Starchild Abraham Cherrix: It’s over

Sadly, Starchild Abraham Cherrix is almost certainly doomed:

ACCOMAC, Virginia (AP) — A 16-year-old cancer patient’s legal fight ended in victory Wednesday when his family’s attorneys and social services officials reached an agreement that would allow him to forgo chemotherapy.

At the start of what was scheduled to be a two-day hearing, Circuit Judge Glen A. Tyler announced that both sides had reached a consent decree, which Tyler approved.

Under the decree, Starchild Abraham Cherrix, who is battling Hodgkin’s disease, will be treated by an oncologist of his choice who is board-certified in radiation therapy and interested in alternative treatments.

The family must provide the court updates on Abraham’s treatment and condition every three months until he’s cured or turns 18.

“It’s all over. It’s everything we fought for, everything we wanted to ever have, we’ve won. We got our freedom back,” Abraham said outside the courthouse after the hearing.

Tyler emphasized that the decree states that the parents weren’t medically neglectful.

Abraham said that he saw the doctor last week, and the doctor assured him that his cancer is curable. The teen said he’ll continue following an alternative herbal treatment called the Hoxsey method as well as his doctor’s treatment plan. The regimen won’t include chemotherapy, but radiation is a possibility, he said.

Video of the story can be found here and here.

It just goes to show that Board certification doesn’t necessarily guarantee adherence to evidence-based medicine. If this new oncologist truly believes that Abraham can be cured with the Hoxsey therapy, he’s gone pretty far off the rails of his profession. I do note with interest that he is not a medical oncologist (the kind of oncologist that gives chemotherapy) but rather a radiation oncologist. Don’t get me wrong. I’m not bashing radiation oncologists. I like radiation oncologists. I even spent nearly three years in the laboratory of a radiation oncologist doing research, a man for whom I have nothing but the utmost respect. The reason I like radiation oncologists is because they are a lot like surgeons (except for their way more civilized working hours) in that they are very good at treating local cancers. Consequently, they tend to think a lot like surgeons. (They do, however, tend by and large to have cooler toys, though.) Unfortunately, what Abraham clearly needs is systemic treatment (treatment of the whole body), and that’s not what radiation oncologists do, any more than that’s what surgeons do. Also, I’m quite curious who this doctor is and am rather puzzled that his name isn’t mentioned in the story. In his interview, Abraham says that this mysterious doctor offers “immunotherapy” in addition to radiation therapy. (He also shows evidence of the magical thinking that I discussed earlier when he compares Hodgkin’s lymphoma to a cold or a fever that he just has to get rid of, although he does acknowledge that it will be “difficult.”)

Curious, I did a little Googling and made a guess. It turns out that my guess was correct. In any case, the mysterious radiation oncologist is: R. Arnold Smith, M.D. (also mentioned here). Here is the tale:

Smith’s clinic employs immunotherapy, an innovative treatment that works to restore the immune system that age and cancer break down, helping the body fight back.

Combined with radiation therapy to debulk cancer, molecular targeted therapies to arrest host defenses, genomic assays, and chemotherapy when necessary, immunotherapy helps patients live a higher-quality, longer life, the oncologist says.

Today, after the short hearing, the judge looked at Abraham and said, “God bless you, Mr. Cherrix.”

Greenwood Leflore Hospital has prepared for the onslaught of national media because Cherrix’ s case has been featured on major all-news stations, including CNN.
Shannon M. Melton, marketing/communications director for the hospital sent an e-mail to all hospital directors Tuesday telling them to prepare for the VIP patient.

This morning, Melton declined to identify or confirm the patient and referred all questions to Wilson Gaillard at the Cancer Center.

Every door of the hospital will be manned by security guards, she said.

“We plan to bring in additional support from the police department, if necessary,” the memo states.

Gee, you don’t think that Dr. Smith’s clinic will get a huge influx of new business from this, do you? Dr. Smith will be offering the young Cherrix the following treatments:

Dr. Arnold Smith was awarded a method patent for his application of Interleukin 2 to create a factory for natural killer cells. This treatment appears to be a significant innovation and advance. Interleukin 2, when injected subcutaneously, has been known for some time to produce a firm nodule often called an “injection site nodule.” These nodules, we believe, are composed of significant colonies of clonally-replicating natural killer cells.

Additional daily injections of Interleukin 2 are best exploited if they are given by injection just on the periphery of the nodule or plaque. Our current policy is to “grow” the initial nodule by progressive injections until a sizable plaque is created, measuring 8-10 cm in diameter. It becomes slightly inflamed, hot, swollen, sore, and red. The plaques are not very painful, but have occasionally contained areas of skin necrosis which have always healed completely.

It may be that use of Cimetidine, antioxidants, and replacement hormones facilitate the production of these plaques to a significant degree. We have seen several patients with lung cancer and colon cancer who have shown progressive decline in Carcinoembryonic Antigen after Interleukin 2. Belly Plaques were created and sustained.

I looked for articles in the peer-reviewed scientific literature published by Dr. Smith about this technique, but there was nothing in Medline more recent than the 1990’s that I could find and none of it was about IL-2. However, Dr. Smith did list a number of publications on his CV on this technique in a journal I’ve never heard of before, Bulletin of Urgent and Recovery Medicine, a website for which I’ve been thus far unable to find. Looking at his CV and publication record, it appears that sometime around 1998 or so his publications stopped being mainstream and moved into this new “immunotherapy” and “anti-aging” medicine.

It is true that IL-2 is used for melanoma and renal cell carcinoma. It can actually be fairly nasty stuff, with a lot of side effects, including capillary leak syndrome, hypotension, and acidosis. It’s also not all that effective, with perhaps a 20% response rate, but, unfortunately, for refractory tumors like melanoma and renal cell carcinoma, it and interferon are about the best we have. Sadly, no evidence is presented that Dr. Smith’s method does anything other than raise a really nasty looking wheal on the abdomen. He has posted a provisional patent application, but I’ve failed to find an actual patent yet on the U.S. Patent and Trademark Office website. In addition, Dr. Smith’s website is long on testimonials but short on data (for example, he claims that there are a lot more natural killer cells generated but never actually shows any data that there are), preferring instead vague platitudes about immunotherapy like this:

When the immune system is weakened by old age, environmental causes or other factors, it can be more easily overwhelmed by cancerous cells. Cancer begins to occur when the immune system can no longer defend against invading tumor cells. There is evidence that in many cancer patients that rebuilding the immune system slows down the growth and spread of tumors.

Immunotherapy works to help restore the immune system that age and cancer break down, giving your body strength to fight back. By combining this treatment with chemotherapy, surgery and radiotherapy, Dr. Arnold Smith is helping more and more cancer patients become cancer survivors.

Or, get a load of this:

If Immunotherapy works so well, why isn’t everyone using it?

One reason is that researchers are used to dealing only in easily measured data, and subjective quality of life benefits are hard to precisely quantify. Conventional medicine can sometimes be slow to embrace new methods, but Steven Rosenberg, M.D., chief of surgery at the National Cancer Institute, is working to civilize the treatment of cancer, and his stratagem is immunotherapy. “Immunotherapy uses the body’s own immune system, a system that evolved to detect exquisitely small changes in molecules to tell non-self from the body, to fight cancer. If we can take advantage of that system, we’re more likely to have a treatment that is effective and carries minimal side effects,” says Rosenberg.

Another reason is that because many of these natural supplements that we find so beneficial are unpatentable. This means that pharmaceutical companies do not want to go the major expense to fund a study for FDA approval when they will not be able to have a proprietary drug to bring in revenue to offset the cost of the study.

Woo.

I particularly detest that Smith’s dragged Steven Rosenberg into this. I’ve met Steve Rosenberg on a couple of occasions. He is a giant among surgeons as far as surgical research goes. But, to give the real answer why everyone isn’t using immunotherapy, I’ll just say: Because it’s difficult and has been disappointing in its results in clinical trials. Immunotherapy was all the rage in the late 1980’s and early 1990’s. All sorts of investigators were injecting cytokines and taking out T-cells, activating them, and reinfusing them. Some of these therapies were really toxic, necessitating ICU monitoring to use. The real answer to the question is that we just don’t understand the immune system well enough yet to have truly effective immunotherapy with an acceptable toxicity profile.

I have to say, I find it rather odd that Abraham would pick a therapy that is guaranteed to result in large painful welts on his abdomen using a cytokine that is not without side effects all because he’s so adamant that he doesn’t want to suffer the side effects of chemotherapy again, but I’ve given up trying to understand his thought processes. Instead, I’ll just wish him well and hope that I’m wrong. I certainly don’t want him to die, but I’m afraid that this judicial decision has made that all but inevitable.

I suppose that this settlement is about the best that could be hoped for, given Abraham’s age and tenacity. It wouldn’t have been practical to tie him down and force him to undergo chemotherapy, and, given the immunosuppression that the chemotherapy would cause, any injury he might suffer resisting could have dire consequences. Sadly, this decision won’t save Abraham’s life, nor will it get him to see reality. Abraham’s invested far too much in his quest now to easily be persuaded that he’s made a huge mistake. On the other hand, I’m somewhat reassured that Abraham will be followed by someone who is at least nominally able to provide conventional care, even if this Dr. Smith does appear to be deep into woo of the immunotherapy variety as well. Perhaps if Abraham’s tumors keep growing he’ll finally realize that what he is doing isn’t working before it really is too late, but, for all we know it may be too late already. We can only hope that it’s not. I’m also heartened that Abraham has agreed to radiation therapy, at least in principle. He’ll very likely need it before the end to shrink those tumors in his neck before they start obstructing his windpipe or esophagus. Accepting radiation for local therapy may save him the indignity of a tracheostomy or a feeding tube, and there is value in that, even if it does come at the price of xerostomia.

Through all this, I had continued to hope against hope that Abraham would sooner or later realize the mistake he is making, but it’s become quite clear that he won’t and that he still thinks that he can beat his tumor using the Hoxsey therapy and whatever other stuff his new radiation oncologist plans on giving him. All I can do now is to wish him the best of luck with his cancer and the best of times during the little time he has left to live in this mortal coil–and hope that I’m wrong.

It’s very unlikely that I am, though.

Technorati tags: , , , , , , ,