Hodgkin lymphoma.
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110752/
    Looking at breast, bowel and prostate cancer there is also some evidence from observational studies that suggests that…

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  14. Kaye Ellis

    Meditation Teacher

    I heard Ian Gawler speak in Albury 20 years before I had cancer myself. He inspired me then as he continues to inspire all these years later. No "evidence" could convince me that Ian is other than a caring individual who has shown remarkable courage, determination and dedication, firstly to getting well himself and secondly to helping others do the same. Clearly there is an unworthy agenda behind the efforts of those who try to discredit his work. Three years ago my oncologist told me he could only help me when it came to the time for palliative care. The Gawler Foundation gave me the courage and the tools with which to fight for my wellness.
    I feel great! Thank you Ian and those who continue to give hope to vulnerable people

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  15. caroline campbell

    colon hydrotherapist / wedding planner

    Here, here Kaye. I have been a participant in three Gawler programs all of which have assisted on my journey through breast cancer. Twenty two months ago I was diagnosed with a small tumour in my left breast. This was completely removed with all parameters clear. I have learnt a great deal since that time. There is no history within my family anywhere. The Gawler foundation ,using evidence based practice , empower intelligent people to make their own choices. They educate,support, encourage and at times just hold your space. I could not speak more highly of them. I am organic Vegan and proud of this , and I am well! From my initial ten day retreat a group of girls have formed an ongoing support group and we speak over facebook daily. The Gawler foundation are doing incredible work .

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  16. Pip Cornall

    logged in via email @gracegawler.com

    Ruth Gawler – said “The Foundation attracts many people with common sense and intelligence who think deeply about their situations.”

    A tragic email below found on the ‘Gawlerites’ conversation string, (Foundation course participants) demonstrates how desperate cancer patients can neglect ‘common sense and intelligence’ in wishing to believe that the vegan diet/meditation will work ‘miracles’ for them as implied it did for Ian Gawler - in Ruth Gawler & George Jelinek’s 2008 MJA article.

    Ian…

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    1. Edward John Fearn
      Edward John Fearn is a Friend of The Conversation.

      Hypnotherapist and Naturopath

      In reply to Pip Cornall

      Pip
      Although the query on Ian’s website was posted on what could be considered a public forum, I am not sure that the ethics of discussing this case is sound. How would the carer or the patient involved feel about us using their details in this context. How would it affect their emotional wellbeing?
      In respect to Dr Hall’s comments that the program leader claimed there was no evidence to show chemotherapy was effective, she is well within her rights to complain to The Office of the Health Services Commissioner. I also agree that the comments made by the staff member could also be potentially harmful. However it does appear to be the viewpoint of the one individual involved and according to the age article all staff had been counselled on this issue.
      http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Complaints_about_health_services

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  17. Pip Cornall

    logged in via email @gracegawler.com

    Some phrases by Ruth Gawler – ‘Haines and Lowenthal’s paternalistic attack on a therapeutic competitor’ – ‘oncologists' discomfort with losing their authority to dictate patient choices’ – ‘blindness in many oncologists to some of the consequences of the treatments’ – ‘involves a lot of hardship and genuine suffering for minor gains’

    Ruth’s proposition – ‘that a compromise be reached that rejects paternalism and accepts the possibility of patients being more directive in the therapies and included…

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  18. Grace Gawler

    Founder/Director the Grace Gawler Institute

    The actual title of the topic and content of the Jelinek/Allenby article TB or not TB is not being addressed. The question remains an "elphant in the living room" that eveyone pretends isn't there. Did Ian Gawler have TB or metastatic osteosarcoma? The burden of proof should not fall on cancer patients, or employees or friends of the Gawler Foundation to say yay or nay when they don't have access to all the pieces in the puzzle. Surely this is the most crucial aspect of this case. For the record…

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  19. Jo Rankin

    logged in via email @bigpond.com

    My goodness gracious me. What a lot of waffle about who has what and who has not, qualifications and intentions, past history, honesty and dishonesty, promises and guarantees. As a past participant in a retreat and an ongoing member of, and attendee at, the Gawler foundation the only thing of importance here is the wonderful support given to those, like myself, who have been through major illness and debilitating treatment and left floundering in a morass of sickness and depression with nowhere…

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    1. Grace Gawler

      Founder/Director the Grace Gawler Institute

      In reply to Jo Rankin

      First of all Jo – As Ian Gawler’s 24/7 carer throughout his illness and his wife for 2 decades, as well being the co Founder whose original idea created the Yarra Valley Centre; if you as an individual have had the experience you describe at the Gawler Foundation – then I am happy for you. However peace, care, friendship, compassion etc is not in question here. Many orgs offer this kind of support today and at no cost to the patient..
      The fact is you ARE a patient and there have been a few other…

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