Ron Rosenbaum on Starchild Abraham Cherrix and his choosing the Hoxsey treatment over chemotherapy:
Young Cherrix has expressed his feelings this way to the Associated Press: "I'll fight until I do die. I'm not going to let it go. I would rather die healthy and strong and in my house than die in a hospital bed, bedridden and unable to even open my eyes."
It's a moving and heartfelt plea, but a problematic one as well. My instinct to support young Cherrix on libertarian grounds is undermined by the not quite fully developed thought process this statement suggests.
Is the choice he faces really the one he poses? Does one die from cancer (or any illness) when one is "healthy and strong"? Or is the fact that he feels good now deceiving him? Is he thinking like an "adult" or like a "juvenile" who needs advice and protection? Of course, the thought processes of many adults are not necessarily "fully developed," but that's not because of their age.
Is Abraham capable of making a rational choice? Does the state have the responsibility or the right to step in and make what it thinks is the rational choice? (Especially when states are not notable for their record of "rational choice.")
These are exactly the issues I've been discussing with regard to this case.
His description of a visit to the Hoxsey clinic that Rosenbaum himself made:
In shabby clinics cheek-by-jowl with auto theft/repair junkyards and in grand, deluxe, ocean-side playas, we had fascinating talks with some of the patients. We hit the historic Tijuana clinic hotspots, among them the Hoxsey clinic, a kind of relic of a charismatic "healer," Harry Hoxsey, who in the first half of the last century peddled a mysterious "tonic" in clinics in 17 states before he was driven by the law beneath the border.At the time I visited the clinic, it was being run by Hoxsey's original nurse, a kindly-seeming woman who gave one particularly impoverished member of the carful of cancer patients I was traveling with a bottle of the tonic gratis. When I ventured that I'd like a taste, she poured out a little from a large brown bottle into a paper cup. It tasted like gnarly cough syrup. The problem with the Hoxsey tonic is that there has been a running dispute over its actual composition and thus, to my knowledge, there have been no clinical trials of its value. Indeed, in one of the paradoxes I found in the below-the-border realm, "value" is something these remedies are endowed with by the patients rather than vice versa.
Indeed, this is the magical thinking that I have described, where belief in these remedies gives them their value, rather than actual objective evidence of their efficacy, and I think that Rosenbaum comes closer to why the belief in these clinics is nigh religious in nature:
I've evolved a theory of the below-the-border "cancer cure" clinics, which is that the science, almost without exception, is bogus--but that the cancer patient's decision to make the break with orthodoxy, to cross the border (a border that is not just geographic but psychological), to take control of one's destiny and place one's faith in a cure (however baseless its science), in the psychogenic power of hope (even false hope), might have had some hyped-up placebo effect in making a difference in the lives of those who went that route.
Maybe. However, no study that I've ever seen has ever actually shown that a placebo affect can increase survival in terminally ill cancer patients. Certainly the placebo effect can account for a decrease in pain or other symptoms, but, as far as we know thus far, it can't prolong survival. Consequently, I find Rosenbaum's postulate unconvincing in that respect, but I do agree that part of the appeal of these clinics is indeed the liberating effect that a "break" with orthodoxy can produce, that feeling of "taking control" of one's own destiny.
And that's part of the problem. That very feeling of empowerment is tied up with the false hope that the Tijuana clinics promise. That's what makes such quackery so seductive.
So what's not empowering to choose a conventional course of therapy?
So what's not empowering to choose a conventional course of therapy?
It's what THEY want you to do, so it's just giving in to the Man and not taking control of your own destiny.
The sad thing is - if you go the alt-med route, you're less like to get well, have less money to spend and won't take advantage of palliative care if the cancer becomes terminal. So basically, you're empowered to be pretty damn miserable and broke until you die.
Interesting. I never thought about it as a pilgrimage before, but there's a long tradition (both in the West and in Asia) of pilgrimage to holy sites of healing. Someone better versed than I in the sociology of religion should do a comparison...
Orac,
If Cherrix were not intent on pursuing an ineffective "alternative medicine" treatment, would you support the courts overriding his decision?
In addition to Cherrix's belief that the Hoxsey treatment may be helpful, he seems to have a strong adversion to recieving more chemotherapy. While his assessment of Hoxsey suggests he's not making fully rational decisions, he may be acting rationally by declining chemo if the pain he has to endure because of it isn't worth the increased chance of survival.
There are really two distinct decisions that Cherrix made - first not to recieve more chemo, and second to pursue the Hoxsey treatment. Even if the second decision wasn't rational, I can't conclude that the first wasn't, especially given that Cherrix wasn't intersted in pursuing alternative and conventional treatment at the same time and doesn't seem to have an irrational hostility towards conventional medicine. Unless the false hope placed in the Hoxsey treatment was a privotal factor in rejecting chemo, only the rationality of the first decision matters.
Brilliant breakdown, MattXIV. I agree completely.
Matt,
I don't think the two scenarios are equivalent.
Flatly refusing any treatment is one thing, and indicates a rational desire not to endure any more, but rather to take control of the circumstances of one's own death. Refusing one treatment in favour of another, however, indicates a desire to survive - and the criteria upon which that decision was based must be carefully examined.
In the first instance, death is a certainty, and this can be carefully explained in a rational fashion, allowing an individual to make their own decision on that basis. In the second instance, if a known good treatment is rejected in favour of a known useless treatment, the circumstances under which the individual made that decision must be called into question.
You are logically separating the two decisions, but is it even possible to establish with any certainty that, in the absence of the "alternative therapy", Cherrix would still have elected simply to die? The words to that effect are just that - words. But is it possible to accurately predict what your own reaction in one hypothetical situation would be based on your reaction in a very different situation?
I've seen a lot of debate on here about whether Cherrix is or isn't competent, and what his various public statements imply... I've not said anything so far, but I'm going to stick my oar in now:
None of us are in any position to make a proper assessment of his state of mind. You just can't do that based on the evidence available - it's like Bill Frist pronouncing on Terri Schiavo's condition on the basis of some video footage.
Now, I haven't looked closely at the details of the judge's ruling, but I would certainly hope (and expect) that it was informed by at least one, and preferably two independant psychological assessments performed by competent professionals. Without access to that sort of evidence, you can't really make the call.
I certainly don't agree with the idea that he must be incompetent solely because of his decision to favour a ridiculous and ineffective treatment over an effective but unpleasant one. Sure, it's not rational, but I think there's quite a large gap between being irrational and being incompetent to the point of involuntary commitment. Heck, if being irrational about major life decisions was the bar, about 90% of the population would be over it.
I think Orac's treatment of this matter has been excellent - the phrase that leaps to mind is "right in the middle of the gray area". Whether the judges decision was right or wrong is not a matter I'm prepared to comment on - he (hopefully) had access to more information than I do (or anybody else commenting here), and I'm prepared to defer to his judgement on that basis. After all, that's what judges are for.
Dave,
The lack of certainty is why I think that the government may be overstepping here. To have the courts force someone to undergo treatment, I think that it should be necessary for the government to demonstrate that the patient did not competently make the decision to decline. In Cherrix's case, it should have been incumbent on the government to establish that in the absence of his misplaced hope for the Hoxsey treatment, he would have instead chose to go forward with the chemo.
dearest doc-o-rac
if hyperdodo is on here, this ones for you too,(ie a parody)
An electrical engineer exbuddy of mine is on the local electrical safety board. A couple of years ago He and a few of his cronies decided to make law. A Law that would have helped us electric dudes. The law would state unless you had a state license you couldn't even wire a switch in the county. Crime punishable by fines court cost and jail time. What a bunch of docs. Well having the libertarian bent that I do my blood started to simmer. (Oh by the way each time you say libertarian it heats up) I asked him wouldn't he and I have just a little bit too much to gain from such a law!? He said it was about public safety. To which, I replied Bull-cookies. Sure it would be best if you non-electrical hacks would leave the wiring to us but I have followed up on quite a few pros and can't even imagine what was going through there minds. Make criminals of law abiding people in there own homes?!
Docs are no different than that guy... follow the money..
Can't you guys just hock your poisons show your stats make your claims and let the courts chase the frauds out of the country or is there not enough money in it.
by the way with all the "evidence based medicine" how are we getting all these bad meds.?!
Please stop saying you are libertarian. You are not!!!
You want Liberty in every aspect except in your chosen profession. There you want to be the Elitest that determines what is good for the masses. You are a educated Elitest. You are a snob. not a Libertarian!!!
You are a doc.
If you could take a step back and take a deap breath you could maybe question everything including your own motives.
Hey I am just and ass from KY. Don't let me offend you, just consider the source.
love phil