Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments (5)

The Fallacy Of Relying On Anecdotes In Medicine

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.

*This blog post was originally published at Science-Based Medicine*


You may also like these posts

Read comments »


5 Responses to “The Fallacy Of Relying On Anecdotes In Medicine”

  1. pip cornall says:

    Since the Melbourne Age article, Dec 31, 2011, (Cancer Experts Challenge Gawler’s ‘Cure’) there has been much inquiry about the role of TB (tuberculosis) in Ian Gawler’s healing story.
    Given Gawler’s influence as Australia’s most famous recovered cancer patient it is of concern to me that his story is told accurately – I’m the only other person alive who was present 24/7 during his illness.
    At the time of the first publication, You Can Conquer Cancer, 1984, (when I was married to Ian Gawler) I was concerned that his previously diagnosed advanced TB was not mentioned. It had been suggested at the time of his ‘remission’ that the TB may have had something to do with his recovery (Dr Alistair Robertson, Adelaide)
    So I believe it would be fair, in a book regarded by many as the bible for cancer patients, that disclosure of the TB would have been appropriate. Even more confusing was a report in the MJA, Dec 2008 that stated Ian Gawler developed TB in 1978 implying it was after his remission, when in fact he had it for more than two years. More factual inconsistencies appear in Ian Gawler’s biography. The TB has not been mentioned in the new edition of You Can Conquer Cancer, 2001.
    For some reason Australia’s media have shown no interest in investigating or reporting on the original evidence in my possession that in fact lends more weight to the recent report in the Internal Medicine Journal (IMJ) by Profs Haines and Lowenthal that Ian Gawler was likely misdiagnosed.
    This has left me with no option but to blog widely on the issue. It was surprising that only one newspaper reported on my letter published in the Medical Journal of Australia (MJA) in September 2010, which outlined errors in two previous MJA articles about Ian Gawler’s recovery.
    Many ask why I’ve been so persistent. Having observed significant changes in Ian Gawler’s story over the years I have felt a public obligation to set the record straight.
    In my current practice I see increasing numbers of desperate cancer patients who have continually reported: “If Ian can do it – I can do it.” These patients are often advanced and have foregone conventional medicine in the hope of being another Gawler miracle. If Ian Gawler recovered from advanced TB with the assistance of medical drugs then patients have a right to know because their lives may depend upon what now looks like a misdiagnosis.
    On my website on the menu under Medical then MJA, I have included the entire history with photographic evidence. (gracegawlerinstitute.com)
    Grace Gawler

  2. Ross Taylor says:

    Sadly, when those who wish to protect the ‘medical model’ are threatened by people who simply want to empower patients to contribute to their own cancer recovery, they will look for any opportunity to attack such people. People such as Dr Ian Gawler.

    I was diagnosed with metastatic melanoma over 18 years ago. They have already sent my lymph nodes back to pathology three times because..”Ross isn’t dead yet so maybe we made a mistake?”. The only ‘mistake’ was that they didn’t understand that with the guidance of Dr Gawler I was able to drastically improve my GENERAL HEALTH and wellbeing to a point whereby I have lived very well with cancer for this extended period of time. No MAGIC. Just good sensible strategies to live well.

    The world needs more people like Ian Gawler.

    Those who feel threatened by Dr Gawler can say what they like. They have big money backing them. But so many people who I have known have lived better for having embraced the teachings of Dr Gawler.

  3. Toenail Fungus says:

    Very nice article. Thank you

  4. Cancer treatment in India says:

    science based medicine is true for this based on this articles…

  5. rc toys says:

    Xtreme RC Toys is the ultimate stop for all your rc needs. We have all the newest RC Helciopters, rc cars, rc boats, rc parts, rc batteries, xtreme rc toys, team losi, losi rc, hobby shop, team losi racing, traxxas e-maxx, rc store, hobby shop, redcat rc, rc helicopters, rc cars, rc helicopter

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »