Abraham Cherrix and the promotion of pseudoscience in medical school

One of the aspects of blogging that I’ve come to like is the ability to follow a story’s evolution over the long term and to comment on new developments as they come along. If you’re good at blogging, you can take that story and make it your own, adding it to your list of “signature” issues for which you become known and about which people come to you for commentary as new developments arise. Indeed, now that the fourth anniversary of the start of this blog is fast approaching (December 11, in case you don’t remember!), I can look back and see a number of issues that I’ve done this with, including the dichloroacetate saga; the Abubakar Tariq Nadama case and inextricably entwined Dr. Roy Kerry prosecution; the sad case of Katie Wernecke (if anyone knows what’s happened to her, by the way, please let me know, as I haven’t been able to find out anything recent and my last installment from more than a year and a half ago was depressing in the extreme; is Katie even still alive?); and even the recent speculation about Steve Jobs’ health, including a post that brought in more traffic than any post this year that I can recall and that still brings me inquiries about whether I have any special insight into what’s going on with him (I don’t; I just used publicly available news sources and made some informed speculations based on my surgical knowledge). Of all these “signature” blog issues I’ve written about over the last few years, perhaps the one that I’ve covered the longest is the at the same time unfortunate and fortunate case of Starchild Abraham Cherrix, who at age 15 rejected scientific medicine in favor of the sheer quackery that is the Hoxsey therapy.

When last I mentioned Abraham Cherrix, he had just turned eighteen and appeared to be doing OK, his tumor in remission thanks to low dose radiation therapy–not due to the dubious other therapies that he’s been undergoing–meaning that legally he can now make his own health care decisions. Now he’s shown up at a medical school to give a talk. Sadly, the description of the talk is uncritical and credulous. I guess I shouldn’t be surprised, given that the journalist (Colleen Redman) who reported it cites Mothering as her favorite magazine and did a puff piece on Cherrix a few months ago chock full of support for “health freedom.”

The article begins:

“You can pull up the weeds but if you don’t get the root, they’ll come back,” Abraham Cherrix recently told a Medical Ethics class at the Edward Via Virginia College of Osteopathic on the Virginia Tech campus in Blacksburg.

It seemed an unlikely statement for an eighteen year old young man to make to a lecture hall full of future doctors. But Cherrix – who made national news in 2005 when he refused radiation and a second round of chemotherapy for Hodgkin’s disease – was talking about his approach to wellness.

Invited by Professor Robert Miller for his second speaking engagement at the College, Abraham was accompanied by his mother, Rose Cherrix. Rose and Abraham’s father were found guilty of medical neglect for supporting Abraham’s decision to forgo more standard cancer treatments. She and her five children moved to Floyd County from Chincoteague Island, Virginia, in the spring of 2007, after losing their home and businesses to mounting medical bills, but winning their court case appeal. It was a case that prompted the passing of a new Virginia Law in Abraham’s name, one that gives teenagers the right to have a say in their health care decisions.

Actually, Cherrix might have been an interesting speaker to have as a guest for a class in medical ethics, and that’s where he spoke. However, what disturbed me wasn’t so much that he was invited to speak but that apparently there was no questioning of his choices or of his role in advocating quackery. I understand that he’s young and he has cancer (I say “has” cancer because he’s only been in remission for less than a year), but that doesn’t mean he shouldn’t have been politely challenged regarding the dubious science and magical thinking behind his quest. As tenacious and determined as he was, he used his tenacity in a cause that endangered his life and may very well still cost him it.

In fact, although neither Abraham nor his supporters would ever recognize it, when the State of Virginia tried to force him to undergo conventional and effective therapy for his lymphoma, it did Abraham the biggest favor in his life. Before that, he was undergoing the Hoxsey therapy at the Association for Research and Enlightenment, the center founded by psychic Edgar Cayce. As you may or may not recall, the Hoxsey treatment involves herbal concoctions popularized by Harry Hoxsey in the early part of the 20th century. Different varieties exist, including an “internal” treatment and external treatments with various pastes made up of mixtures of subsets of the components of his treatment. Hoxsey’s claim for the development of his therapy was that his grandfather John Hoxsey had mixed together grasses and flowering wild plants growing in a pasture where one of his horses grazed daily. The horse supposedly developed a cancerous growth that went away after grazing in that location, and Hoxsey thought that it was due to the plants there. He took plants from the pasture, mixed them together, added some ingredients for home remedies for cancer at the time, and came up with what he billed as a cure for cancer.

The Hoxsey therapy is pure quackery, and Cherrix believed it would cure him, even as his tumors continued to grow.

Enter the court. It was the court that saved Cherrix’s life–at least for now. You’re probably surprised to see me write that, but it did. As part of a compromise worked out through the legal action, Cherrix agreed to switch his care to a physician named Dr. R. Arnold Smith. Dr. Smith is a radiation oncologist by training, but along the way he has become a believer in woo, specifically an unproven “immunotherapy” that is primitive and almost certainly worthless. Fortunately for Cherrix, though, Dr. Smith did not lose his faith in radiation therapy, which he still administers. True, he generally uses what he characterizes as “low dose” radiation (what that means is not exactly clear), but he still uses radiation. When Cherrix grew large tumors in his chest and neck, the latter of which could have obstructed his trachea or esophagus if it continued to grow, Dr. Smith was able to shrink them with radiation therapy.

Far worse is the horrible law passed in his name that in essence strips teens between the ages of 14 and 17 of any protection against quackery. The law was bad enough when it applied only to children with terminal illnesses, but its wording in its final form applies it to children with “life-threatening” illnesses. In essence, it gives teens the “right” to refuse treatment for such illnesses. When his cancer recurred elsewheretwice!–more radiation shrank the recurrences to undetectable. In other words, Dr. Smith was playing Whac-A-Mole with these tumors, a strategy that is excellent palliation but very unlikely to result in long term survival. There is a small chance that it might, perhaps even greater than average given how well Cherrix has done until now, but it’s still unlikely that Cherrix will escape recurrence. If he does, it will not have been the Hoxsey therapy or other woo that he’s taken, but rather the radiation.

Given that, I wish someone had asked Cherrix why he attributes his survival to “alternative” therapy and not to good, old-fashioned (but not as “old” as most “alternative” therapy) radiation therapy. Unfortunately, no such question was asked:

Following Abraham’s narrative, the class engaged in an hour long question and answer period. Many of the student’s questions revolved around the diet and lifestyle changes that Abraham says have contributed to his healing.

Abraham pointed out that the re-occurrence of his tumors and the degree they returned seemed to correlate with his diet, especially with the ingestion of too much sugar. “Tumors feed on sugar,” Dr. Smith answered when Abraham asked if he could eat donuts.

Currently Abraham is committed to an alkaline diet that includes lots of vegetables, no sugar, and no artificial additives. He spoke of other preventative therapies he uses to maintain his well being, such as a detox foot bath and Laser Therapy, administered by local chiropractor Garry Collins to stimulate or inhibit certain cell function and to boost immune function.

The whole bit about tumors feeding on sugar is nonsense. No, it’s not nonsense that tumors use sugar for their metabolism. Clearly they do; indeed, the avidity of tumors for glucose is the scientific basis behind why PET scans work. What’s nonsense is the claim that eating too much sugar will have an effect on tumor growth that Cherrix would be able to detect. Even more nonsensical is the “alkaline diet,” for reasons that I’ve outlined in detail before. Of course, most nonsensical of all is the detox foot bath, and that Cherrix could believe in such quackery–yes, quackery, there’s no other word to describe “detox” footbaths–shows that he has close to zero critical thinking skills when it comes to medical science.

Apparently the medical students there just lapped it up. I realize the medical school where Cherrix appeared is an osteopathic school, but these days in my experience there is really no difference between standard M.D.’s or D.O.’s when it comes to practicing medicine. It’s possible to challenge Cherrix without being too harsh, for instance by asking him what the evidence is that any of this stuff other than the radiation did him any good, pointing out that his tumors kept growing through it all and didn’t actually shrink until he underwent radiation therapy.

Not surprisingly, Cherrix has gone beyond believing in woo to being a practitioner:

He is planning to get his GED and is interested in possibly becoming a Naturopath, saying, “I might even be joining you here in this class.” He also designs WebPages and does Reiki (a hands-on healing modality) and would like to pursue those interests more.

[…]

Both Abraham and his mother stressed the importance of mainstream medical treatments, but said they would like to see those combined with alternative therapies that don’t create side effects. “I’ve talked to hundreds who have been cured with alternative therapies. How can I not think they can work?” Abraham said.

If Cherrix is lucky enough to survive to achieve this, I foresee a bright future for him as chief of a division of “integrative” medicine somewhere.

One of the topics I would most have liked to see covered in a medical ethics class is the ethics and legality of what has been termed “Abraham’s law.” This law goes far beyond “giving teenagers the right to have a say in their health care decisions.” What it does in essence is to allow teens between the ages of 14 and 17 suffering from any life-threatening condition to refuse any therapy. Its original incarnation was more modest, applying only to teens with “terminal” illness, but along the way the language was broadened to include any life-threatening illness.

The implications of this law are staggering. For example, let’s say there is a family that is of one of the fundamentalist Christian sects that believes that prayer and Jesus will heal, not medicine. In fact, let’s pretend that Madeleine Neumann, the 11-year-old in Wisconsin who died of diabetic ketoacidosis because her parents tried to cure her with prayer rather than taking her to a doctor for insulin and intravenous fluids, lived in Virginia and was 15 instead of 11. Let’s further pretend that the authorities found out about it before she died. Under “Abraham’s law,” there would be nothing the state could do to stop the parents and save her life unless the child were to rebel against her parents and request scientific treatment (highly unlikely in such a family). Moreover, the parents couldn’t be charged for abuse or neglect because the child would have chosen to refuse effective treatment. In essence, Abraham’s law has stripped all 14- to 17-year-olds of any real protection against quackery. If they happen to buy into their parents’ belief system, there would be nothing the state could do about it. True, the state had precious little power before, but now it has in essence none. The only child that Abraham’s law might benefit, ironically enough, would likely be one with woo-loving parents who decides he wants science-based therapy.

I very much wish that some medical student challenged Cherrix on that unintended aspect of his legacy.

Once again, I hope Cherrix is one of the lucky few who can survive a recurrence of lymphoma with such minimal treatment consisting of, in essence, nothing more localized radiation therapy to individual tumor deposits. However, it’s becoming increasingly apparent that if he does he will become a potent force for pseudoscience and use his testimonial as his most powerful ammunition. It doesn’t matter that it was the radiation that shrank his tumors when none of the woo he was using would; like all subjects of testimonials, Cherrix attributes his good fortune to “alternative” therapies rather than the one conventional therapy the Virginia court forced him to accept. That the medical students failed to realize this and failed to do anything other than (apparently) fawn all over him does not bode well for their ability to become practitioners of science- and evidence-based medicine.