August 16, 2006

Must Have Been A Tough Call

The story: 16-year-old kid gets Hodgkin's lymphoma, a nasty form of cancer that is often incurable and fatal. He undergoes treatment which includes chemotherapy. He reacts badly to chemo. So he wants to discontinue chemotherapy, and start taking an "alternative" treatment instead. The "alternative" treatment, called the "Hoxsey Method," has not been legal in the United States since 1960 and the herbal components of which must be imported from Mexico, had not survived any kind of scientific testing for efficacy on Hodgkin's lymphoma.

This tears me up inside. Some sixteen-year-olds are likely to be intelligent and mature enough to understand what it means to forego medical treatment that the overwhelming weight of conventional treatment wisdom tells him to take; to understand that not following a doctor's advice while undergoing treatment for cancer is literally risking one's own life; and that such a young person is able to weigh that risk against the alternatives (including doing nothing). I can see someone with maturity and intelligence comparing the trauma of chemotherapy to his curent medical condition and deciding that maybe the pain and weakness isn't worth the marginally improved chances of survival that he would gain.

But a lot of sixteen-year-olds would not be so mature, I think. They would tend to make more impetuous decisions and deal with the issue from the standpoint of a disbelief in personal vulnerability. Death was a hard concept for me to understand as a sixteen-year-old, and I think I was a pretty mature and intelligent sixteen-year-old. Not until some of my relatives and friends died did I start really thinking hard about death and my own mortality. Still, let's give this young man the benefit of the doubt -- he's been sick for a while and has probably pondered these things much more than his peers.

So who are we, as a society, to require a person of sufficient maturity and intelligence to accept medical care that he does not want? Certainly we should satisfy ourselves that he is really making an informed, voluntary choice in not getting this medical care, but once we have satisfied ourselves of that, my basically libertarian principles tell me that society's role in the process is now complete and he can make his own decision and live (or die) with the consequences.

But then I see that he is relying on an effectively disproved treatment method, one which is probably being pushed on him by charlatans espousing the evils of the "traditional medical establishment" with some foggy-headed appeal to hope based on nothing reasonable or provable. If this young man is a person of faith, then by all means, an appeal to the diety of his choice for healing or palliation is in order, and that can be done consistently with getting medical care. But an appeal to quack medicine is just not something I can endorse. Suggesting that this alternative treatment is somehow equivalent to chemotherapy is simply incorrect. The shame of it is if he really thinks this other procedure will help him.

I guess if he has faith in it, that's worth something. But faith and prayer simply aren't good tools for healing the sick. At best, they create a kind of placebo effect; one recent study actually had cardiac patients who received intercessory prayer suffering more complications than those who did not. Of course, there are also statistical apologetics for prayer's purported healing effects, and I tend to think that the real value of scientific studies on the medical value of prayer neither confirm nor deny its value but instead strongly confirm the observer-expectancy effect. This comment isn't directly about the medical value of prayer anyway -- and seeking divine aid to recover from his illness is not mentioned in a lot of the reports about this story.

The point is that this young man is consciously choosing to take therapy that has been amply demonstrated to be quackery. He seems to be placing real hope in this course of treatment that lacks substantial scientific support. That suggests that perhaps his decision to forego chemotherapy is not so well-informed after all.

[The previous two paragraphs were edited from a previous version of this post -- TL]

I wouldn't have wanted to have been the judge in this case. That must have been a very difficult decision. But I suppose, on balance, that allowing this young man to get quack medicine instead of chemotherapy was effectively the same thing as allowing him to get no treatment at all if that were his decision. So I guess it was the right call. But it leaves a bad taste in my mouth.

(A footnote, directly appropos of no substantive issue this story raises -- the 16-year-old in question bears the unlikely name "Starchild Abraham Cherrix." If he's sixteen now, that means he was born in 1990. What kind of a parent decides in 1990 to name their son "Starchild"? They can do it if they want, I guess, but that seems like the sort of thing that hippie parents would have named their kids in the late 60's or early 70's. This young man with a lot of more important things on his mind than silly issues like baby-name fashions apparently prefers to be called by his middle name, "Abraham," which seems like a pretty good idea to me, or at least a less flaky one.)


Pamela said...

"But faith and prayer simply aren't good tools for healing the sick. At best, they create a kind of placebo effect."

I disagree with the above comment. I have witnessed many cases of prayer healing people. Once there was a man in our church who's body was filled with cancer. They gave him only a short time to live, and could not proceed with any type of surgery because of how quickly the cancer was spreading.
I remember when that man came before the church asking to be prayed for. It was his only hope. His complexion was a gray-green color, and he was so skinny. The pastors and elders of the church annointed his head with oil, and the whole church began to pray together. The room was filled with so much love. After that Sunday, we all continued to pray for him asking that God would be with him and restore his health.
A few weeks later, we saw him, and he looked like a completely different man. His face was literally glowing. He came up in front of the church with tears in his eyes and told us that the doctors checked him, and that every bit of cancer was gone! The man was fully restored, in fact, he looked like a completely different person! He is still living today, and I will never forget it! If I hadn't seen it with my own eyes, I wouldn't believe it.
There are countless testimonies of people who have been miraculously healed through prayer, but sadly, the stories never make it to the news. That's why the majority of people don't believe that it could possibly be true.

Burt Likko said...

Thank you for your story, Pam! I am very glad to hear of this man's recovery. We'll have to agree to disagree about the reasons underlying it. You write, "If I hadn't seen it with my own eyes, I wouldn't believe it." So you can at least appreciate my skepticism; I didn't see this happen with my own eyes. Still, I'm not suggesting that the events you describe didn't happen; the source of the story is impeccably trustworthy, so that means this event really happened.

Now, it's quite likely that the man's sickly, green appearance was caused by his cancer therapies (radiation and chemotherapy can be devastating) rather than the cancer itself. So when the doctors discontinued that treatment in favor of palliative care, his body would have begun to heal from the damage that the radiation and chemo treatment were causing.

Also, have you considered the possibility that the doctors misdiagnosed this man and he never actually had cancer at all -- or possibly that his cancer wasn't nearly as bad as had been diagnosed? There are certainly limits to the extent of science's knowledge and ability to both measure and alter medical events. Doctors misdiagnose their patients, particularly their gravely ill patients, a lot more than some of them would like to admit.

And I'm assuming that the man you're describing was a believer himself and that he thought that the prayer would do him some good. Even if the prayer is inherently useless, his own belief in it would have affected him to some degree, which is the placebo effect I mentioned.

The combination of the placebo effect from the prayer session, discontinuing treatments that were destroying the man's body, and considering that he might not have been nearly as sick as his doctors had told him he was, could reasonably account for the man's remarkable turnaround.

None of that renders impossible the alternative suggestion that the prayers and blessings were not responsible for his turnaround; I can't and won't try to prove that this is impossible. That's why in my original post I referenced a reasonably valid-looking statistical study supporting the use of prayer as a healing technique with positive effect. One study one way or the other does not often prove or disprove any particular theory. When evaluating an issue like this, it is important to also remember the observer-expectancy effect -- when you go looking for something in a mass of statistical evidence, you're more likely to find what you're looking for than its opposite. So if you want to believe that prayer has a positive effect, that's what the evidence will tell you; if you want to believe the opposite, the same evidence will lead you to the opposite conclusion.