Cherrix refusal of pediatric chemotherapy: the view from a PhD

I've stayed out of the Starchild Abraham Cherrix case, where a 16-year-old boy and his parents are trying to refuse known, effective, and life-saving chemotherapy for a curable cancer in lieu of a scientifically unproven alternative regimen that includes coffee enemas.

Orac of Respectful Insolence has been most prolific in commenting on the issues at hand and yesterday, The Cheerful Oncologist, weighed in. I'm happy about this because both fellas are MDs with highly-specialized oncology training in surgical and medical oncology, respectively. Hence, I defer to them on issues of life and death in cancer.

I'm a PhD cancer researcher not affiliated with any pharmaceutical company and whose income and laboratory support comes from the US National Cancer Institute and a non-profit academic research entity. If I think about it more, my livelihood comes from my American readers who pay federal income tax.

So, what could I have added to this discussion that hasn't already been said?

In my readings of the print media and blogosphere, I have one concern that may not have been addressed adequately: empathetic and effective, fact-based communication with the Cherrix family that respects their belief systems and acknowledges the risks of chemotherapy together with its benefits.

I've come to this thought because chemotherapy is sometimes misrepresented horribly to and by the general public and, despite the clear damage it causes to normal tissues, is the single most effective adjunct to surgery and radiation in creating cancer cures.

I thought about this both because of work in my lab and because of the comments of a pediatric medical oncologist at Columbia University interviewed recently by ABC News:

"Some doctors alienate patients in their beliefs, say there is no data, no science and dismiss it [alternative medicine.]"

It is very important for doctors to acknowledge a patient's belief system, and she says, "see if some kind of compromise could be worked out so alternative beliefs can be supported."

In the end, many experts say, it isn't age or authority that matters, but the ability of doctors and patients to come together and battle cancer as a team.

According to Kelly, "there is nothing that has been proven more successful than chemotherapy," but alternative medicine can be used to support a patient. [my emphasis added]

She says, "If people believe it helps them, maybe it will help conventional therapies to work better."

I had the pleasure of recently speaking personally with this oncologist. She is of the mind that the conventional oncology medical community must develop better mechanisms to communicate with patients. True believers in pursuing alternative medicine as their sole source of cancer therapy cannot really be convinced otherwise - it would be like trying to talk the new pope out of being Roman Catholic - and perhaps the Cherrix family couldn't be convinced otherwise.

But the rest of this post is for those in the oncology community who deal with the largest population: the fence-sitters between chemo and the seeming promise of vendors of alternative therapies.

I'm interested in this whole topic because I'm working hard on the side with some psychology and oncology colleagues to better educate patients about the truths
surrounding cancer chemotherapy. Not sugar-coating it, not selling it, not discouraging it (or any alternative therapy, for that matter), but just providing the facts that might resonate with an alternative-minded family who is scared shitless about their kid.

What would I have said to the Cherrix family if I was called in by their original oncologist to have a little chat?

1. Yes, cancer is a bitch. But did you know that cancer is really just our own cells gone awry? It's not like a bacterial infection. So, that's why it's really hard to just kill the cancer cells and not normal cells. We're working harder to find drugs that are more specific for the cancer, but there is nothing more scientifically proven to help your son than the stuff my colleagues are hoping to give him.

2. I know that it scares the hell out of you to see all of these sick kids around here who just got chemo. You're seeing them here at their sickest, really just a snapshot of their journey through cancer. Yeah, it's tough but its the best thing we have for treating a lot of cancers.

3. Have you ever tried to kill weeds in your lawn? Sometimes when you spray that stuff on the weeds, you kill a little of the surrounding grass. But in the long run, you end up with a really nice healthy lawn. You're seeing these other kids right after the lawn got sprayed. Let me hook you up with some families whose kids are now the same as those healthy, thick green lawns.

4. Oh, you want to try something more natural? Let's talk about that. Did you know that people like me have spent 20 years searching nature for the best drugs to kill cancer? In fact, my professors have been doing it for almost 50 years - your own government still works really hard to make sure people like me can look for these natural remedies.

5. What's that?.. oh, yeah, sure, I study herbs - there are some really promising things out there - I can't wait to get some of my discoveries into animals that have human cancers and, ultimately, into real people. Sadly the road is long from lab to drug and none of this helps you today, does it?

6. But, I've got some really good news that might make you folks happy, give your son the best chance for beating this disease, and satisfy your need to give something natural to your son. Three of the four drugs these oncologists want to use actually come from nature. How cool is that!?! Oh yeah, one comes from a plant that grows in Madagascar, another was a traditional medicine of the Penobscot Indians from Maine, and this other one comes from a sea sponge found in the Pacific. How 'bout we talk about that? Let's look at some pictures of the plants - we've got some growing outside the cancer center in our gardens. And later on, come back to my office where I have a saltwater aquarium with some of these life-giving sponges and creatures. Oh yeah, absolutely, I'm really fortunate to do this kind of research.

7. Now, don't get me wrong, natural doesn't always mean 100% safe. These natural remedies have been purified from the plants and sea critters to give us chemicals that are more powerful than they occur in nature. But that's what we have to do to give my doctor friends the good stuff to treat your son's cancer. Remember us talking about the weed killer stuff; this chemotherapy stuff is possibly and probably going to make your son feel bad, maybe really badly, for a short period of time. No one is going to deny that fact. But this is the best way we know how to save him - and I can tell you that thousands of people like me around the world have tested this stuff to make sure that you get the biggest bang for your buck: the best treatment of the cancer with the least hurt being put on the normal cells. But we have lots of other goodies to give him that we didn't even have 15 years ago, things like blood growth factors that will help him fight infection and feel less tired.

8. Yes, that's a picture of my daughter - thank God she got Mom's genes, huh? She'd look silly with the goatee, for sure. Well, if she had this diagnosis we'd be doing exactly what my colleagues are suggesting for your son. I'm an open-minded believer in things - really just a hippie born a decade too late, a real tree-huggin' kind of guy. But I believe in facts - and the fact is that 80% of kids with your son's cancer are cured completely with these drugs we're talking about.

9. Oh yeah, certainly, let's talk about some of these other herbal therapies, antioxidants, and such - but let's save those for after your son gets his treatment. Remember how I said that cancer cells are just like our normal cells? Well, a lot of these antioxidants and such will protect the cancer cells from chemotherapy just as well as they protect normal cells. Let's give the drugs time to work and kill the cancer, and my colleagues and I will do everything in our power to help your son recover as quickly as possible - we've got some great nutritionists and clinical pharmacists who can talk to you about foods and supplements.

10. We want to help you and we want to do it together.

Would that have helped?