August 7, 2006, Volume 13 Nr. 51, Issue 219

All Natural

JeanneE Hand-Boniakowski

Ah, the seduction of that meme: "natural".  We are enchanted by a notion of the natural world that reads like a personals ad: "loves long moonlit walks on the beach."  Just as one should be realistic about Mr. Box # 4723, so should one examine assumptions about nature.  Parasites and polio, tsunamis and tsetse flies, volcanoes and vipers are all natural.  When we get that wistful idea of Nature, we are thinking of nature tamed, nature nice, nature, nature under human control. A definition of "natural" could be inclusive of everything, but seems, in practice, usually reserved for plants, birds and mammals and some few fishes and rocks. That is the friendly, polished parkland of nature that exists in the imaginings of folks who are, lucky us, mostly isolated most of the time from the nastier realities of nature.

Here is a fable, but based on an actual case, to help frame my argument that "natural" is a meme having little to do with, well, Nature, but much to do with modern culture in the industrialized "West" which, itself, is a  designation based not on natural geography as much as economic and cultural distinctions.

The Starchild and the Quacks, or Dying a Natural Death.  A Fable

A tall, handsome young man is dancing with Nature.  It is a masquerade, and she is flirting, cajoling, flattering the young man in the guise of his parents, the media, countless cyber-friends and ex-pat Americans in Tijuana (1).  They tell the prince that he is brave and noble and holy.  She dances in his arms, her hand resting on his neck.  She holds her hand there to control his head, lest he turn from her mesmerizing gaze and look at those he has struck off his dance card: the scientists, the medicine people.

When the prince gives his speeches, he is calm and strong saying, "I used to dance with the scientists, but it didn't work.  They almost killed me.  Now I will only dance with Nature.  I will fly in machines to the land of the sun, I will use machines to tell the world.  And I will get better because I dance only with Nature, and because I believe and pray and drink the essences of plants.  And if I die, I will die healthy!"

And the people cheer for the brave prince.  And Nature, in her beautiful mask, keeps her hand on his neck.  She does not remove her hand and, nearly unseen, her fingers embed themselves in his flesh.

The longer the prince stays with her, under her spell, the smaller the chance that he could leave her and dance with another.  The medicine people still hold out bouquets of purple periwinkle flowers (2) and beg the prince to dance, crying: 

"We know the flowers are poison.  We hope to poison Nature's hand in your throat so she lets you go. We know this will poison you as well, but you'll probably live.  Maybe you will have scars, a limp, an injury left over after the flowers and the lights.  We will be careful, but we won't lie.  It is a battle worthy of a man, a king, and you may still die young.  But if you dance only with her, with Nature, you will surely die.  Her hand in your throat will grow until she is choking you, and her deadly fingers will migrate until she has hands all over you.  And a young man should be able to feel loving hands all over his body, but this will be no marriage bed, no lovers' entanglement, only the natural course of her dance. We have seen it before, many times. You have been sheltered, dear prince, but we have seen it, and we dread it."

The young man, proud and determined, leans into her embrace, and Nature is what she is, awesome and amoral.

Cancer treatment mostly sucks, sometimes cures

The prince is based on Starchild Abraham Cherrix, who was diagnosed with Hodgkin's Lymphoma.  One of the great successes of cancer medicine is that Hodgkin's lymphoma is no longer a killer of nearly every young person who gets it.   Today, with relatively early diagnosis, such as it seems Cherrix had, treatment results in a very high ten-year survival.  Cure. Yes, cure.

There are several aspects to the story prompting various discussions of ethics and age of consent, and, for the record, I do not think the state should intervene to enforce medical treatment in this case but an important angle is generally downplayed or ignored by much media coverage and by more of the blogging.  This is the false equivalence, the fallacy about "balanced" journalism that taints nearly every story with culturally explosive implications: gay rights, global heating, stem cell science, evolution.

Ignorance on the web is pervasive, and so buckets of righteous blather is pasted onto every discussion I have visited so far about Cherrix.  A few posters would, it is clear, have been happier if Abraham had never used any medical treatment, but he did.  It made him sick, and it did not completely eliminate the cancer, but it did get rid of most of it.  This situation is usually painted as "the chemo failed", which is inaccurate.  In any case, it is likely that Abraham has a more aggressive tumor and his chance of beating the cancer went down to 35-70% with further medical treatment.  That all sucks.  That he got lymphoma in the first place sucks.

But pretending won't make it better.  And faith won't make it go away.  Yet the media, for the most part, present this as a case of a kid trying a legitimate medical alternative in his Tijuana pilgrimage for Hoxsey juice.  The framing of Cherrix as a heroic underdog, and of the medical doctors as villainous agents of the an evil state, is not journalism, it is melodrama.  Self-conscious reporters practice their soulful gaze in the mirror, pat themselves on the back and dream of Pulitzers, satisfied that they covered all the bases:

Balance: Be sure to say  Hoxsey is "experimental", "unconventional" or even just "alternative", and maybe let one talking head scientist have a few seconds, edited so he sounds like a cranky individual with his personal opinion, rather than a voice of reason with consensus of evidence as authority.

Empathy: Look concerned, furrow your brow, nod your head, don't ask questions that may offend the boy's faith-based notions.

Inspiration: Be sure to say the prince is brave to fight for his rights and so bright to have "researched" alternatives.  Indicate that smart consumers are using the internet to find information to empower themselves in their medical care, and hold Abraham up as a "health freedom" hero.

The journalist may consider another aspect, such as Accurate Information about the subject at hand, but information is not as important as "balance", empathy and inspiration.

Alternative?

If a child said he was going to tie red ribbons around his dog and swim in pudding to cure his lymphoma, would the media treat him this way?  If he said he researched the Hoxsey therapy by reading rooster entrails, would the media act like he was pursuing an informed choice? For all the deference reporters are giving Abraham, you wouldn't know that Hoxsey has exactly the same chance of curing him as the dog ribbons and pudding swims. And the "research" to prove Hoxsey's efficacy is no more useful than trying to read bird guts.  The most frequent claim in the articles and blogs I have seen is "80% cured" Numbers are impressive looking, but this number is meaningless (3).  Worse than meaningless.

Since "Right to Die" was last year's hot topic on the patient pathos beat, folks may mix it up with the Cherrix case.  But Abraham is not asking for a right to refuse all treatment, to be allowed to die.  He believes Hoxsey will cure him.  In fact, he believes that his belief itself is part of the cure, that if he loses faith, if he doubts or questions the path he has chosen, that he will compromise his cure. He echoes countless hopeful pilgrims who visit faith healers and shrines: if I do not get better, it will be because I lost faith, did not do the rituals properly.

Evidence of Abraham's magical thinking, evidence against claims that he is making an informed decision, come from his own mouth:

Abraham said he also was informed that the cancerous tumor, which is near his windpipe, had grown since February.

Abraham said he was not surprised,  "I care about it, but I know it will get batter," he said after the test.  "If I follow the diet I'm on and have faith, it will get better."

The teen said he also had noticed that a different tumor, in his neck, had grown since the beginning of the year but that it stopped growing in May, which he attributes to his alternative treatment. (Virginian-Pilot June 10, 2006 )

And in his recent appearance on Sean Hannity's show:

HANNITY: Abraham, let me ask you a very tough question. I've come to be very impressed with you and your knowledge of your disease, your knowledge of your situation, your seeking alternative remedies, I think it's really admirable. 

ABRAHAM: Thank you.

HANNITY: But at the end of the day if you make a wrong decision it could result in your life.

ABRAHAM: Yes.

HANNITY: Do you think about that?

ABRAHAM: Well, I really can't think about that, you know?

HANNITY: But don't you have to?

ABRAHAM: Well, there's always that possibility and, yes, you can look at it. But if I'm going to get better I have to maintain a positive attitude.

HANNITY: No, I agree with that.

And the strangest, saddest nonsense Abraham Cherrix said has been quoted elsewhere, mostly by those who support him as a hero of the "health freedom" movement. In late July, he said to the Associated Press:

So there's that possibility that somewhere along this line we made a wrong decision. But you know what? If I die, I'll die happy, and I will die healthy, and I will die in my home with my family, not in a hospital bed, bedridden and sick."

No one dies healthy from cancer.

Satanic Ritual Oncology

The prevalence, even predominance, of misinformation on cancer and cancer treatment is appalling.  Just two very common examples:

Katie Wernecke's dad has a blog (Katie Wernecke is another teen with Hodgkin's who is not using medicine. Her case may be even more tragic, since she is younger and did not have any chemo until long after diagnosis.  She was using IV Vitamin C and perhaps other things.  Then the state intervened and Katie had some chemotherapy, but by then her cancer had progressed so much that her chances of surviving it had dropped from 85% to 25%.  Edward Wernecke, two months ago, said his daughter's treatment has to be kept secret now:

On a condition of receiving treatments there can be no publicity at all. That is why there has been no communication on this website for months. We cannot tell you what we are doing or where we are at simply because the doctors and hospital would refuse to continue treatments. Katie's tumor grew in March but now is receding with the new treatments. Katie is doing very well and has 2 inch long curly hair now. (Tuesday, May 9, 2006 at http://prayforkatie.blogspot.com)

On Katie's birthday, June 11, he posted this: 

Our government and medical establishment has lost the War on Cancer after billions were spent on research and squandered. You can't cure something if you don't even know the cause of it. All you can do is treat the symptoms. Chemotherapy and radiation are not solutions; although it seems to help a few in the short run, the use of these does nothing but cause cancer again. You have been lied to. The use of mammograms will cause more breast cancer, there are safer alternative detection methods such as thermography.

Here is a link where, within a post about magical thinking evident in both these cases, cancer surgeon and researcher "Orac" points out  the fallacies in Wernecke's words: http://scienceblogs.com/insolence/2006/06/magical_thinking_versus_
lympho.php

For extensive discussion of these two cases, see Orac's Respectful Insolence at Science blogs. 

Two young victims of alternative medicine
Update on Abraham Cherrix
A "defense" of Abraham Cherrix and his parents?
Magical thinking versus lymphoma
Choosing quackery over evidence-based medicine: When is a patient old enough?
The decision is in: Starchild Abraham Cherrix must have chemotherapy
Some questions for those who decry the decision in the Abraham Cherrix case

Another person expresses a common, unfounded notion: 

With the court's decision on Abraham Cherrix, conventional medicine has once against proven itself to be grounded in tyranny. That oncologists must use intimidation and the threat of arrest to scare patients away from safer, natural treatments is a powerful indicator of the sad state of desperation to which the cancer industry has sunk in order to acquire paying customers.

("Agent Tim" from the blogosphere.  If you want to find him, you are on your own; I am not linking to folks who are earnestly, passionately wrong).

Has Agent Tim actually met any oncologists?  Have the people who rubbish them so really found them to be the greedy, uncaring monsters or robotic idiots that is too commonly thought?  When I ask for examples and evidence, nearly all I ever hear is vague, third-hand, without actual facts or even names to back up the attitude.  I think this vast evil cancer industry, which hides evidence of safe and painless cures, has no more reality than the widely believed monsters of the late 1980's and early 1990's, the Satanic panic tales that were born of false memories elicited by "unconventional" therapists.  Because no matter how many testimonials I hear, no one ever shows me any of the mountains of evidence that supposedly exists.

Footnotes:

(1)   The Biomedical Centre is where Hoxsey's old quackery is administered, along with some other snake oils like chelation and laetrile. It didn't save Hoxsey.

(2)   Vincristine and Vinblastine are potent chemotherapy drugs, derived from vinca, also called periwinkle, a common flowering groundcover. 

(3)    Mildred Nelson, Hoxsey's nurse, ran the clinic in Mexico until her death in 1999 (Harry Hoxsey died of  - betcha can't guess - cancer), and she claimed great results, though she did not provide evidence, and her method of prognosis was magical: 
  
Nelson claims that about 80 percent of the cancer patients who take her herbal treatment are cured. She believes that a "bad attitude" is usually responsible for her   "20 percent failure rate", and that she can tell who is going to get well and who is not from their attitude when they first arrive at the clinic; a patient's strong belief that the treatment is going to lead to recovery is the best predictor of success, she says.

(from Quackwatch report on Unconventional Herbal Cancer Treatments) http://www.quackwatch.org/01QuackeryRelatedTopics/
OTA/ota04.html#Hoxsey

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