Mal's Musings

Malcolm A Traill

IN  THE  PUBLIC  INTEREST
 

 

PROFESSOR LESTER JOHN PETERS

 

 

Memory Lapses.  The VCAT Panel should feel saddened that, after such a distinguished career in the field of radiation oncology (particularly dealing with head and neck cancer) Professor Peters presented before the Panel evidence of memory lapses*. As a planner and overseer of permanently destructive ionizing radiation upon members of the public, the Panel should entertain concerns about his health, and bring such concerns to the attention of the appropriate section of the Medical Board.                             *See later.

 

The Weight of his Testimony. Professor Peters is the only Expert Witness brought forward to the VCAT by the Board. In general, the comments contained in Exhibit A (15th February, p29-34) still apply. There can be elaboration and emphasis :

a)     He is a radiation Oncologist, in which he can be accepted as an expert. He is not an expert in Medical Oncology, Pathology Oncology, microanatomy, immunology, biochemistry, clinical chemistry, morbid anatomy and histopathology, physiology, biophysics, diagnosis, Quantum theory, the history of science, electrical engineering and is not the President of his College. The Applicant did not perform any radiotherapy procedures on any of the patients concerned. Professor Peters' field of expertise is largely irrelevant to the Hearing before the VCAT. Under the VCAT Code of Conduct for expert witnesses, he should have made clear which fields were outside his area of expertise, for example Medical Oncology, the biological effects of UHF and the non-psychiatric uses of Lithium; yet he did not. His claimed experience with hyperthermia was old and very limited - hardly that of an expert. His views (which seem to be personal) may be of possibly slight interest, but should carry no, or very little weight for the VCAT Panel.

b)     Bias. Professor Peters led the charge in the 'turf war' with his outburst (TB1, Tab 1; RESP.001.066:16-31;  067:15-069:3): 'What I was saying in my report was that it appears that you have had no training as a specialist in oncology. You may have had a little mentorship but your specialty is in pathology. So you don't have the training or experience or qualifications to treat patients with cancer.' Applicant: 'So what is the function of a Pathologist ? 'To read slides and do pathologic tests.' etc. The basis for his opinions was the Evidence Book (Book of Evidence ~Review Book). He seems oblivious to the claim by Professor Fox that the latter assumed the descriptor of medical Oncologist by virtue of a 'golden handshake' from the RACP under the 'grandfather' provision, recognizing his age and experience - not by 'registrarship in the specialty leading to some proper certification by a college.' Professor Peters seemed to have amnesia concerning this interchange, which should give concern (see earlier). See later about College domains and staged performance. The Applicant submits that half a day per week of 'mentoring' for 25 years, plus collaboration in papers prepared, written or published, amounts to more than 'a little mentorship,' an undefined term (or similar) that Professor Peters repeats in case the observer might forget it. The Applicant submits that, by Professor Peters presenting his personal minimalist views in this way, and not following accepted practice of going through the relevant College Presidents, Professor Peters has assumed a maverick stance and presented false or misleading views to sustain his position for the Board.

c)     The NH&MRC Review emphasized the comparisons between those treated by radiotherapy with or without the [UHF+GBA] (see �In Summary, . . ; p106. In this paragraph the UHF+GBA only was never mentioned !). The [UHF+GBA] group had no control negative comparison, and attracted little specific comment, but was the group of relevance for 'A Current Affair' and the VCAT Hearing. Professor Peters' understanding of the report largely related to the radiotherapy +/- [UHF+GBA] and he could provide no plausible explanation for the tabulated findings for the [UHF+GBA], with him suggesting (speculation) that the patients were having other treatments at the same time (not supported by the documentation) and that the study was not strict (a view at odds with the authors of the study who, in a paragraph of self-adulation note [p 105] 'One of the strengths of the study was the meticulous audit process undertaken by experienced data management and clinical staff with expertise in clinical trial design. . . . etc.')  Professor Peters was also sceptical of control negative 'guestimates[1]' from an expert medical Oncologist (Professor Fox), also supported by the Applicant, a recognized and relevant Specialist. He has produced no proof that [UHF+GBA], when given to incurable cancer patients, does not provide some benefit (slowed growth &/or reduced symptoms) in greater than 50% of cases. His views on this issue seem tainted with bias.

d)     Holt's spectral pattern. Professor Peters could offer no scientific explanation for this, merely describing it as a phenomenon, remote from effects upon patients. (An observer with some biological knowledge would assume that, if a cancer can show a resonance phenomenon, then some powerful intracellular forces must be at play which, very likely, would disturb cancer growth.)

e)     UHF & GBA. Professor Peters could not answer if the GBA killed cancer. He claims that Hornback was convinced that the UHF was ofno benefit. Apparently, Professor Peters had not read the Applicant's analysis of the Hornback experience (Exhibit B, RB2, Tab 128, TRA.002.0356-7). Why, having had a preliminary finding that seemed favourable, Hornback and his group went on to use 2,400 MHz is unclear: there may be some doubt that he ever fully realized the significance of his results. There may have been the problem with the FDA and/or to pursue some research that his group had done using the higher frequency in animal studies. The Applicant doubts the accuracy of the Hornback feed-back and cannot accept Professor Peters as an expert in the topic.

f)       Hyperthermia.

                                 i.           He has produced no proof showing that the superficial local hyperthermia that was applied to Ms ST did not have a beneficial effect.

                               ii.           He claims no recent personal experience with hyperthermia, claiming having used it on some (unknown number of) patients in the 1970s. He cannot claim to be a practising expert in the hyperthermic procedures. His name cannot be found in PubMed linked to papers using hyperthermia since 1996 at least - searching does not go further back.

                              iii.           He claimed that when he used thermometers, they were held in place with adhesive tape. (Such a technique is flawed and should be considered unreliable and possibly dangerously deceptive, see later regarding the art form.)

                             iv.           He makes much of the desirability of good thermometry and documentation as recommended in 2003 (after the events) for non-superficial hyperthermia, claiming falsely that, without these controls, the superficial hyperthermia cannot be of benefit. This is not a proof of ineffectiveness. By analogy, a famous violinist cannot perform in concert unless there is a metronome and an oscillator producing an 'A' in the background, both in order to ensure that there are maintained correct timing and pitch.

                               v.           He draws the false analogy between the (alleged) need for thermometry and documentation for superficial hyperthermia and the need for such documentation for radiotherapy. (Radiotherapy is permanently damaging, ionic radiation, showing a slow response, and with a cumulative effect. Accordingly, there must be good documentation for safety at the time and in the future.) Superficial hyperthermia aims to heat the skin [epidermis+dermis] and the surface is visible and accessible. Safety comes from careful application of the heat, as an art form - a labour-intensive requirement, not practicable in most public hospitals. Hyperthermia has no accumulative, damaging effect and, if there is a burn, it is apparent within hours, and heals within days. The two treatments are, in these regards quite different, and are not analogous, and his argument is flawed and specious.

                             vi.           He claims, on the basis of the thermometry and associated monitoring methods needed for non-superficial hyperthermia, that the training of Nurse F was inadequate (without defining what is adequate). In following the basic protocol described by van der Zee (see later) for superficial hyperthermia without thermometry, such specialized technical (as opposed to nursing) training he envisages is not necessary. His claims are not in accord with world experience using air interface superficial local hyperthermia.

                            vii.           When asked by Mr O'Neill about the whole body hyperthermia 'treatment' (that was never administered) and gaining the patient's confidence, he considered it inappropriate. The Applicant has never claimed that the heating was treatment, and no-one has ever claimed that the temperature reached would be effective as a monotherapy. She was not billed. The episode was a heating experience at the patient's request, at the time considered helpful to gain her confidence but, as we now know, so that she had the grounds so that she could lodge a complaint. Professor Peters is not an expert in the field involving this technique and his statements on the issue imply a stage managed performance.

g)      Professor Herbert Fröhlich[2]. First Professor Peters said that he could not make a meaningful comment. Then he went on to assume that the Fröhlich publications were some 'Internet theories' and adding derogatory comments, concluding that theories without clinical trials are of no benefit, later stating that he did not know much about Fröhlich's work, believing it to be dealing with solid state physics. (The relevant biophysical work concerns membrane resonance theory. See Exhibit G,TB2, Tab127; TRA.002.0419-21) Professor Peters clearly did not know much about this topic, yet had a few words to say nevertheless ! His views on Fröhlich and ramifications, should have no standing.(Professor Fröhlich was at the Max Planck Institute and the Liverpool university. He died in 1991. The Panel of 2005 demoted him to 'Mr.' There are some who believe that he should be ranked with Albert Einstein. His seminal publication, in a journal for Quantum theories, was in 1968, some 5+ years before the NH&MRC Inquiry of 1974. He subsequently published in 1969 and again in Nature in 1970. A competent Biophysicist would be expected to know of his work. Alas, none could be found for both the 1974 Inquiry and the 2005 NH&MRC Review, despite outsourcing the literature reviewing.) Without a sound theoretical basis, no empirical observations will gain credibility or acceptance.

h)     Lithium. Once again, the Lithium issue was dragged before a Radiotherapist. (Lithium is said to have very limited net beneficial effects upon bone marrow when the micro-architecture has been damaged. This happens after Radiotherapy.) Radiotherapists would not be expected to be interested in its use, even if they reviewed patients much after radiotherapy.Most of the medical Oncologists had heard of it, although better (and far more expensive) colony stimulating factors are available to cope with the severe changes induced by cytotoxic chemotherapy. It can be regarded like a poor [wo]man's Filgrastim (or similar). Its use is summarized by Hager et al. Exhibit A, Exhibit MAT1-8. and other references are submitted in full Tab 10. As usual, the issue seemed to surround the false assumption that Lithium itself, has an anti-cancer function (for all practical purposes, it does not). Professor Peters (not as a medical Oncologist) nearly always make reference to 'anticancer' in addressing the matter - as though he was deliberately channelling the subject onto that aspect and repeating the term often so that the observer might not forget what he has said (another staged performance outside his field of expertise). He did concede TB1, Tab1, RESP.001.065:18-19, 'That Lithium stimulates the bone marrow.' He was unable to explain why, and therefore considered it irrelevant ! (The old adage: 'The less you know, the more you think you know.') There has been a reasonable discourse on this issue in Exhibit A p31-33. The Applicant was not given an opportunity to explain the use of Lithium to the VCAT Panel and will present information on this topic later. The attached reference by the Chinese group demonstrated the immunological factors that are believed to be involved - not direct Lithium action upon the cancer cells. Professor Peters was not an Immunologist.

i)       Training in Oncology. Professor Peters has pursued the view that the Applicant can not call himself a Pathologist Oncologist because of lack of training and experience. He seems to believe that only Radiation Oncologists and medical Oncologists (RACP with specific College training) can assume the descriptor. He is not his College's President, and he is telling a Specialist, categorized as a Pathologist (consulting) how he should practise - what a cheek ! He had problems explaining the attitudes of the Presidents of other Colleges, such as the RACS. He seemed vague in trying to explain why a minimum of 5 years postgraduate training in morbid anatomy, histopathology, cytology, immunology, pharmacology and clinical chemistry, with the study of the causes, mechanisms, classifications, behaviour, effects of treatments and causes of death relating to cancer should be considered of little foundation towards the title 'Pathologist Oncologist.' He has been dismissive of the 'mentoring' the Applicant received over some 25 years (~½ day per week), the papers and publications prepared, read or published, as practical experience towards being a Pathologist Oncologist. A Pathologist Oncologist would/should not attempt to apply radiation, nor attempt to apply potentially 'curative' treatments to untreated patients, such as leukaemia, lymphoma, seminoma etc. The Pathologist Oncologist occupies a Specialist position below the Consultant Physician, and can apply treatments or managements consistent with the Pathology training and later experience, just as a General Surgeon may function at a level below a Neurosurgeon or a Cardiac Surgeon. Professor Peters was wrong when he claimed at the Hearing 2005 that 'There is a specialty of surgical oncology within the College of Surgeons' TB1, Tab1; RESP.001.066; Exhibit A, MAT1-9. There are aspects of the training for Pathology that place such practitioners in a special position with respect to scientific background, as in immunology or understanding and explaining the UHF treatment. He seems oblivious to the call for multidisciplinary approaches to the management of cancer patients (Exhibit D, TB2, Tab 127; TRA.002.0212.) Professor Peters had not considered the concept possibility of the 'golden handshake' into Pathology Oncology by virtue of training, experience and age. His statement that the Applicant had 'no formal Oncological training' lacks a definition of 'formal Oncological training' for those in the RCPA. The 'essence' of his Oncology has not been defined.

j)       Uric Acid. It is not a 'marker.' Who, apart from the Board, said it was ? See in relation to Associate Professor GG. Since this issue had not been found out, it was irrelevant, but introduced as defamation under privilege. Professor Peters was not a relevant Specialist to proffer opinions. The Applicant was a relevant Specialist/expert.

k)     Photomicrographs. Initially, Professor Peters said that he could not comment, and then proceeded to do so ! He considered them (to the effect) 'interesting, but not evidence - they do not prove that there was an effect.' Earlier, in the 2005 Hearing (TB1, Tab1; RESP.001.057) he noted that 'There has been cytological change. I don't think you can say there has been objective response.' He was unable to translate cytological changes (smaller nuclei, more crowding and more degenerating, apoptotic nuclei) to the macroscopic tumour. He was outside his field of expertise. The Applicant (a relevant Specialist/expert) submits that there has not only been objective cytological change, but that it can be interpreted as beneficial in the clinical context. The Board has produced no relevant Expert to dispute this.

l)       Van der Zee. Professor Peters was full of praise for her and her work, but concluded that it did not have much bearing and that thermometry was definitely necessary. That differs from van der Zee's published account on superficial (local) hyperthermia (Exhibit D, Tab 127; TRA.002.0269-75 [incomplete]) The protocols used by the Applicant's staff followed the protocol that she describes (2002) for air interface, superficial hyperthermia. The following list her page numbers :      

 

Page 1175        Energy is inhomogeneous, because of

                                                Energy distribution

                                                Thermal tissue characteristics

                                                Blood flow

 

Pages 1175-6   Tumour (skin) temperatures are increased to levels that are as high as possible, as long as the tolerance limits of the surrounding normal tissues are not exceeded

 

Pages 1178-9   The toxicity from superficial hyperthermia is usually a skin burn.

 

She has not mentioned the obvious problems associated with, and created by, the production of sweat, the convection currents and evaporation. Plastic heat indicators 'floated off,' and adhesive tape would add an unpredictable quality, including sweat collection and a tendency to lift off in unpredictable ways.

If staff were to put trust in thermometry under such circumstances, and direct their attention to other matters in the belief that effective controls are in place, their faith could be severely misplaced, and harm could occur as a result. Because of the number of variables, no protocol can be written to cover all eventualities (as for playing the piano or violin). Accordingly, it is a labour intensive art form, not applicable for most pubic hospitals. No harm came to any patient - it was applied safely. There is objective evidence that the treatments produced cytological changes. No proof has been provided to show that the treatments were ineffective. (Interestingly, the van der Zee Figure 1, p.1175, shows a set-up using a water bolus interface, applicable for deeper, larger metastases. The frequency of the UHF is 433 MHz, an European standard. This may be expected to set up a resonance effect and may explain why results from studies in Europe differ from those in the USA, where that frequency is said to be used for Police work.)

m)   Uric Acid Graphs. As a Specialist in a non-relevant field (and not as a medical Oncologist), he concluded that 'I don't think you can deduce anything.' He has neither the training nor the background to claim to be a Clinical Chemist (Pathology). His views reflect bias and should carry no weight.

n)     Spontaneous remissions. He (not as a medical Oncologist) noted that growth rates could change for no apparent reason (referring to anecdotes), but was unable to provide a percentage which, if "anecdotal," may be presumed to be of a low percentage (eg <0.5%, as suggested by Professor Fox).

o)     SO's Prognosis. Naturally he (not as a medical Oncologist), like the Applicant at the time, considered that Ms SO had a treatable condition for which there can be obtained long term remissions, which some people call cures. He felt that the treatment should be 'curative' (as did the Applicant), but Professor Peters did not have to try to persuade her to have it. He noted the difficulty in applying a percentage result to an individual case. Whilst the initial cytotoxic chemotherapy did have a 'good' response (according to him), the response was not good enough for her to be likely to be in the top 15% who might go on to have a long-term remission. In that context, it was disappointing. She may have obtained a 'complete remission' if the cytotoxic chemotherapy courses that were planned were continued, but that must be distinguished from a long term remission, which some people may call a cure.

p)     X-ray changes.  Quite rightly, Professor Peters (not as a medical Oncologist)  assessed Ms SO changes after the chemotherapy as indicating sensitivity to the cytotoxic chemotherapy. As noted in o) above, that degree of change was disappointing with regard to long term remission possibility. After this, Professor Peters became vague. Not wishing to accept that the minimal change after 5/10/2000 could be due to the action of the UHF, stating that he could not make any conclusion.

q)     The gap in cytotoxic chemotherapy treatment. Professor Peters considered (not as a medical Oncologist) that the gap affected her adversely, but he did not say why it would, if indeed she was not in the 'potentially curable' class. He considered that the interruption was inappropriate. He seems to have forgotten that it was Ms SO who interrupted the treatment, against everyone's advice (other than Dr Scarlett's initial advice when explaining the use of a PET or CT review in the context of a possible adverse finding, or that of a secret adviser who discovered the lymph node and who knew she was incurable.)

r)      The Bad Reaction. Professor Peters admitted (not as a medical Oncologist) that one cannot deny the patient the option of abandoning treatment. There now is good reason to believe that she never had a bad reaction.

 

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Malcolm Adams Traill

  ©Copyright MA Traill,  2006


 

[1] An assessment between an intelligent guess and an estimate (from knowledge)

[2]  A longer Fröhlich biography is attached. (Often indexed as "Frohlich")