Choosing quackery over evidence-based medicine: When is a patient old enough?

Over the couple of days or so, a minor flurry of comments have hit the ol’ blog. I hate to let commenters dictate the content of my blog, but it’s strictly a coincidence that this happens to be a post I had been planning sometime this week anyway and it comes around the same time as the minor altie comment deluge hit the blog. Or maybe it’s not such a coincidence, coming as it does in the wake of a court hearing relevant to the case of Starchild Abraham Cherrix. Recent commenters have castigated me, claiming that the Hoxsey treatment is not quackery; asserting that cancer is “not due to a chemo deficiency“; telling me that I should have a “more open mind” while at the same time calling me and other skeptics “morons”; assuring me (and us other nasty skeptics) he would pray for us spiritual healing, while ranting about the perceived evils of conventional medicine; and making wild and unsubstantiated claims that untreated cancer patients live four times longer than treated patients based on a dubious “study” from 37 years ago, that, as far as I’m able to tell, has never been published in the peer reviewed literature.

I tell ya, it’s been a while since I have been subjected to so much altie vitriol.

All of this makes me wonder if (1) whether the posts that I had written before had somehow been distributed to an altie mailing list somewhere (certainly, I couldn’t find any referring links that would explain the sudden influx of comments on posts that were between two to six weeks old) or (2) lots of people were doing the same thing as I in anticipation of this case and had seen my previous posts popping up in their Google searches, which is certainly possible. Either way, it’s led to an influx of died-in-the-wool alties castigating me. What provoked this lurry of comments was my recent posts about Starchild Abraham Cherrix, a now 16-year-old Virginian boy diagnosed last year with lymphoma and who refused further chemotherapy when he relapsed, opting instead for the quackery known as the Hoxsey treatment at an altie clinic in Tijuana, a therapy that involves taking a bunch of herbal concoctions with no known efficacy against cancer. Recently, a court-ordered imaging study showed that his tumor had grown, but Abraham dismissed it, saying that his healer had told him that his tumors would grow a bit before they started to shrink, leading to my post entitled Magical Thinking versus Lymphoma. (It never ceases to amaze me how alties will so easily make excuses for the failure of their preferred treatment that they would never accept if made for a conventional medical therapy.) Whatever the cause, however, coincidence or my posts being circulated on an e-mail list, I will stick to the plan, since I have found a couple of news articles about Abraham. Here’s an excerpt from the first one:

(AP) Three months of chemotherapy last year made Starchild Abraham Cherrix nauseated and so weak that at times the tall, skinny teenager had to be carried by his father because he couldn’t walk.

So when he learned in February that the cancer was active once again, he balked when doctors recommended another round of the drugs, as well as radiation.

“I think it would kill me the second time,” said Abraham, who instead turned to a sugar-free organic diet, herbs and visits to a clinic in Mexico to treat his Hodgkin’s disease, a cancer of the lymph nodes.

On Monday, Abraham and his family will be in juvenile court for a closed hearing to determine whether the 16-year-old can make his own medical decisions — and whether he can keep living with his parents and four siblings on Chincoteague, an island off Virginia’s Eastern Shore.

A social worker had asked a judge to require Abraham to continue conventional treatment, and in May the judge issued a temporary order finding Jay and Rose Cherrix neglectful for supporting their son’s choice to pursue alternatives.

Judge Jesse E. Demps also ordered the parents to share custody of Abraham with the Accomack County Department of Social Services; they face losing custody completely.

And:

Abraham and his parents researched alternative medicine and heard about the Hoxsey treatment of liquid herbal supplements and a diet heavy on fresh fruits and vegetables. The treatment used to be available in the United States but proponents moved their clinic from Texas to Mexico in the early 1960s after repeated clashes with federal authorities.

Rose Cherrix said she supports her son’s decision to follow this approach because he is mature and thoughtful.

Hmmm. I wonder if Rose would support her son’s decision so strongly if he wanted to have sex or wanted to do drugs–as long as he came to his decision in a “mature and thoughtful” manner, of course. Somehow, I doubt it. Even if Abraham is indeed “thoughtful,” he’s apparently not thoughtful enough (or he’s thoughtful in a non-analytical way). For one thing, he’s based his decision on a lie, a lie told to him when the doctors at the Tijuana clinic told him that the Hoxsey treatment cured 80% of patients with cancer treated. If that were really the case, then Abraham’s decision would not be unreasonable. Sadly, however, there is no evidence whatsoever to think that the Hoxsey treatment is that effective or that it is even effective at all at halting the progress of lymphoma. Instead, he and his family have bought into the magical thinking:

Cherrix now administers herbs to his son four times a day, carefully decanting into a small measuring glass a dark elixir with ingredients such as licorice and red clover. Father and son also pray together before Abraham drinks the concoction.

The court hearing itself apparently finished up on Tuesday:

RICHMOND, Va. (AP) — A teen cancer patient fighting to use alternative medical treatment told a juvenile court judge in a two-day, closed hearing what it’s like to go through chemotherapy and that he didn’t want to relive it.

“I told him my story … so he could understand where I was coming from and live through me,” Starchild Abraham Cherrix, 16, said.

In all, the judge heard 11 hours of testimony before the hearing concluded late Tuesday. At issue is if the teen can make his own medical decisions and whether he can keep living with his parents and four siblings on Chincoteague, an island off Virginia’s Eastern Shore.

The judge is expected to issue a written decision by July 18.

The teen, who goes by Abraham, has Hodgkin’s disease, a cancer of the lymph nodes.

Three months of chemotherapy last year made him extremely weak. So when he learned in February that his cancer was active again, he turned – against doctors’ advice – to a sugar-free organic diet, herbs and visits to a clinic in Mexico.

A social worker asked a judge to require the teen to continue conventional treatment.

In May, the judge issued a temporary order finding Jay and Rose Cherrix neglectful for supporting their son’s choice to pursue alternatives. Judge Jesse E. Demps also ordered the parents to share custody of Abraham with the Accomack County Department of Social Services.

Abraham’s parents face losing custody completely.

“What it boils down to is does the American family have the right to decide on the health of their child,” Jay Cherrix said, “or is the government allowed to come in and determine that themselves and threaten one way or the other to split our family up?”

Abraham and his parents think a doctor reported them to Social Services for not continuing with chemotherapy. The judge initially forbid the family to leave Virginia, then let Abraham return to the Mexican clinic last month after the teen had X-rays to assess his disease.

The X-rays showed the chest tumor had grown mildly, Abraham said.

I think that everyone knows my position on the specific decision that the Cherrixes are making; so I won’t belabor it other than a brief summary. It’s magical thinking that has led to a very foolish one that will preclude Abraham’s surviving his cancer. The Hoxsey treatment is quackery and will not cure Abraham, for reasons that I’ve enumerated in detail. Conventional therapy (high dose chemotherapy followed by stem cell transplant) has probably around a 50-50 chance of resulting in long-term survival, down from 80% or more, mainly because his tumor relapsed after an initial course of chemotherapy, implying that it is a more aggressive tumor. Also, this is not a matter of Abraham’s giving up and letting nature take its course because his situation is hopeless, a perfectly rational decision in cases that really are hopeless. Abraham clearly wants to live and believes that the Hoxsey treatment has a better chance of curing him than chemotherapy and without the nasty side effects. He has in essence fallen for a lie and, if successful in his quest, will pay for it with his life.

Adults, of course, are perfectly free to choose the lie of quackery over evidence-based medicine if they desire. Indeed, they do so all the time, and some of them pay a horrible price for it. It is assumed that, because they are autonomous adults, they can choose whatever they wish when it comes to their health. Children, however, are a different matter. There is no disagreement that, below a certain age, children are not capable of making such decisions rationally and must therefore depend on their parents to look out for their best interests. That is why they are not allowed to vote, drink alcoholic beverages, or sign legally binding contracts. As this article points out:

Although he is not old enough to cast a vote or buy an alcoholic drink, Abraham argues that he is old enough to make decisions about treatment to save his life.

The disagreement is, of course, over just that in Abraham’s case (and occasional cases like his), given that some children may mature more quickly and thus become capable of such decisions sooner and some later. (We’ll leave aside the frequently observation that some never reach this stage, no matter how old they get.) The real difficulty in deciding such issues comes when parents choose a course for their child that is so obviously not in the child’s best interest or, as in this case, when they “support” a decision by their child over medical care that is clearly going to lead to the child’s death. Whether it is because of their own beliefs or because they are “supporting” their child’s bad decision (or a combination of the two) doesn’t much matter, the end result is the same.

We as a society expect that the state will step in when parents fail in their duty to act in the best interests of the child. Usually, because we value freedom and the autonomy of parents to raise their children as they see fit, the state is, contrary to the claims of Cherrix’s defenders, usually pretty slow to intervene, sometimes with tragic results. Worse, all too often when the state does intervene its actions arguably make the situation worse. Indeed, a case like Abraham’s does, despite the fury of my attacks on the quackery and my pointing out the magical thinking that has doomed this child to an early grave if the state doesn’t intervene, nonetheless causes conflict in me. My libertarian leanings and distrust of government intrusion into family life and how parents raise their children butts up against my absolute abhorrence of quackery and seeing a child suffer because of a bad decision or parental beliefs. When Abraham’s lawyer argues that letting the state take custody of Abraham would open the door to social workers invoking the power of the state when they do not agree with medical care decisions made by the parents, I can’t dismiss it completely, even though I know it’s an overblown argument, the obvious retort to which is that social workers have had that power for years to act when they perceive a child being endangered by unconventional medical practices. So what makes this case such a threat to parent autonomy compared to the many cases that have gone before?

In the end, I tend to view such a case as no different from Jehovah’s Witnesses who refuse to allow a life-saving transfusion in their child or Christian Scientists who think that prayer will cure their child of deadly diseases. In the case of a minor (for example Katie Wernecke, who is only 14), the state has the right and duty to intervene to prevent harm. However, Abraham is older and at an age that is more of a gray area. Consequently, the question hinges on whether or not Abraham demonstrates the maturity to be considered an adult and thus free to choose his own therapy, even if it is quackery that he chooses. I’m not sure that I know the answer. A strike against Abraham is that his thinking has not clearly not exactly been reality-based thus far, and certainly his parents haven’t helped matters by feeding his magical thinking.

Neither have all the alties like the ones who have recently descended upon my blog who are touting his decision (and are presumably sending Abraham similar letters of support) as a life-saving repudiation of the “poison” and “burning” of conventional medicine and who believe, without evidence, that the Hoxsey treatment has a high probability of curing Abraham with no side effects. I’m guessing that, when Abraham ultimately dies, many of them will just sadly shrug and say it was God’s will.

The ruling is due July 18, and I’ll try to keep an eye out for it.

ADDENDUM: I just found out that Abraham was on Sean Hannity’s radio program yesterday. That may explain some of this. A lot of people are probably Googling his name.