Ian Gawler Blog: A Good Life

They used to say a picture is worth a thousand words. What price then a movie? What does a good life look like? And what does the American Society of Integrative Oncology have to say about cancer treatment?

In 2009 the ABC program “Compass” put together a documentary on my life and work and gave it the imposing title of “A Good Life”. With that exceptional interviewer Geraldine Doogue at the helm, we ranged over the trials and tribulations, as well as the deeper issues and some of the successes – the some that adds up to make a good life.

It is a revealing program and anyone interested in what is on offer through the paradigm I represent (the way of thinking and how I teach) may find it helpful, so this week, an introduction and a link to the program.

Then some news from the New Zealand tour, but first




Thought for the day

If we know the Laws that govern Botany

We can take a diminutive acorn

And grow a massive oak tree

Amidst a beautiful garden

If we know the Laws that govern our mind

We can take a simple idea

And grow something meaningful 

Amidst a beautiful life 

PS - the garden features heavily in the Compass program



A Good Life – according to Ian Gawler - Here is the ABC’s introduction:
In this three-part series prominent Australians present their views and ideas on ‘a good life’. Each program features one guest whose argument is then examined in interview with Compass presenter Geraldine Doogue.

In Episode 1, Ian Gawler, cancer survivor and renowned healer, talks about his pioneering work in integrated ‘mind-body’ medicine and the therapeutic use of meditation and nutrition. He claims his prescription for healthy living is synonymous with a good life.
Story producer: Dina Volaric
To view the program, CLICK HERE

Integrative oncology in North America
The American based Society of Integrative Oncology (SIO) recently published guidelines for integrative medicine in lung cancer, which were developed in accordance with American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines (Chest. 2013;143[5 Suppl]:e420S-e436S).

The SIO guidelines recommend, for example, mind–body therapies as part of a multidisciplinary approach to reduce anxiety, mood disturbance, sleep disturbance, and acute or chronic pain, and to improve quality of life.

Another suggestion is that acupuncture or related techniques can be used as an adjunct treatment option for nausea and vomiting related to chemotherapy or radiation therapy, and for cancer-related pain and peripheral neuropathy.

Clinical guidelines provide evidence-based recommendations for clinicians, explained Gary Deng, MD, PhD, from the integrative medicine service at Memorial Sloan-Kettering Cancer Center in New York City. This is even more important for integrative medicine because clinicians might not be as familiar with it, he added.

"When patients ask them about therapies, they may not know what to say," said Dr. Deng, who spoke about the guidelines during a plenary session at the 10th International Conference of the SIO, and is first author on the guidelines. "This gives them something to fall back on, and makes them more comfortable making a recommendation."

In 2005, the ACCP asked the SIO for information on integrative medicine that could help physicians address questions from patients. Guidelines were published in 2007, and then updated with more current data. To date, the SIO has published 4 separate evidence-based clinical guidelines; the latest are for the diagnosis and management of lung cancer.

Current Guidelines
There were 2 main goals for these guidelines, said coauthor Heather Greenlee, ND, PhD, assistant professor of epidemiology at the Mailman School of Public Health at Columbia University in New York City, and SIO president-elect.

"The first was to assess current evidence on the benefits and risks of complementary modalities as adjuncts to mainstream medicine to control symptoms associated with cancer and cancer treatment," she said. "The second was to form the evidence base from which specific recommendations can be made to guide clinical practice."

Dr. Greenlee noted that the goal was to be conservative, to look at where the evidence is right now, and to ask, "What can we say given the evidence to date?"

A systematic literature review was conducted, and a large number of randomized controlled trials, systematic reviews, and meta-analyses met the predetermined inclusion criteria, as did a number of prospective cohort studies.

The included trials addressed many issues faced by lung cancer patients, such as symptoms of anxiety, mood disturbance, pain, quality of life, and treatment-related events. Available data covered a wide variety of complementary interventions, including acupuncture, nutrition, mind–body therapies, exercise, and massage.

The authors conclude that the "the body of evidence supports a series of recommendations. An evidenced-based approach to modern cancer care should integrate complementary therapies with standard cancer therapies such as surgery, radiation, chemotherapy, and best supportive care measures."

In the summary of recommendations, they note that "it is suggested that all lung cancer patients should be asked about their interest in and usage of complementary therapies. Counseling on the benefits and risks of those therapies should be provided."

The next set of guidelines from SIO will be on breast cancer, specifically integrative therapies for related adverse effects and quality of life.

RELATED BLOGS
The Cancer Council's Australian Guidelines on CAM

NOTICEBOARD
Ruth and I are currently presenting a range of public talks, workshops and retreats around New Zealand

There are a range of events still to come in Auckland, Christchurch and Nelson.

We are delighted to be including our first meditation retreat in New Zealand (which quite a few Aussies have also booked for already!) - December 2 -8.

Please do let anyone you may know in NZ about the visit -  all the details are on my new public Facebook page: Dr Ian Gawler,    or the website.

NEWS
The events in Auckland (evening public lecture) and day in Rotorua have been well received. In Auckland, I had conversations with 8 long term cancer survivors who had used the approach I advocate and were there many years after their initial prognosis had run out. It was good to ask them what had been most helpful, and to hear them say it was everything, the diet, especially the meditation, and the hope they received in the first place to think it was possible to defy the odds and to recover.

The Rotorua organisers, the Aratika Trust are doing an exceptional job. Having first benefited from attending the Foundation’s programs, they have now trained there, bring Foundation staff over to run local programs and provide excellent support to their local community. Ruth and I received a formal Maori welcome – very moving – and were made most welcome.

Ian Gawler Blog: Research, daily life and cancer

Groups, mushrooms, CD47, surgeons, PSA tests, mistletoe and coconut oil.
What do they have in common? They all feature in important research that throws light on what might make for a good choice if you or someone you love has cancer – or wants to avoid it. So this week, some compelling reading that just might help to save a life.

Plus Ruth and I start our tour of New Zealand next week, so more details of the talks and retreats, but first

Thought for the day
If I die
I want to be the healthiest person ever to die of this disease
                           One of the women in my Friday cancer group

Yes, that dot in the middle is me speaking at the Happiness and its Causes Conference in Perth last week; some highlights next week.

1. Attending a therapeutic group halves the risk of recurrence and the risk of dying from breast cancer
This study is a few years old now, but very significant all the same.

After a median of 11 years of follow-up, this study involving 227 women showed that those women provided with a psychological intervention via small groups that included strategies to reduce stress, improve mood and alter health behaviours, were found to have around halved the risk of both breast cancer recurrence (hazards ratio [HR] of 0.55; P=.034) and death from breast cancer (HR of 0.44; P=.016).

Follow-up analyses also demonstrated that women in the groups had a 50% reduced risk of death from all causes (HR of 0.51; P=.028) during the time of the study.
The authors concluded that psychological interventions can improve breast cancer survival.

Reference: Andersen BL et al, Psychologic Intervention Improves Survival for Breast Cancer Patients - A Randomized Clinical Trial.  Cancer. 2008; 113:3450-3458

2. Psychological and behavioural variables can have profound effects on cancer. 
In a related study, a meta-analysis (analysis of a large number of studies) revealed stress-related psychosocial factors to be associated with a higher cancer incidence in initially healthy people, poorer survival in patients diagnosed with cancer, and higher cancer mortality.1

Reference: Chida Y, Hamer M, Wardle J, Steptoe A. Do stress-related psychological factors contribute to cancer incidence and survival? Nat Clin Pract Oncol. 2008;5:466–475. [PubMed]

3. CD47: The cancer breakthrough I believe may really happen
Many of those who attend my workshops may remember I have been speaking hopefully of CD47 for some time. Here is an update.

CD47 is a kind of protein that is found on the surface of many cells in the body. It tells circulating immune cells called macrophages not to eat these cells. The body uses the CD47 protein to protect cells that should be protected and to help dispose of cells that are aged or diseased.

Unfortunately, some cells that should be destroyed are not. Researchers at Stanford discovered that nearly every kind of cancer cell has a large amount of CD47 on the cell surface. This protein signal protects the cancer against attack by the body's immune system.

Stanford investigators have discovered if they block the CD47 "don't-eat-me" signal through the use of anti-CD47 antibodies, macrophages will consume and destroy cancer cells. Deadly human cancers have been diminished or eliminated in animal models through the use of anti-CD47 antibody.

For the last year, many people have been working to make clinical trials in humans possible. Stanford is hopeful that the first human clinical trials of anti-CD47 antibody will take place in mid-2014, and clinical trials may also be done in the United Kingdom. Stay tuned; this one just might work!

4. Mushrooms – cook them and reap the rewards!
Some will know that mushrooms have been under something of a cloud (OK – bad pun ) and even on the Gerson banned list. I have never been able to find a satisfying rationale for this avoidance and more recent research indicates that maybe the problem was eating them raw, while cooking them seems quite beneficial.

In 2009 a study of 2,018 women correlated a large decrease of breast cancer in women who consumed common white button mushrooms (Agaricus bisporus). Women in the study who consumed fresh mushrooms daily were 64% less likely to develop breast cancer, while those that combined a mushroom diet with regular green tea consumption reduced their risk of breast cancer by nearly 90%.

Some studies have revealed that raw A. bisporus - along with some other edible mushrooms - contain small amounts of carcinogens. However, this research also noted that when cooked, these compounds were reduced significantly.

Reference: Zhang, M et al;  "Dietary intakes of mushrooms and green tea combine to reduce the risk of breast cancer in Chinese women". International Journal of Cancer 124 (6): 1404–1408.

HERE IS THE INVITATION

Pause,  focus on the scene below,  take a deeper breath or two,  bring yourself into this present moment     :-) 

then read on

Photo taken near the river at the Gawler Foundation's Yarra Valley Living Centre where we conducted the training /retreat with Dr Nimrod Sheinman recently and where Ruth and I will lead next year's pre-Easter retreat Meditation in the Forest

5. Would you travel to save your life? Surgeons and survival
A fairly well kept secret is that when it comes to cancer surgery, particularly the more complex, complicated surgery, your surgeon’s experience levels can drastically affect your chances of long-term survival. This is an excellent thing to know BEFORE you might ever need it. Tell anyone you care for about it!

This proposition has been further validated recently by a well-funded Swedish prospective cohort study in which all patients who underwent eosophagectomy between 1987 and 2005 were followed until 2011.

Results demonstrated that surgeons who performed above the Swedish median number of operations per year had a 20% reduction in mortality. The median number was about 10 operations per year. What that means is that if you had been operated on by a surgeon who was doing more than 10 esophagectomies per year, you would have had a 20% reduction in mortality.

What should we make of this? Seek an experienced surgeon if you need a tricky operation.

Reference: Derogar M et al. Hospital and surgeon volume in relation to survival after esophageal cancer surgery in a population-based study. J Clin Oncol. 2013;31:551-557.

6. Are PSA tests more trouble than they are worth?
Here we go! This is really going Out on a Limb! PSA testing for prostate cancer seems to ignite untold passions in many of those involved, but speaking in The Age recently, health reporter Julia Medew pointed out

“PSA tests are controversial because they can cause "overdiagnosis" of prostate cancer that is so slow-growing it was never going to cause men harm. It is now estimated that for every man thought to be saved by the test, another 12 to 47 will be diagnosed with cancer that will not kill them. Many will have surgery and other interventions that can lead to sexual impotence and incontinence.”

A recent Australian review has called into question one of the major studies that is used to support PSA screening and in doing so, adds more caution to taking that test.

Here is the Abstract of the paper so that if you are interested you have some facts.

Major clinical trials using prostate-specific antigen (PSA) as the screening test to detect localized early-stage prostate cancer and to attempt to change its natural history with early intervention have yielded conflicting interpretations.

The US Prostate, Lung, Colorectal, and Ovarian (US PLCO) cancer screening trial concluded that PSA-based screening conferred no meaningful survival benefit, whereas the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the GOTEBORG clinical trial (GOTEBORG) trials claimed statistically significant life-saving benefits.

These divergent outcomes have not provided physicians with clarity on the best evidence-based treatment. To determine the extent to which these divergent outcomes are clinically meaningful, we evaluated these data and those of a long-term prospective cohort study in the context of the clinically documented harms of androgen deprivation therapy (ADT) (hormone treatment).

We noted the unheralded fact that in both European trials far more patients received hormonal treatment in the control than the prostatectomy arm, whereas hormonal therapy in the US trial was balanced between arms. We examined this imbalance in ADT treatment and prostate cancer–related deaths in the contexts of contamination, stage migration, and attribution of cause of death, all of which impinge on data interpretation.

The ERSPC and GOTEBORG data are compatible with the hypothesis that ADT treatment contributes differentially to an increase in prostate cancer deaths in control patients. If so, the claim of a reduction in prostate cancer deaths in the screened cohort requires reappraisal.

The conventional interpretation that PSA screening and radical treatment intervention are the major contributors to the results of these two studies needs more rigorous scientific scrutiny, as does the role of ADT treatment of nonmetastatic disease.

Reference: Haines I, Miklos G et al; Prostate-Specific Antigen Screening Trials and Prostate Cancer Deaths: The Androgen Deprivation Connection JNCI J Natl Cancer Inst, Vol 105; 20, 1534-1539.


To read The Age report: CLICK HERE: 

7. Mistletoe doubles survival in advanced pancreatic cancer
Advanced pancreatic cancer is a tough disease and while over the years I have seen a number of people actually survive for long periods following our approach, often the side-effects of any medical treatments are outweighed by any benefits. This then is an interesting study as although the times were still disappointingly short, the mistletoe injections almost doubled survival. Also, mistletoe has been one of those controversial treatments often labelled as "alternative", so it is good to see it being evaluates scientifically and that it does seem to have some efficacy.

Abstract: The unfavourable side-effects of late-stage pancreatic cancer treatments call for non-toxic and effective therapeutic approaches. Over 12 months, we compared the overall survival (OS) of patients receiving an extract of Viscum album Mistletoe (VaL) or no antineoplastic therapy.

Findings: We present the first interim analysis, including data from 220 patients. Patients in both groups received best supportive care. Median OS was 4.8 for VaL and 2.7 months for control patients (prognosis-adjusted hazard ratio, HR = 0.49; p < 0.0001). Within the ‘good’ prognosis subgroup, median OS was 6.6 versus 3.2 months (HR = 0.43; p < 0.0001), within the ‘poor’ prognosis subgroup, it was 3.4 versus 2.0 months respectively (HR = 0.55; p = 0.0031). No VaL-related adverse events were observed.

Conclusion: VaL therapy showed a significant and clinically relevant prolongation of OS. The study findings suggest VaL to be a non-toxic and effective second-line therapy that offers a prolongation of OS as well as less disease-related symptoms for patients with locally advanced or metastatic pancreatic cancer.

Reference: Tro ̈ger W. et al., Viscum album [L.] extract therapy in patients with locally advanced or metastatic pancreatic cancer: A randomised clinical trial on overall survival, Eur J Cancer (2013), http://dx.doi.org/10.1016/j.ejca.2013.06.043
 

RELATED BLOGS
Let your food be your medicine - more dietary research

Multi-vitamins and cancer

Who needs prostate surgery?

NEWS UPDATE
I am being asked in workshops why coconut oil melts at room temperature, around 22 -24C, yet Prof George Jelinek in his guest blog on coconut oil (Coconut oil- are you nuts?) says the simple, obvious reason not to use coconut oil is that it contains saturated fats that are solid at body temperature - 37C.

At first glance this may seem confusing, but here is the detail, and again, I quote George:

The explanation for this melting point of the oil is pretty simple. Coconut oil is a complex mixture of fats; while 88.7% is saturated fat, there are also mono- and poly-unsaturated fats in the oil, as with other oils.

So the melting point of the oil depends on the relative proportions of the various fats making up the oil, and is lower than the individual melting points of the saturated fats referred to in the blog because of the lower melting points of some of the other shorter chain saturated fats, mono-unsaturated fats, and poly-unsaturated fats.

However, coconut oil does not get absorbed whole, but rather as the individual fatty acids, and it is the melting point of each of those individual fatty acids that is the important factor when they are incorporated into cell membranes.

By way of example, butter melts at 32-35C despite being composed of 63% saturated fats, most of them with melting points higher than body temperature, yet no-one would recommend it for good health.

NOTICEBOARD
Ruth and I will be presenting a range of public talks, workshops and retreats around New Zealand
in November/December.

There are a range of events in Auckland, Rotorua, Christchurch and Nelson.

We are delighted to be including our first meditation retreat in New Zealand (which quite a few Aussies have also booked for already!) - December 2 -8.

Please do let anyone you may know in NZ about the visit -  all the details are on my new public Facebook page: Dr Ian Gawler,    or the website.

Meditation’s 3 great gifts

For some reason most probably to do with those delightful but mischievous creatures known as computer gremlins, this blog dropped out of the ethers, so I am re-posting. Apologies for any inconvenience to those who have read it already, I think it one of the better ones for those yet to read it!

Why do so many people meditate these days? What is really on offer? Are you missing out? Or are you experiencing meditation’s 3 major benefits?

This week, we go Out on a Limb, go to the heart of meditation and seek to understand why it is so reliable as a stress-free way to manage stress.

Also, more details on the tour of New Zealand that starts with an evening public talk in Auckland on Thursday 14th November and includes workshops and retreats around the country – details CLICK HERE.

Then breaking news with a very important piece of research examining the effects of taking multi-vitamin/mineral supplements on the lifespan of women with breast cancer, but first

Thought for the day:
In meditation the mind keeps wandering.
We keep bringing it back, and it wanders again.
And we bring it back again, and so it goes on,
Maybe for months and years, until at last the mind becomes stabilised . . .
Thoughts go roving around in the head,
But if we bring them down into the heart, that is, the centre of the person,
They come to rest.
Fr Bede Griffiths. River of Compassion: A Christian Commentary on the Bhagavad Gita.

Being asked to speak at the Happiness and its Causes conferences in Brisbane and Perth this week on the topic of stress and anxiety set me to think deeply about why meditation is such a reliable and all-encompassing antidote to both. This led to understanding meditation's 3 great gifts.

Now to be clear, when I speak of meditation, I speak of learning to relax deeply in a physical sense, and then to go beyond the activity of the thinking mind into a deeper stillness.

In fact, meditation introduces us, or perhaps just makes abundantly clear, that the mind does have these two aspects; there is the active thinking mind and the still mind.

The thinking mind is the domain of stress – how we perceive things, how we interpret things. Clearly a great deal of stress is to do with how we think. To a large extent it is the thinking mind that determines the stress we may or may not experience.

The still mind is beyond all this. The still mind is calm and clear. The still mind is highly creative, highly productive, but it is the domain of deep, natural peace.

How then to help the thinking mind let go of stress, to become clear and calm, to become stress free?

First an analogy. If we were interested in the true nature of the sky but had never seen it before; and went outside on a cloudy grey day, we could form the view that the sky was this grey fluffy stuff that filled the space above us.

However, those of us who do have a little more familiarity with the sky; we know of course that clouds as we call them are only one part of the sky. There is a second part, a second aspect – that big blue canopy we are so familiar with and that is so evident on a cloud-free day.

Those of us that are more familiar with the sky know that clouds come and go, the blue canopy is always there. So even on the cloudiest, stormiest, wildest of days, sooner or later the clouds do clear and there it is. It was always there of course, that clear blue sky, it is just that sometimes the clouds obscure it from our direct sight.

So, the analogy is good. With our minds, thoughts come and go all the time; they are ever-changing and impermanent. Happy thoughts, stressful thoughts. They come and they go. But sooner or later they will clear, and reveal this deeper stillness, the more fundamental enduring, stable aspect of our mind.

So there is the active and the still mind. Meditation provides a reliable way to go beyond the activity of thinking mind and directly experience the stillness of the more fundamental or true nature of our mind. And in doing so, meditation offers 3 major benefits: Profound Peace, Natural Balance, and the View.

Profound Peace speaks for itself. There is a natural ease, an inner clarity and confidence that comes with meditation that provides a profoundly effective antidote to stress.

But more, this profound peace, coupled with deep physical relaxation brings Natural Balance to our whole being. Physically our body chemistry and physiology regains its natural balance. It is like meditation resets our factory settings and recalibrates the physiological changes we know accompany adverse stress, and over time becomes our default setting.

So this is how meditation diffuses stress and anxiety – with a return to a natural, healthy balance. But there is still more! This natural balance flows on to be experienced as emotional balance, mental balance; there is even a deep sense of connectedness and a natural rise of love, compassion and altruism – a spiritual balance.

And perhaps even more profoundly, meditation offers a new perspective. We begin to see the world, and our life, not just from the perspective of the ever-changing “thinking mind”, but also from a more profound vantage point – that of the still mind, the true nature of our mind.

The View is a word that is used to encapsulate how we view the world, how we interpret our life. What meaning and purpose we experience in this life. Our View is tied up with our values, our ethics, our habits, and our beliefs. How we live our life.

Now, our View of course is radically affected by our perspective. For those whose perspective does happen to lead them to think that all they are is just this body, it is easy to imagine how they “over-identify” with their body image and their physical health and in doing so become highly stress-prone.

For those whose perspective or View is such that they conclude life is all about relationships, and in so doing over-identify with their partner or children, or even their community, it is easy to imagine how the ups and downs of life will make them particularly vulnerable to chronic stress.

For those whose View is that life is all about mental reason, and as a consequence over-identify with the rational, logical, scientific aspects of their mind, it is easy to imagine how the mysteries of life, the unexplainable, the new, the challenging makes them significantly prone to stress.

So, one elegant definition of stress is “over-identification with the wrong part of our self”.

Body, emotions and mind are very important, but they are not who we really are. Over-identifying with them will mean we are bound to be stressed, maybe even full on anxious.

When we change our perspective, everything changes. If we have a problem, as we see it, and we fixate on it, it is like holding an egg to our eye – we can see nothing. It is a big problem and it obscures everything. However, if we hold the egg at arms-length, we recognise it for what it is. It is an egg with loads of possibilities, loads of potential.

So meditation introduces us to who we really are, what is in our heart’s essence. And in doing so, meditation offers three great gifts Profound Peace, Natural Balance and the View.

Truly meditation offers a unique pathway to stress free stress-management.

RELATED BLOGS
Meditation in 4 easy steps

NOTICEBOARD
Ruth and I will be presenting a range of public talks, workshops and retreats around New Zealand
in November/December.

We start with an evening Public Talk in Auckland on Thursday November 14th (which will be followed up by a weekend in Auckland on November 30th and December 1st), then there are a range of other events.

We are delighted to be including our first meditation retreat in New Zealand (which quite a few Aussies have also booked for already!) - December 2 -8.

Please do let anyone you may know in NZ about the visit -  all the details are on my new public Facebook page: Dr Ian Gawler,    or the website.

NEWS
An important new study has shown that taking a regular multivitamin and mineral supplement (MVM) significantly reduced mortality for women over 50 with breast cancer.


Given how contentious the supplement issue has been in cancer medicine for years, and how often people tell me that their oncologists have told them MVM will reduce the benefits of treatments and give advice not to take them, this study adds weight to a growing body of research that does support their use.


Here is a short summary of the abstract and the reference for the full article.



This prospective study followed the effects of MVM use on breast cancer mortality in postmenopausal women diagnosed with invasive breast cancer. It included 7,728 women aged 50-79 at 40 clinical sites across the United States and followed them for a mean of 7.1 years after breast cancer diagnosis.



In adjusted analyses, breast cancer mortality was 30 % lower in MVM users as compared to non-users (HR = 0.70; 95 % CI 0.55, 0.91). This association was highly robust and persisted after multiple adjustments for potential confounding variables and in propensity score matched analysis (HR = 0.76; 95 % CI 0.60-0.96). 



The results suggest a possible role for daily MVM use in attenuating breast cancer mortality in women with invasive breast cancer but the findings require confirmation.



Wassertheil-Smoller S et al, Breast Cancer Res Treat. Multivitamin and mineral use and breast cancer mortality in older women with invasive breast cancer in the women's health initiative; 2013 Oct; 141(3):495-505. doi: 10.1007/s10549-013-2712-x. Epub 2013 Oct 9.

For the full reference, CLICK HERE