Cutting The Tall Poppy: Dr. Charlie Teo
What the Medical Council's emergency meeting means for brain cancer patients.
“I have been portrayed as a superhero who tackles extremely difficult brain cancers every day. I know the truth. The reality is that while I have done many very difficult cases like this, in my experience, around 97% of the “inoperable” cases I take on would be removed successfully at numerous places around the world, with little fanfare. It is only in a place where the standards are generally behind the rest of the world, that this is seen as either heroic or insane. In reality, what I do is really neither. I am just a person doing his job, and keeping up on the latest progress in my field, and trying to help people in the way I think is right, which should be the expected minimum standard we have for highly trusted and compensated professionals like neurosurgeons.”
Charlie Teo is many things to many people. His line of work, neurosurgery, is one of the most difficult and demanding specialities in medicine and accounts for a mere 0.5% of the total doctor workforce. From a technical standpoint, the level of skill and razor-thin margin of error in neurosurgery demands nothing less than excellence in the operating theatre, where surgeries can last up to 16 hours and occur as frequently as 10 times a week. Combine that with working on the most delicate and complex vital organ in the human body, and you have a matrix of pressure variables that leave only a handful of people with the required skill set, training, and mental and physical fortitude.
When surgeries go right, neurosurgeons can restore hope in the lives of patients and loved ones and buy time that was thought to be spent. When brain surgeries go wrong, the patient dies on the operating table or sustains such severe damage that they are effectively vegetative for life.
There is a stark asymmetry in the upside and downsides of neurosurgery. The upside is simply allowing a patient to continue to live, the downside is irreparable damage and sudden death. There is no cure for brain cancer, and patient outcomes as a function of time and quality of life have not improved in 3 decades. The doubling rate of aggressive cancers like Glioblastomas can be 48 hours, swelling from a spec on an MRI to a grapefruit in the space of a few weeks. It is such an unrelatable state of shock and grief people find themselves in when facing brain cancer prognoses, that projecting what you would do in their situation is completely undermined by your frame of reference.
“When you are staring down the barrel at death, suddenly your grip on life becomes a whole lot tighter.”
Brain cancer doesn’t discriminate. Brain cancer robs the most good and innocent of the opportunity for life in a way that is totally unfair, and Charlie has lost more good people with whom he’s shared a personal connection than almost anyone on the planet.
For Charlie Teo, this is the world he lives in.
His day-in, day-out for the past 50 years has been fielding the grey area between life and death, performing more than 11,000 operations. He has dedicated, without interruption, his entire career to operating on and researching everything about brain cancer, from the genetic makeup of cells, to the architecture of brain networks, to developing safer and less invasive ways of mapping, planning and executing surgery. In the process, he’s built the biggest brain cancer tumour bank in the Southern Hemisphere, raised millions for cancer research, pioneered less invasive surgical techniques and built companies that will dramatically improve the way we manage cancer in the future. He has accomplished all of this in the process of watching good people die unfairly, on a repeated weekly loop since the beginning of his career.
Charlie Teo is unorthodox in more than just his approach to surgery. He wears casual clothes to serious meetings, makes incredibly inappropriate jokes with people he’s just met and spends a great deal of time attending to and spoiling the several dogs in his life with minced meat.
I have no doubts in my mind that Charlie’s personality has rubbed people the wrong way. He has a wicked sense of humour and is unapologetic about his excellence as a surgeon. A trait that in Australian culture is often quickly categorised as arrogant and conceited. But look at his wrap sheet. The allegation that he’s a narcissist driven by self-interest is a non-starter.
Charlie has always relied on his patients to defend him. He has been targeted by various governing medical bodies countless times in the past 20 years, and critics regularly accuse him of being cavalier, promising ‘false hope’ and operating on people who would be better left to die without surgery. What those detractors argue, is that as a medical professional, he should be more conservative and frankly turn down more operations on severe cases, specifically malignant brain stem tumours and recurrent malignant gliomas, which are his speciality. The claim here is that it is immoral or unethical to offer risky surgery to desperate and vulnerable people who will do anything to care for their loved one, including spending money they don’t have and risk prematurely curtailing their life.
The argument here rests on two basic assumptions. One, that Charlie fails to communicate exactly how risky surgery is to people without medical backgrounds. Two, that people who could comprehend the risks would never willingly make a choice in favour of low-odds surgery. Both assumptions are incredibly patronising and based on no evidence.
The idea that doctors should have medical licences held hostage for performing surgery on people who are fully aware of the risks is ludicrous and assumes that patients who act on their own volition in the context of being well-informed are by default unfit to make choices for themselves. ‘Inoperable cancers’ are not cancers that are impossible to operate on, they are operable cancers that have an incredibly low likelihood of being successful. The distinction is a meaningful one because it’s possible to arbitrarily impose ‘inoperable’ labels on patients and then accuse surgeons who do work on them as being negligent or cavalier.
“Around 15 years ago, several large, well performed studies from all over the world demonstrated clearly that it is beneficial to remove as much of these tumours as possible. Numerous professional organizations in the US, Europe, and Asia have published treatment guidelines strongly recommending surgery for gliomas to the furthest extent possible. There is very little debate on this topic presently. The big exception to this is Australia. While certainly some neurosurgeons perform excellent surgery aligned with international standards, I personally have seen many, many patients who unfortunately have been given advice far below the standards expected in the rest of the world. I have seen young patients with very simple gliomas, told by multidisciplinary teams that their tumour was “inoperable,” which often defied even a basic understanding of neuroanatomy or neuro-oncology. I would not state this so strongly if this were a mere difference of opinion: it is obvious and egregious.”
Following an emergency meeting of the Medical Council of NSW, Charlie Teo now has his hands tied. The temporary conditions stipulate that he is required to get written approval from another neurosurgeon approved by the Medical Council before conducting certain types of procedures on patients with brain tumours. Other conditions include a requirement that Dr Teo participate in a medical records audit and supervision meetings with a Council‐approved supervisor.
The real victims here are the patients who develop brain tumours, present and future, who will now die without a chance of a surgeon respecting their wishes and having a go at a resection. This is the true cost of the witch-hunt.
No one gets coerced into brain surgery with Charlie Teo. People are free to get second opinions and explore the market. We need to support those medical professionals willing to challenge the pervading dogma in order to save lives. No one else will.
My name is Elizabeth McIntosh – this is what I know and have lived with. I was diagnosed with ALL leukemia in 1982, aged 2. I had chemotherapy for three years, at Prince of Wales Hospital in Randwick, then on-going checkups until I was 18. My chemotherapy included six weeks of radiation. My mother Sue McIntosh was with me every step of the way. She supported me, trusting the doctors’ knowledge, experience and recommendations, because that is what they knew at the time. She knew what they knew and trusted the process. The chemotherapy and procedures kept me alive, although they made me sick at the time. I was cured and lived as much as possible a normal life. Risk, knowledge and expertise were all known.
In 1989, age 7, I had a laminectomy. It followed several weeks of me limping and my doctor ordering x-rays. It was found that, because of a procedure involving a lumber puncture, a piece of skin had been pushed through into my body and, from there, had grown into a tumour which was pressing on my vertebrae. The surgeon said there was a risk that I would never walk again, but he was confident that an operation would be successful. He removed some of my lower vertebrae and the tumour. There was a risk involved but my Mum agreed to the operation in the full knowledge of a possible failure and my condition worsening. Whatever happened, we would all get through this, regardless of whether I could walk or not. Once again, risk, knowledge, expertise were all known.
Fast forward to 2010. I was now 30. I had sight problems and eventually an MRI revealed a tumour on my optic nerve. There were also several meningiomas in my brain, caused by the radiation when I was a child. Although very tiny, they would cause damage to my brain if left alone. The first specialist I saw recommended the use of a gamma knife radiation, to “get rid” of the tumours. It would deliver precise radiation to the tumours and he gave no other options. It would cost a minimum of $30,000 and treatment in Sydney. When my Mum and I left the consultation, we sat in the car in the carpark. I cried and my Mum hugged me. “What is going to happen to me?” I cried. Again, we relied on the risk, knowledge and expertise.
I spoke to a friend who I knew through my work in childcare. He was a parent and a brain surgeon and I told him about my diagnosis and the recommendations of the specialist. He said “Don’t do it as the treatment (gamma radiation) could turn them cancerous”. Radiation had caused the tumours in the first place. Although the meningiomas were benign, I was at high risk of them later turning cancerous. So here I was, not speaking, in shock and gob-smacked, thinking I had dodged a nasty bullet of possibly getting cancer again. My friend said “I will refer you to a wonderful friend of mine, Charlie Teo”. A second opinion was needed and we wanted to have choices.
I met Charlie soon after. He is a beautiful, knowledgeable skilled Professor and neurosurgeon and I call him an artist with his skills, and an archangel given to us by the gods and our Creator. He gave us knowledge, options, explanations and hope. He also offered to refer us to the public health system, where I could have had the gamma radiation and care at no cost. He told me that the meningiomas were tiny tumours, and one had wrapped itself around my optic nerve in its little sheath. I had three complex surgeries on my optic nerve and my sight was saved from deteriorating further. Charlie’s skills involved precise, delicate movements in a tiny area using his skilled hands. He preferred the surgery over radiation, to allow me to live my life again. In the years 2010-2015 I had five surgeries, removing 31 meningiomas. One of the surgeries involved Charlie giving me a craniotomy to remove the lining of my brain, which held 22 of them. The other surgeries were keyhole. Once the swelling had gone down, there was minimal scarring and my hair grew back better than ever. Charlie is a truly gifted person and has always shown us absolute respect, explaining the risks and procedures involved, giving us choices and not charging us for some of the procedures and consultations. He has always treated us fairly and his team are wonderful. Again, we relied on the risk, knowledge and expertise. We had choices and we chose Charlie Teo
Very well written. My little boy who died 8 months ago with brain cancer had 5 surgeries by Charlie. He only charged for one. He bought us such great quality time. But every surgery was a fight to get to and was always made hard for me. I was doing what was best for my son and I knew Charlie was doing the same. He never gave false hope ever!! But he gave hope and two wonderful years more with my child.