Respectful Insolence

Given how much I’ve written about the Abraham Cherrix case, I would be remiss in not pointing out some posts by fellow ScienceBloggers:

1. First, Abel Pharmboy discusses how this might all come down to a failure of communication between Cherrix’s doctors and Cherrix and his parents. While this is probably true, I’m not sure that any amount of communication and empathy would have changed Cherrix’s mind. Abel also makes some good points about “natural” therapies in cancer. I would also agree with him that it is important to be as nonconfrontational as possible when a patient insists on ineffective alternative medicines instead of evidence-based treatments with a chance to cure. Even so, one must be careful. Ethically, as physicians, we must do everything in our power to dissuade patients from ineffective therapy like the Hoxsey therapy. Because we deal so much in the world of evidence, we are at a disadvantage in that we can can never promise what the altie docs can as far as survival chances or lack of toxicity. In addition, we will have a hard time matching the altie docs in terms of empathy and giving the appearance of “empowering” the patient. (Remember, one of the main reasons Cherrix chose Hoxsey’s clinic in Tijuana and then chose Dr. R. Arnold Smith is because they basically bent over backwards to be accepting and caring, never telling him that he was wrong about anything. Ethically and legally, we physicians can’t be so accommodating. We can, however, try to be as nonjudgmental and supportive as possible and educate the patient in evidence-based medicine. Nonetheless, when the rubber hits the road, we are obligated to tell it like it is with regards to these unproven therapies. As they say, you can lead a horse to water, but you can’t make him drink.

2. Retrospectacle also weighs in with a position that’s closer to mine.

Comments

  1. #1 Abel Pharmboy
    August 22, 2006

    Yes, indeed, the laws are very, very different for docs like you and altie promoters of everything under the sun. My main premise was to get people like the Cherrix family to a deeper understanding of the value of chemotherapy.

    “As they say, you can lead a horse to water, but you can’t make him drink.

    In this context, unfortunately, I’d modify that old adage to, “you can lead a horse to water, but you can’t make him think.”