Cancer Complementary and alternative medicine Medicine Quackery

Starchild Abraham Cherrix turns 18

Somehow, with all the blogging about vaccines last week, I totally missed a major update to a story that’s been of great interest to me since I first became aware of it. It turns out that Starchild Abraham Cherrix, the teen who two years ago rejected conventional therapy for his lymphoma and sought out the quackery known as Hoxsey therapy, has turned 18:

Abraham Cherrix, the teenager who fought a court battle on the Eastern Shore for the right to choose his own cancer care, turns 18 today, officially freed from reporting his medical condition to the Accomack County court that has required regular updates since August 2006.

“When I turn 18, I can make my own decisions,” Abraham said Thursday from his home in Floyd, in the far western part of the state where he lives with his mother and siblings.

His latest blood results show no indication of the Hodgkin’s disease he first was diagnosed with in 2005, according to Abraham and his mother.

He gained worldwide attention in the spring of 2006 when social workers took his parents, Jay and Rose Cherrix, to court, accusing them of medical neglect. Abraham, who was living in Chincoteague at the time, had refused to go through a second round of chemotherapy for his lymphatic cancer and also shunned radiation treatment.

He instead traveled to Tijuana, Mexico, with his father for a controversial alternative medicine treatment called the Hoxsey method.

First off, let me just say that no one’s happier that my estimation of Cherrix’s prognosis was more pessimistic than how things have turned out thus far. I certainly hope that Cherrix is the one to beat the odds. I truly hated the thought of a young man with a potentially curable cancer being lured into eschewing effective therapy by the siren call of quackery. Remember that the first therapy that Cherrix wandered into was indeed quackery, specifically the Hoxsey therapy. Cherrix went to the Association of Research and Enlightenment founded by the infamous psychic “healer” Edgar Cayce. Cayce’s center is a center devoted to some serious woo. Now is a good time to review Cherrix’s case because if they haven’t already purveyors of unscientific treatments will almost certainly point to his reaching eighteen as proof that he has beaten cancer using only alternative therapies. It’s not. Not by any means, for reasons that I’ll discuss. I still hope he beats the odds but hold no illusions that he is “cured.”

After Cherrix went through one round of chemotherapy and still had residual tumor when he completed it in February 2006. He had had a great deal of difficulty with nausea and other side effects and decided at that time that he had had enough, even though his tumor was still potentially curable (with an estimated long term survival with treatment of over 70%) and his doctors recommended another course. His parents supported him in this decision and apparently helped him seek out “alternative” and “natural” therapies. It was through Cayce’s Association that Abraham and his parents were introduced to the Hoxsey therapy, which involves herbal concoctions claimed to be able to cure cancer. A man named Harry Hoxsey had claimed that the recipe for this “therapy” had been passed down to him from his father, who had received it from his father, who had discovered it. His grandfather, or so the claim goes, had supposedly noticed regression of a cancerous tumor of one of his horses who grazed in a particular field. He then took plants and flowers from that field and ground them up to make a paste to which he also added some other ingredients from home remedies and came up with a concoction that, according to him, could cure cancer. All that appears to be in it is a mixture of antimony, zinc and bloodroot, arsenic, sulfur, and talc as external treatments, and a liquid mixture of licorice, red clover, burdock root, Stillingia root, barberry, Cascara, prickly ash bark, buckthorn bark, and potassium iodide for internal consumption. According to Mildred Nelson, Harry Hoxsey’s former nurse and director of the Bio-Medical Center in Tijuana after his death, claimed an 80% success rate for all cancers. (Conveniently enough, the failures were blamed on a “bad attitude,” further claiming that a patient’s strong belief that the treatment is going to lead to recovery was the best predictor of success. Cherrix chose this to treat the tumors in his neck and chest rather than radiation and chemotherapy.

The results of Cherrix’s battle were two-fold:

  • A court battle in which the State of Virginia tried to abrogate the Cherrixes’ parental rights and compell Abraham to undergo therapy. I was very conflicted about this court case because, on the one hand, I truly hated the thought of a young man losing his potentially savable life due to quackery but, on the other hand, I had many of the same reservations about governmental power that supporters of Cherrix’s right to choose quackery over science-based treatments did. The first decision was that Cherrix had to undergo chemotherapy, but a compromise was struck in which Cherrix agreed to undertake treatment under the supervison of a woo-friendly radiation oncologist named Dr. R. Arnold Smith. The good news was that Dr. Smith would treat Abraham with low dose radiation therapy, which, as I pointed out at the time, is effective palliation for lymphoma. And Cherrix needed palliation, because he had tumorous deposits in his neck that were endangering his airway and esophagus. The bad news is that Dr. Smith is also fond of all manner of dubious treatments, including a bizarre “immunotherapy” with no scientific or clinical basis to support its efficacy called belly plaques. Abraham had some recurrences, which popped up and were treated like a deadly game of Whac-A-Mole™, eventually producing an apparent remission late last year. The Cheerful Oncologist pointed out that the use of radiation in this fashion, rather than an aggressive campaign of combined chemotherapy and radiation therapy, possibly leading to stem cell transplantation, to treat relapsed lymphoma was the fallacy of moderation. He also noted that occasionally long term survival in cases like Abrahams has been achieved with radiation therapy alone, but the odds are long. If he becomes a long-term survivor, as I hope he does, we can say with great confidence that it was the radiation, not the Hoxsey therapy, the various other woo he has pursued, or Dr. Smith’s other ministrations, that cured him.
  • A very badly conceived law. Inspired by Abraham’s battle, a lawmaker in Virginia proposed and got passed a law called “Abraham’s Law” that, as I described before, in essence gives parents the right to pursue any manner of unscientific treatment they want for teenagers between 14 and 17 suffering from “life threatenening” diseases, as long as the decision is “made jointly” between parents and child. This is how I described it before:
  • In essence, if you’re a child between the ages of 14-18, the State of Virginia no longer protects you from quackery or religious idiocy. In essence, parental stupidity, something state laws normally try to protect children against as much as possible in medical matters, is now legal. Worse, it’s not just limited to children with “terminal” illnesses, where, it can be argued, nothing can save them and taking them away from their parents to have them obtain conventional therapy would cause them undue stress in the remaining weeks or months of their lives. It now includes any child with a life-threatening condition.

I see nothing that has happened since to change my assessment.

So what’s going on with Abraham now? Let’s find out:

Since the fall of 2006, Abraham has received several rounds of radiation treatment under Smith’s care, along with immunotherapy, in which supplements and medicines are used to bolster the immune system.

Abraham’s latest bloodwork was reviewed by Smith this week, according to Rose Cherrix.

“Dr. Smith is very pleased,” she said. “He said to keep doing what we’re doing.” Calls to Smith on Thursday afternoon were not returned.

Abraham said he still is taking vitamins and supplements recommended by Smith. He also adheres to a sugar-free, organic-based diet.

He said it’s been about six months since he’s had a scan of his chest and neck area, the location of previous tumors, but he has detailed blood work conducted every couple of months, the results of which are forwarded to Smith for review.

Once again, it must be emphasized that there is no good evidence that immunotherapy of the unconventional variety administered by Dr. Smith has any efficacy against Hodgkin’s lymphoma. It almost certainly was the multiple courses of radiation therapy that Cherrix underwent that resulted in his fortunate condition right now. I do, however, have to wonder about Dr. Smith’s followup. NCCN guidelines for followup after treatment for Hodgkin’s lymphoma recommend the following:

Interim H&P:

Every 2-4 mo for 1-2 y, then every 3-6 mo for next 3-5 y Consider annual influenza vaccine especially in high risk patients (eg, treated with chest RT, bleomycin)

Laboratory studies:

CBC, platelets, ESR (if elevated at time of initial diagnosis), chemistry profile every 2-4 mo for 1-2 y, then every 3-6 mo for next 3-5 y TSH at least annually if RT to neck Chest imaging: Chest x-ray or CT every 6-12 mo during first 2-5 y

Cherrix has been fortunate enough to have been in apparent remission for nine months now, and it’s been six months since his last scan. Arguably, he’s due for a chest X-ray and, given that he had tumors in his chest treated with radiation, almost certainly a chest CT as well. Blood tests are very insensitive to detect recurrence. I rather wonder what Dr. Smith told Cherrix. Certainly normal blood tests are a good thing, but they by no means tell us a lot. The vast majority of lymphoma recurrences are not detected by blood tests; they’re detected by clinical symptoms or by findings on physical exam, such as a new enlarged lymph node popping up. Moreover, Abraham hasn’t really entered the time period when most lymphoma recurrences are diagnosed, which is between 12-18 months, and he can’t really breathe easier until five years. I hope he makes it, but remain pessimistic that he will. I also know that advocates of unscientific medicine will point and claim that Cherrix is “proof” that conventional treatments don’t work and so-called “alternative” medicine does. He’s nothing of the sort.

Now that Abraham is 18, he can basically do anything he wants. He can go back to Mexico to the Bio-Medical Clinic if he wishes. He can continue with Dr. Smith if he wishes. He can even elect to go back to doing conventional therapy if he wants, although if imaging studies show no detectable disease (otherwise known as “no evaluable disease, or N.E.D.) it’s not clear to me what a conventional oncologist would recommend, given that I don’t routinely treat lymphoma. Watchful waiting is probably the best way to go.

Sadly, this story was reported by the media (and continues to be reported by the media) as that tried-and-true story of the underdog fighting the power and actually winning. That he did so in the cause of quackery, apparently, is irrelevant to the press, because such stories are irresistable to them. What really bothers me about the case is that it will affect far more than just Abraham. Given that he was almost of age anyway, it could easily be argued that he had a right to do what he wanted with his own body. The problem is that his case didn’t end up applying just to him. His struggle led to a very bad law that in essence puts 14-17 year olds at the mercy of parents who prefer quackery, be it unscientific medicine or religion-inspired. No doubt Abraham doesn’t see it that way, but he unintentionally weakened measures designed to protect children against quackery and religious woo. Children in the state of Virginia are the worse off for it.

ADDENDUM: Well, that didn’t take long. It’s already begun.

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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