Junk Science number 7
Steve Jobs died on October 5th 2011; he was just 56. The visionary founder of Apple was also the charismatic, no-nonsense, black turtle-necked presenter who introduced the iPhone, iPad and iPod to the world. His ‘simplify, simplify’ attitude to new ideas was coupled with an understanding of what the consumer would want – even if they didn’t yet know that they wanted it.
In his youth Jobs dropped out of Oregon’s Reed College after just one term, and then quit one of his first jobs (at Atari designing video games) choosing to backpack across India, live in an Ashram, become Buddhist and vegan whilst experimenting with psychedelic drugs.
In 2003 he was diagnosed with pancreatic cancer.
Shortly after his death, it was announced that, when first diagnosed, Steve Jobs had ignored orthodox medical advice and pursued an ‘alternative’ approach to his cancer treatments. On October 20th in CBS’ 60 minutes programme, his biographer Walter Isaacson said that Steve Jobs refused to allow surgeons to perform what could have been life-saving surgery on his pancreatic cancer and, in one particular interview, Jobs told him he regretted his decision to try alternative therapies and said he put off the operation because it was too invasive.
And then it started. One hundred and one articles all claiming that ‘Steve Jobs could have lived longer but for those mumbo-jumbo alternative therapies’. Better late than never, even the Daily Telegraph jumped on the bandwagon three months on with ‘Alternative Medicine is looking a bit sickly’. (Well California is a long way from London, after all).
I quote: One detail worth mentioning: anyone (sic) who has read Walter Isaacson’s superb biography of Steve Jobs is left in little doubt that unorthodox therapies hastened the death of Apple’s co-founder. Jobs’s (sic) pancreatic cancer was spotted very early, but he wasted precious months on faddy diets before he agreed to surgery, by which time the tumour had grown. Apple fans know this; it’s one of many reasons that CAM is no longer cool’. The writer then driveled on about everything from homeopathy to Ayurvedic medicine. It reminded me of black and white comedy programmes where old men sat in pubs criticising all things German because they tried to bomb the chip shop.
Let’s put some sort of scientific discipline on this:
1. Steve Jobs had pancreatic cancer:
The cancer was detected during a non-routine abdominal scan in October 2003 following a lengthy history of gastrointestinal problems. These problems quite probably would have also reduced his immune defences. However, there is no confirmation whatsoever that when the cancer was detected it was ‘spotted very early’.
Most pancreatic cancer has a terrible prognosis – half of all patients with locally advanced pancreatic cancer die within ten months of the diagnosis; half of those, in whom it has metastasized, die within six months. These pancreatic cancers are cancers of the pancreatic cells, like the cancer of Patrick Swayze.
However, Jobs had a particularly rare cancer in the islets of Langerhans – the cells that produce insulin. This cancer is called a neuroendocrine cancer and, although it was inside the pancreas it was not typical pancreatic cancer. “If you catch it early, there is a real potential for cure” according to cancer surgeon Joseph Kim of City of Hope, the comprehensive cancer center in Duarte, California.
If he had symptoms before the scan they would have been driven by high insulin levels and a profound drop in blood sugar which can lead to shakiness, cold sweats, nausea, vomiting, blackouts, and neurological changes such as impaired judgment, moodiness, irritability, apathy, and confusion.
Importantly, the type of cancer Jobs had is defined as slow growing, or indolent. Indeed it can be so indolent that patients can die with it, rather than because of it. This rare cancer is diagnosed in about 2,500 Americans a year and is thought to be linked to poor diet and alcohol. Autopsies show that it is likely to be present in more than double this number of people – people who had no idea it was present, such is the slow growth.
2. Steve Jobs put off the surgery because he considered it too invasive.
Whichever way anyone might try to spin this, Jobs’ own account to his biographer (and also confirmed by his wife) was that he was afraid of having the surgery. This is quite understandable as the procedure is not without risks. Importantly, at the time, Jobs did not actually rule out having orthodox treatment – he made a positive decision to delay it whilst exploring other routes. With an aggressive cancer a delay of nine months might be serious but the neuroendocrine cancer is NOT an aggressive cancer.
He may well have been told his cancer was slow growing – that people died with it, rather than from it? He certainly would have found this out when he searched the internet. Did that make him think he had time to try less invasive routes?
When he finally had the surgery, the normal Whipple procedure needed to be modified to remove the right side of the pancreas, the gallbladder, and parts of the stomach, bile duct, and small intestine. Was this also part of his original fear? Did the metastases to his bile duct, stomach and small intestine really occur in the nine months delay? Or was there already a discussion about possible spread to other organs at the outset, thus making him worry even more?
Another option is that at the time of the original diagnosis no one knew that the cancer had spread so far – such extensive surgery is called for only after metastases and, according to Joseph Kim, these may not be detectable until the patient is actually operated on. Jobs was certainly not stupid – a few hours on the internet would have told him all the options.
Jobs would also have known that the surgery may be followed by chemotherapy and radiotherapy, both of which can cause significant suffering. It’s a lot to handle if you are an independent spirit like Jobs; a spirit used to being in control of all around him. Would he really have wanted to hand over control to orthodox medical practitioners immediately?
“Your time is limited, so don’t waste it living someone else’s life. Don’t be trapped by dogma – which is living with the results of other people’s thinking. Don’t let the noise of others’ opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.” Steve Jobs
3. Jobs did have orthodox treatment.
Even those neuroendocrine tumours that have been present for years, and in some cases decades, often stay safely confined to the pancreas.
However, a 2004 scan showed that Jobs’ tumour had grown in size – but I can find no confirmation that it showed spread.
And there is little debate about the best treatment – patients with neuroendocrine cancer that has not spread beyond the pancreas can live for many more years, again because this is such a slow growing cancer.
After spread to the liver, Jobs had a liver transplant. There must have been huge debate about that. On one hand his liver was damaged, on the other the immune suppressants following a transplant would have made the fight with the cancer harder, even unwinnable.
4. Steve Jobs did not have ‘alternative’ cancer treatments.
Let’s be clear about this. Alternative cancer treatments include such developments as Dendritic Cell Therapy (used, for example, by Duke University Medical Center for brain tumours), Virotherapy (used, for example, by MD Anderson for lung cancers); Localised Hyperthermia (see the research on HIFU for prostate cancer or from the Karolinska for breast tumours) and so on. (See http://www.canceractive.com/cancer-active-page-link.aspx?n=2656&Title=Alternative%20cancer%20treatments, where we try to get a sense of proportion on it all, whilst bring patients the latest information). There is a relevant ‘Diet Therapy’ from Dr Nicholas Gonzalez in New York and in early Clinical Trials it did seem to outperform the orthodox route for pancreatic cancer. There is debate on later trials and, anyway, Jobs did not have ‘common’ pancreatic cancer.
But this is not what Jobs did. He had a ‘special diet’ (apparently the Dr Dean Ornish anti-cancer diet) including a low fat and vegan approach, juice fasts, herbs, bowel cleansing, acupuncture and spiritual healing. He even consulted a psychic. These may be ‘complementary therapies’ but anyone who considers these ‘alternative therapies for cancer’ is in mumbo-jumbo land. And that includes both Jobs and the journalists who have been writing articles along these lines.
I have written before, for example, on subjects such as going vegan once diagnosed with cancer. Yes, I know there is research showing vegetarians get less cancer but there is not one single drop of research that says, once you have it, turning vegetarian extends survival times. I have also covered 4 research studies in the last 5 years on the dangers of glucose (people with lower blood glucose levels survive longer), but there is no research to my knowledge that says low fat diets increase survival times too.
Modified diets, bowel cleanse, acupuncture? These are, at best, treatments you may use to complement your core treatments, or reduce side effects. Yes, I know the woman down the road found homeopathy helped her through her chemotherapy. But as an alternative cure for cancer?
Did these unorthodox therapies ‘hasten the death of Steve Jobs’? Did they cause the spread of an indolent cancer? Was there hard evidence that surgery 9 months earlier would have found no metastases? I cannot find anything other than conjecture, but my take is that it is highly likely the slow spread from the islets had already taken place.
However, the orthodox medical profession will be rubbing their hands with glee, and the PR departments at the drug companies and orthodox charities will be working overtime to get more and more articles out, aided and abetted by journalists (?) who jump on the bandwagon, however tardy. Extrapolations will be made to include any treatment not approved in triplicate by the FDA, the BMA, the drugs companies and a committee of approved oncologists. We have had it all before; for example, if you are British you may remember how Jade Goody’s life would clearly have been spared had she received the wondrous HPV vaccine? Get your daughter vaccinated today – you have been warned.
I will leave the last (scientifically proven, of course) words to the Telegraph’s blogger from the article which featured Mr. Jobs in picture and content: The market for snake oil remains enormous in other countries: the dodgy “experts” who once had a foothold in Western universities are now offloading their vitamin treatments for Aids on the developing world. Despicable.
In Britain, however, the demand for expensive placebos and assorted rip-off courses is now severely curtailed. If we exclude immigrants, who have their own useless remedies, the major consumers of CAM are ladies who lunch. I keep meeting rich Tory women who spend a fortune on alternative medicine. They find it so rejuvenating, they mutter through their freeze-dried facelifts.
Oh dear – quick, where’s my bottle of shark cartilage?