Charlie Teo : Nobel material or just another very clever neurosurgeon? Only the data can say.

Spoiler alert : no Teo bashing or anecdotal support here. Just a call to reason.

Prof Woo from Sydney has raised questions about the GoFundMe campaigns for Charlie Teo’s surgery. Dr Teo has responded that he should go back to his lab and find a cure for prostate cancer, while Charlie will concentrate on curing brain cancer. Why is there even a discussion going on here? Doctors don’t normally do this.

For our conservative profession it is a red flag when a doctor or other health care provider does not hose down suggestions that they can do things that no-one else can do. I have seen people that I consider to be the most insightful surgeons at the top of their game defer to colleagues and say – I think she or he has more skill and experience than me in this particular case. We encourage a healthy culture that calls for help and operates in multidisciplinary teams. No-one can claim to be the best unless the data backs them up, so default humility is wise. But someone has to be the best, don’t they?

Science is by definition reproducible and as in all fields of human endeavour there are very few examples of people who can excel beyond all others sustainably. Football, music, and art all see stars come and go but whenever an individual shines there are always a few alongside and many nearby that are arguably as good.

There are a few other factors that muddy the water around the issue of whether Charlie Teo, in operating on brain cancer, really is special. It is a hard message to give a human that treatment for them, or their child, would likely be futile. Not futile because the patient is worthless, but because what is offered is only hope in a procedure that cannot help. A procedure that may cost their family a lot, not just in dollars but in time with their loved one. An extra day of life in hospital is not equivalent to a day at the beach with your family.

The other mud is money. The suggestion that our universal health care system cannot provide the best for everyone is not new, in fact in the real world it is inherently obvious, but neither can we have one celebrity surgeon operate on everyone. The idea that Dr Teo could run a training program to pass on his methods to others has merit only if his outcomes really are better.

Add to all that the alpha world of egos that can exist in science. It is nothing new for an important breakthrough to be rubbished by those already at the top. Barry Marshall did not get many plaudits at first – he was pilloried by the establishment for his upstart nonsense about ulcers being caused by bacteria. But here is the rub – his science was reproducible, he was open to being audited and people had to acknowledge he was right and scientists the world over changed their ways. And gave him the Nobel.

So the answer here is to do what science always does – distil the facts. Look at the outcomes objectively. Science doesn’t care if Dr Teo is a hero or anything else – that changes nothing. Most patients with brain cancer unfortunately do not do well in the long run, though it is not possible to predict any individual’s survival accurately. We need to compare the trends in Dr Teo’s outcomes, not the anecdotes, with those of everyone else because if it is true that others can learn from him, we need to know. If he has improved survival and quality of life on average it should be obvious in the dismal landscape that is glioma. If however some of his operations are just interruptions to a patients final months, or unnecessary for a long term cure that would have come anyway, then we need to know that too.

As for money, the love of which is the root of all evil apparently, well that is the usually easiest data of all to audit so let’s see all the numbers – dollars from consult to discharge. Transparency is good for everyone. If Dr Teo is cheaper than the public system then we need to ask hard questions of the administrators in public.

With this important discussion no-one has anything to fear – let’s measure the outcomes and the incomes and then decide – scientifically.