Respectful Insolence

Abraham Cherrix’s lymphoma in “remission”?

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It would appear that there’s finally some good news in the strange and sad case of Starchild Abraham Cherrix. The AP reports that he and his doctor are reporting that his lymphoma is in remission again:

FLOYD, Va. – A 17-year-old who won a court battle against state officials who tried to force him to undergo chemotherapy for his lymphatic cancer is in remission following radiation treatments over the past year, the teen and his doctor said.

Starchild Abraham Cherrix’s case spurred debate on whether the government should get involved in family medical decisions. It also led to a state law named after him that gives Virginia teenagers and their parents the right to refuse doctor-recommended treatments for life-threatening ailments.

Tests show that the sole remaining tumor in Cherrix’s body — a nickel-sized mass in his right lung — appears to be gone, radiation oncologist Dr. Arnold Smith told The Associated Press by telephone from his clinic in Greenwood, Miss.

Cherrix is not cured, but “he is N.E.D., our abbreviation for ‘no evidence of disease.’ He’s in a total remission,” Smith said Thursday.

“There may be some microscopic tumor somewhere still there, but everything we see is gone,” Smith said.

Cherrix said he understands that he is not cured. But he’s full of energy and optimistic.

“I’ve been cancer-free four times now, but this time it looks much, much better,” he told The AP on Wednesday in an interview in Floyd, the southwest Virginia mountain town where he lives with his mother and four younger siblings. They moved there in May from Chincoteague, an island across the state.


Actually, this is in essence little different from the last time that Abraham was reported to be shrinking his tumor or to be “cancer-free” and then recurred again three months ago. I wish it were, but it’s not. Almost certainly, Abraham still has microscopic deposits of tumor left in his body, which makes this the perfect time for him to undergo chemotherapy to try to mop up his cancer while his burden of disease is only microscopic.

As you may recall, Abraham Cherrix is a now 17-year-old adolescent who was diagnosed with Hodgkin’s lymphoma in late 2005. In February 2006, after a round of chemotherapy, there was still residual tumor left, after which his oncologists made a very standard recommendation in cases like this: More chemotherapy plus radiation. It was then that Abraham, then 15, in concert with his parents, decided that he wanted to pursue quackery rather than evidence-based medicine. And, showing a lot of evidence of magical thinking, he chose a doozy of a bit of quackery as well. Specifically, he chose to go to Tijuana to undergo the Hoxsey therapy, a treatment involving an herbal concoction developed by a man named Harry Hoxsey. This is a therapy supported by no good evidence and, indeed, for which there is good evidence that it doesn’t work.

Not surprisingly (or, if you have a more cynical view of how well state social services protect minors from medical neglect, surprisingly), the Accomack County Department of Social Services stepped in, leading to a court battle over whether Abraham was old enough to choose woo over evidence-based medicine. The initial ruling was that Abraham had to have chemotherapy, but ultimately there was a compromise. This “compromise” involved having Abraham go to a radiation oncologist in Mississippi with a penchant for woo named Dr. Arnold Smith, who would give him low dose radiation therapy. Although that is highly unlikely to cure Abraham’s cancer, it is legitimate medical therapy that is highly useful for palliation by shrinking individual tumors that are causing symptoms.

What’s not so legitimate is the rather odd form of “immunotherapy” that Dr. Smith administers to his patients. I’ve already deconstructed this form of immunotherapy in detail before, but in case you’re not interested in clicking and reading I’ll give the CliffsNotes version here. Basically, Dr. Smith injects an immune system stimulator called interleukin-2 into the patient’s belly until it forms a raised, red area that he calls a “belly plaque” (which look like this), which he “believes” to be filled with “significant colonies of clonally-replicating natural killer cells.” Of course, he presents no good evidence from well-designed clinical trials to support any of his claims for his “immunotherapy,” and he hasn’t published on this technique in anything other than woo journals since the 1990s at least. Moreover, apparently he is administering supplements and high dose vitamin C, neither of which, given the existing evidence, are efficacious against cancer.

Suffice it to say, I agree with the assessment of prominent bioethicist Arthur Caplan on this one:

Art Caplan, director of the Center for Bioethics at the University of Pennsylvania, doubted the immunotherapy had value. But he said Cherrix’s seemingly improved health shows the state was right to intervene.

While Cherrix is not getting the complete medical treatment that his original doctor wanted, the radiation means he’s getting most of it, Caplan said.

“He’d probably be dead by now if they (state officials) did not react,” Caplan said.

This is very likely true. At the very least, state intervention and the resultant compromise ruling have saved Abraham from significant morbidity. Remember, at the time of the compromise ruling, Abraham had, by this report, a baseball-sized mass in his neck. Without radiation to shrink it, that mass would very likely have continued to grow to the point that it started to obstruct his esophagus, compromising his ability to eat and/or his trachea, shutting down his airway.

How likely, though, is it that this new remission that Abraham has reportedly achieved will be durable or permanent? Sadly, not very. It’s possible, and I certainly hope that this is one area where I turn out to be wrong, with Abraham being one of the lucky few for whom radiation alone can take care of relapsed Hodgkin’s disease, but in reality treating these new tumors as they pop up is a lot like the game of Whac-A-Mole. Dr. Craig Hildreth (a.k.a. The Cheerful Oncologist) described it well in his excellent discussion of the role of radiation therapy in treating lymphoma of the type that Abraham has. I particularly the term that Dr. Hildreth uses for radiation therapy of the type that Dr. Smith is administering to Abraham, namely “spot-weld” radiation therapy, although “Whac-A-Mole” gives a better flavor as to its ultimate effectiveness. Contrary to the triumphant trumpeting of this announcement by certain bloggers, no doubt to be followed by Mike Adams (who has already published articles erroneously claiming that the Cherrix case is evidence that the Hoxsey therapy “works”) and other defenders of quackery weighing in today, if they haven’t already. In fact, I’m surprised how few have done so thus far, but that may just be because the story was reported late Friday afternoon. Expect a lot of crowing about how well “alternative medicine” works (never mind that it was almost certainly the radiation that shrank Abraham’s tumors to an undetectable size) and in favor of “health freedom” (in reality the “freedom” from having to listen to regulatory bodies that try to make sure, however imperfectly, that ineffective or unproven treatments are not touted as miracle cures).

Depressingly, this crowing will almost certainly be premature. Overall, this is a very sad case, and has been from the very beginning. It’s always sad to see a young man struck down by cancer before he even has the opportunity to live his life. However, what makes this case particularly poignant is that this young man refused his one best chance for beating his cancer and living to a ripe old age, fighting a battle that tore his family apart and resulted in his parents’ financial hardship and divorce. There is still a small chance that he may achieve the desired end of long-term survival with targeted radiation therapy, but his odds are considerably longer than they would have been if he had pursued more chemotherapy along with radiation in the first place.

Of course, if Abraham had been 18 or older when he first decided to pursue the quackery known as the Hoxsey therapy rather than conventional medicine, his case would likely never have been an issue. After all, adults are free to reject life-saving therapy if they wish. The question that Abraham brought up is the age at which a person should be allowed to make that decision for himself, the balance between the personal freedom to reject life-saving therapy and pursue whatever woo one wants, and how far the state should be allowed to go to force a child to undergo life-saving treatment for serious diseases or injuries when the parents either choose quackery or acquiesce to the child’s desire to pursue quackery. In the case of children nowhere near the age of being able to weigh such decisions for themselves, I think there is a clear case for state intervention when parents choose quackery over medicine. However, because Abraham was older than, for example, Katie Wernecke, putting him in that fuzzy age range where children become adults, his case was considerably more difficult, especially given his apparent maturity, which made his magical thinking not as obvious as it should have been to the credulous press that lapped up his story. Indeed, even I expressed considerable uncertainty before reluctantly coming down on the side of state intervention.

What also makes this case troubling is that it inspired a very bad piece of legislation in Virginia known as Abraham’s Law, which was recently passed and foolishly signed into law by Virginia Governor Timothy M. Kaine. In essence, this law appears to strip 14- to 18-year olds of any protection from the state if their parents choose woo over evidence-based medicine, even if they choose faith healing. It’s not as though the state was intervening in the health care decisions of parents and adolescent children left and right, given that the old law was weak enough, but this new law makes it almost impossible for social services to intervene in the case of medical neglect. It’s sad enough that Abraham Cherrix is highly unlikely to cure his cancer due to his own misguided faith in the Hoxsey therapy and fear of chemotherapy, but what compounds this sadness is that advocates of “health freedom” in Abraham’s name have made it likely that more adolescents in Virginia will suffer based on his example.

Comments

  1. #1 Save Your
    September 17, 2007

    I agree with you: I also hope you’re wrong regarding what is the likely path for Abraham Cherrix now (i.e., a less than robust remission). Let’s hope that his remission is complete and durable.

    Regardless of the specifics of this particular case, in the main it would be worse for individuals and ultimately for society if the state were given even more power to intervene. Although parents will occasionally exercise less than perfect judgment, considering that in most cases they care a lot more about their children than any state agency ever will or even can, I’ll put my money on the parents in most cases to do what is in the best interest of their kids. The few cases where the state might make a better decision than devoted parents will almost certainly be offset by a much larger number of cases of worse decisions and worse consequences.

  2. #2 Coin
    September 17, 2007

    “I’ve been cancer-free four times now, but this time it looks much, much better,”

    …something seems… unusual about this statement.

  3. #3 The Cheerful Oncologist
    September 17, 2007

    I have a response to Mr. Cherrix but it got so long-winded as a comment here I decided to post it on my own site.

    Prolixity, Thy Name is Mine!

  4. #4 Lepht
    September 17, 2007

    infuriating. this guy is killing himself, and we can’t stop him, and there are people who would give everything they have to have been given the opportunity he threw away; infuriating doesn’t cut it at all, but it’s the only thing i can say without getting crude. what a disgusting waste of a human life.

    Lepht

  5. #5 sailor
    September 17, 2007

    I wish this guy the best of luck. But when you think about it, not many people refuse proper treatment. A much worse problem is many uninsured people not being able to get proper medical attention.

  6. #6 Rjaye
    September 17, 2007

    I have mixed feelings on this case, and I hope along with others that this young man has his “miracle” outcome despite his and his parents misguided choices.

    While I feel that there are cases of minors whose family situation need intervention from the state, how do we decide which ones to do so in? I agree with others here that most parents will do what we would consider right, but in the end, we each make our own path, and Abraham Cherryx is now 17, and now old enough to join the armed services, and I feel old enough to make his own decisions, no matter what anyone thinks.

    While these cases are on the rare side, the bigger concern is how they affect the public’s perception of “altie medicine” and perhaps giving it the seriousness it doesn’t deserve.

    I wish Abraham luck and that his immune system is stronger than his cancer, or that he has a change of heart.

  7. #7 Rjaye
    September 17, 2007

    I have mixed feelings on this case, and I hope along with others that this young man has his “miracle” outcome despite his and his parents misguided choices.

    While I feel that there are cases of minors whose family situation need intervention from the state, how do we decide which ones to do so in? I agree with others here that most parents will do what we would consider right, but in the end, we each make our own path, and Abraham Cherryx is now 17, and now old enough to join the armed services, and I feel old enough to make his own decisions, no matter what anyone thinks.

    While these cases are on the rare side, the bigger concern is how they affect the public’s perception of “altie medicine” and perhaps giving it the seriousness it doesn’t deserve.

    I wish Abraham luck and that his immune system is stronger than his cancer, or that he has a change of heart.

  8. #8 Russ
    September 18, 2007

    The “cancer free four times now” line reminds me of the W.C. Fields line about quitting drinking isn’t a big deal because he’s done it a thousand times.

  9. #9 Bronze Dog
    September 18, 2007

    One thing that’s going to be really annoying: The moment the expected happens, and Cherrix dies, the woos will just drop the matter from their rhetoric.

  10. #10 MartinM
    September 18, 2007

    Oh, now be fair. They’ll rant for a bit about how any and all conventional treatment he got prevented the alternative stuff from working first.

  11. #11 Dianne
    September 19, 2007

    Cancer can be strange. Nearly all oncologists who have practiced for any length of time have some sort of story of a “miracle cure” occurring. I heard one in which a man with metastatic pancreatic cancer concluded, quite reasonably, that medicine had little to offer him, and decided that he would simply go on vacation and enjoy life while he could. He took some morphine with him for the inevitable pain but had no treatment, conventional or woo. A year later he showed up again, with the unusual complaint of “how come I’m not dead yet?” Scans showed no evidence of disease. The cancer had been well documented and biopsy proven. His immune system, apparently, finally got its act together and destroyed it. My point? Just about anything can happen in anecdote and I hope that Mr. Cherrix is lucky enough to be one of those who survive a disease that “should” kill them without effective treatment. But I wouldn’t be suprised if it came back, unfortunately.

  12. #12 Laura
    September 20, 2007

    Did any of the news articles about this say whether or not Abraham received independent counseling (without his parents) from the state, whether or not he was evaluated by a psychiatrist as to his state of mind, and what the viewpoint of his parents was about medicine versus alternative medicine? I have not really been following the story, but if he was cancer free four times, it sounds like he’d been getting medical treatment, and I’m wondering what made himself or his parents decide to switch from the medical treatment he had been getting to the alternative therapy.

  13. #13 Patrick
    September 21, 2007

    I’m gonna take Coin and Russ one step farther. And I hope the great and wonderful Orac sees why.

    The “cancer free four times” statement is absolutely False, that is what our revered OncoSurgeon has alluded to during these episodic ‘recoveries’. While he may Appear to be cancer free there are likely individual cells or clusters of cells that are technicaly subclinical, or ‘indetectable’, but they are still likely there, and will become active again.

  14. #14 Hoxey Proof
    May 21, 2008

    Well, i have never seen someone write with such hatred towards alternative therapies before. If you really think money has nothing to do with “treatments” then you are sadly misguided. Money is the driving force in the U.S., period. Why sell a therapy for 1,000 dollars that can get rid of 80 percent of cancers when you can sell 10′s of thousands of dollars in chemo poison? Its just good buisness. Your remission rate with chemo overall is much lower than Hoxsey’s treatment. How many people have to come forward to prove that Hoxey does have a success rate? Over 250,000 people were treated successfully. What did they have to gain by lying? They were not compensated. Rent the video before you make wild accusations that it does not work.

    You used the word quack so many times are you a duck? Not one reputable medical report claims that Hoxey is not at all effective at treating cancer. The AMA claims it is unknown and not fully researched. Uh, ok dummy, then research it. If they are so adamate that it does not work, why has the AMA and all other reaserch firms linked to the AMA and pharmy companies refused to test it to its fullest extent? I mean pharmies have no problem hiring their own doctors to report “edited” results to the public. Remember Phen Phen?

    Anyone with any common sense knows cancer starts by an immune deficency. Your conclusions are biased without doing your research. Why dont you go to the clinic and view the records yourself? Your going to take the word of one doctor and one medical report? Gimmie a break.

    My uncle used Hoxey for his lymphoma with no other treatments and he was given 30 days by the doctors. 9 years later he is still with us but i suppose it was spontanious remission and had nothing to do with the Hoxey therepy and his complete change in diet. Even though the herbs he used in the tonic have immune boosting properties. Ever take a multi vitamin? Do you feel better after a week of taking it? Notice your hair and nails are growing faster and you dont get sick as often? You can thank the vitamins and herbal additives for that but what your seeing is not really happining because we dont have the FDA or AMA’s blessing on it so i guess its not really happening huh? You think 2,000 years of chinese therepies and medicine is worthless because uncle sam does not have his seal of approval on it? Why endorse eating 45 bucks worth of weeds when you can charge thousands in perscriptions? There are exceptions of course so dont use that statement to generalize. Just because we are the US does not mean we know or have the answers to everything.

    I just hope your narrow mindedness and refusal to read, learn, and research things does not cause you to lose a loved one. I suppose you think chiropractors are fake too huh even though a misalignment pressing on a nerve in your spine has nothing to do with back pain but a pill will magically make it slip back into place? Please. This country, like others suppresses all kinds of knowledge from the public both medically and defense wise. Cure cancer? Bad for buisness. Doctors and hospitals would lose 60 percent of their revenue. Pharmacutical companies spend billions and billions to give us “treatments” not cures. Just by chance we should have come up with a few cures by now or we need to get some smarter scientists. Where is the new penacyllin or polio vaccine? Have not had a major breakthrough in years.

    Sure, we have cholesterol lowering drugs and erectile dysfuntion drugs but once again treatments not cures. How sad. The reason? Money. Period. Anyone else who says otherwise should remain a sheep like the rest or in your case, a duck. Enjoy your chemo slick.

  15. #15 HCN
    May 22, 2008

    Hoaxy Proof said “Over 250,000 people were treated successfully.”

    Evidence? What video is there to rent? Why isn’t it on YouTube?

    Where is this written up? What journal? Who diagnosed the cancers, and then verified that these people were cured? How many are alive after five years? Or after ten years?

    Even though the plural of anecdote is not evidence, why should we believe you?

    Especially since this document:
    http://caonline.amcancersoc.org/cgi/reprint/40/1/51 … concludes “In summary, the Hoxsey medicines for cancer have been extensively tested and found to be both useless (the internal treatments) and archaic (the external treatments).”

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