ELIZABETH:

From Schwartz Media. I’m Elizabeth Kulas. This is 7am.

Charlie Teo is Australia’s best-known surgeon. He is also the country’s most controversial specialist. Martin McKenzie-Murray on the balance that he asks us to strike between hope and orthodoxy.

[Music starts]

ARCHIVED RECORDING - Unidentified journalist 1:

"Charlie Teo is one of Australia’s leading neurosurgeons, he’s known for his trail-blazing work saving lives."

ARCHIVED RECORDING - Unidentified journalist 2:

"But today, Dr Charlie Teo is being forced to defend himself against criticism from a colleague."

ARCHIVED RECORDING - Unidentified journalist 1 :

"Henry Woo tweeted ‘something is seriously wrong if a terminally-ill girl with a brain tumour has to raise to 120k dollars’."

ARCHIVED RECORDING - CHARLIE TEO:

"The last bill, for example, of that $120,000, I got $8,000 of it. So, you know, it’s not $120,000, or even a significant amount that goes to me."

[Music ends]

ELIZABETH:

Marty, you first wrote about the neurosurgeon Charlie Teo for the Saturday paper two years ago ... How did you first come to this story?

MARTIN:

Two years ago, I received a handwritten letter. A rare, rare thing these days, from a neurosurgeon that contained a lot of our grievances with Charlie Teo. Charlie Teo is arguably Australia's most famous surgeon. He's a neurosurgeon state finalist for Australian of the year. He's been a fixture, I think in Australian life, certainly New South Wales life for a couple of decades now.

ELIZABETH:

Martin Mackenzie-Murray is The Saturday Paper’s chief correspondent

MARTIN:

And the neurosurgeon had been incredibly aggrieved by Charlie Teo. There are a number of problems that they say were gnawing at them. The concerns were that families were almost destituting themselves, selling family assets in order to undertake surgery, very expensive surgery from Charlie Teo, which would otherwise be available at world class levels for free in the public health system. But this neurosurgeon, the author of the letter wouldn't go on record. But that was the beginning of reporting. I then spoke with about five neurosurgeons and then associated medical specialists like anaesthetists and other specialists that work with neurosurgeons, not one of them would go on record.

ELIZABETH:

But that was two years ago.

MARTIN:

Yes.

ELIZABETH:

And now?

MARTIN:

About a week ago, a professor Henry Woo, who’s a urologist and Professor of Surgery put his name to a criticism of Charlie Teo. He did this on Twitter. He said in one tweet that if families felt the need to raise upwards of $100,000 for surgery, that could otherwise be performed for free, he found that ‘really disturbing’ were his words.

ELIZABETH:

So you've talked about these fees that Teo charges, they're exorbitant by some accounts from others in the industry. How does he justify them?

MARTIN:

Surgical costs will vary but some might be $120,000, he says two thirds of that will go to the hospital itself. And then the remaining say, $40,000, most of that is partitioned amongst a large and expensive team anesthetists, nurses, registrar. So he says from $120,000 he might pocket only $8000.

ELIZABETH:

And why do you think the media found Teo so exciting, so kind-of worthy of coverage. Why were they supporting him?

MARTIN:

He's somewhat exotic in that he's a neurosurgeon. What an extraordinary job. And he's a very gifted one. His critics will talk about his fine hands. His good hands. He's a talented man. But he also presents himself and is readily accepted by the media as this great rebel. A man that detests pomposity, a man whose brilliance just wants to express itself by saving lives. If only the pricks would let him. And those pricks are timid bureaucrats and inferior surgeons who are jealous of his abilities. So, he presents himself as this as both his virtuosic rebel but also, I find this — almost this Trumpism, this elitism in the story about Charlie Teo. I think the people see this fine hero that keeps being thwarted by timidity, cowardice, and professional jealousies.
A neurosurgeon said to me this morning that Henry Woo was either incredibly brave or incredibly naive to come out and criticise Charlie Teo. I heard more than once the same phrase, criticising Charlie Teo would be like shooting Bambi. So valorized is Charlie Teo. And so collegial is the relationship between Charlie Teo and the media.

ELIZABETH:

When you were first covering Teo, I assume you also spoke to a number of patients that he may have worked with or their families. What happened to some of them?

MARTIN:

So he's not just beloved of the media. He's beloved of the families that sought his help. I spoke with the mother of Luke Westaway. He was a man with an aggressive brain tumour. He did die. The family believes, however that Charlie Teo added about three months to Luke's life, three months, which they cherished and the mother was very insistent on the warmth and humanity, not just the skill of Charlie Teo. And the families who have had loved ones treated by Charlie Teo will almost uniformly praise Charlie Teo. Now these are people in extraordinarily difficult circumstances. It might be a very, very young child that has an aggressive brain tumour. It's important to be sensitive to the kind of profundity of their grief and desperation. But the question that was put to me by neurosurgeons critical of Charlie Teo, is that it's very difficult to be remorseful of such huge expenditure. That you will find any way to justify it. And those three months will come to seem, beautiful and necessary.
They were also concerned that there were these patterns in how we reported, how the media reported on Charlie Teo, by selling it almost as miracles, that he was a miracle worker. And yet you'd see this pattern that for every story about life-saving surgery there'd be a subsequent obituary. Sometimes, just months later.

ELIZABETH:

And how is it that surgeons decide when to operate?

MARTIN:

This is the ethical rub. Really. I mean this is one of the central animating fixtures of the debate between Charlie Teo and most of the neurosurgical fraternity. That is, he will do operations which others have said is inoperable. Now, by inoperable, surgeons don't mean that it's physically impossible to do.

[Music starts]

MARTIN:

As a neurosurgeon put to me, they can remove wholly a brain. Technically. The question is whether they should. So when they say something is inoperable, that patient has been looked at by a team of specialists, not just the neurosurgeon. There'll be an oncologist involved, other specialists and a cost-benefit analysis has been done, and that cost benefit analysis commends not operating.

ELIZABETH:

And Teo himself offers something different?

MARTIN:

He offers hope and he would say that it would be condescending to remove a patient's ability to choose for themselves.

ELIZABETH:

We’ll be right back.

[Music ends]

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ELIZABETH:

Marty, when you last wrote about Teo a few years back you did speak to him yourself. Tell me about that interview.

MARTIN:

Charlie Teo, is, there is a formidable confidence to the man. You know, as I reported a couple of years ago, it's churlish I think to criticise surgeons confidence, especially neurosurgeons, you know they're dealing with such an extraordinarily delicate organ. An errant cut can mean profound damage to the patient.
He spoke of the pro-bono work internationally. He said countries that routinely fly him over to perform surgery. Singapore and India, he gave as examples.
When I asked him how he felt about media reporting and I suggested that it creates not so much a reputation, as a mystique about him and that much of the reporting was misleading and sloppy, it mischaracterised what an aggressive brain tumour is, he agreed that quite a bit of media reporting is exaggerated, but he reiterated the point that when he's in that consultation room with a patient, he's laying it all out for them — very clearly and very honestly. And then they can make a decision.

ELIZABETH:

So does he buy into the idea that he might be giving people and giving patients false hope?

MARTIN:

No not at all not at all.

ARCHIVED RECORDING - Charlie Teo Ted Talk

[Applause]

MARTIN:

He gave a TED talk a few years ago ...

ARCHIVED RECORDING - Charlie Teo

"Thank you. When you turn on the TV and surf the channels it’s invariably that you’ll see a story about death and disaster."

MARTIN:

And the title of it was false hope, there's no such thing.

ARCHIVED RECORDING - Charlie Teo

"As doctors, caring for patients who have been given the diagnosis of a terminal illness but who remain hopeful, our job is to respect and nurture that hope, not shatter it. False hope, there’s no such thing."

[Applause]

MARTIN:

So, that's his position.

ELIZABETH:

But he also told you about a man that he operated on whose life was extended by 16 weeks, and for him that was a success.

MARTIN:

Yeah. Charlie Teo said he operated on a man and gave him probably another four months of life. And this man in his gratitude bought a dog, and named the dog after Charlie Teo. In those four months he also got married. Neurosurgeons again, will come back to the point that the surgery if deemed beneficial can be done for free. And if it's not deemed beneficial then there's probably a good reason for that. And Charlie Teo would come back and say I laid it all out. I didn't withhold anything from the man. He could decide. And I gave him four months.

ELIZABETH:

And what about the efficacy of his work, is there evidence out there of how successful he’s been?

MARTIN:

No, so this is a little opaque. There's certainly kind of uniform agreement that he's a gifted surgeon. You know no one's suggesting that he's incompetent at all. But he often boasts of greater efficacy, greater results, more refined procedures, but he hasn't published many of these results. There's an opacity about the actual effectiveness. And this is something that his critics keep raising.

ELIZABETH:

And do you think there's any value at all to the claim that his peers in the industry, in the profession, might be jealous that his peers, in the profession, might be jealous?

MARTIN:

I can't speak for all of them. But no, in short. I spoke to a good number of neurosurgeons and, and then associated specialists who work with neurosurgeons. And I think we often keep coming back to these discussions about: are his critics jealous, are his critics racist? That often gets far more airtime than the substantive ethical questions at the heart of the Charlie Teo controversy. That's a real shame. One neurosurgeon told me this morning that given it was Dr. Henry Woo who made these criticisms, he's somewhat inoculated from those criticisms, from the racism, because he's a man of Asian heritage, from the charge of of jealousy, because he's at the peak of his profession but in another discipline, which is urology. So Henry Woo has done the debate a service, this neurosurgeon said, by kind of deflecting some of that criticism.

ELIZABETH:

Marty, in many ways this is a story where you’re weighing up the balance between hope, and medical orthodoxy. Did you make up your mind through that reporting, one way or the other?

MARTIN:

On the issue of patient autonomy - no. I mean there's ... that is, that is vexed. So, Charlie Teo, absolutely has a point to say I find it condescending that I would think that these people aren't capable of making up their own minds.

[Music starts]

MARTIN:

Simultaneously I find it persuasive that the idea of informed patient consent, about something so complicated and in a time of such extraordinary emotional terror it's fraught. Can you say that consent actually exists? And now another problem here is that I think in all of these discussions, the public health system has denigrated, and I think these lofty expectations that are created by the media, that Charlie Teo assists in developing them. And I'm not saying it's deliberate, but the consequence, I think, is a denigrated public health system. And people who don't either A: understand that they can receive the surgery for free or B: they realise it that but they think it's inferior. And I don't think either of those things are true.

ELIZABETH:

Thank you, Marty.

MARTIN:

Thank you.

[Music ends]

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ELIZABETH:

Elsewhere in the news:

ARCHIVED RECORDING - Craig McMurtrie

"Sometimes when we talk about press freedom to people who aren't in the media, that can sound like a bit of a cliche, But we should feel uncomfortable about this."r

ELIZABETH:

The Australian Federal Police have raided the ABC headquarters in Sydney, with a search warrant that named journalists Dan Oakes and Sam Clark, as well as the ABC's director of news, Gaven Morris. The raid relates to stories published in 2017, showing misconduct by special forces troops in Afghanistan. This misconduct included possible unlawful killings. The AFP says that the raid was not connected to Tuesday's raid on the home of a News Corp journalist. The ABC editorial director, Craig McMurtrie, said the police raid as a "very unwelcome and serious development".

And four people have been killed in Darwin, in a series of shootings allegedly carried out by one gunman. The shootings took place over the course of an hour on Tuesday evening. The alleged killer is now in custody.

This is 7am.

I’m Elizabeth Kulas.

See you Friday.