Dr Charlie Teo, renowned Australian neurosurgeon, talks about his foundation’s work in driving forward brain cancer research, the latest medical advances and his sense of urgency to find a cure.
An insightful conversation with a highly passionate and respected practitioner and advocate. Charlie provides an overview of the state of affairs in brain cancer research today, sheds light on the medical advances he has witnessed since his days as a medical student and shares his optimism for much less invasive and much more effective treatments in the not too distant future.
From founding the Charlie Teo Foundation to helping set up a pro bono hospital in India, Charlie’s story will inspire and inform you.
The following is a full transcript of the podcast episode:
Alberto Lidji: Charlie, a big heartfelt welcome on to The Do One Better! Podcast today.
Charlie Teo: It is a great privilege and a pleasure to be here Alberto, Thank you.
Alberto Lidji: Great. Why don't we start by finding out a little bit about the Charlie Teo Foundation. Why did you start it? What does it do?
Charlie Teo: Well, it started I guess, serendipitously I returned from America 20 years ago, where there is a lot of philanthropy and a lot of generous donors to non-government organizations. And I didn't find the same thing when I came back to Australia. So, I set up a foundation called the Cure For Life Foundation, which was going to concentrate on brain cancer research. And it was very successful. Within two or three years, we became the largest funder of brain cancer research in Australia. That morphed into the Cure Brain Cancer Foundation. We felt that we grew enough to own that space where we could call ourselves Cure Brain Cancer Foundation. And again, over a 10 year period, we raised millions of dollars, and I guess in total up to $20 million over that period of time. But then I was giving a talk one day, Alberto, and I came off the stage where I would said why you should fund us because we are low cost, a charity and we run lean. And one of the COO’s of the foundation said, “Charlie, you can't say that anymore. We are running at about 58% to 68% overheads.” And it upset me and shocked me. And I said to the Board, “You've got to change. That's ridiculous. I like running, really lean and efficiently and that's too high administration costs.” And a few weeks later, climbed to 73%. And I said, “Well, you know this, I think we should fire everyone. And….
Alberto Lidji: You were not very popular…
Charlie Teo: …..Yeah, not very popular. So they said, “Well, listen, if you do not like the way we run, you should leave, And I go, “it is my foundation, I set it up, how can I do that?” Anyway, it was not an acrimonious separation, but it certainly was not pleasant. And so I thought, listen, if I'm going to continue raising money for brain cancer research, I want to make sure that I fulfil a few criteria. The most obvious criteria was to be efficient, and try and keep the administration costs below a certain percentage. I initially said 10%, everyone said “That's impossible.” So we are now running almost around 10-15% overheads, which is, a world first, essentially.
Alberto Lidji: So, in terms of the foundation and your work, driving forward excellence and brain cancer research and neurosurgery. Tell me a little bit about where the need is more pronounced in Australia, and then also in the other countries where you operate. How is it that you're making a difference?
Charlie Teo: Look Alberto, it is pretty simple. It goes like this - brain cancer is devastating. No one will ever deny that it is ranked as the worst cancer known to mankind. No one survives it,100% mortality. Most people are dead within a year of diagnosis. It kills more children than any other cancer in developed countries, and kills more children than any other disease in the UK, US, and Australia. So it is a terrible, terrible cancer that's killing our children. And with facts like that, you would think that governments in all those continents would fund it higher than other cancers. But in fact, it is the lowest and the least funded of all the cancers. So, that terrible disparity between impact on society, killing our youth, and getting funding is something that I felt I needed to be addressed, and we are. The brain cancer research community is very, very dependent on non-government organizations raising money for research because governments tend not to fund it. And you're probably sitting back there thinking, “Well, hang on. That is, that can't be right. If it is killing more than any other disease surely gets the most funding.” But no, Alberto, in all the developed first world countries, it is the least funded of all the cancers. It is probably multifactorial, as to why that happens. But one of the major things, of course, is that it is not one of the more common cancers. So, governments have to stay in power. They stay in power by being popular. How do they be popular? They fund cancers that are, I guess, in inverted commas, popular cancers, so ‘breast cancer, prostate cancer’, they all get extraordinary amounts of funding, disparate to their impact on society. And cancers like brain cancer, which is very unattractive, everyone dies, people are very nihilistic about it. And it is not a common cancer, gets very, very little funding, because really, it doesn't get the same votes if you fund brain cancer research. So it was, it was a no brainer to set up an organization to raise money for it when it was so poorly funded by our government.
Alberto Lidji: And when we talk about brain cancer, we are talking about a malignant tumor, for instance, or various varieties? When you're addressing brain cancer, what is that?
Charlie Teo: Yes, no there are many different varieties. But there is one that stands out as the most common of all the primary brain tumors and it is called a malignant glioma. It has lots of synonyms GBM, which stands for glioblastoma multiforme. Another synonym is stage four glioma or stage four astrocytoma. But they're all the same thing. It is all brain cancer. Now, there are rarer types, and some of those rarer types actually have a higher success rate of treatment. And some of them can actually be cured such as medulloblastoma, but GBM is incurable. And there is a high mortality rate. And like I say, unfortunately, it is also the most common. So that's the one that we are targeting, when we try to raise money for brain cancer research. It is the GBM that we are trying to target.
Alberto Lidji: Got it. And how far away are we from being in a state of affairs where there are some treatments that are going to be successful? I know a lot of cancers are these days, you know, you get it, but you're expected to recover fairly well. But there are a few that persist. How far away are we far from having the ability to tackle this in a more successful manner?
Charlie Teo: Well, at the current rate, Alberto, it does not look good, because many of the other cancers have improved their survival rates dramatically in the last two or three decades. Leukemia is one of them. When I was a medical student, 30-40 years ago, we were taught that there was almost a 90% mortality rate from leukemia. And with billions of dollars of research and time and effort, we have now basically flipped those figures so that the mortality rates are about 10%, 5-10% and the success rates are about 90%. Other cancers, for example, breast cancer, the success rates are much higher now bowel cancer, melanoma. But historically, brain cancer survival rates and mortality rates have not changed in the last 20/30/40/50 years. And so if we continue on that sort of gradient, then of course, we are not going to find a cure for ages. I'm hoping that things are going to be ramped up now. And why do I say that? It is because we've now mapped the human genome. We know what normal is so hopefully we can tell what abnormal is. We have now realized and discovered scientifically that the immune system has a major role to play with brain cancer. And before it was felt that the immune system had no role to play. So with those major changes in our understanding of brain cancer, I'm hoping that things will accelerate now. But look, it has been pretty dismal. It has been very pessimistic. But I have a newfound optimism that in the next decade, we'll be finding some pretty effective treatments for brain cancer and possibly even a cure.
Alberto Lidji: And from your side, when you are addressing this issue, and you are really trying to mobilize philanthropic engagement, and just the population in general to try to address this problem. Is it more than anything, a policy issue of asking policymakers and those who control the purse strings to fund this in a more robust manner? Or is there something else that needs to be done?
Charlie Teo: Look, my last Foundation, we had four government lobbyists employed under our banner. And even with that, we made very little headway with governments. I am sorry Alberto, I know, it sounds a little bit cynical, but I am very cynical about governments, you know. It is about staying in power, it is about staying popular, and it is not so much about the root cause. All the efforts that are going to find answers, it is more about staying in power with the government. So now, I'm personally not dependent on governments, I don’t lobby them at all, I'm pretty pessimistic about the way they approach funding for cancers. And I think it is up to me to actually do it on my own. So, I am good at raising money. I have operated on enough people in Australia, where there is almost a single degree of separation between me and someone on whom I have operated. So, I do have a lot of contacts. And with that, I have been very, very lucky in that high-net-worth individuals and corporations have come on board and helped me try and realize my vision of finding a cure for brain cancer.
Alberto Lidji: So tell me from your side, then, and from the foundation's perspective, you're able to do very well, with certain philanthropists and corporate partners, as you mentioned, what do you then do? Are you mainly driving forward the research? Are you performing operations? What are the key activity areas that you're focusing on?
Charlie Teo: Yeah, I have always thought of doing surgeries better is like having the ambulance at the bottom of the cliff, you know, as opposed to the fence at the top of the cliff. And I've always tried to take the approach of building the fence at the top of the cliff or stopping people from getting brain cancer or treating it, you know, as you first diagnosed is better than having better surgical techniques. Not that surgery, of course, is not without its role as a surgeon, of course, it is very important, but I would much rather devote the money and the time and expertise to try and find reasons as to why we've got cancer and targeted treatments. So, the Charlie Teo Foundation is unique, for several reasons. One, because it runs so lean, and we keep our administration costs down. Two, because we are incredibly transparent about that. And again, I know it sounds a little bit cynical, but it turns out that major charity corporations often spin their figures to make them look good. And, you know, talk about administration costs being 10%, because they do not include salaries, they include salaries under raising awareness, and that’s you know, is a bit of a, I think it is conning the public myself. So, the Charlie Teo Foundation - firstly, runs lean, we believe in volunteerism. And we have people paying for our office, our electricity, our stationary, and we have corporations doing our marketing and sales all pro bono. We only have three full time employees, and yet we raise millions every year. Secondly, the transparency and thirdly, I do not know I just was a little bit self-critical about how much money I raised with my previous foundations, but how little impact I had made. And I thought I was doing something wrong. I mean, I'll tell you a little story, which is really interesting. I was on a selection committee to pick the head of the brain cancer, part of the cancer center at my university. And, there were about four of us in the room and the candidates came in and made their presentations and this one guy came in wearing a beanie. He looked a little bit unkempt. He was a bit manic but clearly the guy was a genius. And he told us why we should employ him and his theories about brain cancer. And he walked out of the room, we all felt, we all looked at each other and thought, “Oh my God, that's the guy who's going to find the cure for brain cancer.” But believe it or not, Alberto, we did not pick him. And we didn't pick him because he just didn't fit the mould. He didn't have any publications to his name. He wasn't the sort of person who could manage a group of scientists. He certainly wasn't the sort of person who had been in front of an audience to get funding but he was clearly a genius. And it occurred to me that, I was funding all this science research at major universities because, the people we were funding had track records, they had NIH funding, they were good speakers, they presented well, there are good people managers, but the real geniuses were out there somewhere who we weren't funding. Well, if you look at, if you do your research, you find that many of the major breakthroughs we've made in medical science have been by those left field thinkers, the people who think outside the box, the people who are a little bit disruptive in their approach, and they're often not funded by the major universities. In fact, some of them have to experiment on themselves. I'm sure you know, the Nobel laureate, Barry Marshall, who discovered that cancers were due to a bug called helicobacter. Well, it turns out that Barry Marshall was ostracized by his colleagues, everyone thought he was a bit of an oddball. He wasn't funded. And he had so little funding that he actually had to use himself as a guinea pig and give himself the bug to cause an ulcer. So my charter, and my aim is to find the Barry Marshalls of brain cancer research. To search the world for these people who may not have the big names, they may not be funded by universities, and they may not have these big grants but they are geniuses who think outside the box. And, yeah, that is part of our agenda at the Charlie Teo Foundation to find those people. And I must say that we have identified a few people already who are just, whose theories are just way out there Alberto, but they do have science behind them. And, if they come to fruition, they could be the, you know the magic bullet. Things like, believe it or not, cancer cells do not grow well, in an anti-gravity environment.
Alberto Lidji: I have to admit, I was not aware of that.
Charlie Teo: Yeah, nor was I, of course, I met this scientist. And so this scientist has actually come up with a device that creates an anti-gravity environment to impede the growth of cancer cells. And our first experiment, of course, this is taking your cancer cells up into space and watching what mechanisms are at play that reduce the proliferation rate of cancer cells in an anti-gravity environment.
Alberto Lidji: Incredible.
Charlie Teo: Isn't that incredible? I mean, it is really left field but who knows? It could actually be the answer
Alberto Lidji: A bit of an expensive experiment, right? You have to fly cargo up there or something.
Charlie Teo: Yeah, well, he is getting it free. He is actually getting to send the specimens up there under someone else's cost.
Alberto Lidji: Great, great. It must be quite challenging though, finding that talent pipeline as it were. Because, by definition, if they are not the ones who are publishing extensively, if they're not the ones in the big organizations, then it is a little bit of detective work for you to go out and find talented individuals who are slightly off the, outside the mould.
Charlie Teo: Of course, of course, because, again, not a politically correct statement… everyone thinks, well, I used to think, that scientists were all very altruistic. They were sitting in their little lab without any sort of recognition. They were in it for humanity in the betterment of mankind. And but, you know, that's a very naive opinion of scientists. Scientists are like any other humans, they have egos. You know, everyone wants to find, be the one who finds a cure for cancer. There is politics involved, there is personalities involved. And it wasn't until I set up my foundation, and I built up a medical advisory board that I realized that there is politics in everything. I can remember an application that came in, I thought, “Gee, that'd be a great project, we should fund that.” And one of our medical advisory board said, “Oh, no, that guy's, you know, pretty nasty person.” And so we didn't fund it because he had a personality conflict with him. And then, it struck me, and I do not know why I never thought this, but it struck me that, what we've got to do is try and rise above the politics, rise above the power struggles, the old school thinking and the established thinkers. And we've got to try and find those people who probably do have the answer, Alberto, and they're just not recognized.
Alberto Lidji: Easier said than done, but the effort will probably pay off.
Charlie Teo: Well, I think so. And I hope so. And, part of it has been the fact that I have this sense of urgency that, every day, kids and people are dying of brain cancer. And, they say it is $50 billion and 50 years to find a cure for cancer. But I would like to think that I do not have that 50 years, I would like to find it in a much shorter period of time with much less money. So that's why we've taken that sort of track to try and find those people.
Alberto Lidji: What drove you into this specialism? Was it simply the curiosity and the love for the field? Or did you have a personal experience with or… how did you end up where you are today?
Charlie Teo: It was serendipity. I hated neurosurgery as a medical student. I thought it was too uncompromising. I thought it was too high risk. I just didn't like it. You know, in my day, when I first started neurosurgery, we used to call the neurosurgical ward the veggie patch, because people did so poorly and surgery was very invasive, or they often did poorly after surgery. They looked terrible. They had their hair shaved off. It was just terrible. And so I started doing pediatric surgery and the neurosurgical registrar fell ill, I think, with hepatitis and they said, “Listen, would you mind covering his core for neurosurgery.” So even though I hated neurosurgery, I was thrust into it against my will. And when I started learning about it, the fear left me and I realized that it was a specialty that was examining an organ that was a great unknown, that you could still be a pioneer, and especially because it is such a young specialty, it only been around since 1910. And all those things appealed to me, you know, the degree of difficulty, the high risk nature, the ability to still discover new horizons. And, yeah, so I was thrust into it, but then I fell in love with it.
Alberto Lidji: That's great. And the degree of invasiveness, you touched on that briefly. So how non-invasive are things today compared to what they were when you started off on things?
Charlie Teo: Yeah, well, they are significantly different now. When I started, there was no such thing as computers, of course, we had to find a lesion deep within the brain by poking around, and I mean, literally poking around. We would get a needle, a thick needle, put it through the brain, try to find the tumor, suck out a little bit, look at it under a naked eye to see if it looked any different to a normal brain, and then follow that track down once we found it. Oftentimes, you'd be poking this needle around four, five, six, ten times to find the tumor. Every time you pass a needle into the brain, it runs the risk of damage. And that was why we found deep seated tumors. And then thankfully, with technology, we now have a GPS system for the brain called frameless stereotactic guidance. We now do a preoperative image, which we then feed those images into our computer, the computer then figures out the coordinates to find the deep set of tumors to submillimeter accuracy, where we just use a computer fiducial reference frame and special pointer that is connected to the computer and we take all the guesswork out of neurosurgery and that's something that's only come in the last 10-15 years. Yes, so it is changing rapidly. My main claim to fame of course now is keyhole minimally invasive neurosurgery where we develop techniques with small incisions. Less invasive, do not have to shave the hair. Often we do that through the nose to get to the skull base. So there is no scar. We do through the nose because we've got nice single shafted micro instruments and good visualization with endoscopes. A lot of my surgeries I do through the eyebrow. And so……
Alberto Lidji: Different world…
Charlie Teo: Oh my god, the change in the last 30 years. Yeah, absolutely different.
Alberto Lidji: And now you're spending about three months, four months out of the year outside of Australia. Tell me a little bit about that.
Charlie Teo: Oh, I guess it is part of my upbringing, I went to a Christian school, my best friend is Muslim, my best friend in Australia is Jewish, I was raised a Buddhist. And the one common thread with all those religions is that, you know, it is better to give than to receive. And so that philosophy was always drummed into me by my mom. And neurosurgery gives you a lot, it gives you status in the community, gives you a good salary, gives you the great feeling of helping other people. And so I've always felt that, you can't just keep taking and taking and taking, and you have to give back a little bit. So, I guess about 20 years ago, 30 years ago, I decided to spend a few months every year, helping teach neurosurgeons in developing countries and operating on poor people in developing countries. So I have been doing that for 30 years. Initially, I did it in South America, because I was stationed in America. And now I do it mostly in Southeast Asia. I have a hospital in India, which is a pro bono hospital, servicing a small city called Jabalpur in Madhya Pradesh, and I set that up with my own funds. But now it runs so well that private patients go there as well. And the private patients support the public patients and yeah, it's self running now. So it is a great lesson, that you know, all it takes is a vision, a little bit of generosity and charity to start off with. But then if you, if it is a good model, and if you have good people working there, then it can run itself and actually even possibly turn a profit.
Alberto Lidji: Must be incredibly rewarding to have done that.
Charlie Teo: Oh, it is great. Because it all started because I have a fellowship program that trains neurosurgeons from around the world. And one of the trainees was from India. I met him a few years after he finished my fellowship and said, “Ashish, how's it going?” and he goes, “Look, unfortunately, I haven't been able to use your techniques as we do not have a microscope.” And that's when I said, “Oh, well, I'll pay for a microscope, I'll buy you one.” And with the money I gave him, the cost of living is so low in India that instead of buying a microscope, you could actually buy this hospital. That's how it started. And I go back there, two weeks in every year, three weeks in every year, to teach and run a course. And that guy's amazing. He's built up this fantastic surgical specialty hospital with not only neurosurgery, but orthopedics. He's got a board of really lovely charitable sort of people that basically make sure that it is fiscally efficient, and the whole thing is worked out very, very well.
Alberto Lidji: Now, this is maybe a little bit of an unfair question. But what's the bigger challenge, is it about the equipment or is it about the human capital, the individuals on the ground, who would be able to know what they're doing in neurosurgery?
Charlie Teo: Ah, it is probably the latter. I mean, you know, a tool is only as good as the person who's using it, so the people definitely have to be trained well, and then if you give them the equipment, they can be more efficient and better surgeons. But no, the basic substrate that you require is good teaching, good hearted people. People who care, doctors who care, and doctors who are willing to sort of upskill and keep up with the latest trends and educate themselves and offer the patients the best treatments. And then of course, you've given them technology as well, it makes them even better still, but no, I think more important than technology is the human factor.
Alberto Lidji: And in terms of the technology, you mentioned how it enabled you to go from highly invasive procedures to procedures that you wouldn't even be able to visually see that had taken place. What about using technology to enable individuals like you who might be in Australia or the UK, to remotely deliver their expertise to a field hospital someplace else, or to train individuals who might be located in very remote regions? Is there much of that?
Charlie Teo: Look, you are talking about the da Vinci sort of model. And so with general surgery and acute trauma surgery, they are using the remote surgeons who work in machines that can then remotely work in machines at the site. But unfortunately, neurosurgery is so technically challenging. And haptic feedback is incredibly important in terms of the way the brain is manipulated, and you know, the brain is such a soft organ, it is easy to destroy and damage just with too much retraction or poor technique. No, I am not saying that cardiothoracic surgeons and general surgeons use poor technique, but it is just a little bit less forgiving. Well, it is a lot less forgiving the brain. And so those virtual reality, or offside surgical processes haven't quite reached neurosurgery yet. So the remoteness all comes in about, you know, speaking to patients teaching neurosurgeons via zoom and by the internet, if you can't get there, but actually remote surgery, no, we are not, we are not in that state.
Alberto Lidji: If you and I are having a coffee or a podcast in 2030, 10 years from now, what would success look like to you? What is it that you'd love to have achieved by then?
Charlie Teo: Well, ideally, I would like to be out of a job Alberto. Look, and that is not so far from reality. And what I mean by that is that already, we have focused radiation machines that can deliver focused radiation to tumors and zap them without putting a knife to a patient so that it doesn't get much more minimally invasive than that. We also have some forms of laser, it’s called blit, that can place a probe in someone's brain and pass an energy source or heat source into the tumor and kill the tumor without actually having to visualize it or open up… all guided by computers and MRI images. So in 10 years’ time, in the ideal world, I would like to be able to say, you know, isn't it terrible, you know, that10 years ago we are cutting people open to take out tumors. Now all we have to do is put them under a special machine or give them a special tablet. So that's in the ideal world. And that's sort of really looking into the future. But I guess, some halfway mark would be that all neurosurgery is minimally invasive, because technology has advanced so much that we do not have to destroy any, or we can reduce collateral damage, and that we hopefully have a treatment for brain cancer. You see the worst thing about a patient who is diagnosed with brain cancer is that when they see their oncologist, the oncologist goes, “Oh, we've got one drug called Temozolomide.” And then, okay, “Doctor, what if, what if that doesn't work? What have we got?” Nothing. So there is nothing else we have, one chemotherapeutic agent, we have radiotherapy and surgery, and that’s it. And if they fail, yeah, we've got second line chemotherapy and experimental therapy, but they are very, very ineffective. And as opposed to other cancers, where you see a breast cancer specialist, and he goes, we've got first line, second line, third line, fourth line up to 10th line treatments, if the first one fails. And I want to be able to offer brain cancer patients that you know that we do have alternatives if the first one doesn't work. We can't do that at the moment.
Alberto Lidji: Yeah. Well, here is to you being unemployed in 10 years time!
Charlie Teo: Wouldn't that be great!
Alberto Lidji: A key takeaway for our listeners, before we wrap things up, what is the one thing you would love for them to keep in mind after they finished listening to today's episode?
Charlie Teo: Well, this is a little bit philosophical, but during these COVID times, where we are all a bit challenged, and we are all suffering a little bit, I guess the word I would like to get out is that, there is always someone worse off than you. And I know that sounds a bit cliché-ish, but you know, we are also concerned about getting this virus or losing our income. And, you know, at least we do not have brain cancer. Alberto, when you're labeled with brain cancer, those poor patients are basically given a use-by-date on them. And, I think we should all step back and be less concerned about ourselves and more concerned about others who are less fortunate if it is not brain cancer, and then someone in a war zone or someone who's suffering from hunger and is impoverished. And, look, I do not know, I guess the lesson I would like people to realize is that brain cancer is so terrible. Please do not ever be worried about your own plight. When there are other people out there with a death sentence and no potential treatments. And that's what we want to change. We really want to change it. So the poor old brain cancer patient, then I can say to the brain cancer patient, what are you worried about? You've only got brain cancer. I would love to be able to do that,
Alberto Lidji: Before we wrap up, what is your website address. What is the best way to reach out if somebody’s listening to this and they think, well, I would like to find out more?
Charlie Teo: Oh, that is lovely. It is the charlieteofoundation.org.au. And, we are desperate for donations. We are in desperate need and patients really need your help. So yeah, if I can give a plug for that it is unabashed for brain cancer research and the Charlie Teo Foundation. And why the Charlie Teo Foundation? Because, I can promise you that we make sure that we run so lean that most of the money that's raised goes to brain cancer research and not to the running of the foundation itself.
Alberto Lidji: Charlie, it has been an absolute pleasure hosting you on The Do One Better! Podcast today. Thanks ever so much for your time, and for the insight and for the passion that you're clearly bringing into this whole field. So it has been a real pleasure.
Charlie Teo: Thanks, Alberto. And thanks for the opportunity.