Teen's case shines spotlight on alternative therapy
http://home.hamptonroads.com/stories/story.cfm?story=109181&...
By ELIZABETH SIMPSON
August 14, 2006
A horse's diet of wild herbs in the 1840s was the unlikely beginning of an alternative cancer treatment called the Hoxsey method.
The horse's owner believed the herbs healed a tumor on its leg, and he began mixing a concoction to treat other horses. Years later, his
great-grandson Harry Hoxsey would market a similar tonic as a human cancer treatment that eventually was banned in the United States.
One of Hoxsey's nurses set up a clinic using the method in Tijuana, Mexico, in the 1960s, where it has quietly operated ever since.
Many people in Hampton Roads, and in the country, for that matter, would never have heard of the method had it not been for a 16-year-old boy from
Chincoteague.
Abraham Cherrix was diagnosed with Hodgkin's disease last summer. When a debilitating four-month round of chemotherapy at Children's Hospital of The
King's Daughters failed to eradicate his disease, he went to Tijuana in March to try the Hoxsey method.
His case made headlines across the country after Social Services accused his parents, Jay and Rose Cherrix, of medical neglect. In July, a juvenile
court judge ordered Abraham's parents to return him to conventional treatment.
An Accomack County Circuit Court judge will hear the Cherrixes' appeal of that decision on Wednesday.
Abraham's story shows that while alternative and conventional treatments for cancer tend to quietly co-exist, at the core they are still viewed as in
conflict by much of the medical and legal establishment.
"We look at things as either/or, God or the devil, proven/unproven," said Michael Cohen, a Cambridge, Mass., lawyer who specializes in legal cases
dealing with alternative medicine.
Cohen believes doctors need to be more open in discussing unconventional treatments with their patients, so cases don't end up in court.
Abraham's case might not have caused such a stir were it not for some gray areas.
While he isn't a child, he is two years from legal adulthood. If he were 18, he could freely choose.
And while the conventional treatment recommended for him has a good success rate, it's not a slam-dunk. Hodgkin's has a five-year survival rate of 85
percent, making the lymphatic disease one of the more treatable cancers. But the first round of chemo did not eradicate Abraham's cancer, suggesting a
tougher case.
Those following Abraham's battle fall into several camps:
Proponents of alternative medicine believe Abraham and his family should be allowed to choose a route outside of the medical establishment. Believers
in conventional medicine, meanwhile, think Abraham should return to chemotherapy and radiation treatment to save his life.
Then there are people who believe the government is acting improperly in ordering unwanted treatment.
"What I ask is, 'Would you be willing to tie this kid down for treatment?' " said Douglas Scott Diekema, a Seattle pediatrician and a member of an
American Academy of Pediatrics ethics committee. "To me, that's an obvious no. That would cross the line. I would argue that it doesn't matter what
the law says - it's not ethical to force treatment on someone of this age."
The case has underscored that unproven treatment methods are common among cancer patients. They are among those who most frequently seek alternatives
because of the seriousness of the disease, and the fact that conventional treatment is not always successful. Usually, they turn to alternatives when
conventional therapies fail, or when they have little chance of being cured.
"It's a huge part of oncology treatment," said Dr. Megan Burke, a pediatric oncologist at the Cleveland Clinic.
One study of complementary and alternative medicine published in 2000 found that almost 70 percent of 453 cancer patients had used at least one such
therapy as part of their treatment.
That can range from something as simple as aromatherapy to quell chemo-induced nausea to the more dramatic decision by Abraham to drop conventional
treatment altogether.
Abraham learned about Hoxsey after his first round of chemo at CHKD.
During that time, the cancer had stopped growing, but when February tests showed active cancer cells, an oncologist recommended a stronger round of
chemotherapy and also radiation therapy.
Abraham resisted because the initial chemo had left him nauseated, feverish and weak. He said he felt a stronger round would kill him and was dismayed
by the potential side effects of radiation such as other cancers later in life.
He learned about the Hoxsey method at The Association for Research and Enlightenment, founded in Virginia Beach in 1931 by psychic Edgar Cayce. The
method - which includes an organic diet and a tonic of natural herbs, such as red clover, burdock root, and licorice - has been around since the
1920s. Harry Hoxsey was not medically trained but marketed the mix in clinics in 17 states.
The Food and Drug Administration forced Hoxsey to close his U.S. clinics in 1960, saying his method had no scientific backing. Three years later, one
of Hoxsey's nurses set up the Biomedical Center in Tijuana, which Abraham visited in March.
A message left on Thursday for a clinic spokesman was not returned. On Friday, questions were referred to director Liz Jones, who was out of the
office until next week. People who have sought treatment at the clinic - which only provides outpatient services - say the one-time treatment cost is
$3,500, but patients also pay for travel and hotel costs.
According to the American Cancer Society, there have been no large, evidence-based clinical trials of the treatment. A small study published in the
Journal of Naturopathic Medicine in 1994 involved 39 people who took the Hoxsey herbal treatment. Ten patients died after an average of 15 months and
23 failed to complete the study. Six patients were disease-free after two years.
A 2001 study paid for by the National Institutes of Health tried to track Hoxsey patients but found many had not had biopsies to confirm cancer, and
some had received conventional treatment along with the Hoxsey method.
Burke said the lack of scientific backing of a child's alternative treatment doesn't necessarily constitute medical neglect by a parent. It depends on
the patient's chance of survival using conventional methods, she said.
"The general rule of thumb is if chances are less than 50 percent, legally there is nothing we can do to force a family to comply," she said. "But if
there's a 90 percent chance of survival with treatment, and the family says we are not going to seek treatment, that's a major medical issue."
In such a case, a bioethics committee at the hospital would examine the case to see whether the hospital should seek medical power of attorney, and
whether the family should be reported.
Burke said she also considers how well the child and the family understand the consequences. Are they making an informed decision after thoughtful
consideration? Or are they acting impulsively? How dangerous is the alternative treatment, and does the patient have time to try it?
Burke said in some cases she has agreed to monitor a child's health through an alternative treatment attempt. Some families returned children to
conventional treatment; others returned for pain-easing palliative care, provided in the last stage of life, because the treatment didn't work.
Abraham's family says he's in stage two of the disease, with the worst stage being four. Social Services investigators and CHKD officials have
declined to comment on Abraham's case, citing federal privacy policies.
While the American Cancer Society has pegged the rate of survival of Hodgkin's disease after five years at 85 percent, the success of a treatment
depends on the stage and type of cancer.
A quick relapse after conventional treatments would suggest a harder cancer to beat.
"The doses of chemo and radiation will have to be more toxic, and he'll get sicker from that treatment," said Dr. Lawrence Rosen, a New Jersey
pediatrician who helps doctors and families handle such issues as a member of the American Academy of Pediatrics' Complementary, Holistic and
Integrative Medicine committee. "The risks are greater than in the beginning."
Burke said children who have had both chemotherapy and radiation therapy generally face about a 20 to 30 percent chance of the Hodgkin's recurring.
When there is chemotherapy only, that figure is about 50 percent.
But because radiation has negative side effects, including a higher risk of other cancers later in life, doctors sometimes hold off giving it at the
beginning, then add it if the disease returns to eradicate lingering, resilient cancer cells.
Younger people have higher rates of survival because their bodies can withstand the intense treatment.
Publicity of Abraham's case has brought a flood of calls, letters and e-mails to the family, some from medical professionals who are willing to help
Abraham with other methods suited to his desire for a more natural, less toxic approach.
John Stepanovich, the attorney who represents Jay and Rose Cherrix, said the family is reviewing a wide range of methods.
"Up until now they've felt backed into a corner," he said. "Instead of looking around at what's available, they've had to protect their family."
For now, though, Abraham continues to use the Hoxsey method. "I always have an open mind, but I also believe you have to stick with what you believe
is right," Abraham said Thursday.
Court-ordered X-rays at CHKD in June showed Abraham's tumors - one in his neck, the other next to his windpipe - had grown since February. Tests at
the Biomedical Center in June also showed some growth, but Abraham said adjustments were made to his diet in June.
Some who have corresponded with Abraham after learning about his case have encouraged him to keep pursuing alternative treatment. Others have urged
him to return to conventional therapies.
Michael Dunne, 42, hopes Abraham can choose what's best for him. Dunne was diagnosed with Hodgkin's disease when he was 16.
Radiation treatment in 1981 eradicated the disease, and he went through two decades without a problem. In 2001, the Norfolk resident was diagnosed
with sarcoma, a cancer of the connective tissue that is commonly associated with radiation. He has had both surgery and chemotherapy since then, and
continues to be monitored.
He doesn't regret any of his medical decisions and believes Abraham and his family have the right to decide on treatment within the privacy of their
own home.
What disturbs Dunne is the thought of the teen fighting his disease in such a public manner.
"To sit and listen to testimony about your own case, that has got to be devastating," he said. "It's traumatic enough to have cancer, but to have to
go through that on top of it... that's cruelty there."
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