Respectful Insolence

One of the aspects of blogging that I’ve come to like is the ability to follow a story’s evolution over the long term and to comment on new developments as they come along. If you’re good at blogging, you can take that story and make it your own, adding it to your list of “signature” issues for which you become known and about which people come to you for commentary as new developments arise. Indeed, now that the fourth anniversary of the start of this blog is fast approaching (December 11, in case you don’t remember!), I can look back and see a number of issues that I’ve done this with, including the dichloroacetate saga; the Abubakar Tariq Nadama case and inextricably entwined Dr. Roy Kerry prosecution; the sad case of Katie Wernecke (if anyone knows what’s happened to her, by the way, please let me know, as I haven’t been able to find out anything recent and my last installment from more than a year and a half ago was depressing in the extreme; is Katie even still alive?); and even the recent speculation about Steve Jobs’ health, including a post that brought in more traffic than any post this year that I can recall and that still brings me inquiries about whether I have any special insight into what’s going on with him (I don’t; I just used publicly available news sources and made some informed speculations based on my surgical knowledge). Of all these “signature” blog issues I’ve written about over the last few years, perhaps the one that I’ve covered the longest is the at the same time unfortunate and fortunate case of Starchild Abraham Cherrix, who at age 15 rejected scientific medicine in favor of the sheer quackery that is the Hoxsey therapy.

When last I mentioned Abraham Cherrix, he had just turned eighteen and appeared to be doing OK, his tumor in remission thanks to low dose radiation therapy–not due to the dubious other therapies that he’s been undergoing–meaning that legally he can now make his own health care decisions. Now he’s shown up at a medical school to give a talk. Sadly, the description of the talk is uncritical and credulous. I guess I shouldn’t be surprised, given that the journalist (Colleen Redman) who reported it cites Mothering as her favorite magazine and did a puff piece on Cherrix a few months ago chock full of support for “health freedom.”

The article begins:

“You can pull up the weeds but if you don’t get the root, they’ll come back,” Abraham Cherrix recently told a Medical Ethics class at the Edward Via Virginia College of Osteopathic on the Virginia Tech campus in Blacksburg.

It seemed an unlikely statement for an eighteen year old young man to make to a lecture hall full of future doctors. But Cherrix – who made national news in 2005 when he refused radiation and a second round of chemotherapy for Hodgkin’s disease – was talking about his approach to wellness.

Invited by Professor Robert Miller for his second speaking engagement at the College, Abraham was accompanied by his mother, Rose Cherrix. Rose and Abraham’s father were found guilty of medical neglect for supporting Abraham’s decision to forgo more standard cancer treatments. She and her five children moved to Floyd County from Chincoteague Island, Virginia, in the spring of 2007, after losing their home and businesses to mounting medical bills, but winning their court case appeal. It was a case that prompted the passing of a new Virginia Law in Abraham’s name, one that gives teenagers the right to have a say in their health care decisions.

Actually, Cherrix might have been an interesting speaker to have as a guest for a class in medical ethics, and that’s where he spoke. However, what disturbed me wasn’t so much that he was invited to speak but that apparently there was no questioning of his choices or of his role in advocating quackery. I understand that he’s young and he has cancer (I say “has” cancer because he’s only been in remission for less than a year), but that doesn’t mean he shouldn’t have been politely challenged regarding the dubious science and magical thinking behind his quest. As tenacious and determined as he was, he used his tenacity in a cause that endangered his life and may very well still cost him it.

In fact, although neither Abraham nor his supporters would ever recognize it, when the State of Virginia tried to force him to undergo conventional and effective therapy for his lymphoma, it did Abraham the biggest favor in his life. Before that, he was undergoing the Hoxsey therapy at the Association for Research and Enlightenment, the center founded by psychic Edgar Cayce. As you may or may not recall, the Hoxsey treatment involves herbal concoctions popularized by Harry Hoxsey in the early part of the 20th century. Different varieties exist, including an “internal” treatment and external treatments with various pastes made up of mixtures of subsets of the components of his treatment. Hoxsey’s claim for the development of his therapy was that his grandfather John Hoxsey had mixed together grasses and flowering wild plants growing in a pasture where one of his horses grazed daily. The horse supposedly developed a cancerous growth that went away after grazing in that location, and Hoxsey thought that it was due to the plants there. He took plants from the pasture, mixed them together, added some ingredients for home remedies for cancer at the time, and came up with what he billed as a cure for cancer.

The Hoxsey therapy is pure quackery, and Cherrix believed it would cure him, even as his tumors continued to grow.

Enter the court. It was the court that saved Cherrix’s life–at least for now. You’re probably surprised to see me write that, but it did. As part of a compromise worked out through the legal action, Cherrix agreed to switch his care to a physician named Dr. R. Arnold Smith. Dr. Smith is a radiation oncologist by training, but along the way he has become a believer in woo, specifically an unproven “immunotherapy” that is primitive and almost certainly worthless. Fortunately for Cherrix, though, Dr. Smith did not lose his faith in radiation therapy, which he still administers. True, he generally uses what he characterizes as “low dose” radiation (what that means is not exactly clear), but he still uses radiation. When Cherrix grew large tumors in his chest and neck, the latter of which could have obstructed his trachea or esophagus if it continued to grow, Dr. Smith was able to shrink them with radiation therapy.

Far worse is the horrible law passed in his name that in essence strips teens between the ages of 14 and 17 of any protection against quackery. The law was bad enough when it applied only to children with terminal illnesses, but its wording in its final form applies it to children with “life-threatening” illnesses. In essence, it gives teens the “right” to refuse treatment for such illnesses. When his cancer recurred elsewheretwice!–more radiation shrank the recurrences to undetectable. In other words, Dr. Smith was playing Whac-A-Mole with these tumors, a strategy that is excellent palliation but very unlikely to result in long term survival. There is a small chance that it might, perhaps even greater than average given how well Cherrix has done until now, but it’s still unlikely that Cherrix will escape recurrence. If he does, it will not have been the Hoxsey therapy or other woo that he’s taken, but rather the radiation.

Given that, I wish someone had asked Cherrix why he attributes his survival to “alternative” therapy and not to good, old-fashioned (but not as “old” as most “alternative” therapy) radiation therapy. Unfortunately, no such question was asked:

Following Abraham’s narrative, the class engaged in an hour long question and answer period. Many of the student’s questions revolved around the diet and lifestyle changes that Abraham says have contributed to his healing.

Abraham pointed out that the re-occurrence of his tumors and the degree they returned seemed to correlate with his diet, especially with the ingestion of too much sugar. “Tumors feed on sugar,” Dr. Smith answered when Abraham asked if he could eat donuts.

Currently Abraham is committed to an alkaline diet that includes lots of vegetables, no sugar, and no artificial additives. He spoke of other preventative therapies he uses to maintain his well being, such as a detox foot bath and Laser Therapy, administered by local chiropractor Garry Collins to stimulate or inhibit certain cell function and to boost immune function.

The whole bit about tumors feeding on sugar is nonsense. No, it’s not nonsense that tumors use sugar for their metabolism. Clearly they do; indeed, the avidity of tumors for glucose is the scientific basis behind why PET scans work. What’s nonsense is the claim that eating too much sugar will have an effect on tumor growth that Cherrix would be able to detect. Even more nonsensical is the “alkaline diet,” for reasons that I’ve outlined in detail before. Of course, most nonsensical of all is the detox foot bath, and that Cherrix could believe in such quackery–yes, quackery, there’s no other word to describe “detox” footbaths–shows that he has close to zero critical thinking skills when it comes to medical science.

Apparently the medical students there just lapped it up. I realize the medical school where Cherrix appeared is an osteopathic school, but these days in my experience there is really no difference between standard M.D.’s or D.O.’s when it comes to practicing medicine. It’s possible to challenge Cherrix without being too harsh, for instance by asking him what the evidence is that any of this stuff other than the radiation did him any good, pointing out that his tumors kept growing through it all and didn’t actually shrink until he underwent radiation therapy.

Not surprisingly, Cherrix has gone beyond believing in woo to being a practitioner:

He is planning to get his GED and is interested in possibly becoming a Naturopath, saying, “I might even be joining you here in this class.” He also designs WebPages and does Reiki (a hands-on healing modality) and would like to pursue those interests more.

[...]

Both Abraham and his mother stressed the importance of mainstream medical treatments, but said they would like to see those combined with alternative therapies that don’t create side effects. “I’ve talked to hundreds who have been cured with alternative therapies. How can I not think they can work?” Abraham said.

If Cherrix is lucky enough to survive to achieve this, I foresee a bright future for him as chief of a division of “integrative” medicine somewhere.

One of the topics I would most have liked to see covered in a medical ethics class is the ethics and legality of what has been termed “Abraham’s law.” This law goes far beyond “giving teenagers the right to have a say in their health care decisions.” What it does in essence is to allow teens between the ages of 14 and 17 suffering from any life-threatening condition to refuse any therapy. Its original incarnation was more modest, applying only to teens with “terminal” illness, but along the way the language was broadened to include any life-threatening illness.

The implications of this law are staggering. For example, let’s say there is a family that is of one of the fundamentalist Christian sects that believes that prayer and Jesus will heal, not medicine. In fact, let’s pretend that Madeleine Neumann, the 11-year-old in Wisconsin who died of diabetic ketoacidosis because her parents tried to cure her with prayer rather than taking her to a doctor for insulin and intravenous fluids, lived in Virginia and was 15 instead of 11. Let’s further pretend that the authorities found out about it before she died. Under “Abraham’s law,” there would be nothing the state could do to stop the parents and save her life unless the child were to rebel against her parents and request scientific treatment (highly unlikely in such a family). Moreover, the parents couldn’t be charged for abuse or neglect because the child would have chosen to refuse effective treatment. In essence, Abraham’s law has stripped all 14- to 17-year-olds of any real protection against quackery. If they happen to buy into their parents’ belief system, there would be nothing the state could do about it. True, the state had precious little power before, but now it has in essence none. The only child that Abraham’s law might benefit, ironically enough, would likely be one with woo-loving parents who decides he wants science-based therapy.

I very much wish that some medical student challenged Cherrix on that unintended aspect of his legacy.

Once again, I hope Cherrix is one of the lucky few who can survive a recurrence of lymphoma with such minimal treatment consisting of, in essence, nothing more localized radiation therapy to individual tumor deposits. However, it’s becoming increasingly apparent that if he does he will become a potent force for pseudoscience and use his testimonial as his most powerful ammunition. It doesn’t matter that it was the radiation that shrank his tumors when none of the woo he was using would; like all subjects of testimonials, Cherrix attributes his good fortune to “alternative” therapies rather than the one conventional therapy the Virginia court forced him to accept. That the medical students failed to realize this and failed to do anything other than (apparently) fawn all over him does not bode well for their ability to become practitioners of science- and evidence-based medicine.

Comments

  1. #1 Rev Matt
    September 15, 2008

    Of course if he does ultimately die from cancer (particularly in the short term) they will blame the radiation rather than the SCAM modalities. With people of this mindset the anti-scientific methods can only be praised for their successes, their failures never acknowledged because it would be clear that the failures vastly outnumber the successes (if any).

  2. #2 Flaky
    September 15, 2008

    People don’t go to medical school because they want to be scientist, they go because they wish to help people, and that sadly means that many simply are not equipped to grasp the distinction between what feels good and what’s backed up by evidence.

  3. #3 Calli Arcale
    September 15, 2008

    Sometimes they have even less reason. Some go into it because they feel it is expected of them (family business). And some go into it for the same reason certain personality types go into teaching, law, the clergy, and so forth — because they enjoy being in a position of authority. Most go into it because they want to help people, but there is a significant subset whose motives are less pure, and unfortunately, that subset is responsible for a lot of the resurgence of woo. Some become practitioners of woo, because it’s a lot easier than real medicine, and others merely disillusion people about real medicine, by being so incompetent or unethical that people start assuming all doctors are like that. And that is very sad.

  4. #4 Paul
    September 15, 2008

    “Apparently the medical students there just lapped it up. I realize the medical school where Cherrix appeared is an osteopathic school, but these days in my experience there is really no difference between standard M.D.’s or D.O.’s when it comes to practicing medicine.”

    It may be the case that in the majority of cases in the USA there is little difference between how D.O.’s and M.D.’s practice medicine you have to ask yourself in that case why students decide to study to become osteopaths rather than regular “allopathic” doctors. I reckon that those who study and practice osteopathy are still a lot more likely to be woo-friendly than most medical students, especially if their Professor is a fan of alternative medicine.

  5. #5 Karl
    September 15, 2008

    “no difference between standard M.D.’s or D.O.’s when it comes to practicing medicine.”
    Then what is the difference? Why do they get different titles?

  6. #6 Jason
    September 15, 2008

    Paul-
    For what it’s worth, I’m an osteopathic medical student and I’m going here because it’s where I got in (and believe me when I say my scores were good enough for most all allopathic schools, it just didn’t happen). Aside from modest musculoskeletal benefits, neither I nor my friends put a great deal of stock in the woo-ier aspects of osteopathy. From what I understand, that’s the case almost all the time once D.O.’s get out in the field.

    Of course, it doesn’t sound like it’s the same story in Virginia, but I do wonder if there were a number of students there who may have disagreed but kept their mouths shut for not wanting to ostracize the speaker (or not being far enough along in education to put together a good argument).

  7. #7 Rogue Epidemiologist
    September 15, 2008

    Having spent a lot of my education at political, philosophical and methodological odds with my peers and teachers (I am a rogue, after all), I have to add to what Jason said. Some students know when to keep their mouths shut and just be polite. It’s about picking battles. I could only hope that the class isn’t *that* into woo.

    On a wholly different note…

    In many states, minors as young as 12 can consent to their own sexual health care including abortions, birth control Rx and what-not without their parents’ knowledge or consent. If a pre-teen can consent to an abortion, at what age should we also say it is appropriate for her to refuse cancer treatment? I ask this knowing that a lot of teen girls are refusing to get Gardasil because the shots hurt. Pain is a remarkable deterrent for people who can only think myopically.

  8. #8 mba
    September 15, 2008

    Karl –

    They get different titles for historical reasons, basically because A.T. Still was a raging quack of his day who based his practice and philosophy on techniques that greatly resemble chiropractic medicine, although he and Plamer were often at odds, they were basically saying the same things. At least I can’t see much difference in what I’ve read about it. His dying wish was for Osteopaths to “keep it pure”. But, facing the fate of chiropractic “medicine”, Osteopaths didn’t keep it pure. Instead, they cleaned up their act and went mainstream. Currently, they have all but eliminated pseudoscience from their curriculum. OMT (Osteopathic Manipulative Treatment) is all that remains to distinguish them from MD trained physicians, and they stubbornly hold on to in in spite of no real evidence that it is of much benefit. Most of their students put little stock in the procedure, but take the course as part of training. So they get a silly and meaningless title (Doctor of “Osteopathy”) which has no descriptive value for what they do, prompting MDs to adopt another silly and meaningless title invented by a Homeopath to distinguish them (the stupid term “Allopathy” just won’t die). Apparently the titles “MD” and “DO” are not effective enough on their own.

    Currently, DO schools fill a huge deficit of trained physicians in America, since the powers that be have for decades refused to expand the number of MDs graduating each year and have still not really seriously addressed the issue. Why bother when enough foreign trained physicians are imported every year to fill the gab nicely without the need for the government to subsidize loans for their education?

  9. #9 Robin
    September 15, 2008

    As a FYI…

    This school is VERY new, with the first class starting in August 2003 and will graduating June 2, 2007. According to this article, Virginia Tech and Carilion are seeking accreditation for a school of allopathic medicine, also. The Edward Via Virginia College of Osteopathic Medicine has already been accredited by the Commission on Osteopathic College Accreditation (COCA) of the American Osteopathic Association (AOA).

    And a comment: Just because they allowed him to come and speak does not mean they condone what he and his “caregivers” did. I imagine there was some lively discussion after he left both times. And the topic was not whether it was a good or bad choice, from what I understand, but the ethics involved in the choosing. (BTW, I agree with you about the “junk science”.)

    BTW…Floyd County, VA is a place where all the old hippies retire from all over the world. It is a very “unique” place, and you just have to visit it to understand it. It’s gorgeous country, too. VT is in an adjacent county just a few miles away.

    Also, if you notice in the articles, Carilion is mentioned as partnering with the medical school(s). For interesting information on that, see Dr. Wes’ blog:

    http://drwes.blogspot.com/2008/08/eating-competition.html

    http://drwes.blogspot.com/2008/09/more-consumption.html

  10. #10 JimM
    September 15, 2008

    The most crtitcal info is the radiation dose from the “radiation therapy?”

    Anybody have any idea? estimate from the previous/original discussions?

  11. #11 HCN
    September 16, 2008

    Jason and Robin, if you wish to be taken seriously you would restrict your use of the word “allopathy”. That is a made up word by Hahnemann to describe anything that was not homeopathy:
    http://skepdic.com/allopathy.html

    The use of “allopathy” is considered derogatory to most doctors. Since you must plan to become board certified, you will become one of those “allopaths” (ODs must past the same state tests as MDs). Think about it.

    (also it doesn’t help that Jason mentioned he is going to an osteopathic college because his grades were not good enough for medical school!)

  12. #12 Sly
    September 16, 2008

    I was hesitant about expressing my views, but the possibility of influencing, and the reward of annoying someone outweighed it. I’ve been studying for the last two years, with the objective of becoming a M.D. with U.S. training, being motivated by the budgets dedicated to research, I would also like to obtain the necessary education to become a scientist, be able to contribute to the knowledge I’ve obtained and will continue to obtain, and improve my clinical skills. I am frustrated by my inability to influence people regarding their choices, I’ve tried regurgitating vast amounts of information, understanding their lack of motivation; by means of ridicule; iridology (jk); “proof” is a concept so foreign to some, I attribute it to a lack of curiosity, an existence that needs no more than anecdote to be at ease. Personally, I could hardly settle for an explanation that does not allow repetition, what is the purpose if you can’t transmit the information, for me that is what “it doesn’t exist” means. Maybe that’s why I’m not good with people, nor do I understand the subtleties of interaction, I don’t believe in altruism between humans, I believe benefit is almost always sought, I value life, I do not believe youth is an excuse for endangering my own integrity, although, it is certainly convenient to hide behind it as an excuse for my insolence, as I do it all the time. The issue of choice at hand makes me wish that medical ethics on terminally ill adolescent patients should not be based on their judgement nor their parents’, but in a consensus among doctorS treating the patient (with a proper experiment to measure results of course) (I know, insane right? taking their freedom like that, maybe because i have no children), but generalizing the ability of teens to maintain their own integrity, when their values, priorities, personalities, sense of consequence, are not defined well enough to value existence, should make it not such a bad idea. I do not like people, but I still have so much to learn, and we are so interesting, that I might eventually change my mind. I do not care about people, I care about their life, I place no value on individuals, because I know, they rarely change, but they will live. I hope I didn’t show my age.

  13. #13 Robin
    September 16, 2008

    “Jason and Robin, if you wish to be taken seriously you would restrict your use of the word “allopathy”. That is a made up word by Hahnemann to describe anything that was not homeopathy: http://skepdic.com/allopathy.html

    HCN…I was simply quoting the article. It used the terms.

  14. #14 Jason
    September 16, 2008

    HCN-
    Two things: 1. I am quite aware of the roots of the word “allopathy”, that it doesn’t really mean anything useful. However, I wasn’t aware it was a pejorative, since I’ve heard a number of MDs use it without wincing, simply to emphasize that they were discussing MD schools, as opposed to DO schools. I intended to use it in the same way. My bad.
    2. Actually, I said my grades were good enough to get in to MD school. Just that it didn’t work out for me. I intend to be a good physician regardless, and will be. Thanks though.

  15. #15 Scotty B
    September 16, 2008

    Its too bad that this sort of thing is well established enough that it infiltrates our institutions.

  16. #16 Reginald
    September 16, 2008

    You always have to wonder when they acknowledge naturopathy as the be-all whether they do so out of ingorance or selfish cynicism. Sadly here it’s pretty obvious.

  17. #17 Kemist
    September 16, 2008

    Sly:

    I don’t think you don’t like people: you’re simply frustrated at the bad things they do to themselves. I feel the same every time I’m confronted with woo. I generally feel pity for the consumers of woo : it’s not their fault, they’re desperate and easily bamboozled into believing anyone who can give them hope, no matter if it’s false. I reserve my anger for the purveyors and promoters of quackery, those who prey on the desperate, be they well-meaning or not.

    I was confronted to this when my own best friend was diagnosed with cancer. This friend of mine is into ayurveda and hangs out with people who tend to avoid real medicine (even though she is a researcher herself!). They advised her not to undergo adjuvant chemotherapy. Fortunately, she has another circle of friends, which includes myself and an MD, and we managed to convince her to get her treatment. She is now in remission.

    So you see, you can do some good. Some you will lose, some you will save. You just have to do your darn best for your patients.

    And I agree with you on the issue of teenagers: teenagehood is a confused and difficult time. One of my collegues has a 16 years old who has stage VI testicular cancer. The poor boy is very frustrated at his illness : how come he can’t party like his friends ? So once he showed up totally drunk for a chemo session. How can any *sane* person suggest that this boy take decisions for his treatment ? Even with his parents support, it is difficult to get him to comply. I cannot imagine how it would be if his parents were into woo.

  18. #18 HCN
    September 16, 2008

    Jason said “. However, I wasn’t aware it was a pejorative, since I’ve heard a number of MDs use it without wincing, simply to emphasize that they were discussing MD schools, as opposed to DO schools.”

    Then you have not gone head to head with a homeopath. Trust me, it is an education in total denial. For some fun you should try going on the JREF forums (http://forums.randi.org) and check out the conversations with homeopaths, and there are several instances where they are asked not to call everyone “allopaths”. Here is an example:
    http://forums.randi.org/showthread.php?p=4021462#post4021462

  19. #19 kitty
    September 16, 2008

    “What it does in essence is to allow teens between the ages of 14 and 17 suffering from any life-threatening condition to refuse any therapy.”
    I am curious as to if there are any provisions or exceptions with regard to public health under this law e.g. for communicable diseases. For example, would this law allow a teen to refuse TB treatment? TB is clearly a life-threatening disease…

  20. #20 mba
    September 17, 2008

    The term “allopathy” is becoming quite a problem. Jason is right that many MDs use the term freely. It has made its way into medical journals and many of the professors at my MD school use it frequently. I don’t know if it’s just laziness on their part or if most docs and lay people are really totally ignorant of its literal meaning “opposite suffering” and also ignorant of its homeopathic roots, both of which are absurd and should compel any reasonably reflective person to avoid its use. It does seem to be used colloquially as a way to differentiate MD training from DO training, which is becoming increasingly unnecessary, since they both must practice the same evidence based medicine, “holistic” claims aside. I never understood why the terms MD and DO aren’t good enough to distinguish the two. After all, DOs chose the title long ago, silly or not. Personally, as DO training has mostly completed its transition to evidenced based medicine over the last few decades, it would seem to make sense to me for the them to MERGE, as heretical as that may sound to the AOA. Just drop the silly “Doctor of Osteopathy”, which is about as meaningless as the term “allopathy”, and we can all just use the simple, direct, and unpretentious term “medical doctor”.

  21. #21 daijiyobu
    September 22, 2008

    The cited article states: “he is [...] interested in possibly becoming a naturopath.”

    Anybody else interested in such a thing?

    You may want to first investigate what that education precisely entails,

    beyond the propaganda,

    because naturopathy schools surely aren’t going to be honest with you.

    I went to ND school, and left in disgust:

    see http://aanpalliancesciencebasedclaim.blogspot.com/ .

    This warning may help others make an informed decision: “danger Will Robinson, unethical sectarian pseudoscience!!!”

    NDs love the term allopathy, because built into their licensing exam is homeopathy — which they label, ISYN, a “clinical science.”

    I regard the label “allopathy” to be “a reverse sectarian accusation,” and it may have been useful when Hahnemann coined it to describe the still dominant heroic / Galenic medical interventions going on in his time…

    but, nowadays, when applied to modern medicine, it’s totally inappropriate.

  22. #22 oyun
    September 22, 2008

    Sly:

    I don’t think you don’t like people: you’re simply frustrated at the bad things they do to themselves. I feel the same every time I’m confronted with woo. I generally feel pity for the consumers of woo : it’s not their fault, they’re desperate and easily bamboozled into believing anyone who can give them hope, no matter if it’s false. I reserve my anger for the purveyors and promoters of quackery, those who prey on the desperate, be they well-meaning or not.

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