Respectful Insolence

Not surprisingly, since the court decided that Abraham Cherrix, a Virginia teen who was diagnosed with Hodgkin’s disease at age 15, underwent chemotherapy, relapsed, and then refused to undergo any further chemotherapy, opting instead for an “alternative medicine” treatment known as the Hoxsey treatment, to be administered at the Biomedical Center in Tijuana, the blogosphere has been abuzz with chatter about the decision. Not surprisingly, I find myself in the minority in approving of the decision, even if I do so reluctantly. Indeed, not only do I find myself in the minority, but I find myself in a seemingly very tiny minority in the blogosphere. Some of those who have responded have accused me of “partying” over the decision, even though anyone with any reading comprehension whatsoever could see that my reaction, reluctantly and marginally approving as it was, could not be appropriate characterized as “partying.” Other reactions to the decision in the blogosphere have been unrelentingly hostile, ranging from characterizing it as “forced poisoning“; the “nanny state” run amok; part of the “arrogance” of the U.S. medical profession because in our belief in evidence-based medicine we consider many of the alternative medicine clinics in Tijuana to be pushing quackery; another example of “Big Brother” (of course); and, as part of some really egregious rhetoric by a hardcore altie, “death by lethal injection.” There were even some truly Hitler Zombie-worthy analogies, with over-the-top references to the Nuremberg Code and “children concentration camps.” Perhaps the least inflammatory rhetoric simply suggested that Abraham should apply for emancipation, but even that suggestion was couched in language suggesting that this ruling was an atrocity that needs to be fought at all costs, provoking calls to “call the judge” and overblown concerns that judges might start locking parents up for not taking their child to a doctor when they get the flu.

Indeed, the situation was so bad that at the time of this search, I could only find one other blogger who agreed with me, and he is a doctor too. I was tempted to address some of the more hysterical rhetoric, but decided that it’s not worth it. When hysterical twits like Mike Adams (a.k.a. the Health Ranger) start claiming that alternative medicines do better than conventional medicines, confidently and ignorantly asserting that most diseases can be cured without drugs or surgery, ranting in essence that the “guv’mint’s comin’ for yer children” (and you), and routinely portraying conventional doctors as slavering, greedy monsters and tools of big pharma, who are just waiting for the chance to force their patients to submit to their wills and let them inject poison into their veins, his hyperbole speaks for itself, at least to reasonable people. In any case, I’m not likely to change the mind of anyone who actually believes such X-Files-worthy conspiracy theories, anyway.

Nonetheless, I thought I’d add a little more before I give this case a rest and move on to other topics (barring additional developments that pique my interest, of course).

I want to emphasize one more time that, although reasonable people can disagree on where parental rights end and the obligation of the state to step in when parents undertake courses of treatment that will lead to the harm or death of their children begins or whether Abraham, now 16 years old, is old enough to make such a decision, there should be no doubt about the scientific and medical issues involved in this case. For one thing, this is clearly not a case of Abraham “giving up” and opting for quality of life over quantity of life. All you have to do is to listen to him in his interviews to realize that Abraham really thinks that the Hoxsey therapy has a high probability of curing his cancer and clings to that belief, even though his tumors have clearly grown while he’s been on the treatment. The Hoxsey treatment is quackery, period. Credulous bloggers who seem to believe that it’s a medically valid alternative to chemotherapy need to understand that it is most definitely is not. I realize that I’m not likely to change the mind of hardcore alties on this, but for those who are unsure, thanks to Peter Moran, a retired general surgeon from Australia and also regular on the Usenet newsgroup misc.health.alternative, we have some evidence showing how worthless the Hoxsey treatment is:

The results at the Biomedical Centre were broadly similar to those of the L-W clinic. Only 17 (11%) out of an initial 149 patients could be established to be alive five years later. 68 were known to be dead, but a colossal 64 were lost to follow-up and therefore had unknown outcomes.

There was also a poorer level of patient documentation at this clinic. Only 85 out of the initial 149 could be evaluated for stage and the researchers rightly did not bother with any full analysis of the results. The types of cancers were similar to those at the L-W clinic except that there were more brain tumours and skin cancers. Four skin lesions described as basal cell carcinoma or squamous cell carcinoma, normally excellent prognosis conditions were included, the numbers of locally (27.3% vs 9%) and regionally confined (26.6% vs 17.9%) cancers were higher, and the number of metastatic cancers lower (38.5% vs 68.3%) than with the L-W group, indicating that this was a much better prognosis group of patients. A similar number had “no evidence of disease”.

Very likely reasons for loss of contact with patients are death, or obvious cancer progression despite the treatment. It can thus be argued that the lost patients are likely to be heavily weighted with poor outcomes. However, even if they survived at the same rate as the others, they would contribute about 13 more survivors (multiply 64 by 17 and divide by 85) creating a 20% overall 5 YSR. Not very impressive in such a patient population .

75% of patients presented to the biomedical centre within one year of diagnosis/ staging.

[Source: Richardson MA, Russell NC, Sanders T, Barrett R, Salveson C. Assessment of outcomes at alternative medicine cancer clinics: a feasibility study. J Altern Complement Med. 2001 Feb;7(1):1-3.]

I now actually recall having seen this study and should have mentioned it. Given the mix of patients, the results were pretty bad. True, one could say that this study doesn’t necessarily rule out a small positive effect. However, it should be remembered that the Biomedical Center is not making a claim for a small positive effect. The adherents of the Hoxsey treatment are claiming an 80% efficacy in curing cancer. If indeed the Hoxsey treatment were anywhere near that efficacious, a review of its records would have shown evidence of its efficacy easily, and I’d be all for investigating it further as a promising new therapy. However, there was precious little in these results to provide even weak justification for further clinical investigation in randomized trials. As Dr. Moran put it:

Such studies cannot exclude the possibility of small effects on cancer survival (actually for either good or ill). What they do demonstrate beyond reasonable doubt is that any beneficial effects of these popular methods are so small or infrequent as to be unlikely to have ever been reliably detected by the clinically inexperienced inventors of the methods, or by later well-meaning supporters, from casual clinical observations.

So, make no mistake about it. By choosing the Hoxsey treatment over conventional medicine, Abraham is choosing death based on a false belief, and his parents are complicit in his choice. With these facts as the background, let me ask all those who are so adamant that Abraham should be allowed to “choose” a few quick questions. They should be very easy to answer–if you’re a zealot. If you’re not, they should be a a whole lot tougher and require a bit of thought and soul-searching:

1. If Abraham and his parents chose crystal therapy or, like Christian Scientists, decided that they would use prayer alone to “cure” Abraham’s lymphoma, would you be as adamant in your belief that the state should not intervene. If not, why not? (Remember, contrary to what many of you seem to believe, there is no difference in efficacy between the Hoxsey therapy and crystal therapy or prayer alone; all are equally worthless. If you’re going to try to claim otherwise, then go to question #4 instead.)

2. If Abraham were 14 years old would you still think that the state has no business intervening in his care? (Consider the case of Katie Wernecke, which is often mentioned in the same discussions as Abraham’s.) What about if Abraham were 12 years old? 10 years old? 8 years old? In other words, is the right of parents to decide medical care for their children absolute, and, if it is not, what are the specific situations in which the state is justified in intervening to overrule the decision of the parents?

3. Are there any circumstances you can envision in which the state should intervene to direct the medical care of a child against the parents’ will? Please give a specific hypothetical example of such a case and explain how that is different from that of Abraham Cherrix. If there is no circumstance you can vision in which the state should intervene to protect a child from a medical choice as bad as Abraham’s, please state so explicitly and justify.

4. For those who think that the Hoxsey treatment is a valid medical option for the treatment of relapsed Hodgkin’s lymphoma, please provide valid scientific and/or clinical evidence that it is any better than doing nothing. Testimonials do not count.

5. This one is for those of you who give Abraham breathtakingly bad advice, such as to “to be as non-compliant as possible with their orders. Make the government charge in with guns blazing to take him to the hospital. Refuse to comply with any hospital officials, thus putting the government in the position of having to point yet more guns at doctors and 16-year olds so as to get their way. Also, make sure the tape is rolling at all times in the camcorder to show the world exactly what is going on.” Do you really think that this advice is in Abraham’s best interests? Or, through this advice, are you instead simply hoping that by resisting so vigorously Abraham will become a sacrificial lamb, a martyr for your political beliefs? Do you just want bad P.R. for “conventional medicine” and the child protective services system of the State of Virginia, the cost to Abraham be damned? Inquiring minds want to know!

The bottom line is that the questions raised by this case are not medical questions. We know the medicine behind the case. We know that Abraham has no chance of survival with the Hoxsey therapy and a decent chance of living a long life if he undergoes conventional medicine. No, the questions raised by this case are primarily political and a balancing of competing rights, such as (1) the rights of parents to raise their children without interference versus the duty of the state to intervene when parents endanger the lives of their children and (2) at what age a teen should be considered an adult, with all the rights to decide his own fate, even if that decision leads to his death. Neither of these questions have easy answers, but those who are so viciously castigating the judge, the State of Virginia, and the health care professional (whoever it was) who reported Abraham to the state are generating a lot of heat, but little light. I’m guessing that we’ll see a lot more of the same beginning today, given that the decision was released right before the weekend.

ADDENDUM: Amazing, I’ve found one other blogger who agrees with me, and she isn’t a doctor.

I would quibble with her reference to abortion, however.

ADDENDUM #2: Bioethicist Arthur Caplan weighs in.

Previous posts on this topic:

Two young victims of alternative medicine

Update on Abraham Cherrix
A “defense” of Abraham Cherrix and his parents?
Magical thinking versus lymphoma
Choosing quackery over evidence-based medicine: When is a patient old enough?
The decision is in: Starchild Abraham Cherrix must have chemotherapy

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Comments

  1. #1 Bronze Dog
    July 24, 2006

    I believe in informed choice. Unfortunately, Abraham was not basing his choice on information.

  2. #2 Drowned
    July 24, 2006

    A show of support – I don’t have to time to Blog, but I agree with you! In some ways, things are as bad for us here in the UK, though the altie crowd overhere tend to be slightly quieter, it seems, than your lot, expect for goofy prince charlie. Not only do people demand the right to whatever treatment they so wish (as ineffective as it may be), but they also demand that the National Health Service then pay for it.

  3. #3 mumkeepingsane
    July 24, 2006

    Annother show of support here! I agree with you.

  4. #4 anjou
    July 24, 2006

    Show of support from a lymphoma suvivor, who actually put up an action alert, a month or so ago, on many support boards in an attempt to get the many lymphoma transplant survivors who are doing well to write Abraham. The support on the board that I post on is mixed, with a bunch supporting your stance sending me off list notes, not wanting to get into the fray.

  5. #5 Rev. BigDumbChimp
    July 24, 2006

    “to be as non-compliant as possible with their orders. Make the government charge in with guns blazing to take him to the hospital. Refuse to comply with any hospital officials, thus putting the government in the position of having to point yet more guns at doctors and 16-year olds so as to get their way. Also, make sure the tape is rolling at all times in the camcorder to show the world exactly what is going on.”

    Making Abraham into a martyr for their cause.

    Shameful.

  6. #6 nomial
    July 24, 2006

    To take the contrary position. There are too many people on this planet, there must be a cull, whether we like it or not, so letting the stupid ones kill themselves, is good.

  7. #7 Eric
    July 24, 2006

    In total agreement. I would feel completly different if he were making a completly informed decision to forgoe *any* treatment, but this flase beliefe that he can be cured through alternative medicine is crazy.

    The wingnuts are portraying this as “medical terrorism” and “the nanny state”, but since when have we allowed children to commit sucide by quackery?

  8. #8 Prup aka Jim Benton
    July 24, 2006

    Were I keeping up my blog instead of finding it dying from lack of time, I too would be supporting your position. I do find it difficult to fit my answer into a ‘theoretical framework’ but perhaps for the opposite reasons. I tend to support lowering the age of maturity in several areas, but am not afraid of ‘big government,’ feeling instead that this is precisely the point where government IS most useful, in protecting its citizens.
    I’m not sure, though I need to find that framework. This, of all areas, is where Emerson’s remark on a ‘foolish consistency’ applies. Abraham is, unwittingly, committing suicide. I’m interested in saving his life first, and then justifying my actions later.

  9. #9 TheProbe
    July 24, 2006

    One must remember that this i snot a new issue. There have been cases where parents, for religious reasons, have refused treatment, e.g. blood transfusion, for their child, and the court has ordered it. What is new in this mix is the Altie slant. I have no doubt that many of those severely criticizing the decision are doing so for the reason that they want to advance quackery, and not individual rights. This is right in line with those who took up Yurko’s case, where he murdered a child, just to use it to trash vaccination.

  10. #10 TheProbe
    July 24, 2006

    One more comment. This case was NOT started by BIG GOVERNMENT, but by his doctors who were rightly worried that the course he chose would result in his death. Imagine the outcry if they stood idly by and did nothing.

  11. #11 Bronze Dog
    July 24, 2006

    Imagine the outcry if they stood idly by and did nothing.

    I’d certainly be spraying a lot of venom in their direction. Reeks of pseudo-moderatism.

    Of course, if they did nothing, the mainstream media probably wouldn’t bother. A kid dying from altie-ism isn’t a story: It’d lower their ratings if there was any hint that they were interested in investigating the truth.

  12. #12 Skeptico
    July 24, 2006

    I’m conflicted on this one, but I’m marginally against this decision. Sure, I believe that children should be protected from the bad decisions of their woo parents, but I think that by the age of 16 the state shouldn’t be forcing you to have therapies you don’t want. Any age limit is arbitrary – at 14 or 15 the state should probably step in – but I just think by 16 you should have the right to make these decisions by yourself. Just an opinion, and I realize a little arbitrary, but so is the legal age of (presumably) 18.

    Of course, he’s not making this decision based on a true understanding of the facts – he apparently thinks the Hoxley treatment will work, and it undoubtedly will not. But if he was legally adult he would be able to make the decision himself, and many adults make wrong decisions based on an incorrect understanding of the facts. The state shouldn’t and doesn’t have the power to make decisions like this for adults, based on whether they think we understand the evidence of not. And yes, for adults, that would also apply if they wanted to chose crystal therapy, or prayer – if adults are so deluded they think such nonsense works then they have the right to choose them.

  13. #13 gravitybear
    July 24, 2006

    …”add a little more“?
    Anyway, I would approach this from a different angle. While I agree that there is no question what would be medically appropriate care (what his doctors recommend), I think that a 16 year old should have the right (as the rest of us do) to refuse care, even if the refusal is so that he can pursue an altie ‘treatment.’
    I come to this decision with a heavy heart, knowing that it would probably lead to this teenager’s death. I would wish that he would change his mind and resume chemo, but I would not force it on him. What if he refuses to cooperate? Will they jail him? or his parents?

  14. #14 Sid Schwab
    July 24, 2006

    Orac’s questions are excellent, and right on the point. Unless one argues for absolute parental right to do anything to their children under all circumstances, regardless of obvious harm (starve them, beat them, give them drugs, make them read blogs) then the questions are highly relevant. That this young man is close to the age of majority ought not matter, philosophically. It makes it harder. But is the argument just about age? Obviously not. It’s only by rejecting science altogether that one can argue that the parents’ decision is not harmful to the child. So to argue against the legal decision is to argue that parents have the unconditional right to harm a child. Whatever specifics one may apply here, that is the bottom line. I’m going to leave my baby in the sun because I don’t believe in UV light, I don’t believe that SPF matters, and I washed him in holy water this morning. I don’t see where the analogy breaks down.

  15. #15 quitter
    July 24, 2006

    While it is sad that this kid chose a quack treatment, I think the discussion of patient autonomy shouldn’t necessarily be focused on whether or not the choices patients make are good ones.

    The American Pediatric Association has a code of ethics dealing with this, and they too recognize the arbitrariness of selecting a specific age in which consent of the patient should be sought. But definitely by 16 the kid should be able to make such choices, even bad ones.

    You can look up the associations guidelines here (might not have an electronic copy but a good lay summary here.)

    This isn’t a new discussion or argument, it’s one pediatricians have encountered before. However, I think in this case the wrong decision was reached. People have to right to make bad decisions, and the age at which the state should recognize your right to make bad decisions about your medical care is somewhere between 12-14. Further, think of this in terms of things like pregnancy and abortion, where this ethical issue has gotten sticky in the past. Would you think it OK for the state, parents, doctors, whoever to require a pregnant teen to either carry her fetus to term or get an abortion “for her own good.” Probably not. Most of us, (and I know some wackos might just go crazy about this example, but there it is) recognize women have the right to make that decision for themselves, and the American Pediatric Association code of ethics requires doctors to treat such patients as capable of making decisions for themselves and independent of their parents if necessary at any age.

  16. #16 dogscratcher
    July 24, 2006

    You aren’t alone, even amongst the laity: the judge made a difficult but correct decision.

  17. #17 Alexander Whiteside
    July 24, 2006

    That judge decided he’d rather face the combined bullshitting power of the altie crowd than let a 16 year old die. He’s going to have to deal with their demonising self-righteous claptrap turning up in the media for a long time. If that’s not heroic I don’t know what is.

  18. #18 anonimouse
    July 24, 2006

    The problem with a case like this is that it sits squarely in the gray area. I tend to believe that adults should be able to make their own health decisions – as stupid as some of them might be. (whether it’s downing a quart of ice cream a day or taking herbs for cancer) I also believe that parents should be allowed to make the vast majority of non-emergency health decisions for their children, unless there is compelling reasons to not allow them to do so.

    I believe this is a case where Abraham has the right to make a decision that he believes is in his best interests. It doesn’t matter if the treatment is a sham – the child in question is old enough to understand the magnitude of what he’s undertaking and the inherent risks involved. If he wants to believe that the Hoxsey treatment works, I believe he’s old enough to make decisions based on that belief. If Abraham were 18 – two years older – and posed similar arguments would we even be having this discussion?

    If we’re going to let a 16-year-old get behind the wheel of a car (in most states) and take his life into his own hands every day, we have to let him take his own life into his hands when it comes to medical treatment. If his parents don’t want to stop him, well, they’re going to have to bear the burden of the inevitable consequences.

  19. #19 anonimouse
    July 24, 2006

    I’m going to leave my baby in the sun because I don’t believe in UV light, I don’t believe that SPF matters, and I washed him in holy water this morning. I don’t see where the analogy breaks down.

    The difference is that the child in that case is at the complete and utter mercy of his parents. The child in question does not have the capability to understand that they should not be in the sun. If that child was old enough to have a comprehension of the dangers of the UV light and chose to ignore them, that’s a little bit different.

    If there was clear evidence that Abraham was unable to appreciate the magnitude of his actions or didn’t understand what he was getting into, then I’d absolutely side with the judge. As it is, I find it harder to do so.

  20. #20 msampie
    July 24, 2006

    My child had a cancer with dismal prospects, JMML. We were told to take her home and plan her funeral. I couldn’t bear the thought of her dying. So we poisoned and burned with chemo/radiation and injected with her Aunt’s stem cells. 13 years later I now go speak to my daughter in person instead of visiting her at a cemetery. Are there late term effects from her treatment? Yes. Do we care? Of course, but the best late term effect is life.

  21. #21 msampie
    July 24, 2006

    To all of you who think that a 16 year is old enough to make his/her own decisions, I urge you to lobby the government to start taking 16 year olds into the army. I also urge you to give your 16 year olds complete power of attorney over all of your financial affairs.

  22. #22 Sid Schwab
    July 24, 2006

    anonimouse: so it seems you boil the whole issue down to the age of the child? Fair enough. But where’s the cut-off? Six months? Six years? Sixteen? By what criteria do we decide? I’d say there’s much more than age involved here. I do agree that the age of this person makes it more difficult. But unless there were to be some sort of test — IQ?, SAT?, Rohrshak? — to determine ability to understand, there has to be an admittedly arbitrary line drawn. Which is why I made my example a baby: except for arbitrary age, there’s no difference. Or so I’d argue.

  23. #23 dogscratcher
    July 24, 2006

    anonimouse:
    “The problem with a case like this is that it sits squarely in the gray area.”

    Very true. In another comment you say,
    “If there was clear evidence that Abraham was unable to appreciate the magnitude of his actions or didn’t understand what he was getting into, then I’d absolutely side with the judge.”

    Isn’t the fact that he is opting for a treatment that doesn’t work, over treatment that at least in principle can work, evidence that he is “unable to appreciate the magnitude of his actions?”

  24. #24 Deacon Barry
    July 24, 2006

    Of course it’s a grey area, but that’s why you have a judge who is an expert in the law and is able to make decisions in this type of case.
    Abraham may have turned 16, putting him on the adult side of an arbitrary legal line, but the events leading to this court decision occurred when he was a minor. If a minor commits a crime, then they are tried as a minor, even if they become an adult before the trial begins. As a minor, Abraham has been ‘brainwashed’ into believing that the Hoxley treatment will save his life, therefore, even though he is legally an adult, he is, in this case, not competant to make a decision about his treatment, and should be treated as if he were still a minor.
    I’m a nurse, not a lawyer, but that’s how I think the judge may have decided the case. Definitely the right decision IMHO.

  25. #25 David Harmon
    July 24, 2006

    Jim Benton: “I’m interested in saving his life first, and then justifying my actions later.”

    Well, that’s part of my problem with this case — everyone wants to get “their way” and damn the consequences! As I commented at the prior article, part of the consequences here are that this precedent is now available to other judges — including altie judges. To flesh out the issues, I’ll take Orac’s questions for 300 zorkmids….

    1. If Abraham and his parents chose crystal therapy or, like Christian Scientists, decided that they would use prayer alone to “cure” Abraham’s lymphoma, would you be as adamant in your belief that the state should not intervene. If not, why not?

    For starters, I’m not “adamant” about this, I think it’s a tough call, that should have gone the other way. Given the ruling went against my position, I’m not horrified or seriously upset, just worried about future developments. Part of my problem here is that, if the state has both cause and necessity to overrule a child’s guardian(s) regarding lifesaving medical treatments, they really ought also to have cause to declare the guardians unfit. Of course, that leaves the kid in state custody, begging the question of who pays for the treatment.

    2. If Abraham were 14 years old would you still think that the state has no business intervening in his care? …

    To me there are basically two places here where the age is relevant: (a) Is the “child” competent to decide on their own behalf? (more likely if older) (b) Is the state prepared and willing to claim custody? (more likely if younger, I’d guess) My counter-question: What if Abraham was 18?

    3. Are there any circumstances you can envision in which the state should intervene to direct the medical care of a child against the parents’ will?

    The most immediately relevant, is the one I’ve been championing, where the state is doing this as part of claiming custody from parents judged as unfit. (If the child themselves did want the real medical treatment, that should be an open-and-shut case.)

    Another reason, less controversial but probably more common, would be based on “danger to the public” (e.g., refusal to immunize for certain diseases).

    4. For those who think that the Hoxsey treatment is a valid medical option …

    I don’t. My position here is purely an extension of the “right to go to hell in your own way”.

    5. This one is for those of you who give Abraham breathtakingly bad advice, such as to “to be as non-compliant as possible with their orders. Make the government charge in with guns blazing to take him to the hospital.

    I haven’t and wouldn’t advice any such thing… but the knowledge that others will advice that, and some folks would actually
    do such things, is part of my reason for counselling against the intervention by the state. Part of realistic politics is recognizing that the state’s power is not absolute. Every time you use force against the public, you potentially risk escalation of the conflict, and any such escalated conflict may undercut your popular support. In America, popular support is supposed to be important, and it still determines which laws the government(s) can actually make stick.

    The real question here is, just what is it worth, to the state, to get a partial chance to save this one kid’s life? Is it worth sending police to take him by force? Is it worth pulling a dozen hospital staff away from their other duties so they can hold the kid down for his shots? How many chances to help or save other lives will be lost, while the cops and medicos are dealing with this one kid who doesn’t even want to be “saved”?

  26. #26 Spunky
    July 24, 2006

    There have been two Supreme Court ruling that should be considered here,

    Because parents have a constitutionally protected liberty interest in the care, custody and management of their children against the state’s unwarranted “usurpation, disregard, or disrespect”, the Supreme Court has held that parents retain a substantial, if not the dominant, role in decisions affecting the child, including decisions affecting medical treatment. Tennenbaum v. Williams, 193 F. 3d 581, 594 (1999), Cf. Parham v. J.R., 442 U.S. 584, 99 S. Ct. 2493, 61 L. Ed. 2d 101; 1979 U.S. LEXIS 130 (1979); Meyer v. Nebraska, 262 U.S. 390, 39, 67 L. Ed. 1042, 43 S. Ct. 625 (1923).

    The Supreme Court explained,

    “Simply because the decision of a parent is not agreeable to a child, or because it involves risks, does not automatically transfer the power to make that decision from the parents to some agency or officer of the state. The same characterizations can be made for a tonsillectomy, appendectomy, or other medical procedure…Parents can and must make those judgments…Neither state officials nor federal courts are equipped to review such parental decisions.” Parham v. J.R. , 442 U.S. 584;602-606, 99 S. Ct. 2493; 61 L. Ed. 2d 101; 1979 U.S. LEXIS 130 (1979).

    I a free country we give the compelling interest to the rights of the parent. One man’s quackery is another man’s cure. I just spoke with my neighbor who recently attended the funeral of their nephew. He had the same disease at the same age as Abraham. He went through chemo twice, and died anyway. His last days were wretched and horrible. But that is the choice his parents made for him. Abraham wants to avoid that. He believes the chemo will kill him and he doesn’t want to die that way. Sure it COULD cure him, but it could also make his last days miserable and kill him. The responsibility begins and ends with the parents.

  27. #27 Orac
    July 24, 2006

    One man’s quackery is another man’s cure.

    Wrong.

    In this case, the medical issue is very clear-cut. The Hoxsey therapy is quackery. It’s not a cure for Abraham or for any one else. It may be a delusion or false hope of a cure, but it isn’t a cure. Pursuing it is nothing but a death sentence for Abraham. If you’re going to argue that the parents’ right to raise Abraham as they see fit extends to their choosing/supporting a course of therapy that will surely result in Abraham’s death, then go ahead and try to make that argument. Or try to argue that Abraham is old enough to choose to forgo further treatment and die. But don’t try arguing a false equivalence between the Hoxsey therapy and conventional medicine for treating cancer to make it seem as though choosing the Hoxsey therapy is anything other than a death sentence. It won’t fly.

  28. #28 Skeptico
    July 24, 2006

    msample

    Re: To all of you who think that a 16 year is old enough to make his/her own decisions, I urge you … to give your 16 year olds complete power of attorney over all of your financial affairs.

    How on earth does that follow?

  29. #29 anonimouse
    July 24, 2006

    Syd:

    so it seems you boil the whole issue down to the age of the child? Fair enough. But where’s the cut-off? Six months? Six years? Sixteen? By what criteria do we decide? I’d say there’s much more than age involved here. I do agree that the age of this person makes it more difficult.

    Actually, I don’t. That’s why I believe cases like this need to err on the side of the minor UNLESS you can show reasonable grounds as to why the minor can’t make decisions on his behalf. For example, if you could illustrate the child was being manipulated into taking this course of treatment by his parents, that’s considerably different than Abraham making the decision of his own free will and volition. I do not suggest that every 16-year-old can make this call.

    Dogscratcher:

    Isn’t the fact that he is opting for a treatment that doesn’t work, over treatment that at least in principle can work, evidence that he is “unable to appreciate the magnitude of his actions?”

    I’m not here to argue the benefits (or lack thereof) of the Hoxsey treatment. It’s never been proven to work, and is unlikely to work in this case. Abraham’s long-term prospects are better with standard medical care. That is not the entire issue, though.

    The issue is at what point does a minor get to make decisions about their own medical care? Again, if Abraham was making similar arguments and doing similar “research” at 18 and not 16, is this even an issue? I feel that unless you can provide some evidence that Abraham is not coming to this decision of his own volition and doesn’t understand what he’s getting into, then you need to err on the side of allowing him to make his own mistake.

    Otherwise, what are the alternatives? Mandatory state intervention anytime a minor doesn’t want to puruse mainstream medical treatment? I’m not sure that’s the right answer either. The purpose behind state intervention in medical matters should be to help those who cannot make these decisions for themselves or whose caregivers are making poor decisions on their behalf. That is different than a near-adult making his OWN decision to forego accepted medical treatment.

  30. #30 Kristjan Wager
    July 24, 2006

    The issue is at what point does a minor get to make decisions about their own medical care?

    Well, technically speaking, a minor never get to do that. That’s part of being a minor. A distinction people seem to miss.

  31. #31 Eric
    July 24, 2006

    1) How old is old enough to make an ill and mis-informed decision about your own heath care? Death by ignorance and Suicide by Quackery are both things that our society should protect against. If Abraham wanted to forgo all treatment and die I would support that, but to hold out some false hope that this cure will work obviously shows that he *is* incapable of making this decision. How old does someone have to be before it’s ok to allow them to die stricly because of ignorance?

    2) Those people that think this is some big conspiracy between “big-pharm” and “the medical establishment” need to take a step back. Alternative medicine and supplements are generate hundreds of billions in revenue every year and are almost completely unregulated. If you are looking for people who are profiting off the backs of those in harms way you had better look at the harm that alternative medicine does every day by offering out a cure ( for a not so small profit ) to those most in need of conventional medicine.

    3) The hoxley method specifically has been used for over 50 years. If it did have curative properties they would be shoving it in our face rather than hiding their treatment records.

    The judge made the correct call.

  32. #32 anjou
    July 24, 2006

    If the boy wanted to commit suicide, and the parents where handing him the rope– should rights be terminated then? Obviously the case is not as black and white as that, its hoxsey 0 chance and conventional treatment significantly less than 100%. The courts do not come to these decisions easily, and the judge had to review both the medical facts of the case and prior case law in the area. He took quite a long time and thought long and hard before arriving at his decision.

    The situation is not one where the parents are rationally refusing further conventional treatment, where there is no hope as would be the case with a metastacized solid tumor etc–the kids odds of cure are quite good with conventional treatment. Both the boy and his parents, who obviously love him, want him to live–unfortunately theyve been deluded by a sham clinic. Harry Hoxsey died of cancer– he turned to conventional treatment when his own sham cure failed him– it was too late, he died. I hope that doesnt happen to Abraham, just have seen one too many folks die from lymphoma already and hope that someone is able to break the families delusional thinking about the effectiveness of the Hoxsey Clinic. How the Hoxsey family allows his name to be associated with a treatment that didnt work for its founder is beyond me–guess they are used to the income from snake oil sales and don’t want to give it up.

  33. #33 TheProbe
    July 24, 2006

    Anjou…where did you find proof that Hoaxsey turned to conventional treatment before he died? I’ve heard this before, and can never find a reference.

  34. #34 anjou
    July 24, 2006

    Here’s a few references

    American Cancer Society page on Hoxsey Clinics
    http://www.cancer.org/docroot/ETO/content/ETO_5_3X_Hoxsey_Herbal_Treatment.asp?sitearea=ETO

    “By 1960, after battling Hoxsey for a decade, the Food and Drug Administration (FDA) finally banned the sale of the Hoxsey herbal treatment in the United States and forced Hoxsey to close all of his clinics in the United States. In 1963, one of Hoxsey’s nurses set up a clinic in Tijuana, Mexico. Just before her death in 1999, the clinic was taken over by her sister and still operates today. Hoxsey developed prostate cancer in 1967. When he did not respond to his own treatment, Hoxsey underwent conventional surgery. He died seven years later.”

    http://www.bccancer.bc.ca/PPI/UnconventionalTherapies/HoxseysHerbalTonicHoxseyHerbalTreatment.htm
    Hoxsey developed prostate cancer in 1967 and treated himself unsuccessfully with his tonic. He eventually underwent conventional surgery. He died in 1974. (Hafner)

    http://www.healthy.net/scr/article.asp?ID=2010
    When Mildred Nelson moved the clinic to Mexico in 1963, Hoxsey stayed in Dallas in the oil business. In 1967, he developed prostate cancer. He took his own tonic, but ironically, it didn’t work for him. Although surgery is fairly routine for prostate cancer, he refused to have it, fearing that the Dallas doctors would take their revenge on him on the operating table. Hoxsey spent his last seven years as an invalid, dying in isolation, nearly forgotten. He was buried around Christmas in 1974, without an obituary or tribute in the Dallas newspapers.

  35. #35 anjou
    July 24, 2006

    Hi -the probe– for some reason wouldnt post–trying again

    American Cancer Society page on Hoxsey Clinics
    http://www.cancer.org/docroot/ETO/content/ETO_5_3X_Hoxsey_Herbal_Treatment.asp?sitearea=ETO

    “By 1960, after battling Hoxsey for a decade, the Food and Drug Administration (FDA) finally banned the sale of the Hoxsey herbal treatment in the United States and forced Hoxsey to close all of his clinics in the United States. In 1963, one of Hoxsey’s nurses set up a clinic in Tijuana, Mexico. Just before her death in 1999, the clinic was taken over by her sister and still operates today. Hoxsey developed prostate cancer in 1967. When he did not respond to his own treatment, Hoxsey underwent conventional surgery. He died seven years later.”

    http://www.bccancer.bc.ca/PPI/UnconventionalTherapies/HoxseysHerbalTonicHoxseyHerbalTreatment.htm
    Hoxsey developed prostate cancer in 1967 and treated himself unsuccessfully with his tonic. He eventually underwent conventional surgery. He died in 1974. (Hafner)

    http://www.healthy.net/scr/article.asp?ID=2010
    When Mildred Nelson moved the clinic to Mexico in 1963, Hoxsey stayed in Dallas in the oil business. In 1967, he developed prostate cancer. He took his own tonic, but ironically, it didn’t work for him. Although surgery is fairly routine for prostate cancer, he refused to have it, fearing that the Dallas doctors would take their revenge on him on the operating table. Hoxsey spent his last seven years as an invalid, dying in isolation, nearly forgotten. He was buried around Christmas in 1974, without an obituary or tribute in the Dallas newspapers.

  36. #36 HCN
    July 24, 2006

    I found a reference to Hoxsey using conventional therapy here:
    http://documents.cancer.org/6516.00/

  37. #37 anjou
    July 24, 2006

    American Cancer Society page on Hoxsey Clinics
    http://www.cancer.org/docroot/ETO/content/ETO_5_3X_Hoxsey_Herbal_Treatment.asp?sitearea=ETO

    “By 1960, after battling Hoxsey for a decade, the Food and Drug Administration (FDA) finally banned the sale of the Hoxsey herbal treatment in the United States and forced Hoxsey to close all of his clinics in the United States. In 1963, one of Hoxsey’s nurses set up a clinic in Tijuana, Mexico. Just before her death in 1999, the clinic was taken over by her sister and still operates today. Hoxsey developed prostate cancer in 1967. When he did not respond to his own treatment, Hoxsey underwent conventional surgery. He died seven years later.”

    http://www.bccancer.bc.ca/PPI/UnconventionalTherapies/HoxseysHerbalTonicHoxseyHerbalTreatment.htm
    Hoxsey developed prostate cancer in 1967 and treated himself unsuccessfully with his tonic. He eventually underwent conventional surgery. He died in 1974. (Hafner)

    http://www.healthy.net/scr/article.asp?ID=2010
    When Mildred Nelson moved the clinic to Mexico in 1963, Hoxsey stayed in Dallas in the oil business. In 1967, he developed prostate cancer. He took his own tonic, but ironically, it didn’t work for him. Although surgery is fairly routine for prostate cancer, he refused to have it, fearing that the Dallas doctors would take their revenge on him on the operating table. Hoxsey spent his last seven years as an invalid, dying in isolation, nearly forgotten. He was buried around Christmas in 1974, without an obituary or tribute in the Dallas newspapers.

  38. #38 HCN
    July 24, 2006

    This is a chapter of a book called _The Medical Massiahs_ that gives more details into Hoxsey (but does not mention his own cancer):
    http://www.quackwatch.org/13Hx/MM/17.html

  39. #39 HCN
    July 24, 2006

    Ah, searching some more, I found a reference to Hoxsey’s prostate cancer that had a reference:
    http://www.bccancer.bc.ca/PPI/UnconventionalTherapies/HoxseysHerbalTonicHoxseyHerbalTreatment.htm

    The reference being:
    Hafner AW, editor. Reader’s guide to alternative health methods. Milwaukee, Wisconsin: American Medical Association, 1993:128-130.

  40. #40 Sid Schwab
    July 24, 2006

    interestingly, Dr Krebs, the “brains” behind laetrile also died of prostate cancer and turned to conventional care at the end. I know because I was working in the San Francisco General Hospital Emergency Room when he came in.

  41. #41 dogscratcher
    July 24, 2006

    anonimouse:
    “I feel that unless you can provide some evidence that Abraham is not coming to this decision of his own volition and doesn’t understand what he’s getting into, then you need to err on the side of allowing him to make his own mistake.”

    I can’t speak to his “volition,” but if we simply assume he wants to continue living, then he clearly doesn’t understand what he is “getting into.”

  42. #42 Amy Alkon
    July 24, 2006

    I’m a fan of your blog, and a blogger as well — and I agree with you and posted a piece “Stupidity Can Be Fatal” — condemning Hoxsey and “medicine” without evidence behind it.

    http://www.advicegoddess.com/archives/2006/07/stupidity_can_b.html

  43. #44 epador
    July 25, 2006
  44. #45 Tammy
    July 25, 2006

    Though I might be one of the few people out there who see your side of this debate, I do have to take issue in the statement you make about how western medicine is an evidence-based practice. This is, for the most part, not true. At the moment, the National Academies of Sciences is doing serval studies on the fact that medicine is not working this way! I was actually quite surprised when my colleaugue told me about the premise of this project. I assumed western medicine was entirely ecidence based. Many traditional procedures used on patients are not the most effective, but the choice to use them is based upon other reasons (financial, political, least effort on the part of the patient or doctor, health insurance, drug companies, etc.). Rarely are the most poplar treatements in hospitals today the most effective.

    All of this being said, I have found incredible solutions to health issues in medical alternatives. However, it is quite narrow minded to reject all of the incredible findings that modern medicine has discovered.

    The best medicine is to educate yourself on your own body and the many medical options out there. And rememebr that extraordenary claims require extraordinary evidence.

  45. #46 simple
    July 25, 2006

    Isn’t it kind of circular logic to argue that he’s not allowed to choose his treatment unless he’s capable of understanding his choices and the saying that because he picked option b he doesn’t understand his choice and therefore isn’t allowed to choose?

    (Yes, that’s a long sentence.)

  46. #47 Eric
    July 25, 2006

    Simple,

    If he had chosen to die and refused chemo that would be consistant. The state can not stop an informed adult from refusing treatment. He has stated that he wants to live and believes the Hoxsey treatment will cure him, this is completly irrational and the state should stop this since he is a danger to himself and his parents are encouraging this self destructive behavior.

    I don’t care what age someone is the state has a duity to protect them from themselves and others. This includes the snake oil salesmen who wish to sell him an ill-advices and non-effective cure.

    Tammy,

    I have to say *CITE SOURCES* otherwise I and most people here will dismiss your comments. I know of several probelem in the past with treatments that were not proerly tested, but that is becomming less and less of a problem. As for the most effective treatments not being used, no shit. The most effective treatment is often expensive or require training; a more common, but perfectly acceptable, treatment is substituted. Nothing suprising about that.

  47. #48 Kristjan Wager
    July 25, 2006

    Isn’t it kind of circular logic to argue that he’s not allowed to choose his treatment unless he’s capable of understanding his choices and the saying that because he picked option b he doesn’t understand his choice and therefore isn’t allowed to choose?

    It’s not the choice that shows that he is unable of understanding his choices, but the reasoning behind it.

  48. #49 whimsy
    July 25, 2006

    Don’t we occasionally try 16 year olds who commit crimes as adults?

    It seems the courts have held that some 16 year old do in fact, have the capacity to reason as an adult.

    I find this frightening on so many levels. Mostly because I don’t know if there is a clear right and wrong.

  49. #50 Kaethe
    July 25, 2006

    1. If Abraham and his parents chose crystal therapy….would you be as adamant in your belief that the state should not intervene.

    If Abraham and his parents chose nothing but green tea, I think the state should not intervene. He underwent chemo once, found it horrible. If he chooses not to do it again, he shouldn’t have to. To use Hoxsey is to wish on a four-leaf clover, but clearly, he’d take anything over going through chemo again.

    2. If Abraham were 14 years old would you still think that the state has no business intervening in his care?

    I think the age issue is dependent on the kid involved, but I don’t think the state should pursue treatment for someone who has tried it once and rejected it.

    3. Are there any circumstances you can envision in which the state should intervene to direct the medical care of a child against the parents’ will?

    Absolutely. If it is parents vs child in the decision-making, then the state can weigh in. If it is a single emergency procedure, a surgery or a transfusion, then probably the state should intervene.

    4. For those who think that the Hoxsey treatment is a valid medical option ….

    Nope, not even a little.

    5. This one is for those of you who give Abraham breathtakingly bad advice….

    Part of why I think this is a bad decision. Because chemo involves a long process, it isn’t a one-off like surgery performed on an unconscious patient. I simply do not see the value in the state attempting to enforce compliance.

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