Being with Dr Ian Gawler talking about Lifestyle Medicine

Transcript of interview on 8 March 2016

Jane: Hi, I’m Jane Treleaven from Essentially Being and welcome to this video.

It’s a real privilege today to be speaking to the man who wrote the book that I wished was on my bookshelf when I was diagnosed with cancer three years ago. The book contains all sorts of practical advice for dealing with a cancer diagnosis, including questions to ask about treatment, how to decide which is the best treatment for you, managing stress and negative emotions through meditation, using the mind to activate healing and diet and lifestyle. The book? “You Can Conquer Cancer,” if you don’t yet have a copy, I really recommend you get one. The man? Dr Ian Gawler. A long term cancer survivor, Dr Gawler was diagnosed with bone cancer and his right leg was amputated in 1975. However, the disease recurred later that year and drawing on an integrated approach, he experienced a remarkable recovery. So remarkable that he’s here a number of years later. In 1981 Ian began one of the world’s first lifestyle based cancer support groups. He’s the founder of the Gawler Cancer Foundation, an organisation dedicated to providing people with real options for improved health and well-being. He’s a well known advocate of self help techniques and a healthy lifestyle. Ian is one of Australia’s most experienced and respected authorities on mind-body medicine and meditation, and he’s helped a lot of people in their quest for peace of mind, good health and spiritual fulfilment. So, welcome Ian!

Ian: Hello Jane. Nice to see you again.

Jane: Lovely to have you here. How are you?

Ian: I’m particularly well, thank you.

Jane: Good, good to hear.

Ian: Every time I hear an intro like that, it reminds me that at the end of 1975 all informed people thought I’d live for a couple of weeks, so to be around 41 years later is not a bad deal at all.

Jane: No, it’s definitely bonus time, isn’t it?

Ian: Yeah, yeah, it’s good.

Jane: It is good. And not just for you, but for so many other people, I have to say. Myself included. So you’ve been described as a pioneer in the field of mind-body medicine. How did you find yourself involved in that field?

Ian: Well, I think it was sort of a fortunate conjunction of events, really. I was diagnosed with a nasty disease, sarcoma, which is a particularly difficult form of bone cancer. After I had my leg amputated, the cancer reoccurred, and that was in ’75. And in those days there was no medical cure. And in those days, I was working as a veterinarian, and I had a fairly open, curious, solution-based mind. I think vets are trained to solve problems and we often have to think in different situations.

Perhaps part of the fact of that  the doctors have just one to focus on and all that sort of stuff. Anyway, whatever that context was, it just occurred to me that, I basically had two choices – I could accept the diagnosis and I probably would have quite happily died on time –I don’t know how happy I would have been but I could have died on time, I think, quite easily. Or, be almost silly believe that it was possible to get well, but realistic enough to think that if I was going to get well, it was going to take quite a lot of hard work, because it obviously didn’t happen as a routine event. And I think I was helped with in that I came out of a decathlon athletic background, so I was pretty used to applying myself. And so when it was presented to me that an intensive dietary regime might be helpful, I took that wholeheartedly. And with the support of the nutritional training we veterinarians get, you know, it made a lot of sense and I was astounded to find that the doctors of the day, firstly, weren’t trained in nutrition and, secondly, discounted it and, thirdly, actually attacked me for doing it. That was quite strange really.

But then also I was around in those pioneering days when meditation was just starting to become being used therapeutically. And from my own background interest in philosophy and spirituality and a latent interest in meditation, I had heard about it but hadn’t done it, then I took that up as well. So that’s how I got into it, it’s really out of necessity. When I recovered, I was probably as surprised as anybody, and it just occurred to me that in those days, because now we’re sort of moving into the end of ’70s, start of the ’80s, for any other person affected by cancer at that time, there wasn’t anywhere they could go to learn about these things, particularly in an integrated way. I had gone to particular experts in different fields and benefited from their particular expertise, but there wasn’t anybody who was sort of putting it all together. So I thought perhaps that was something I might be able to help with, and that’s when I started running groups in 1981.

Jane: And what was the reception of those groups? How did people respond to the ideas that you were advocating?

Ian: Yeah, the public was very enthused. We had a lot of people come. And I think that reflected the fact that in those days, people in the, you know, cancer progression reached a point where the doctor said there was nothing more they could do for them. And so, in fact, in those early days we had a lot of people who basically had been told to go home and die. So we were working with people with fairly difficult illness, that was remarkable how many of them turned that around. And I guess then the press got interested, because there were lots of stories of personal recovery.

The medical profession was a bit mixed. Quite a lot of the doctors, and particularly the GP’s took the attitude, well, they didn’t understand it, but it didn’t sound like it did much harm, so what the heck? But then more you went up the cancer hierarchy, the more difficult the responses became, and it seemed they were worried about people being lead away from what they perceived as effective medical treatments and doing these sort of softer options. And I think the lack of understanding lead to confusion about it. And unfortunately some of the people who had strong voices came out pretty hard in an antagonistic way.

So part of what happened was that they tried to brand what we were doing as alternative. It would have a sense of sort of being divisive, and that was really unhelpful, and that lead to the strong emphasis on people talking about complementary therapies and the combined approach, and that’s lead on to integrated medicine being the sort of buzzword. I think, in reality, what we’re doing is actually much, is far better described in any other way than by describing it as lifestyle medicine, because lifestyle medicine is really about what people can do for themselves in a context of their own life, and that’s really what I’ve been interested in. I haven’t been interested in coming up with potions or things like that. I’ve been very interested in helping people to work with medical treatment, get the best out of it, minimise side effects, but true, what they can do for themselves like diet and exercise and meditation, positive thinking, emotional life, all  that sort of stuff.

Jane: And, in fact, in Kelly Turner’s book “Radical Remission” there’s a chapter devoted to people taking responsibility for their own health, isn’t there?. So it’s that personal agency and involvement in the process, no matter which path you go down.

Ian: Yeah, it’s not an easy thing, and it doesn’t appeal to everybody. In fact, I think only a minority of people that are either interested or capable of going down that path. And I think that’s where I have some difficulty with the medical management of oncology as it is at the moment, because there’s a large body of people who get diagnosed with cancer who really look first and foremost and almost exclusively to the medical profession for their guidance. And when the medical profession takes a narrow view to the management of cancer, rather than being more expansive and including the patient, and I think that’s really limiting. And I’ll tell you a good thing is over the years there’s no doubt that cancer management, from the straight medical point of view, has become more inclusive and the patient’s role and the family’s role, the support to the system’s roles are much better recognised, but I still think there’s quite a bit of work to do in that area.

Jane: Well, at least it’s moving in the general direction of inclusion, which is terrific.

Ian: Yeah, and one of the things that has brokered that has been research. One of the complaints that the medical people had in ’81 when we first had running these groups, was there was no research for it. And that perplexed me a bit too, because science advances firstly through people making observation and developing a hypothesis and then testing it. So I felt that in ’81 we were basically testing a hypothesis that cancer patients, people affected by cancer, could improve their own outcomes by using their own resources. And it seemed a bit daft to me to attack that, because there wasn’t any science for it when, in fact, it was completely new. We were pioneering something new, so how could it be any science. And I also had a big problem, because despite our best efforts, we couldn’t get any doctor to actually research these things.

Jane: Which is actually quite unscientific in some respects, isn’t it?

Ian: Exactly.

Jane: Because a scientist needs to investigate the anomalies that arise along the way.

Ian: Yes, and you’ve referred to the Couchman show, it was screened on ABC TV in 1988 in some of your posts. That was one of the things that got mentioned back then, and I’ve mentioned it publicly quite many times that if people want to fall back on science, as their main way of validating things and be consistent in having a scientific approach. And so when you see things happening that are unexpected rather than attack them, as a scientist your duty of, just the fact of being a scientist, is you should be curious rather than be aggressive. It really did surprise me in those early days how many people claimed to be scientific and approach what we were doing emotionally rather than scientifically.

Jane: And that’s giving rise too, to the label sort of “spontaneous remission,” because, they haven’t investigated how people…

Ian: What a put down of a word that is. You hear people saying it when somebody has an unexpected recovery, they try and dismiss it as a spontaneous remission, which is so unscientific. I mean, that’s intellectual laziness at its best or its worst. It’s amazing. And I find it extraordinary how many people over the years, and it would be hundreds, who’ve have these long term cancer survivals that were completely against the odds and unexpected, and when they tried to explain them to their doctors why they thought they’d become long term survivors, instead of getting curiosity, they got attacked. And I find that remarkable. I had the same experience with the majority of my own doctors that… It seemed like … the conclusion I came to was that I got well for the wrong reasons. [laughter]

Jane: So what reasons did you get well for?

Ian: Did I get well for? Well, I got well because I used my inner sources. I used the best of what was available medically. I never turned my back on medicine, it’s just that it had limited scope in what it could offer. And in some ways I was fortunate, because the equation was clearer back then. It was pretty clear that the treatments that I could have when I developed secondaries had very little benefit, big side effects and the equation in terms of cost-benefit was hopeless, really. It was barely worth thinking about. And one of the things that’s happened in modern times is there’s been a big shift in that. And so, for example, most chemotherapy that’s being given, and this is straight out of the medical literature, is being given palliatively, whereas most patients consider it to be curative. And I think these days people aren’t doing their maths very well. They’re not, people who are affected by cancer just aren’t actually going into the cost-benefit analysis of the treatment options that they’ve got thoroughly enough. I think a lot of people as a result end up with side effects that are quite difficult for a marginal benefit. And if they were considering their quality of life and could cope with the anxiety that comes with not having a treatment that’s got marginal benefit, then I think many people could actually be better off.

Jane: And, in fact, there was this study that came out, was it in the second half of last year, about the quality of life for people having so called palliative treatment. And that even those who appeared reasonably well at the time of beginning treatment, the effect was incredibly adverse for them.

Ian: Yes, there’s another study that, or I think there’s a few studies now showing that in palliative care people who have had palliative chemotherapy actually on the average don’t live as long and their quality of life’s not as good. So we got to be careful in talking about it, because we’re talking here generalisations, and the difficulty is that individuals are individuals and there’s a 100 different types of cancer and there’s a myriad of different treatments. But that’s the issue, I think. One of the problems I find is that very often with a cancer diagnosis, people’s fear overrides them, and instead of thinking clearly, they try to think through this fog of emotion and anxiety and all the natural… You can understand, it makes sense, but this is why I think it’s so important that people take the opportunity to learn some personal skills in terms of how to manage the natural stresses, the anxiety that can come with a diagnosis and the treatment options, and actually take time to think through those options clearly. You know, obviously, to get good advice and then weight it up and work out what’s going to be best in their individual situation. And it’s not always what culturally might seem obvious.

Jane: No, that’s right. The question of taking the time to do that research and find what a person feels is the best thing for them in the circumstances, though, can be difficult, can’t it? Because the medical model works very quickly, and it’s very easy to find yourself swept up onto that conveyor belt of tests, more tests, advice, more tests.

Ian: Yeah, absolutely. And it’s a very efficient conveyor belt. And, really, for a lot of people it’s driven by fear. And so yeah, it’s difficult. And this is what I think… It’s really in incumbent on the medical profession to be addressing these things, because if people get rushed into a treatment and they make it in a confused or an emotionally distressed state then it’s very easy for them to start their treatment, get a little bit down the track and perhaps they get some side effects from or a bit of a set back or something, and then there’s always confusion that arises. And they just fail to get the benefit of what can come from positive thinking when you’ve got conviction and real confidence in what you’re doing. So, to me it’s pretty clear that in terms of delaying the start of treatment for a week or two while you make these more informed and clear decisions, that winding back to long term outcome of a diagnosis. But a lot of people have this sort of false sense that “I’ve got a diagnosis, I’ve got to start treatment in the next five minutes or 24 hours max.” And there’s this sense of panic and rush. And it’s really useful, I think, for people to realise that slowing things down, taking their time to get over the emotional impact of a diagnosis and the implications of treatment… Everything’s going to change in your life after cancer diagnosis, it’s just a fact. It’s a major impact, but it’s on the individual and the family and friends, it affects everybody, and that comes with quite an emotional effect. It can really agitate people’s minds. The studies show that 50% of the people who get cancer diagnosis get post-traumatic stress just from the diagnosis. So if that’s not addressed, then people are really restricted in their capacity to respond effectively. And that’s where taking time to use these techniques… You know, either reading books or going to groups, getting good advice, finding individuals that can help you to navigate that situation, is really useful.

Jane: And of course, that’s part of the reason that we’re doing this interview, because we want to get the word out there, so that people know where to go or who to ask when this happens to them. Because, even Google, there’s so much on the internet, it’s very difficult to get some clarity about a path to take, and it’s much easier to have a solid resource, rather than the fluidity of Google, I think, when you’re in this situation.

Ian: Yes, so I think it’s important for people who are newly diagnosed or even later, if they’re just coming to this now, to really give some thought as to the team that’s helping them. It starts with the medical people, natural therapists, and what sort of support system you can get going where you can learn about things like good nutrition, therapeutic nutrition, mental attitude and meditation, and imagery, all those sorts of things.

Jane: Yes. And so I’d like to move now to meditation. And you’ve talked about the potential for even a diagnosis alone to give rise to post-traumatic stress for someone. And a lot of your work has focused on teaching people how to consciously relax their body. And I have to say from my personal experience that doing the technique that I learned from you, it actually felt like I was coming home to my body. It was a relief, an absolute relief.

Ian: That’s something like reconnecting? Because I think if we explain that a bit for people, I think a lot of people when they have it pointed out to them can relate to the fact that it’s almost like they’re mobile heads, sort of like they’re all in their head and there’s very little connection with the body. So that being home is reconnecting with your body.

And the problem with being a mobile head is you’re just not in touch with what’s going on in your body. So if it’s showing symptoms, trying to tell you “Hey, Jane there’s a problem brewing here, you better pay attention!” you just don’t hear it. And so it’s not until some things falls over basically, that your body really gets your attention, and in a cancer situation, of course, that can be pretty dire. And the other element about that is that if you’re a mobile head, it’s very hard to help your body with the healing process in an active way. So by learning to reconnect with your body not only you get information back from it, but you can actually help to direct it in a constructive and easier way.

Jane: Absolutely. And so where did you first learn these techniques for relaxation and meditation?

[23.22] Ian: Well, I was very fortunate, because when I was diagnosed with secondaries Dr Ainslie Meares, he was a renowned psychiatrist living and working in Melbourne, which was my home town at the time, and he had just put forward this idea that he felt that as a psychiatrist, his observation was that he felt that stress actually impacted on people’s cortisol levels that in turn impacted their immune function. And he felt a particular pattern of chronic stress was a significant precursor to the onset of cancer. And that once people were diagnosed with cancer it was very easy for them to be stressed and that would further debilitate their immune system and complicate recovery. So he postulated that when you meditate, you relax deeply, your cortisol levels go down, your immune system goes up and healing becomes more possible. And he put forward the idea that if you did that intensively, which is like three long sessions of 40 minutes to an hour a day, that could actually contribute directly to the recovery from cancer. So that was the sort of premise I took up on. And I think, like yourself, I found this very intense meditation incredibly helpful, and I’m sure it was the mainstay of my recovery. It helped me on every level, basically.

Jane: Yes, it really not only is there that a sense of coming home to the body, but it then spills over, doesn’t it? Into the other things that you need to do and you develop a greater confidence and clarity about the things that you need to do, and then your commitment to them.

Ian: Yeah, and I think because your mind is clearer when you meditate, because things have settled a bit, the emotions settle and your mind becomes clearer, then what to do, in the day to day decisions, – what to do about a particular medical treatment, what to do about your nutritional approach, what to do about your work situation, what to do in your family – all those things start to become clearer. And as you say, because they’re clearer, you can make, I think, better decisions and make them more confidently. So you’re more likely to persist and follow through and actually get good results from the things you do choose to do.

Jane: Yes. And so you used the word “postulate” when you were talking about Ainslie Meares speaking about this stuff back in the ’70s. But there’s a huge body of research now, isn’t there, that confirms what he was postulating back then.

Ian: Yeah. And I think it’s sad he died without that research confirming his hypotheses. And because we ended up running groups that were probably these real pioneering groups in this field in the same city back in the early ’80s, we spent quite a bit of time talking to each other, and he was a real mentor for me for many years. And I know that it’s a fact he died disappointed. He felt that he’d really come up with something with great significance, which I’m sure he did, but that he died without the sort of recognition that, on a personal level, I think, he would have appreciated.

Jane: Well, perhaps it’s time to truly acknowledge his work, because last week there was a terrific study released here in Melbourne, done by Monash which confirms the relationship between chronic stress and cancer progression. And even for you personally, having met the hostility of the medical profession that you have over the years, how did you feel about that study last week?

Ian: It was lovely to see it, but [laughs]. There’s a mixture of responses, I think. I mean, firstly, it’s like a study that, to me, common sense could have gotten you to 35 years ago. And if there had been more enthusiasm for Anslie’s approach and then the sort of work I started doing by the early ’80s, I just think, so many more people could have been helped. And so I look back on that, I sort of regret that through the foundation I set up we weren’t able to solve the research question. We tried quite hard in a number of ways, both internally and externally, to get this sort of research going that could have established this 25 years ago. And we just had one obstacle after another, basically. So it’s really nice to see that the momentum in research is shifting and that these areas are now areas of interest and that there are good scientists out there who happy to delve into this. And I think one of the things about a study like this is that it will lead to many more. One of the problems we had when we were trying to get these studies up was there were no precedents, there were no previous studies in the area, and the funding bodies are really peculiar in that regard. They say: “Well, what’s the precedence for this? Where is the groundwork?” And I think, an actual fact, I probably wasn’t well advised, because we could have done some pretty simple basic pilot studies that might have actually broken the ground and got things started. We basically felt we had to do the big study that was going to be ground breaking, and I think we didn’t realise that we just had to go slowly, slowly.

So, I think the good thing is that there are lots of people who took up on this thing through their own intelligence, lots of patients who cut through the confounding “this could be good, this could be bad” stuff and did it, and felt the benefit. I think there’s no doubt that research helps to sway medical opinion. I mean, there’s plenty of evidence in the medical literature that it doesn’t do it all that well, but at least it’s getting harder for cancer authorities or other people to say there’s no evidence for this work now, because clearly there is.

Jane: Yes, there is.

Ian: … really, and I think it is exciting. I guess one of the other things I noted was that the Peter Mac cancer hospital here in Melbourne was reported as saying that it’s studying the benefit of beta-blockers as an antidote for stress, and I wonder if there’s anybody who’s going to study meditation as an antidote for stress and cancer. Because my guess is that it would be a reasonable field of inquiry.

Jane: Well, it certainly would be, because, as I understand it, the study describes a relationship between the stress induced neural signalling and inflammation and that then dictates the way the cancer travels through the body. So the research that’s being done on the blood pressure and anxiety medications won’t be so much about stopping stress but more about influencing the way the stress then expresses itself in the body and impacts on the lymphatic system in particular.

Ian: Yes.

Jane: And so, meditation and lifestyle medicine would actually play a very different role in that regard, wouldn’t they?

Ian: Yes, I mean, what meditation specifically can do, but the whole attitude is important in this is that you can actually strike at the cause of stress rather than the outcome. And as you pointed out very clearly that, the beta-blockers are dealing with the outcome of stress. They don’t change the basic nature of how people are stressed and that’s what meditation can do. It can change the way you respond to stressful situations. So you don’t actually have a problem in the first place in terms of physiological adverse effects that stress is renowned for.

[32.28] Jane: Yes, absolutely. Well, just to close Ian, if you were confronted today with someone who has just come from the doctor’s, receiving a diagnosis of cancer, what would you say to them?

Ian: Well, I think, firstly, the thing to do is to be clear that there’s hope, that a lot of people, because I think it’s one of the big problems, people still often equate a diagnosis with a death sentence, and clearly that’s not the case, both from a medical point of view and from this lifestyle point of view. There’s many things that you can do. And more than treating it just as like, in that sense as a physical condition that has the potential to take your life away, I think for many people as time that goes on. they come to see cancer as something that actually helped them to address their life in all its facets, and so it becomes a meaningful event in their life, rather than the disaster it can often seem at the start.

It’s probably not all that useful to tell that to people at the start. You know, “Whoopee! You’ve got cancer, your life is going to change for the better.” It depends. Some people could handle it, but I think the first message is that there’s hope. And the second one is then that there’s a lot that you can do about it and that, really, if you approach cancer passively, you put yourself at quite a risk of getting poor outcomes in many ways, whereas if you take a more proactive approach, then you can really improve your situation greatly. I would say from my point of view that the best way that people can be introduced to the work is through my book “You Can Conquer Cancer.” And I find recommending that people give that to friends, if they’ve had somebody who’s been diagnosed or if they’ve just been freshly diagnosed themselves, that’s a great starting point, because a book is something you can dip into and you can take it at your own pace. If people find that that’s something that’s appealing to them and they want to follow up on… Oh, there you have it…

Jane [holding copy of book]: There it is. It’s referred to just about every day here.

Ian: Looks like it’s been a bit used.

Jane: Yes, it’s got tags. [laughs]

Ian: And actually there’s a CD or a download people can get through my website called The Gawler Cancer Programme.  We talk about that way that the body can respond to cancer and what we can do about it, so that’s another option, if people like listening rather than reading. And then I think, if people are keen, then it makes a lot of sense to find a group that’s been run along these lines and get involved. And so the foundation I set up, they’re running residential programmes. And I actually think that in an ideal world it would be best to do something like that residential programme before getting started. But that rarely happens, as you say, because of the speed of it moving. But that makes a lot of sense. I also hear people saying, “Oh, when the chemotherapy is finished I’ll go and do the programme.” I would do it as soon as possible, juggle things around and make the effort, because the feedback from doing a residential programme is so good. It gives people a chance to step back from their day to day things, to be looked after, to be cared for and have this very informed programme which really gives you access to 35 years of other people’s experience.

Jane: Yeah, fantastic.

Ian: And the research. The real strengths of the book and the residential programmes is that over the years we’ve had so much contact with so many people and we were able to pull that information. The Tibetans have got quite a lovely saying, they say, “An old patient is more useful than a young doctor.”

Jane: [laughs]

Ian: And it’s a little bit tongue in cheek, but I think people get the idea that you get to learn a lot from experience, and that’s one of the strengths of the book and these programmes is that we pool a lot of people’s experience and give people that are new, coming into this, whether as a patient or you’re a partner or support person and give them a chance to work out what they can do to get the best out of the situation.

Jane: Absolutely. And you personally are no longer involved in those programmes at the Gawler Foundation, but you do run your own programmes from time to time, don’t you.?

Ian: I still work for the foundation, my wife is a GP and I run the cancer follow-up programmes for them. So the initial programmes that sort of run along the lines of what  I was doing and I was there, there’s very good people running those, and I feel very happy about advocating for those programmes, because I don’t think, it’s easy for me to say these things, but I don’t think there is anything to compare with them in the world. I think they’re actually world class, and if people are interested in this sort of comprehensive, integrated approach, then they won’t find a better programme like that anywhere in the world that I know of. And I’ve been in the field for 35 years, so I think I’ve got a pretty good idea of it. It is a fact that it’s terrific programmes and the people running them really present them really well, and then Ruth and I really enjoy doing the follow-up programmes, which are 5 day residential programmes, and so we run those at the foundation. But, yeah, I’m not on staff there, I’m not on the board these days. The foundation is running still very nicely on its own, which is nice.

Jane: That’s terrific. And you also run a residential retreat each year in New Zealand, don’t you?

Ian: Yeah, we do, we do a cancer programme, an eight day cancer programme in New Zealand. And also we do our meditation retreats which is staggering because the meditation retreats are pretty … and probably we have a lot of what people just come because they’re interested in meditation, but some of the people who are dealing with illness come to those as well.

Jane: Yes, so I’ll put links to your website under the video on the blog so that people can find you, as well as the foundation itself, so that people can see what’s going on there. Thank you so much for your time today, Ian. It’s been terrific, a wonderful opportunity to speak to you about all of this. And if you have any questions or comments, feel free to leave them in the space below, and we’ll do the best we can do to answer any of your queries. In the meantime, be happy, be well. Thanks for watching.