Complementary and alternative medicine Medicine Quackery

Starchild Abraham Cherrix: Radiation shrinks his tumors

It figures.

After posting yesterday about whose responsibility it is when a cancer patient rejects evidence-based effective treatments in favor of quackery and then progresses, I would have to be made aware of an update in the case of Starchild Abraham Cherrix.

Ever since Cherrix’s story first rose to national prominence a few months ago, I’ve been periodically blogging about it. Cherrix, as you may recall, is the the teenager diagnosed with Hodgkin’s Lymphoma late last year who underwent chemotherapy, went into remission, and then relapsed a few months ago. At that point, he refused to undergo further chemotherapy, opting instead for the quackery known as the Hoxsey therapy. His decision, supported by his parents, led to a huge legal battle in Virginia, which ended in August with a settlement in which Cherrix was allowed to continue with “alternative” therapy under the supervision of a physician in Mississippi named Dr. Arnold Smith. It even led to one Virginia legislator proposing “Abraham’s Law,” a spectacularly poorly thought out piece of legislation that would limit the power of state Social Services to intervene in cases of children with terminal illnesses.

When I learned of this, I predicted that this meant that Abraham had, despite his previously stated distrust of conventional medicine and chemotherapy, decided to undergo radiation therapy, basing my prediction on Dr. Smith’s reported interest in combining a dubious-sounding “immunotherapy” with radiation. In fact, I speculated that the reason Abraham’s tumors were shrinking was not because of any “immunotherapy” he was receiving or because of his Hoxsey therapy, but rather because he had decided to accept radiation therapy.

It turns out that I was correct:

NORFOLK, Va. — Abraham Cherrix is coming home to Virginia this week, feeling energetic and hopeful that five weeks of treatment at a Mississippi clinic will help him defeat cancer.

In August, the 16-year-old Eastern Shore teen won a court fight to forgo chemotherapy and seek alternative treatments. The family chose to work with Dr. Arnold Smith, medical director and radiation oncologist at the North Central Mississippi Regional Cancer Center in Greenwood, Miss., who uses radiation plus immunotherapy to strengthen the immune system through supplements and food.

Low doses of radiation have shrunk the tennis-ball-sized tumor in his neck to the circumference of a half dollar, and the tumor in his chest similarly has decreased, Abraham said Monday by phone after completing his course of treatment.

“I’m feeling wonderful,” said Abraham, who has Hodgkin’s disease, a cancer of the lymphatic system. “There’s a pretty good chance that I am cancer-free

Would that it were so! Unfortunately, Abraham seems to be engaging in more of his magical thinking.

It’s unlikely that Abraham is indeed “cancer-free.” Sure, the tumor in his neck and the tumor in his chest have shrunk. Hodgkin’s lymphoma is a very radiation-sensitive cancer, and Abraham has never received radiation therapy before. I would have been surprised if Abraham’s tumors didn’t shrink markedly in response to the radiation. It may even be possible that, despite the persistence of a half dollar-sized mass in his neck that Abraham has been rendered what we in the biz call NED (i.e., no evaluable disease). NED basically means that there is no tumor detectable on physical examination or radiological imaging. The small remnant may be scar tissue. Or it may not be. (The only way to find out for sure would be to biopsy it, although a PET scan would be helpful.) Chances are, however, that these shrunken masses probably still contain living tumor cells. After all, Abraham has no further to look than his previous experience. His first round of chemotherapy put him into remission, which is by definition NED. Despite the fact that his tumors shrank away to nothing, they nonetheless managed to return. Worse, because he relapsed, it is quite likely that Abrahamstill harbors tumor cells elsewhere in his body. That’s the reason the oncologists wanted to give him chemotherapy to treat his relapse in the first place. The bottom line is that this promising initial result will most likely have little bearing on his ultimate survival. Initial shrinkage all too often does not correlate well with survival, particularly in a case like this (although, certainly, the failure of a tumor to shrink in response to therapy certainly does correlate inversely with survival).

I reiterate, however, that I am glad that Abraham did ultimately accept radiation therapy. It is excellent palliation and likely will prevent the tumor in his neck from obstructing his windpipe or esophagus. Although it’s unlikely to prolong his lif significantly, it will make his quality of life better.

Very little else was revealed about the treatment that Abraham is receiving. Besides Dr. Smith’s rather strange “belly plaque” immunotherapy, Abraham is apparently getting a sampling of even more dubious treatments:

He also received intravenous medications and supplements, such as Vitamin C, to improve his immune system; he did not give details. He said he’s still taking the Hoxsey tonic “here and there” and continues to try to avoid eating sugar.

I’ve already discussed how there is no good evidence that vitamin C does anything for cancer in humans, recent cell culture studies and small unconvincing case series notwithstanding and why the Hoxsey therapy should be viewed as nothing but quackery. The jury’s out on Dr. Smith’s immunotherapy, but I find it very telling that he hasn’t published in reputable peer-reviewed journals since at least 1998, if not longer, preferring instead to publish in dubious journals like Bulletin of Urgent and Recovery Medicine, a journal that doesn’t even appear to have a website that I can peruse even to examine a few of its abstracts (if it has one, I couldn’t find it).

Of course, even though the initial response of Cherrix’s tumor is due to basically nothing more than radiation therapy (in other words, it’s “evil” conventional medicine that finally caused some tumor shrinkage after the tumors kept growing through the Hoxsey therapy), the lack of understanding that this is so is already showing up in the altie blogosphere, where we already see premature gloating:

He [Abraham] is coming home to Virginia to check up on his “alternative treatment” of supplements, nutrition, and some radiation. He says that he feels wonderful and thinks there is a good change that he is cancer free.

Why are we surprised? Where is our common sense? How is it that man has survived wars, plagues, harsh environmental changes, droughts, pestilence, migrated all over the planet only to experience a growth in population that challenges the resources of the planet? Mankind survived because the human body is a miraculous machine designed to heal, adapt, survive, reproduce, and flourish. Healing is as natural today as it was thousands of years ago. Good food, healthy living, and positive beliefs still work as we still are living in human bodies.

Only up to a point will good food and healthy living keep us healthy. Neither infectious disease nor cancer respect good food and healthy living in many cases. For example, the influenza epidemic of 1918 got its start in the U.S. in military barracks, striking down healthy young men in prime physical condition.

“Traditional” medicine is not so traditional. It has only been around since the industrial revolution. The complete worship of science in medicine only began in the 1800’s. Before that time, healing was natural. Mankind looked to natural ways to heal. If mankind had needed chemicals foreign to the body to heal, mankind would have been extinct long before it was discovered making this whole debate a mute point.

And look at the fabulous results, with life expectancies far less than today. This sort of poor reasoning is par for the course for alties, playing on the false dichotomy between “natural” and “synthetic.” Just because it’s “natural” doesn’t mean it’s better. After all, penicillin was isolated from bread mold, and some of the most toxic substances known come from plants, like curare and strychnine. In many situations, the body can heal itself without outside help from “foreign” chemicals. However, all too often the body can’t “heal itself.” This happens when it is attacked by certain infectious diseases, cancers, and other diseases. We know from science that modern medicines can indeed result in healing where the body alone cannot, no matter how healthy. Antibiotics are a prime example. Before antibiotics, common community-acquired pneumonia was a dangerous disease with a significant mortality rate. Now, it rarely kills, thanks to antibiotics. Ditto tuberculosis, which was a feared disease with in essence no effective treatment. In any case, consider this: If the “natural” healing humans sought back in those idyllic days was so great, why was infant mortality so high 100 years ago and even higher centuries before that? Why was infectious disease the most common cause of death among young people hundreds of years ago? Weren’t those “natural cures” good enough? As has been said, if you want to use 18th century treatments, expect to see 18th century mortality rates. It gets worse:

How has mankind fared with this new traditional medicine? Well, it certainly true that people are technically living longer. Is this because of medical inventions or simply in better living conditions brought about by other inventions developed in the industrial revolution? It’s hard to know.

Are people today really living longer? People today die from much different causes than those prior to the early 1800’s. We no longer get run over by horses, or die from tribal attacks, or die from giving birth on a prairie somewhere. No, we start dying around 35 or 40 from chronic disease and just take 30 years to actually finish the process.

I don’t know about you, but personally, I actually would prefer to “start dying of chronic disease at age 40.” Certainly that’s preferable to dying of infectious disease at a young age, getting run over by horses, or dying of trauma before the age of 40. Wouldn’t you? (After all, under the conditions of hundreds of years ago, the odds would be far less of my surviving into my 40’s to transmit my insolence into the blogosphere.) You’ll also note that the altie writer above pointedly leaves out death by infectious disease, which was right up there as one of the most common, if not the most common causes of death for people under 40 for all of human history and prehistory until the last 70 years or so, after which penicillin, followed by other antibiotics, became widely available. Now death from infectious disease at a young age is much less common. And let’s not forget vaccination, which prevented disease in hundreds of millions, if not billions of people.

No, it’s not “hard to know” what’s responsible for increased survival since then; modern medicine and modern sanitation both played a huge role.

I expect to see more of this sort of blather in the coming days after this story. It will come from people who don’t understand that it was not alternative medicine that caused Abraham’s tumors to shrink, which in fact had failed utterly even to slow his tumors’ growth. They will attribute his improvement to the alternative medicine, even though it was good old-fashioned conventional medicine in the form of radiation that shrank his tumors. Remember also that, as good as the news is from Abraham Cherrix right now, it’s not likely to last. Evidence-based medicine shows us that radiation alone in a case like Abraham’s is highly unlikely to eradicate the tumor completely, even though it is quite good for palliation of symptoms. I hope Abraham continues to do well, but the physician in me knows that he almost certainly will not, at least not for very long. Knowing that, I sincerely hope that he enjoys this interlude that radiation therapy has bought him and lives symptom-free as long as possible before the near inevitable return of his tumor.

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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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