Complementary and alternative medicine Medicine Quackery Skepticism/critical thinking

A “defense” of Abraham Cherrix and his parents?

I really have to turn off my Google Alerts for this topic. I’m going to pull out my hair if I don’t.

As you may recall, I’ve been posting about two young victims of the siren call of quackery who will most likely pay with their lives for their trust in quacks. The first, Katie Wernecke, rejected conventional medicine in Texas several months ago and is now at an undisclosed location receiving “secret” treatments, her father claiming that he can’t reveal what treatment she is receiving or the doctors will stop treating her. The second, Abraham Cherrix, has gotten permission to leave Virginia to go to a clinic in Tijuana to receive the dubious, unproven, and almost certainly useless Hoxsey treatment. Since then, I’ve been subscribing to Google Alerts about them, the better to keep you, my readers informed.

Sadly, those notifications made me aware of a horribly argued “defense” of Abraham Cherrix and his parents written by a columnist named Bronwyn Lance Chester. While there are certainly reasonable arguments one can make against the state intervening to take custody away from the Cherrixes, Bronwyn Lance Chester somehow manages not to use a single one of them, opting instead for hysterical emotionalism in lieu of reason.

The article starts off badly, right from the title (Quit torturing young cancer patient’s family) and launches right off from there:

Starchild Abraham Cherrix said no. No stabbing. No poisoning. No burning. Enough.

Oooh, boy. Whenever you see conventional cancer therapy referred contemptuously to as “stabbing,” “poisoning,” or “burning,” you know you have a true believer on your hands. And Chester doesn’t disappoint in ratcheting up the altie rhetoric even more:

But for refusing what amounts to Geneva Convention-levels of torture, Abraham, a 15-year-old with Hodgkin’s disease who lives on Virginia’s Eastern Shore, may be yanked from his parents.

Given the rhetoric in that sentence, I was half expecting a mention of Hitler or the Nazis to follow. I was relieved that it did not, although the Hitler Zombie probably wasn’t. He has been rather hungry lately, and it’s been a long time since he’s feasted. I guess he’ll just have to wait longer. In the meantime, we get more hysterical hyperbole from Chester:

They’ve been accused of neglect for allowing him to pursue alternative cancer treatments at a Mexican clinic instead of returning to the hell that is chemotherapy.

For backing their son’s refusal to submit to high doses of chemo and radiation, Jay and Rose Cherrix have paid a steep price: the temporary loss of full custody of their son, which they’re now forced to share with the local Department of Social Services. That joint custody may become no custody.

No, because there is no evidence that the “alternative treatment” that Abraham and his parents are opting for has any efficacy whatsoever in Hodgkin’s disease, and lots of evidence that that evil chemotherapy and radiation have a high chance of curing Abraham of his disease. Choosing an ineffective therapy over a therapy with a pretty high possibility of success, thus condemning Abraham to a most unpleasant death, is a form of child abuse. It’s that simple. Would Chester say the same thing about Jehovah’s Witnesses refusing to let their child be transfused as he is bleeding to death? Or what if the Cherrix family were Christian Scientists and decided to try to cure Abraham with prayer, rather than even alternative medicine?

She then sets up a straw man:

First, it’s strange indeed when the Cherrixes, who run Wildlife Expeditions, a small-but-bustling paddling business on Chincoteague Island, are put in the same league as parental deadbeats. They shut down their company in August, their busiest month, so that Jay could be at Abraham’s side in Norfolk, Va. — a two-hour drive from their home — during his surgery and on his chemo days for 12 weeks. Not exactly uninvolved slackers.

No, no one that I’m aware of has accused the Cherrixes of being “uninvolved slackers.” No one has questioned their devotion to Abraham, just as no one has questioned the devotion of Katie Wernecke’s parents to her. Abraham and his parents (and Katie Wernecke’s parents) are just wrong about what treatment is best for Abraham and Katie and are making a choice that will directly lead to their deaths of these children from their cancers. It is quite possible to make very wrong decisions with the best of intentions and the maximum of love. You can try to make the argument that Abraham is old enough to make the decision for himself (although I still think that 15 is too young and that it’s impossible to know how much he has been influenced by his parents), but there is no scientifically valid argument that this choice will do anything other than condemn him to die of his disease.

Of course, Chester isn’t finished with the straw men arguments:

Second, the cynics out there will probably take a gander at Abraham’s name and think his pursuit of alternative cancer treatment is New Age-y nonsense.

But alternative medicine isn’t so alternative anymore. A government-funded study in 2004 found that 36 percent of Americans had used some form of alternative healing. Some surely did so because they want the life they have left — even if it’s just days and weeks — to be quality time.

More logical fallacies abound, a straw man followed by argumentum ad populum. No one that I am aware of is making fun of the parents as New Age types, even though they gave Abraham the middle name of “Starchild.” Even if they were New Age types (something that Chester seems to imply but doesn’t know), that would not constitute evidence supporting the contention that the state is overreaching in trying to make sure that Abraham receives appropriate cancer treatment. Second, just because alternative medicine is popular does not constitute evidence that this particular alternative treatment (the Hoxsey treatment) is effective. Heck, it doesn’t even constitute evidence that any alternative treatment is effective! I could point out that astrology is very popular too, but that doesn’t make it valid. Ditto belief in ghosts and the paranormal.

And, what defense of such irrationality would be complete without anecdotes? Chester states:

Back in 2001, when my mother was diagnosed with cancer and given four to six months to live, she was a docile patient, doing everything the oncologists ordered. But she realized something was wrong when she was so sick from the “cure,” or at least the treatment, that she wanted to die anyway.

After the first chemo round, she stopped. My imminently practical and decidedly traditional mother began acupuncture and saw a Chinese medicine practitioner. For a dying woman, she enjoyed — in all sense of the word — an extra year of life. Whether because of the treatment or because the prognosis was wrong — and there goes the myth of medical omniscience — we’ll never know.

Chester has my sympathy for what her mother went through. However, estimates of life expectancy in terminal cancer are just that–estimates. They are fraught with uncertainty, which is why oncologists tend to couch things with relatively vague language with large error ranges. Just because her mother lived several months longer than predicted does not mean that her rejection of chemotherapy and embrace of acupuncture and traditional Chinese medicine prolonged her life. There are also a couple of other important differences here. First, her mother was undeniably an adult, with full autonomy to reject therapy if she so chose. Second, unlike Abraham, she had a terminal cancer. Unlike Abraham, she had no hope of cure or long term survival. Rejecting further therapy other than palliative therapy under such circumstances is a much different decision than a 15-year-old with a curable cancer being allowed to die.

Chester then finishes with a truly breathtaking flourish of bad analogies:

The Cherrixes’ decision is a far cry from the parents who refuse to vaccinate their children — cancer isn’t contagious, after all — or choose to pray over a rupturing appendix rather than having it removed.

The cure for appendicitis is taking the appendix out. But no one knows if Abraham’s chemo and radiation will be a cure or merely a treatment. Or if he’ll even survive. Meanwhile, he’ll endure months of debilitating illness waiting to find out.

My jaw dropped when I read this. Where to begin? In fact, these two paragraphs were what cinched it that I had to fisk Chester’s article. First, I would argue that the Cherrixes’ decision is not a far cry from parents who choose to pray over a ruptured appendix rather than allowing a surgeon (like me) to take it out. There is only infitessimally more evidence that the Hoxsey treatment can cure Hodgkins Disease than there is that prayer can cure appendicitis–and maybe not even that. No, contrary to Chester’s assertion, the two examples (praying to cure appendicitis and using the Hoxsey treatment to treat Hodgkins disease) are not very far removed at all.

As for the last part of her “argument,” well, Ms. Chester, I have to admit, you got me there. I can’t argue with that. I have to concede that “no one knows” for sure whether chemotherapy and radiation will cure Abraham. We do know, however, that there is probably as much as a 70% chance that they can cure him. Those are pretty good odds in my book, and using the 30% possibility that conventional treatment will fail to save Abraham’s life is, in essence, a deceptive appeal to uncertainty. Nothing in medicine is 100% certain; taking a page from Chester’s own argument, patients sometimes still die after having their appendix removed for appendicitis. When we take a patient to the operating room for appendicitis, we don’t know with 100% certainty that we will cure the patient and save his life, although we do know with a high degree of confidence that we probably will. I would counter Chester’s appeal to uncertainty with this: Here’s one thing we do know: The Hoxsey treatment will not cure Abraham. His odds of dying if he pursues only the Hoxsey treatment will approach 100%. If Abraham pursues the Hoxsey treatment in preference to conventional therapy, the only way he’s going to survive is if he happens to be one of the rare lucky patients who undergo spontaneous remission. Even if his chances of survival with chemotherapy and radiation were only 50% (or even 30%, which is possible if his disease has bad prognostic factors that the news accounts didn’t make me aware of), scientific evidence shows that that would still be far superior to anything alternative medicine can offer. Even if Abraham’s disease progressed to the point that he required a bone marrow transplant, those odds (a 35-65% chance of long term survival) would still be better than he has now with the Hoxsey treatment.

In fact, I would further point out again that Abraham and his parents are making this momentous decision based on very incorrect information. As I pointed out before, the proprietors of the clinic to which Abraham wants to go claim that the Hoxsey treatment has an 80% success rate. If you believe the quacks when they claim that they can cure you 80% of the time with no toxicity, it becomes perfectly reasonable to forego chemotherapy with all its attendant complications and choose the less toxic therapy with what you falsely believe to have a better chance of curing you. Chester should reserve her ire for the quacks who are deceiving the Cherrixes with wildly optimistic claims for their ability to cure him based on no good scientific evidence, not for the state agencies that are trying to save his life.

Chester concludes with an emotional appeal that amounts to, essentially, “enough is enough”:

Abraham has already tried it the doctors’ and the social workers’ way. He’s already endured the two-hour drives to the hospital for chemo, the trips to local doctors for shots to counter the drug-induced fever, the trips back to the doctor for another if they didn’t. The return journeys to Norfolk for more chemo. And so on.

Just because the first rounds of chemotherapy failed to completely eliminate the cancer is not an argument in favor of letting the boy and his parents choose a therapy that can’t cure the cancer. Patients with favorable disease at diagnosis (which Abraham appears to have had) not eradicated but confined to an area of initial involvement after chemotherapy and no radiation, can usually be salvaged with further chemotherapy and low-dose involved-field radiation therapy, possibly with a stem cell transplant. Finally, there also seems to me to be a glaring disconnect that Chester bemoans how horrible it is for Abraham to have to be driven a couple of hours to receive his chemotherapy (while being able to stay for the most part in the comfort of his own home during treatment) but apparently thinks nothing of Abraham’s traveling over 2,500 miles to a foreign country to receive an unproven treatment.

As I said before, there are reasonable arguments you can make in support of Abraham’s and his parents’ decision. None of them happen to be scientific arguments demonstrating that their choice of therapy has any chance of saving him comparable to that offered by conventional medicine, but there are arguments. Generally, they would involve asserting patient autonomy, arguing that Abraham is old enough to make up his own mind, and arguments based on freedom, specifically that the state, as a matter of principle in a free society shouldn’t be able to interfere this much with parental prerogatives in deciding what is best for their children. Too bad Chester managed to avoid using every single one of those arguments dispassionately, preferring instead naked emotionalism over rational discussion.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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