Cancer Complementary and alternative medicine Medicine Politics Quackery Skepticism/critical thinking

Abraham Cherrix’s lymphoma in “remission”?


It would appear that there’s finally some good news in the strange and sad case of Starchild Abraham Cherrix. The AP reports that he and his doctor are reporting that his lymphoma is in remission again:

FLOYD, Va. — A 17-year-old who won a court battle against state officials who tried to force him to undergo chemotherapy for his lymphatic cancer is in remission following radiation treatments over the past year, the teen and his doctor said.

Starchild Abraham Cherrix’s case spurred debate on whether the government should get involved in family medical decisions. It also led to a state law named after him that gives Virginia teenagers and their parents the right to refuse doctor-recommended treatments for life-threatening ailments.

Tests show that the sole remaining tumor in Cherrix’s body — a nickel-sized mass in his right lung — appears to be gone, radiation oncologist Dr. Arnold Smith told The Associated Press by telephone from his clinic in Greenwood, Miss.

Cherrix is not cured, but “he is N.E.D., our abbreviation for ‘no evidence of disease.’ He’s in a total remission,” Smith said Thursday.

“There may be some microscopic tumor somewhere still there, but everything we see is gone,” Smith said.

Cherrix said he understands that he is not cured. But he’s full of energy and optimistic.

“I’ve been cancer-free four times now, but this time it looks much, much better,” he told The AP on Wednesday in an interview in Floyd, the southwest Virginia mountain town where he lives with his mother and four younger siblings. They moved there in May from Chincoteague, an island across the state.

Actually, this is in essence little different from the last time that Abraham was reported to be shrinking his tumor or to be “cancer-free” and then recurred again three months ago. I wish it were, but it’s not. Almost certainly, Abraham still has microscopic deposits of tumor left in his body, which makes this the perfect time for him to undergo chemotherapy to try to mop up his cancer while his burden of disease is only microscopic.

As you may recall, Abraham Cherrix is a now 17-year-old adolescent who was diagnosed with Hodgkin’s lymphoma in late 2005. In February 2006, after a round of chemotherapy, there was still residual tumor left, after which his oncologists made a very standard recommendation in cases like this: More chemotherapy plus radiation. It was then that Abraham, then 15, in concert with his parents, decided that he wanted to pursue quackery rather than evidence-based medicine. And, showing a lot of evidence of magical thinking, he chose a doozy of a bit of quackery as well. Specifically, he chose to go to Tijuana to undergo the Hoxsey therapy, a treatment involving an herbal concoction developed by a man named Harry Hoxsey. This is a therapy supported by no good evidence and, indeed, for which there is good evidence that it doesn’t work.

Not surprisingly (or, if you have a more cynical view of how well state social services protect minors from medical neglect, surprisingly), the Accomack County Department of Social Services stepped in, leading to a court battle over whether Abraham was old enough to choose woo over evidence-based medicine. The initial ruling was that Abraham had to have chemotherapy, but ultimately there was a compromise. This “compromise” involved having Abraham go to a radiation oncologist in Mississippi with a penchant for woo named Dr. Arnold Smith, who would give him low dose radiation therapy. Although that is highly unlikely to cure Abraham’s cancer, it is legitimate medical therapy that is highly useful for palliation by shrinking individual tumors that are causing symptoms.

What’s not so legitimate is the rather odd form of “immunotherapy” that Dr. Smith administers to his patients. I’ve already deconstructed this form of immunotherapy in detail before, but in case you’re not interested in clicking and reading I’ll give the CliffsNotes version here. Basically, Dr. Smith injects an immune system stimulator called interleukin-2 into the patient’s belly until it forms a raised, red area that he calls a “belly plaque” (which look like this), which he “believes” to be filled with “significant colonies of clonally-replicating natural killer cells.” Of course, he presents no good evidence from well-designed clinical trials to support any of his claims for his “immunotherapy,” and he hasn’t published on this technique in anything other than woo journals since the 1990s at least. Moreover, apparently he is administering supplements and high dose vitamin C, neither of which, given the existing evidence, are efficacious against cancer.

Suffice it to say, I agree with the assessment of prominent bioethicist Arthur Caplan on this one:

Art Caplan, director of the Center for Bioethics at the University of Pennsylvania, doubted the immunotherapy had value. But he said Cherrix’s seemingly improved health shows the state was right to intervene.

While Cherrix is not getting the complete medical treatment that his original doctor wanted, the radiation means he’s getting most of it, Caplan said.

“He’d probably be dead by now if they (state officials) did not react,” Caplan said.

This is very likely true. At the very least, state intervention and the resultant compromise ruling have saved Abraham from significant morbidity. Remember, at the time of the compromise ruling, Abraham had, by this report, a baseball-sized mass in his neck. Without radiation to shrink it, that mass would very likely have continued to grow to the point that it started to obstruct his esophagus, compromising his ability to eat and/or his trachea, shutting down his airway.

How likely, though, is it that this new remission that Abraham has reportedly achieved will be durable or permanent? Sadly, not very. It’s possible, and I certainly hope that this is one area where I turn out to be wrong, with Abraham being one of the lucky few for whom radiation alone can take care of relapsed Hodgkin’s disease, but in reality treating these new tumors as they pop up is a lot like the game of Whac-A-Mole. Dr. Craig Hildreth (a.k.a. The Cheerful Oncologist) described it well in his excellent discussion of the role of radiation therapy in treating lymphoma of the type that Abraham has. I particularly the term that Dr. Hildreth uses for radiation therapy of the type that Dr. Smith is administering to Abraham, namely “spot-weld” radiation therapy, although “Whac-A-Mole” gives a better flavor as to its ultimate effectiveness. Contrary to the triumphant trumpeting of this announcement by certain bloggers, no doubt to be followed by Mike Adams (who has already published articles erroneously claiming that the Cherrix case is evidence that the Hoxsey therapy “works”) and other defenders of quackery weighing in today, if they haven’t already. In fact, I’m surprised how few have done so thus far, but that may just be because the story was reported late Friday afternoon. Expect a lot of crowing about how well “alternative medicine” works (never mind that it was almost certainly the radiation that shrank Abraham’s tumors to an undetectable size) and in favor of “health freedom” (in reality the “freedom” from having to listen to regulatory bodies that try to make sure, however imperfectly, that ineffective or unproven treatments are not touted as miracle cures).

Depressingly, this crowing will almost certainly be premature. Overall, this is a very sad case, and has been from the very beginning. It’s always sad to see a young man struck down by cancer before he even has the opportunity to live his life. However, what makes this case particularly poignant is that this young man refused his one best chance for beating his cancer and living to a ripe old age, fighting a battle that tore his family apart and resulted in his parents’ financial hardship and divorce. There is still a small chance that he may achieve the desired end of long-term survival with targeted radiation therapy, but his odds are considerably longer than they would have been if he had pursued more chemotherapy along with radiation in the first place.

Of course, if Abraham had been 18 or older when he first decided to pursue the quackery known as the Hoxsey therapy rather than conventional medicine, his case would likely never have been an issue. After all, adults are free to reject life-saving therapy if they wish. The question that Abraham brought up is the age at which a person should be allowed to make that decision for himself, the balance between the personal freedom to reject life-saving therapy and pursue whatever woo one wants, and how far the state should be allowed to go to force a child to undergo life-saving treatment for serious diseases or injuries when the parents either choose quackery or acquiesce to the child’s desire to pursue quackery. In the case of children nowhere near the age of being able to weigh such decisions for themselves, I think there is a clear case for state intervention when parents choose quackery over medicine. However, because Abraham was older than, for example, Katie Wernecke, putting him in that fuzzy age range where children become adults, his case was considerably more difficult, especially given his apparent maturity, which made his magical thinking not as obvious as it should have been to the credulous press that lapped up his story. Indeed, even I expressed considerable uncertainty before reluctantly coming down on the side of state intervention.

What also makes this case troubling is that it inspired a very bad piece of legislation in Virginia known as Abraham’s Law, which was recently passed and foolishly signed into law by Virginia Governor Timothy M. Kaine. In essence, this law appears to strip 14- to 18-year olds of any protection from the state if their parents choose woo over evidence-based medicine, even if they choose faith healing. It’s not as though the state was intervening in the health care decisions of parents and adolescent children left and right, given that the old law was weak enough, but this new law makes it almost impossible for social services to intervene in the case of medical neglect. It’s sad enough that Abraham Cherrix is highly unlikely to cure his cancer due to his own misguided faith in the Hoxsey therapy and fear of chemotherapy, but what compounds this sadness is that advocates of “health freedom” in Abraham’s name have made it likely that more adolescents in Virginia will suffer based on his example.

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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