Healed, or hungry? A personal perspective on the Gawler program

In the state of turmoil following a cancer diagnosis, many patients are drawn to complementary treatments, which may provide an explanation, hope, and a sense of autonomy not provided by conventional medicine. In Australia, one figure who has attained a great following is Ian Gawler, a cancer survivor, whose incredible story of recovery has inspired many through his books and courses run by the Gawler Foundation, which he established in 1983.

His approach — which essentially comprises a strict vegan diet, juicing and extensive meditation — has, anecdotally, provided much benefit to patients. There is great community endorsement of Gawler’s methods, and many patients feel compelled to participate to give themselves every hope of survival. As a medical practitioner who became involved with his program during my own cancer treatment, I feel obliged to raise for discussion some aspects which I found concerning. My involvement consisted of reading the book You can conquer cancer, participating in a 3-day healing meditation retreat, and attending a 12-week non-residential group program for cancer patients.

While the accuracy of Gawler’s medical history has recently been publicly debated, it is not my wish to focus on this issue, as it is not relevant to my concerns with his program. I accept that Gawler, and his staff, are well intentioned and appear to be motivated by what they perceive to be the best interests of people with cancer.

As one who has been trained to respect a scientific approach, the fact that I was drawn to Gawler’s program at all, is, in retrospect, worthy of examination. Did the seismic shift in reality that accompanied my cancer diagnosis cause me to abandon logic in favour of hope? I had heard a little about Gawler and was urged by family and friends, who had heard very positive reports, to explore his approach. Gawler has several qualities that set him apart from other alternative and complementary health practitioners and that lend his ideas credence: he is a qualified veterinarian, and thus presumably has an understanding and appreciation of the scientific method; and he has the imprimatur of several medical practitioners, including Ainslie Meares, who is well known in my own professional circle of psychiatry.

Perhaps an even stronger force that propelled me towards the Gawler system was the prospect of an awful dependency on an imperfect medical system in those early, traumatic days following my diagnosis. I found it difficult to adopt the passive stance that characterises the patient’s role in Western medicine, especially after experiencing the reality and limitations of treatment in a busy public hospital. With my very survival threatened, I needed to believe that I could play an active role in my own recovery; Gawler provided me with this sense of autonomy, for which I remain grateful. I also felt that the program addressed some of the holistic aspects of a cancer diagnosis, which were lacking in my conventional treatment. I have particularly benefited from learning meditation, which was well taught and can claim a reasonable evidence base.1,2

However, other aspects of the program are troubling. One of the cornerstones is the low-fat, essentially vegan, diet with no added salt or sugar and no caffeine. With its scorched earth and guilt-ridden approach to avoiding nearly everything, the diet may avoid some substances which turn out to be harmful for cancer patients, but this comes at considerable cost and does not appear to be justified by the available evidence. Most Australians would find it a challenge to identify any of the food that they are accustomed to as meeting the strict Gawler criteria. Even when presented in expert form at the Gawler Foundation’s Yarra Valley Living Centre, meals were bland and unfulfilling and felt something like a punishment. The “Food, Glorious Food!” sign displayed prominently in the dining room seemed an ironic touch! The dietary restrictions seemed particularly harsh when mouth ulcers and nausea made eating difficult, yet palatable soft-textured food such as ice-cream was forbidden.

And while drinking juice is a not unpleasant way of obtaining many nutrients, juicing the recommended six times a day proved extremely time consuming, in a day already stretched by the demands of medical treatments and meditation. Where was the space for family and friends, music, or reading?

Then, what of the idea espoused by Gawler that those with a certain psychological profile are more likely to develop cancer?3 Are we really “passively subservient” and overly “nice”?3 And does this mean that we should attempt to rectify these aspects of personality to avoid the risk of succumbing to cancer? Without evidence to support this premise,4,5 suggesting to patients, who are already coming to terms with diseased bodies, that our personalities, too, are inadequate seems cruel and unjustified.

Herein lies the most concerning aspect of all. One of the assumptions of the program is that, even if the evidence of efficacy is lacking, the recommendations do not have the potential for harm. I argue that this is not true. Depriving people of the pleasure of tasty and satisfying food, inducing guilt every time we transgress the dietary straitjacket, condemning us to highly time-consuming activities, suggesting that our illness has been brought on by our own faulty characters — these are not benign interventions, especially for those whose conditions are terminal.

No one would disagree that addressing lifestyle factors is important for cancer patients; my concern is that in my opinion the Gawler program goes too far, making far-reaching suggestions that do not appear supported by evidence. There is also the risk that, immersed in the litany of Gawler rules, patients may fail to give priority to the most important lifestyle modifications. An example of this is breast cancer, where there is compelling evidence that taking part in regular exercise6 and limiting alcohol intake7 reduces the risk of recurrence; yet in the Gawler program these changes are buried under an avalanche of recommendations, of which diet and meditation are most prominent. In my own experience, there are only so many changes one is prepared, or able, to make; it is far better for these to be measures that are proven to be effective.

And what about the denigration of more standard medical treatments? While the official Gawler line is to not discourage conventional treatments, they are often presented in a less than positive light — referred to as “toxic”8 and of limited efficacy.9 Of most concern to me was hearing our program leader state that there was no evidence that chemotherapy was effective. This was nothing less than astonishing, patently untrue, and highly disrespectful to those of us undergoing chemotherapy.

In fact, while criticism of conventional medicine is noticeable, there is an almost complete lack of critical analysis among participants of Gawler’s methods — which are supported in a quasi-religious fashion. There seemed to be a worrying tendency to unquestioningly quote Gawler as though his words were above scrutiny, and certainly carrying more weight than the views of any number of esteemed oncologists.

Reading some of the testimonials, it struck me that those participants whose outcomes were poor still wrote positively about the program. It puzzled me as to why this was so; if anything, Gawler’s program seems to me to invite what may be irrational hope and promise far exceeding what most oncologists would offer. Perhaps, as with any system of belief, this is because there are in-built arguments; for those patients whose cancer progresses while on the program, it must have been the (almost inevitable) digressions from the diet, in much the same way as some religious followers blame “lack of faith” for their prayers not being answered. Or, when the person succumbs, the program can be credited with keeping the patient alive for very much longer than the doctors predicted, or living “better” in the time they had left. Surely one can argue whether spending your limited days juicing and meditating is a “better” use of one’s time than, say, indulging in one’s passion for fine wine, coffee, or even a roast lamb dinner.

Yet, even now, despite everything I have written, I feel compelled to juice cabbage and carrots on a daily basis, and feel guilty that I have let my meditation practice slip. Perhaps this is the most insidious aspect of Gawler’s program; that despite having subjected my body to the brutality of multiple surgeries, chemotherapy and radiotherapy, if the darn thing recurs, might I blame myself for not having followed the Gawler path faithfully?