Another case of chemotherapy refusal for pediatric cancer

As sometimes happens, last week I let myself get tied up writing multiple posts about a single topic, namely the promotion of an antivaccine movie by a school board president in California, apparently as part of an attempt to influence California legislators who are considering a law that will make philosophical exemptions for school vaccine mandates easier to obtain. As a result I didn’t get around to blogging about something else that happened last week. It’s a topic near and dear to my heart as a cancer surgeon. On second thought, perhaps “near and dear” is exactly the wrong way to describe it. Rather, it’s a topic that enrages me, because I hate to see children endangered by the woo-filled beliefs of their parents. It also turns out that it’s a perfect storm of quackery combined with conservative wingnuttery. It’s a story that first turned up on–where else?–WorldNetDaily, State demands that child take cancer-causing drugs. It didn’t take long for–again, who else?–that über-quack Mike Adams to pick up the story, calling it
Medical terrorism in Michigan? Parents forced by the state to poison their child with cancer-causing chemicals.

Before I get to the loons’ accounts of the story, let’s take a look at legitimate news sources, which, it turns out, is from my home state. Also, oddly enough, the original story dates back to last year. As Elton John would sing, we’ve seen that movie, too:

Parents who decided to discontinue chemotherapy treatments for their son face a court hearing after Helen DeVos Children’s Hospital accused the parents of medical neglect, according to published reports.

The case involves Jacob Stieler, a 10-year-old boy from Skandia in the Upper Peninsula who was diagnosed with Ewing sarcoma, a rare form of bone cancer. He reportedly underwent three months of chemotherapy, which caused him to feel sick, depressed and nauseated, his parents said.

According to WOOD-TV 8, Jacob’s mother, Erin Stieler, said she and her husband decided to end chemotherapy treatments after two PET scans showed no signs of cancer. WOOD-TV said hospital officials complained to the state Department of Human Services, which is taking the parents to court.

Here is a news story from November:

This story is all too familiar. Remember Abraham Cherrix? It was pretty much the same story. He completed a couple of rounds of chemotherapy, felt sick, and refused to have any more. Actually, it sounds more like the case of Katie Wernecke in that her parents refused radiation therapy and additional chemotherapy after her Hodgkin’s lymphoma responded very well to her initial cycles of chemotherapy. You can see that this sort of false sense of security is at the heart of the case from this video:

This sort of belief that the cancer is gone if the PET scans and CT scans are clear after the initial course of chemotherapy is actually not all that uncommon an occurrence. Not the parents refusing further chemotherapy for their children; usually parents agree to do what their child’s oncologists recommend in these cases. Rather, it’s not at all uncommon for parents of children with cancer patients to be lulled into a false sense of security by an initial excellent response of their tumors to chemotherapy. This initial response will sometiemes lead them to question why they need further therapy if the tumor is “gone.” The problem, of course, is that the tumor might be gone in the sense that it can’t be detected macroscopically. That doesn’t mean there aren’t microscopic tumor deposits left that could blossom into recurrences.

What particularly galled me about the news story above is a segment where the reporter discusses how experts at the local hospital and the University of Michigan argue that, without additional chemotherapy, Jacob’s cancer is at high risk of “roaring back with a vengeance” and then juxtaposes that with Google searches claiming a variety of opinions and prognoses on different websites. To me, that’s no different than when antivaccinationists pit their Google University knowledge against the knowledge of experts. Pediatric oncologists who have actually reviewed Jacob’s case and examined him are in a better position to interpret the existing scientific evidence base regarding the treatment of Ewing’s sarcoma (which is the type of cancer Jacob was diagnosed with in March 2011) and apply that evidence to determining the best treatment recommendation for an individual patient.

Ewing’s sarcoma is a pediatric tumor that most commonly occurs in bone. According to some news reports, Jacob’s tumor was wrapped around his spinal cord, which tells me that it must have been somewhere in his spine. In general, the current standard of care for Ewing’s sarcoma involves neoadjuvant chemotherapy to shrink the tumor as much as possible, followed by surgery and/or radiation therapy to remove the local disease, completed by consolidation chemotherapy to eliminate occult metastatic disease. The local therapy is usually surgery to remove the tumor. Since Ewing’s sarcoma can occur in limbs, part of the purpose of neoadjuvant therapy is to make amputation unnecessary and allow limb-sparing surgery to be done. Again, not knowing the details of Jacob’s case, I can’t say exactly what the plan was. However, the tumor was found in the spine, and Jacob underwent surgery to remove it for diagnostic and therapeutic purposes. (At the time, the identity of the tumor was not known.) However, it was apparently only incompletely removed, which suggested to me that the plan was to give chemotherapy, followed by radiation to the area where the tumor had been incompletely excised, and then followed by consolidation chemotherapy.

In other words, doctors did not recommend additional radiation therapy and chemotherapy for Jacob because they want to poison him. They recommended it because evidence suggests that it is the best way to maximize his chance at cure. If the tumor comes back, it’s likely to come back in the lungs, another bone, or another organ, and then the prognosis will be absolutely dismal. Worse, just like bacteria exposed to a little antibiotic, the tumor is likely to be more resistant to chemotherapy. That is an outcome to be avoided if at all possible.

The Stielers won their first round in court, but apparently the State of Michigan is appealing.

That is, of course, not the impression one gets reading

Government is not merely denying parents and families the right to consume healthful whole foods such as raw milk; now rule-by-force government authorities are threatening a Michigan family with criminal prosecution if they do not poison their child with chemotherapy chemicals — even though their child shows no signs of cancer!

Adams then goes on and on and on in his characteristic fashion about how these chemotherapy agents can actually cause cancer. This is actually true, but deceptively presented. The risk of secondary malignancies is real, but in general relatively small and certainly much less than the risk of dying from the primary malignancy if inadequate treatment is given. In other words, the only pediatric cancer patients who have to worry about secondary malignancies are those who survived their cancer because of–you guessed it!–having undergone life-saving chemotherapy.

But Adams is only getting started:

If you say “no” to an oncologist — who is very much like a car salesman in the sense that he has a financial stake in your decision — you are costing him a loss in profits. He doesn’t like that. His BMW needs an upgrade, you see, and he’s hoping to fly to Hawaii to catch another golf game next week, and to do that, he needs another $20,000 in health insurance reimbursements from your policy. So if you say no, he might just be so angry that he calls the police on you. “You dare to say NO to ME? You’ll see who has the power NOW!”

You can almost hear the “Muah ha ha ha!” following the whole scene.

Did he really write that? Muah ha ha ha”? Seriously? What is this? A comedy? Well, yes, maybe it is. Adams is always so over-the-top that it’s hard to know whether he really believes what he’s writing or not. Of course, he’s only getting started. Those of you familiar with his “work,” probably know what’s coming next, and Adams doesn’t disappoint:

Yes, these pediatric oncologists are some of the most evil, unethical, and downright criminal minds you will find in the medical system today. Far from helping children, they are engaged in mass poisoning crimes that rival the gassing of Jews in Nazi Germany. In fact, some of the chemicals come from the very same sources — drug companies that were once part of IG Farben, the Nazi war crimes chemical conglomerate that was found guilty of crimes against humanity. Today’s Bayer company is an offshoot of IG Farben, in fact, and the former chairperson of Bayer, Fritz ter Meer, was found guilty of war crimes in the Nuremberg trials.

Which leads him to admonish his readers:

So the next time you see a pediatrician pushing chemotherapy, just think to yourself, “Nazi war criminal!” Just because they have a medical license doesn’t mean they aren’t committing crimes against children. Hitler made it the law that Jews should be exterminated, but just because something is the law doesn’t make it right, obviously.

One wonders what analogies Adams would use if Hitler had never lived. We can only speculate about that, but there’s no doubt about what Bob Unruh at WND blames this case on. No, it’s not Hitler, at least not directly. Given how many times right wingers have made likened President Obama to Hitler in a most ridiculous fashion, it shouldn’t be a surprise that Unruh blames this case on Obama. Specifically, he blames it on the Patient Protection and Affordable Care Act, which is often referred to derisively by its opponents as “Obamacare.” He peppers his article with sentiments like “in what is being seen as a preview of a fully implemented Obamacare” and concerns that this case is about enforcing a “national standard of care” is “same type of concern that has been raised by many organizations and individuals about Obamacare.” I never could figure out what the problem was with having a national standard of care myself, as long as it’s based on science, but such a thought seems to disturbe some people greatly.

As I’ve always said before about cases like this, such as those of Katie Wernecke and Abraham Cherrix, I realize that the Stielers love Jacob and want nothing but the best for him. Witness their video of the party they gave him when he was shown to be grossly free of cancer if you don’t believe me. I also realize, as much as it is possible for someone who hasn’t had a child with cancer, that it must be horrible to watch the child you love suffer from his treatment, so bad that you want nothing more than to make it stop. Yet, unfortunately the Stielers have been lulled into a false sense of security because of the excellent response to surgery and chemotherapy, and now is not the time to be complacent. It’s hard, horribly hard, but Jacob needs to complete his therapy. He might get away without any more therapy. Might. Isn’t it better not to rely on “might”? Isn’t it better to listen to pediatric oncologists who have devoted their lives to treating cancers of this type when they say that stopping therapy now is dangerous, rather than relying on prayer, which, if the WND story is to be believed, appears to be what the Stielers are doing now?

The answer should be obvious.