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October 12, 2011 8:40 PM   Subscribe

A Harvard oncologist answers the question (and more): Why did Steve Jobs choose not to effectively treat his cancer?
posted by kyp (122 comments total) 18 users marked this as a favorite

 
Thanks for posting. That question has really been nagging at me since his passing and I've been waiting for some kind of analysis like this.
posted by floam at 8:43 PM on October 12, 2011 [2 favorites]


THe husband of a dear friend died from this. He was the medical director of Kaiser Southern California. Sometimes, shit happens, despite all the treatments, care, meds, etc. you throw at it.
posted by Ideefixe at 8:49 PM on October 12, 2011 [1 favorite]


And yet the actual "why?" answer could have been given by anyone acquainted with Jobs from his depictions in the media, and do not at all derive from the answerer's being an oncologist, much less a Harvard oncologist.
posted by kenko at 8:49 PM on October 12, 2011


This article, written by an oncologist at the Barbara Ann Karmanos Cancer Institute, takes a different view.

"Aside from the initial nine months, Jobs, as far as we know, relied on exclusively on conventional therapy to treat his disease. In fact, he underwent the most invasive, cancer aggressive operation (the Whipple pancreaticoduodenectomy), which is one of the biggest, if not the biggest operation, that surgical oncologists do. Then, after his tumor recurred in his liver, he underwent the biggest, mot technically complex type transplant operation there is, a liver transplant." [...] "So, is it possible, even likely, that Jobs compromised his chances of survival? Yes. Is it definite that he did? No, it’s not, at least it’s not anywhere as definite as Dunning makes it sound. In fact, based on statistics alone, it’s unlikely that a mere nine months took Jobs “from the high end to the low end of the survival rate,” as Dunning puts it."

"If there’s one thing we’re learning increasingly about cancer, it’s that biology is king and queen, and that our ability to fight biology is depressingly limited. [...] Jobs was unfortunate in that he appears to have had an unusually aggressive form of the disease that might well have ultimately killed him no matter what."
posted by vorfeed at 8:50 PM on October 12, 2011 [10 favorites]


He chose to reject conventional medicine altogether.

What the hell? This is really stupid.
posted by lalex at 8:53 PM on October 12, 2011 [3 favorites]


I'd prefer an answer to the question of whose business Steve Job's health decisions was, but that's a pretty simple one to figure out.
posted by localhuman at 8:56 PM on October 12, 2011 [25 favorites]


I'm not a mac user. While I recognize how innovative a company it is, I have found the tributes to Steve Jobs in the wake of his passing have shot way past hagiography into something else altogether.

Now that that's out of the way, an oncologist working from a sketchy (at best) data set saying "it seems sound to assume that Mr. Jobs' choice for alternative medicine has eventually led to an unnecessary death" strikes is as incredibly disrespectful. Am I the only one?
posted by to sir with millipedes at 8:57 PM on October 12, 2011 [17 favorites]


I think the question shouldn't have been "Why?" but "How did his choices affect the outcome?".

In fact, based on statistics alone, it’s unlikely that a mere nine months took Jobs “from the high end to the low end of the survival rate,” as Dunning puts it."

...

Jobs was unfortunate in that he appears to have had an unusually aggressive form of the disease that might well have ultimately killed him no matter what."

I'm not sure exactly what was taken into account in the statistics, and I certainly don't have any special knowledge, but if we take it as granted he had an unusually aggressive form of the disease doesn't it seem that perhaps those 9 months — in hindsight — could have been more critical than the average case?
posted by floam at 8:57 PM on October 12, 2011


Jobs was absolutely correct in bucking conventional wisdom many many times. He was wrong this time.
posted by twoleftfeet at 9:03 PM on October 12, 2011 [5 favorites]


That was an interesting article -- I now know 100 percent more about pancreatic cancer than I did before -- but it took a monstrously silly angle. This guy doesn't know what really went on, so it's just speculation, which is fine if that's all you're doing. Write that same article a slightly different way, and it's a must-read for anyone interested in Jobs' passing.
posted by Cool Papa Bell at 9:06 PM on October 12, 2011 [1 favorite]


It's the top voted answer on quora and it puts down alternative medicine so it has to be right. Can we get this guy to explain how Anna Nicole Smith and Casey Anthonys baby died too?
posted by Potomac Avenue at 9:11 PM on October 12, 2011 [3 favorites]


Thank you, kyp, I found this highly critical article just after Jobs' passing and was seriously tempted to post it but worried that it was too 'flame-bait-y'. But it does represent a common opinion among people who know the medical science more than they know the man involved.
posted by oneswellfoop at 9:12 PM on October 12, 2011


While Mr. Jobs was trying all sorts of alternative mumbo-jumbo I won't even bother to go through as their failure is now sadly irrefutably proven

Please. He spent 9 months on alternative therapies then 7 years in conventional therapies, then died. It's nice to encourage people to use science-based medicine, but many seem to be missing the sad, hypocritical irony of doing so through this sort of wild speculation, blaming events from 8 years ago on Jobs death a week ago, when no one knows the facts of the case. Here's a far more level-headed take
posted by crayz at 9:14 PM on October 12, 2011 [2 favorites]


Maybe, just maybe, we'll see some actual regulation of the homeopaths now that some rich, iconic white guy on the west coast died from following their bullshit as opposed to hordes of poor, anonymous, HIV positive (or susceptible) black peasants in Africa who pop off on a regular basis.

Good to see a doctor coming out with the, "I respect your right to decide your own course of action, but it was fucking stupid then and now in hindsight."

There are times to opt for palliative care, times to just grin and bear it (whether due to financial reasons or a terrible prognosis despite months of painful chemo) and times to get it the fuck out.

If it turns out to be a BS rumor? Still useful in drawing attention to the homeopathy swindlers.
posted by Slackermagee at 9:16 PM on October 12, 2011 [9 favorites]


Something I wish I had added to the description:
"I found the technical details more interesting that the answer itself."

And also more viewpoints for a broader perspective.
posted by kyp at 9:21 PM on October 12, 2011


"Jobs was an acid-tripping hippie back in the day, and a conventional medicine skeptic now. His reaction to the disease gave the disease time to spread."

Sure.
posted by parki at 9:23 PM on October 12, 2011


If it turns out to be a BS rumor? Still useful in drawing attention to the homeopathy swindlers.

It's useful to spread hyperbole if not outright falsehoods to promote what you believe to be best for others. Gotcha
posted by crayz at 9:28 PM on October 12, 2011 [5 favorites]


>He chose to reject conventional medicine altogether.

What the hell? This is really stupid.


What I got from the Quora answer was that Steve Jobs may have underestimated how serious his cancer was. He may also, according to the Quora article, have been in denial. Basically, Steve Jobs was human, just like the rest of us.
posted by KokuRyu at 9:29 PM on October 12, 2011 [8 favorites]


Sorry, what I meant was that the assertion that Jobs rejected conventional medicine altogether is demonstrably false, and that this is a really stupid article.
posted by lalex at 9:31 PM on October 12, 2011 [4 favorites]


"If it turns out to be a BS rumor? Still useful in drawing attention to the homeopathy swindlers."

so, even if there is no evidence to back it up, the object lesson is worth it? the homeopathy side makes up shit all the time as a lesson. i prefer when defending facts to stick with facts.

this is already posted in the Jobs thread. posting this without the rebuttal (and having that only appear in the comments, which sadly a lot of people will miss) is grossly one sided.
posted by nadawi at 9:32 PM on October 12, 2011 [2 favorites]


Good to see a doctor coming out with the, "I respect your right to decide your own course of action, but it was fucking stupid then and now in hindsight."

WTF? What business is it of you or that doctor to pass judgement on what Jobs ( or anyone else, for that matter, including the poor anonymous black HIV peasants) decided to do about his health, his life, or his death?
I wish people would just keep their shitty opinions to themselves. When you get diagnosed with pancreatic cancer, you'll get to make your oh-so-wise decisions for yourself, mkay?
posted by c13 at 9:32 PM on October 12, 2011 [5 favorites]


Excellent post. I think someone should put together a MiFi post on the broader question of why Americans are so prone to falling for alternative medicine//naturopathy/homeopathy and all the related bunk. Here in San Francisco, many conventional medical practices are forced to include homeopathic or other alternative elements, since so many patients believe in it (while presumably the doctors know that most of it is glorified sugar pills). I think a lot of the reason Americans buy into this stuff is a direct result of our insanely screwed up health care system. Not that Jobs in particular ever got screwed by his insurance company or waited 9 hour in an ER to get acute care or any of the other nightmares most of us face, but he is a product of the society which broadly has to face a for-profit system, a society that just doesn't trust the system anymore...
posted by jackbrown at 9:32 PM on October 12, 2011 [1 favorite]


I had this realization the other day listening to Bill Maher describe his alternative food healthy diet thing. All these "whole foods" that magically heal your body, they're still agricultural products created over thousands of years of selective breeding. And guess what, they were not bred to keep individuals alive for centuries.

Pretty much every food stuff out there you can eat is biotechnology already (even organic foods with no gene modification or anything). Everything has been fiddled with by people for a long damn time. Unless you're picking berries and nuts in the woods and stabbing an occasional elk, you're not eating "natural food".
posted by Chekhovian at 9:35 PM on October 12, 2011 [8 favorites]


I'm not sure exactly what was taken into account in the statistics, and I certainly don't have any special knowledge, but if we take it as granted he had an unusually aggressive form of the disease doesn't it seem that perhaps those 9 months — in hindsight — could have been more critical than the average case?

Did you read the rest of the article? Because yes, that's pretty much the conclusion: "I have no doubt that Jobs might well have compromised his chances of survival by delaying, but it’s just not scientifically supportable to leap to the conclusion, as Dunning does, that he compromised his chances so much that “alternative medicine killed him.” What is known about Jobs’s case and insulinomas do not support such a conclusion; at worst they support a conclusion that Jobs might have decreased his chances somewhat. [...] That’s not to say that we shouldn’t take into account his delay in treatment and wonder if it contributed to his ultimate demise. It very well might have, the key word being “might.” We don’t know that it did, which is one reason why we have to be very, very careful not to overstate the case and attribute his death as being definitely due to the delay in therapy due to his wanting to “go alternative.”"

Or I guess you could conclude that "Jobs was an acid-tripping hippie back in the day, and a conventional medicine skeptic now", and that's "why". Who needs nuance?
posted by vorfeed at 9:35 PM on October 12, 2011 [3 favorites]


What the hell? This is really stupid.

The way you're "supposed" to approach the alternative stuff if you're really set on that is you show up for treatment like the doctor tells you, and then go to the sweat lodge on weekends. Or wait until there's no hope from medicine and then give it a shot. The CAM proponents that don't want to get sued will tell you that their treatments should complement conventional medicine whenever anything dangerous is involved. You really, really, really shouldn't go ahead and spend the better part of a year doing your own thing after you've been diagnosed with cancer. I don't think it's really an unfair statement. Much of the alternative medicine people go for is quiet benign, but when folks choose it in lieu of the proven methods, people can die from it.
posted by floam at 9:36 PM on October 12, 2011


And homeopathy, dear lord...if you skin your knee on a rock, no sane person would grind up the rock into a fine powder, dilute it until there was little chance that any of the rock remained, then drink the solution...
posted by Chekhovian at 9:37 PM on October 12, 2011 [1 favorite]


jackbrown, it's not just Americans who fall for it. In many European countries homeopathy is provided and paid for by both public health services and private insurance companies.

My best friend's dad had the exact same diagnosis that Steve Jobs had. He had surgery (not as invasive as Jobs's), and just hit five years in remission. It's the crapshoot of biology.
posted by infinitewindow at 9:38 PM on October 12, 2011


I think this is really hard for people to conceptualize because it involves probability. Jobs was told he had cancer, did nothing for 9 months, then later dies. Clearly his stalling killed him. But consider a hypothetical: what if they hadn't originally found the cancer until 9 months later, when he switched to conventional medicine. Would he still be alive today? You're sure? How long did he have cancer for before those 9 months? It could have been years or decades, according to the same blog

What these people are saying is: those 9 months made the difference between his being alive today and not. That is simply conjecture, and these science fanatics should know better
posted by crayz at 9:50 PM on October 12, 2011 [6 favorites]


@infinitewindow: yeah I guess most of my non-American experience has been in third-world countries where people who can afford real medical treatment are happy to get it and they vaccinate their kids because it's one of the few bits of useful help the state (or at least the WHO) provides its citizens, instead of thinking its a plot to spread autism by Big Pharma (who are indeed a bunch of evil SOBs, but who spread myths about Testosterone Deficiency and ADHD rather than Autism). Still, my not-very-comprehensive impression of Europe is that the amount of advertising of bullshit vitamin-pill cure-alls is considerably less than in the states; moreover I bet that a lot of the homeopathic crap the Germans and French ARE submitted to is unfortunate thought pollution that blows across the atlantic from these benighted shores.
posted by jackbrown at 9:50 PM on October 12, 2011 [1 favorite]


He shouldn't have been able to choose how he wanted to die. How selfish. If he had stayed alive for one or two more years I may have had a slightly better phone.
posted by jimmythefish at 9:50 PM on October 12, 2011 [3 favorites]


when a (very poor) family member got pancreatic cancer as a child, one of the first things after diagnosis that was provided was a liaison between her mother and hospital and all the "cancer treatment centers" - the liaison's job was to look at all the treatments and offers and help the family make the right decisions. i would find it incredibly bizarre if Jobs didn't have a team of people helping him sort through all of this.

none of us were with him at the appointments, none of us know what treatments he did or didn't do. this guy read some magazine articles, called it trusted sources in the media, and jotted off an answer. this is less useful than nancy grace's "legal experts." he's a guy in his underwear, eating cheetos, appealing to authority, and speaking as if his armchair analysis should mean a fucking thing.

also, am i missing something? he doesn't appear to actually be a doctor, just on faculty in oncology, per his CV he's doing post graduate work. per his linkedin profile he's looking for ways to finance the scale and duration of the project. i wonder if this is meant to raise his google profile.
posted by nadawi at 9:51 PM on October 12, 2011 [6 favorites]


Besides, if Jobs had cancer that really did require a Whipple procedure after nine months, and then invaded the liver and forced a transplant after that, and then came back and just plain killed him... well, maybe that's just it. Maybe. That's. Just. It.

I know we all like to think that we can fix these things, but sometimes we can't. Maybe Jobs would have died anyway -- many people in his position do all the right things and then die of cancer just the same. Maybe he chose nine months of living normally rather than "having to eat a diet like that of patients who have their stomachs (or large portions thereof) removed". Maybe he did "opt to dedicate his time to Apple as the disease progressed". And maybe that was worth it to him; maybe that's the way he preferred to live and die.

We don't know.
posted by vorfeed at 9:55 PM on October 12, 2011 [10 favorites]


Nice catch Nadawi. I especially wondered about his claim that he's studied this kind of cancer for 1.5 years. Is that a lot of years? It sounds like a three semester to me--like a junior Philosophy major giving life advice "I've studied wisdom for almost a full term, and I can tell you something about choices!"
posted by Potomac Avenue at 9:56 PM on October 12, 2011 [5 favorites]


This doctor does not seem to understand that falling stars are going to be falling stars.
posted by polymodus at 9:58 PM on October 12, 2011


A lot of people don't seem to realize that homeopathy's 0.001% success rate is in fact 100%, just significantly diluted several times over.
posted by DoctorFedora at 9:58 PM on October 12, 2011 [23 favorites]


If there’s one thing we’re learning increasingly about cancer, it’s that biology is king and queen...

Hand up - who believes your odds of living 10 years after being diagnosed with cancer are about the same now as they were in 1950? So, what, are we now made of different meat these days, or what?

He spent 9 months on alternative therapies then 7 years in conventional therapies...

Cancer is very much like a wild fire. In emergency response circles it is pretty much recognized that "how the first five minutes go can determine how the next five hours will go, and how those five hours go can determine how the next five days go."

Waiting nine months is nuts! If Jobs were literally on fire, who in they're right mind would say "It's OK to let him burn for a little while" and then blame the plastic surgeons for not getting him back to looking like his old self?
posted by Kid Charlemagne at 9:58 PM on October 12, 2011 [25 favorites]


I do not understand why Steve Jobs would have delayed having the tumor removed, but I'm coming at this as someone who had renal cell carcinoma and the first thing I thought was "get it out." I had to wait more than two months for surgery (long story involving doctors and how fat people are treated by them) and the entire time I was worried about whether or not this delay was eventually going to harm me.

Now, three years later, I'm "watchfully waiting" over pulmonary nodules to see if they grow enough to be biopsied. If, it turns out to be mets in my lungs, I will wonder until my dying day if those 2.5 months are when the cells got out.
posted by SuzySmith at 10:00 PM on October 12, 2011 [3 favorites]


It's useful to spread hyperbole if not outright falsehoods to promote what you believe to be best for others. Gotcha

Sugar pills can make you feel good, they won't stop the actual disease. Sorry if that treads on a few toes.
posted by Slackermagee at 10:00 PM on October 12, 2011 [1 favorite]


vorfeed: I agree. And I've read the sciencebasedmedicine.org article, and indeed, it's much better than the quora answer. But I still come to a different conclusion than you. I don't think anyone is arguing that it was a good idea to waste those nine months. Who really cares about the what-if game? He's dead now, he's not coming back. The point to me is, he did practice some unquestionably risky behavior that should not be emulated, and maybe some lives can be saved by learning about that.
posted by floam at 10:00 PM on October 12, 2011 [3 favorites]


this guy on his twitter also claims that Jobs went after alternative medicines for years. sounds like he has an axe to grind and like some people in this thread feels ok if the facts don't back him up as long as the lesson gets out there.
posted by nadawi at 10:01 PM on October 12, 2011 [1 favorite]


like some people in this thread feels ok if the facts don't back him up

I don't know about anyone else - I had know idea Jobs did the alternative medicine thing - but here's what they had to say on CNN.com back in August.
posted by Kid Charlemagne at 10:40 PM on October 12, 2011


a CNN article that talks about the same Forbes article this post-graduate guy read that citing anonymous sources he "confided in" and seemingly passes it off as iron clad fact.

as for the "like some people in this thread" i was talking about the comments that it's ok if this is a BS rumor.
posted by nadawi at 10:49 PM on October 12, 2011 [1 favorite]


I was diagnosed with a form of leukemia two years ago. Within a few days of the formal diagnosis, I sent out an email to friends and family to let them know about it and the treatment prognosis, etc.

I got back a few really stupid, stupid suggestions from downright ignorant people. One suggested that the medical community was a bunch of butchers and didn't understand cancer at all, and that I should go on an acerola diet and a few other pearls of bullshit alternative "wisdom".

I chose, instead, to follow my physician's course of chemotherapy and then hopped onto Gleevec, a wonderful new drug developed in the past twenty years, based on incredibly detailed analysis of the human genome and absurdly diligent pharmaceutical research based on peer-reviewed, double-blind testing. Complete remission, I'm happy to say.

No offense to Jobs, whom I admire greatly, but I suspect that, had I spent 9 months on various alternative therapies before finally trying Gleevec, I'd be dead now. So yeah, I'll stick with the science-based approach to medicine and leave the homeopathy and woo to others.
posted by darkstar at 10:57 PM on October 12, 2011 [16 favorites]


What business is it of you or that doctor to pass judgement

I don't get this objection. Why shouldn't we form opinions on someone's actions? It would be wrong to intrude on his family's grief or the like, but talking about it in a Metafilter comment thread does nothing of the sort.

Someone delaying effective treatment of any form of pancreatic cancer for 9 months has made a serious error in judgment whether or not later treatment saves his or her life. Sometimes that 9 months will kill them, sometimes it will not. Did it kill Jobs? We'll never know with certainty. It sure didn't help.

Choosing to treat cancer for 9 months with a special diet instead of medicine is crazypants. Even if you invented the iPod. There's nothing wrong with saying that here.
posted by Justinian at 11:00 PM on October 12, 2011 [11 favorites]


The point to me is, he did practice some unquestionably risky behavior that should not be emulated, and maybe some lives can be saved by learning about that.

Maybe so. However, I don't think they can be saved by lying about it, and that's exactly what the linked article is doing.

As for "who really cares about the what-if game", the answer is pretty obvious: Steve Jobs cared. I suspect that the what-if game was very real to him when he was making the decision, which is really the only moment that matters here. He was faced with an incredibly nasty surgery with life-altering side-effects in order to cure a cancer known for being slow-growing. I'd say "Jobs might have decreased his chances somewhat" is a pretty fair way to put the decision to wait, and I doubt he was unfamiliar with the weight of the dice he was rolling.

As always with cancer, quality of life versus quantity of life factors into every decision. I do not buy the idea that there's only one answer. Homeopathy is pure bunk, but as far as I'm concerned people have the right to "waste" their lives however they damn well please, unquestionably risky or not.
posted by vorfeed at 11:00 PM on October 12, 2011 [1 favorite]


Good to see a doctor coming out with the, "I respect your right to decide your own course of action, but it was fucking stupid then and now in hindsight."

I wish people would just keep their shitty opinions to themselves. When you get diagnosed with pancreatic cancer, you'll get to make your oh-so-wise decisions for yourself, mkay?


It's not a shitty opinion, it's a critical one, and quite possibly also an accurate one.
People have the right to do fucking stupid things. And people have the right to point out (especially when they care deeply about that person) "hey - what you're doing is fucking stupid".
posted by -harlequin- at 11:01 PM on October 12, 2011 [3 favorites]


Steve Jobs was consistent. Here is a relevant portion of Steve Jobs commencement speech at Stanford University, in 2005. For anyone who hasn't taken 15 minutes to hear the whole thing, it's quite inspirational.

Steve Jobs:
"...I can now say this to you with a bit more certainty than when death was a useful but purely intellectual concept:

"No one wants to die. Even people who want to go to heaven don't want to die to get there. And yet death is the destination we all share. No one has ever escaped it. And that is as its hould be, because Death is very likely the single best invention of Life. It is Life's change agent. It clears out the old to make way for the new. Right now the new is you, but someday not too long from now, you will gradually become the old and be cleared away. Sorry to be so dramatic, but it is quite true.

"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"
posted by Vibrissae at 11:06 PM on October 12, 2011 [2 favorites]


And yes, for the record I think waiting was a bad decision, and it's not the one I'd have made... but these simplistic "fucking stupid", "crazypants", "just like a wildfire" narratives don't begin to address or even acknowledge the trade-off you have to make when it's the top half of your stomach being sewn onto the bottom half of your pancreas. If I'd been faced with that I might've seriously considered putting the bottom half of my pen to the top half of a suicide note... homeopathy ain't the, um, half of it.

You know what's fucking crazypants stupid? Cancer.
posted by vorfeed at 11:14 PM on October 12, 2011 [7 favorites]


But this isn't a decision about, say, a slow growing prostate cancer in an elderly man. That's the kind of situation in which you might reasonably make a choice to avoid treatment because of the side effects. Because it's quite possible you'll die from an unrelated cause before the cancer gets all that bad.

The side effects of a successful Whipple procedure are not nearly as bad as you're implying with the lurid description of the procedure. Yes, the procedure itself is quite major.

The side effects of not getting it done with pancreatic cancer are as follows: death.
posted by Justinian at 11:22 PM on October 12, 2011 [1 favorite]


It most certainly is a shitty opinion. None of us here are Steve Jobs. We know absolutely nothing about what he thought of his diagnosis, prognosis, what trade offs he would have to make, etc, etc, etc. We don't know what his views were about life and mortality (well, aside from Stanford speech). His hopes and fears.. Hell, most of us here don't even know how we ourselves would react when presented with something similar!
Besides, while you may think that your death is the most horrible thing in the universe, something that must not be allowed to happen ever ever at all costs, can you at least imagine that it may be possible for someone to hold a different view? And that this view is no more crazypants or stupid than yours?
posted by c13 at 11:28 PM on October 12, 2011


The side effects of not getting it done with pancreatic cancer are as follows: death.

Presumably that's why he got it done.
posted by vorfeed at 11:40 PM on October 12, 2011


I think Nadawi has tapped into the source and a more critical reading of the material. But lets break out the issues:

* Steve Jobs MAY have sought alternative therapies -- no iron clad confirmation
* His choices MAY have effected his longevity but again we are not sure what his choices were
* Multiple narratives vie for the rhetorical stance that homeopathy is bad or standard treatment is bad -- using Steve Jobs as point/counter-point
* Medical parties commenting are not the the direct participants of the events; speculation abounds from "experts" of differing quality but again, outside speculation
* Personal experience brought in such as, "I had ... and decided to do ....", judgement of Jobs' choices through the prism of personal experience

Have I got this right?
posted by jadepearl at 11:47 PM on October 12, 2011 [4 favorites]


Besides, while you may think that your death is the most horrible thing in the universe, something that must not be allowed to happen ever ever at all costs, can you at least imagine that it may be possible for someone to hold a different view?

This doesn't really seem relevant given that Jobs had the procedure 9 months later.
posted by Justinian at 11:48 PM on October 12, 2011


* Steve Jobs MAY have sought alternative therapies -- no iron clad confirmation

Is there some dispute about the fact that he didn't have surgery for 9 months after diagnosis? Or are you just saying he may not have used alternative therapies in the interim?
posted by Justinian at 11:51 PM on October 12, 2011


Again, not knowing anything that went through his head, can you imagine a possibility that he chaned his mind? For example?
posted by c13 at 11:53 PM on October 12, 2011


Death is very likely the single best invention of Life. It is Life's change agent. It clears out the old to make way for the new. Right now the new is you, but someday not too long from now, you will gradually become the old and be cleared away.

Thanks for quoting all of that, Vibrassae. I saw the part of his speech after that ("have the courage to follow your heart and intuition...", etc.) repeatedly endlessly on network news after Jobs died, but they left out the sentences just before, making the soundbite seem like the usual trite shit - "be true to yourself". I guess they didn't want to scare anybody by acknowledging the reality of death. The context makes it way more powerful.
posted by twoleftfeet at 11:57 PM on October 12, 2011 [1 favorite]


As for "the side effects of a successful Whipple procedure are not nearly as bad as you're implying with the lurid description of the procedure", maybe not -- like I said, putting it off sure isn't the choice I'd have made. But I can certainly see why someone else might make a different decision.

I'd tend to argue that any illness is "the kind of situation in which you might reasonably make a choice to avoid treatment because of the side effects". If the patient has the facts and the treatment is unwanted, that's enough. IMHO the right to make that decision is far more important than making sure everyone knows that homeopathy doesn't do anything (duh), and the disrespect people are showing for the former along with the latter is unfortunate.
posted by vorfeed at 12:00 AM on October 13, 2011 [1 favorite]


"No one wants to die. Even people who want to go to heaven don't want to die to get there. And yet death is the destination we all share. No one has ever escaped it. And that is as its hould be, because Death is very likely the single best invention of Life. It is Life's change agent. It clears out the old to make way for the new. Right now the new is you, but someday not too long from now, you will gradually become the old and be cleared away. Sorry to be so dramatic, but it is quite true.

The doors are locked. Please stay in your seats. You will be immolated shortly.
posted by This, of course, alludes to you at 12:00 AM on October 13, 2011 [2 favorites]


or
quite true.

This is why we are building the superbomb.
posted by This, of course, alludes to you at 12:03 AM on October 13, 2011


IMHO the right to make that decision is far more important than making sure everyone knows that homeopathy doesn't do anything (duh), and the disrespect people are showing for the former along with the latter is unfortunate.

People have the right to make all sorts of decisions, and others have the right to think they made good or bad decsions. Is anyone talking about taking away rights? Do you think we shouldn't make judgments about, say, choosing not to vaccinate?
posted by Justinian at 12:10 AM on October 13, 2011


choosing not to vaccinate compromises herd immunity which puts other people at risk. who did Jobs hurt besides (possibly) himself?

Is there some dispute about the fact that he didn't have surgery for 9 months after diagnosis? Or are you just saying he may not have used alternative therapies in the interim?

personally, what i'm saying is that we don't know what conversations he had with his doctors. we don't know why the surgery was delayed for 9 months. we know, according to him, when he got the diagnosis and we know when he got the surgery. we have no idea what traditional or non-traditional things in did in the interim.

maybe Steve said to his doctor, "i'd like to try other things before the surgery" and his doctor said "ok, try this that or the other, lets give it 6 months." and then at the end of that they scheduled it and there were issues of "it has to be after such and such but before this other thing and we have to make sure this that and the other doctor are available" since none of us were privy to any of these discussions and he's not here to tell us any of it, all this not-doctor is doing is spitballing based upon word of mouth of someone who claims to be trusted by Jobs, but will still blabber to the press.
posted by nadawi at 12:18 AM on October 13, 2011 [1 favorite]


It's fairly straightforward why people dig this 'alternate medicine' nonsense over conventional medicine. Because health is both mundane and fucking scary, people ignore signs until the last moment or at least are in denial.

When reality strikes them, it strikes them hard, so they prefer to believe in magic and voodoo over making rational choices on risk and other mathematical concepts. Essentially, people trust narratives more than they trust math; nothing country-specific about it, you get that in all societies.

The only question I have with regards to Jobs is whether his commencement speech at Stanford was after he came to terms with his cancer (an accepted conventional treatment) or before. In my experience, people suffering from a terminal disease and seeking alternative medicine aren't as karmaic as he sounds in that speech. I have a feeling the speech was a turning point of sorts for him; his earlier comments werent this philosophical and karma-ic.

If it is, then it's a dramatic demonstration of how cancer can grow exponentially, and how a small difference in time can lead to widely differing results.
posted by the cydonian at 12:21 AM on October 13, 2011


I wish people would just keep their shitty opinions to themselves.

Yeah, well, that's just, like, your shitty opinion, man.
posted by obiwanwasabi at 12:54 AM on October 13, 2011 [1 favorite]


Can you imagine that waiting nine months to change his mind may very well have resulted in his untimely death?

Also, nothing I've said here has bee through the filter of personal experience - the people I've been closest to who have died of cancer were not so fortunate for it to be detected when they still had a fighting chance. Instead, it comes from spending the last five or six years thinking really hard about logistic growth curves. The difference is that the curves I've been thinking about weren't populations of rogue cells which, unopposed, would kill me. (I was considering something else that might kill someone else, though.)

While the guy who wrote the comment the FPP links to was unnecessarily harsh, the fact remains that Steve Jobs is dead, he died too young and he died in a pretty unpleasant way. If Jobs deferred treatment for nine months, that was not wise and he may very well have paid the ultimate price for that delay. This is not some damn debate about the Apple design aesthetic. "Think Different" is only slightly less inappropriate right now than Sid Viscious' rendition of "I Did It My Way!"
posted by Kid Charlemagne at 12:58 AM on October 13, 2011 [2 favorites]


But Jobs didn't kill a cat or fuck a bloke - did he?

(Oh, wait - you said Sid Viscious. Sorry, not familiar with that version, but it sounds sticky…)

Steve Jobs made his choices, based on information all but a few can only guess at, and - like all of us - had to live the the outcomes. Criticising those choices now is nothing more than a particularly ghoulish form of armchair quarterbacking, and those who go beyond that and use it to push their own opinions and agendas are simply reprehensible.
posted by Pinback at 1:18 AM on October 13, 2011 [1 favorite]


Justinian, from sources being used there is no one stating explicitly that alternative therapies were used except as secondary information:
let me start by stating that all the details on Jobs specific case are based on secondary sources, albeit from reliable sources in the media...Mr. Jobs allegedly chose to undergo all sorts of alternative treatment options before opting for conventional medicine. (the FPP)
So Jobs doing alternative therapies, whatever that may mean, is not iron-clad. Seriously, we do not have any direct participants in his care or treatment (that I have seen so far) about his choices and thought processes.

I am a bit dubious about the author 1) stating that the author has NO specific details of Jobs' case; 2) admission of secondary sources with the shield of "reliable sources in the media" but no citation; 3) From an alleged action a judgement of treatment paths taken or not taken.
posted by jadepearl at 1:21 AM on October 13, 2011


Vibrissae, everyone has seen that commencement address already multiple times this week. I've seen in on several different TV channels, heard in on NPR, seen it linked on YouTube from multiple places (where it has over 11 million hits, actually more if you count the duplicate copies, some of which themselves have millions of hits. And it has nothing to do with avoiding the obvious effective cure for the disease he had. He said to remember that you will die, not to seek out an early death.
posted by w0mbat at 1:24 AM on October 13, 2011


My Dad died of prostate cancer. He was a full-bore alt-med believer and did nothing useful about his prostate until well after he'd been hospitalized for a stroke and needed a 24x7 catheter.

Mum died of nodular melanoma. She went for conventional treatment, which amongst a wide range of painful and not lastingly effective treatments involved doing nothing much for weeks at a time waiting for the next specialist as the Thing raged on and consumed much of her leg.

Cancer just sucks, and sometimes it doesn't matter what you do about it. If I were a member of Jobs's family, and I were within nose-punching range of people pontificating about What He Should Have Done, noses would undoubtedly be punched.
posted by flabdablet at 1:41 AM on October 13, 2011 [9 favorites]


...the trade-off you have to make when it's the top half of your stomach being sewn onto the bottom half of your pancreas...

As I understand things, given the original diagnosis a Whipple procedure would not have been required had an operation been carried out immediately. The fact that he needed one 9 months later is presumably because the cancer had spread.

This is what the anti-woo people are getting at: Jobs was diagnosed with a form of cancer who's treatment has a very high success rate (something like 90% after five years). We're not talking about chemotherapy that increases your life expectancy by a measly six months or so, nor radical surgery that carries a significant risk of death in it's own right.

It is of course possible that his tumour had already metastasised: we never can know what would actually happen in the a counter-factual world. The odds however lie on the side that immediate effective treatment would have led to complete remission & that Jobs decision not to undergo early surgery ultimately led to his untimely death.

His decision also probably denied someone else a life: livers for transplant are in short supply. Someone else could have had that liver and we'll never know who they were — by now they're probably dead already. Jobs isn't directly responsible for that person's death: assuming the rules were followed the next person on the transplant list in the state Jobs moved to would have been at a higher risk than Jobs himself but nevertheless, his decisions denied that individual a liver that might have saved them.
posted by pharm at 2:25 AM on October 13, 2011 [3 favorites]


What flabdablet said.

This time last year I watched my mother bounce in and out of ICU in either complete misery or morphine-induced haze due to complications from treatment of the leukemia that finally killed her in hospice a couple of weeks later. First it was the congestive heart failure due to overpressure from too many transfusions, then kidney failure due to too many diuretics as they tried to get the water off her heart, then morphine withdrawal. She did a round of chemo so poisonous that you basically weren't supposed to look directly at the bag for too long, much less touch it. As a nice bonus, the leukemia in question was therapy induced: yes, the miracle drug they gave her to cure her lymphoma the third time around gave her cancer.

Her actual oncologist was a magician. Not in the sense that he saved her life (though he did – three times – by odds she should have died in '88), but in the sense that he knew how to handle people. I was there when he basically told her she was never going to leave the hospital, and such was his bedside manner that she and I were both somehow happy to hear it. I still don't understand it, really.

But the guys running the show on the ward weren't doctors as we learned to recognize them in the stories we were told as children. They were systems engineers, debugging and solving a problem. Like this guy, they believed in their tools and seemed to treat the will of the patient as inconvenient, at best. I get the mentality. I'm a hacker myself. And knowing that I thought like this I stayed the hell away from medicine. Well, that and the fluids.

Now, my mom wasn't Steve Jobs. She didn't invent iAnything, and her reality distortion field was a rather minor one: it only worked on me, and then only 'til I was about twelve and realized under the sudden influence of testosterone that I shouldn't be taking orders from someone who couldn't operate the microwave reliably. Depending on how you count, she only saved the lives of a few thousand West Tennessee drug addicts.

Like anyone who armchaired the whole Schiavo circus, I suppose this asshat is entitled to his opinion, just as I'm entitled to mine that he's what's wrong with healthcare (not healthcare finance, that's fucked on its own). I can't blame Jobs for staying as far away from such as he could.
posted by Vetinari at 2:47 AM on October 13, 2011 [3 favorites]


It's useful to spread hyperbole if not outright falsehoods to promote what you believe to be best for others. Gotcha

> Sugar pills can make you feel good, they won't stop the actual disease. Sorry if that treads on a few toes.


Jobs doesn't make a very good poster child for the evils of homeopathy if he didn't actually use homeopathy. The rumor these reports are based on actually claimed that "Jobs sought instead to treat his tumor with a special diet" and “It’s safe to say he was hoping to find a solution that would avoid surgery ... I don’t know if he truly believed that was possible."

The claim that Jobs used homeopathy was apparently made up by commenters in this thread. I haven't seen that in any of the articles people have linked to.

Since the insulinoma he had can cause gastrointestinal problems and lower blood sugar, it's like a special diet would have been prescribed. (And a special diet may have been prescribed before the cancer was diagnosed if he was having gastrointestinal problems.)

The source is clearly a bit confused since it claims that Jobs cancer "during a routine abdominal scan" nine months before he had surgery. It's not a routine procedure; according to Gorski, who's also a doctor, it would only have been done if he had unexplained gastrointestinal or other symptoms. It's possible source is also mixed up about what tests were done when. If Jobs reported symptoms nine months before he had surgery, and tests were done somewhat later, as would be normal, there's nothing odd about this time-line.

It's possible that Jobs did delay treatment. but the evidence for that seems pretty flimsy. The idea that Jobs tried 'woo-woo' alternative treatments before getting surgery seems to be based entirely on Jobs being on a restricted diet and 'we all know Jobs was a hippie.'
posted by nangar at 2:48 AM on October 13, 2011 [5 favorites]


Criticising those choices now is nothing more than a particularly ghoulish form of armchair quarterbacking,

Really? I don't get it. There's a few obscure forums on the Internet where people are trying to dissect his early demise and what could have been done to prevent it, that's pretty much it. It's not like there's some kind of post-mortem anti-Jobs pushback movement going on. Nobody I've noticed here is really criticizing him, just choices he made, if anything.

and those who go beyond that and use it to push their own opinions and agendas are simply reprehensible.

What if the agenda is the health and wellbeing of mankind? Is no agenda really better? This stuff isn't cool, so what about all the mostly meaningless back and forth about his design choices and tenure at Apple? Certainly that stuff can't be off the table, you'd be killing off his essence and spirit or something. Few had a more critical eye than Jobs. I really don't imagine he'd mind all that much. Not that he gets to choose, he's dead.

The silver lining behind any celebrity death from disease is the scores of people that will inevitably be saved after they learn about it. Even if there's zero moral of the story to learn, awareness alone propels research.

There's some kind of spectrum with "Smoke like that stupid Marlboro Man and you'll die!" on one end, "Katie Couric's husband died from colon cancer. It may have been prevented by a screening: colonoscopies work, and you should have them done!" on the other. Maybe even further out is Lou Gehrig or something. The best I can figure is that people think there's something objectively no good about the Marlboro Man Treatment and believe that's where commenters are going. I don't think there's a chance in hell of that happening to his memory period. I sure hope no one here is just jabbing at the guy because they didn't like him. Short of anything like that I can't think of a good argument to just leave it alone, not with a public figure.
posted by floam at 3:01 AM on October 13, 2011 [2 favorites]


d'oh.

edit_fail_count++; edit_window_pony_request_count++; //here are your missing sentences, Metafilter

Now, my mom wasn't Steve Jobs. She was a hippie. She dropped acid once, or so she said when she told me not to. She didn't invent iAnything, and her reality distortion field was a rather minor one: it only worked on me, and then only 'til I was about twelve and realized under the sudden influence of testosterone that I shouldn't be taking orders from someone who couldn't operate the microwave reliably. Depending on how you count, she only saved the lives of a few thousand West Tennessee drug addicts. So I'm relieved I didn't have to read a bunch of crap from Internet pinheads (albeit technically qualified Internet pinheads) second-guessing her own choices in the last days.
posted by Vetinari at 3:02 AM on October 13, 2011


According to the link nangar points too, Jobs would have required a Whipple procedure either way because of the location of the cancer (although he doesn't seem to have a reference for that: anyone got one?). It's major, major surgery so I can completely understand anyone not wanting to go through with it, but the facts of the case remain.
posted by pharm at 3:06 AM on October 13, 2011


I'll just add that my issue here is not that the comment the OP linked to was 'unnecessarily harsh' or that I'm trying to defend homeopathy. My problem is that the claim that Jobs was killed by homeopathy, or some other woo-woo treatment, appears to be a fabrication.
posted by nangar at 3:12 AM on October 13, 2011


(Also, he didn't do nothing in the meantime: he apparently had experimental radiation therapy in Switzerland.)
posted by pharm at 3:13 AM on October 13, 2011


> Sugar pills can make you feel good, they won't stop the actual disease. Sorry if that treads on a few toes.

Jobs doesn't make a very good poster child for the evils of homeopathy if he didn't actually use homeopathy.


"Sugar pills" isn't necessarily homeopathy, it's a term for pills intended to cause the placebo effect, which happens to be the mechanism alternative medicine tends to use. Sorry if you weren't responding to just this, but I couldn't find anyone claiming he used homeopathy.

It's possible that Jobs did delay treatment. but the evidence for that seems pretty flimsy.

And the crazy false report just went uncorrected for years since that Fortune story? It also goes on to say that his behavior concerned Apple's board of directors and they tried to intervene.
posted by floam at 3:16 AM on October 13, 2011


(Er, the inclusion of "homeopathy" in the tags maybe did it? Don't know what OP was thinking there.)
posted by floam at 3:20 AM on October 13, 2011


The article Nangar linked too made it fairly clear that Jobs tried alternative treatments that most people would regard as being based on science rather than woo.

They were unproven treatments that in the end didn't work for him, but they were at least plausible ones.
posted by pharm at 3:24 AM on October 13, 2011


pharm, are you talking about the Switzerland radiation thing? Didn't that happen in 2009, years after he supposedly did the alternative diet stuff?
posted by floam at 3:29 AM on October 13, 2011


Steve Jobs made his choices, based on information all but a few can only guess at, and - like all of us - had to live the the outcomes.

There's a difference between a guess of "faith" and an educated guess. We admire Steve for all the scientific mumbo jumbo he brought into our lives. We don't like it when we discover that his death may have been non-delayed due to his belief in religious hokum.

Kinda similar to what happened to Andy Kaufman, and his latter-day belief in Eastern "medicine" and its ultimate disservice to his health.

We expect certain behaviors from our heroes, for better or worse, and when they don't coincide with ours, people tend to be critical. Especially when the hero is someone who is "supposed to be smarter than us." For many in the high-tech industry, I suspect that spiritualism (i.e. faith) is quickly discarded in favor of pragmatism(i.e. what has been demonstrated to work). We're fine with placing one's creativity in the hands of spiritualism (Jobs, The Beatles, I dunno... Da Vinci?) but when it comes to health, with its very strict set of rules, we tend to wish our heroes would listen to the same set of rules that helped them make their visions come true.

That being said, I think everyone can forgive Jobs for being human, with all its faults, especially when it comes to facing one's inevitable death. And at best, what could we hope for? Another year or two of a very frail Steve being trotted out to plug the latest product? A full recovery seems very unlikely, despite what the article suggests.

My guess is that Steve went just the way he wanted to: no tricks, just himself against his disease, facing off in a battle he knew he would ultimately lose. To put it in cinematic terms, it would be the equivalent of facing an unbeatable foe, casting off one's weapons and armor, and saying "here I am, come at me!"

Western medicine has it ALL over the others when it comes to prolonging life, but we've got a ways to go where it comes to death with dignity and the true quality of an artificially prolonged life.
posted by ShutterBun at 3:34 AM on October 13, 2011


It's odd that the technology wizard spent nine months ignoring modern medicine.
posted by Renoroc at 4:27 AM on October 13, 2011


> I couldn't find anyone claiming he used homeopathy.

This comment: Maybe, just maybe, we'll see some actual regulation of the homeopaths now that some rich, iconic white guy on the west coast died from following their bullshit

(I said "commenters," though. It turns out it was just the same guy twice.)


> are you talking about the Switzerland radiation thing? Didn't that happen in 2009, years after he supposedly did the alternative diet stuff?

That's my understanding too. The thing is, though, that's the only 'alternative' treatment that we actually know Jobs got.

floam, the computer industry press is notoriously gossipy and hyperbolic. I'm inclined to take anything I read in it with a very large grain of salt.

It may be true that Jobs delayed getting surgery initially. I don't know. There at least seem to be a couple sources for that.

The only evidence for Jobs getting 'woo-woo' treatments for his cancer seems to be a report that he was on a special diet and the tech media interpreting this in accordance with Jobs 'hippie' image. Given what he was diagnosed with, I don't doubt that he was on a special diet, but I see no reason to believe it was a 'woo-woo' diet.

Jobs went to a doctor, got tests done, and received an extensive series of medical treatments for his cancer (whether this was after an initial delay or not). This doesn't really sound like somebody who rejected western medicine. I'm pretty skeptical about the woo allegations.
posted by nangar at 4:58 AM on October 13, 2011 [1 favorite]


What business is it of you or that doctor to pass judgement on what Jobs ( or anyone else, for that matter, including the poor anonymous black HIV peasants) decided to do about his health, his life, or his death?

Wow, you think it's no one else's "business" if poor people in Africa are being taught that alternative medicine is effective against HIV? For anyone who cares about the enormous problem of AIDS in Africa, it is everyone's business.

And what's with all the comments that seem to think that as long as you wait less than a year to treat cancer, the decision can't have any negative consequences? It's not like the "5-second rule" for dropping something on the floor!

A lot of the strange comments in this thread seem to be driven by a belief that no one should be criticized for something bad that happened to them. I don't know why you'd believe that.
posted by John Cohen at 5:00 AM on October 13, 2011 [2 favorites]


data point: the surgery performed to remove a neuroendocrine tumour is not the same as a whipple.
posted by onegoodthing at 5:08 AM on October 13, 2011 [1 favorite]


How dare he... make a very personal choice? I fail to see why anyone should disrespect a man for taking a risk that was clearly his own.
posted by sunshinesky at 5:09 AM on October 13, 2011


How is it "disrespect" to think critically about what might have caused someone's early death?
posted by John Cohen at 5:11 AM on October 13, 2011 [3 favorites]


floam, maybe I misread the timeline?
posted by pharm at 5:11 AM on October 13, 2011


onegoodthing: The link posted upthread by nangar says that's not the case if the tumour is located in the head of the pancreas. I have no idea whether that's true or not though.
posted by pharm at 5:13 AM on October 13, 2011


It's odd that the technology wizard spent nine months ignoring modern medicine.

Being the wife of a hot-shot sound engineer and best friends with someone who lived and worked with the French president and his wife, I have had a lot of second-hand experience dealing with the rich and powerful. I'm pretty convinced that being rich and famous changes you psychologically - you begin to genuinely think that you are somehow above and beyond the norm, and you begin to treat yourself and others that way. If this alternative medicine stuff is true, it honestly wouldn't surprise me all that much, considering how the human psyche is often altered by inordinate amounts of personal power. I mean, think about it - would cave men have any reason to develop modules for dealing with having all the riches in their community and never experiencing any danger of harm or rejection in their daily lives?
posted by Mooseli at 5:24 AM on October 13, 2011 [2 favorites]


pharm: thanks, i saw the link. I'd have to slightly disagree with the link though. Yes, surgical removal of tumours located in the head of the pancreas requires a Whipple. Surgical removal of (small) tumours such as neuroendocrine tumours usually require only enucleation. Some hospitals even perform this laparoscopically. If his tumour was diagnosed at a fairly early stage (i.e. small tumour), enucleation may have been enough.

But.

We don't know. His doctors aren't talking (as it should be.) I just thought I'd put it out there, because some people may have thought that a Whipple was an absolute requirement during the first time Jobs was diagnosed with NET.
posted by onegoodthing at 5:33 AM on October 13, 2011


who are indeed a bunch of evil SOBs, but who spread myths about Testosterone Deficiency and ADHD rather than Autism

Are you claiming ADHD is a myth spread by pharmaceutical companies? If so, my psychiatrist would like a word with you.
posted by krinklyfig at 5:33 AM on October 13, 2011 [2 favorites]


I think you likely did pharm, but I think I also misunderstood a little where it was originally coming from. I'd thought nangar originally posted it to make the same point that you did, but he was more of offering it as evidence that Jobs didn't reject western medicine. I think it counts (and that it's not even neccessary).

Nangar raises good points too. I might give a little too much credence to that original article. For me, I read it in 2008 right when it was posted after it got linked to by all the Apple blogs I read. Since then it was just always one of those things I knew about him among all the other folklore I've read. I'd pretty much fully internalized the fact that he spent several months in denial before he got his ass into gear, accepted the right treatments and went on to kick pancreatic cancers' ass. Then he fucking started withering away and then he died.

I never thought of him as a guy that rejected science or medicine — by the time that article came out he'd already come around. I considered it a lapse or something he hadn't really needed to worry about, until medicine was something he really needed to worry about. It was just something he did. Maybe the diet thing wasn't what he really believed in or maybe it's fiction and he just delayed because of the kinds of reasons people put shit-scary medical stuff off. Folks do that all the time. If you argued the take-away would more fairly be something like "be a compliant patient" instead of "don't do that pseudoscience stuff", I wouldn't argue. I can't accept that he made an OK-choice-to-make for anyone that wants to live, though.
posted by floam at 5:36 AM on October 13, 2011


This is classic responding over the loss of Steve Jobs, right? People now bartering over how he died in an attempt to get peace from it?
posted by cavalier at 5:47 AM on October 13, 2011


My maternal grandfather had this. Went in for a spring wellness check and found he had it.

The doctor told him, "If we don't treat this with Chemo you'll be dead in three months. Three months you spend with your family. Or you can have Chemo and live nine months. Nine months were you'll be too sick or weak to enjoy your family. The choice is yours."

After three months of huge family dinners and every ones birthday a celebration he died. It was a good three months.
posted by FunkyHelix at 6:31 AM on October 13, 2011 [4 favorites]


After the fact kibitzing about what Jobs did or did not do is worse than useless. By all accounts Jobs had THE most aggressive care. The 9 month period about which claims have been made is full of unknowns. I'm interested to see what the Jobs biography coming out soon has to say about what the sequence of events was.

All this was covered over in the main Jobs thread.
posted by artlung at 7:12 AM on October 13, 2011


I don't know what treatments Jobs did or did not use. I don't know, for instance, if he was using non-traditional therapies as a complement to conventional approaches. What I do know is that pancreatic cancer is extremely aggressive. Survival rate is something like 25% 1 year after diagnosis, falling to 6% after 5 years. It is also a particularly horrible way to die.

Of the three people I know who developed pancreatic cancer, it killed all three. Whatever decisions Jobs made on weather or not to treat, when to treat, and what types of therapies used were entirely the business of himself, his physician and his loved ones.
posted by TheWhiteSkull at 7:58 AM on October 13, 2011


Surely there's no possibility that Jobs emphasized diet as part of his treatment to minimize concerns about his health that might have had a negative impact on Apple.
posted by snofoam at 8:12 AM on October 13, 2011 [1 favorite]


TheWhiteSkull: We know that Jobs had a rare non-aggressive form of pancreatic cancer that has far better survival rates than the more common sort. You can't compare his outcomes with those of people who had the agressive form.
posted by pharm at 9:15 AM on October 13, 2011


How is it "disrespect" to think critically about what might have caused someone's early death?

I guess because in some respects, death isn't "early." It's just . . . death. Pema Chodron says that every exhale is a rehearsal for the moment of our deaths. And this fascination with his appears to be a searching for a way to save, in retrospect, a "genius." But geniuses have bodies just like the rest of us. Our bodies fail us. It's what they do.

So it's not disrespect, but it is a little sad.
posted by liketitanic at 9:22 AM on October 13, 2011


And, I should add, I say that as someone whose life was shaped by early deaths, before one assumes my callow ignorance.
posted by liketitanic at 9:24 AM on October 13, 2011


It's odd that the technology wizard spent nine months ignoring modern medicine.

Anecdote: I am as science-y as they come in most things, and yet I willfully avoided minor surgery for something long past the time I should have had it. You can be Rational McRational, Esquire in most things and still be weird when it comes to the trauma (mental and physical) of surgery and other aggressive treatments.
posted by zippy at 9:27 AM on October 13, 2011


I wonder how different this thread would be if the deceased was an alternative medicine touting Hollywood celebrity type.
posted by rocket88 at 9:35 AM on October 13, 2011


While working as a pharma copywriter back in the day, it was fair balance copy (see below) that made me laugh every time a designer chose a smiling couple on a bike. I'm sorry but with some diseases and the drugs you take to extend you life, doesn't equate riding a bike. It equates being in bed with one foot in the grave. My mom has been on her last resort chemo + Zometa for the past year. She's 5'3 @ 85lbs. Trust me, she isn't on a bike smiling.

If Jobs wanted to try something different, why not. Wasn't he all about "Think Different"? He knew the pros and cons. All you can do is try.


WARNING
Alpha interferons, including INTRON® A, cause or aggravate fatal or life-threatening
neuropsychiatric, autoimmune, ischemic, and infectious disorders. Patients should be
monitored closely with periodic clinical and laboratory evaluations. Patients with
persistently severe or worsening signs or symptoms of these conditions should be
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stopping INTRON A therapy. See WARNINGS and ADVERSE REACTIONS.
posted by stormpooper at 9:43 AM on October 13, 2011


So working with your doctors for a few months to see if there's any alternatives to surgery is, "woo," but offering diagnoses and treatment plans based on media reports of someone's cancer is "science." Got it.
posted by straight at 9:50 AM on October 13, 2011 [3 favorites]


It's hard to evangelize for contemporary western medicine purely with statistics rather than a personal example like Jobs' case. However, it is a bit harsh to stigmatize someone for making an arguably sub-optimal personal decision. Especially when they aren't going out of their way to evangelize or advocate for alternative treatments.

I wonder if the visionaries and gamblers that do so well in the entrepreneurial space are particularly vulnerable to making bad decisions when gambling with their health. Are they more likely to choose high-risk therapies that give them an all or nothing return on their health decisions rather than choosing to make decisions with a moderate up-front cost but a better statistical outcome?
posted by BrotherCaine at 10:56 AM on October 13, 2011 [2 favorites]


I hesitated a long time before addressing this topic...

For some reason, I just don't believe this.
posted by 4ster at 11:41 AM on October 13, 2011 [1 favorite]


A lot of the strange comments in this thread seem to be driven by a belief that no one should be criticized for something bad that happened to them.

i just want to make it clear that my comments are driven by a belief that this entire thing is based on rumor and an unnamed "trusted" source and for some of it, straight made up. add to it that the guy who answered a quora question isn't a doctor and is looking for funding.

i'm disappointed because this is a community that generally prioritizes fact and science, but in this case a lot of people seem willing to believe word of mouth 3 times removed because it fits your narrative.

if it were an ironclad case that Jobs had favored the woo-woo over the scientific, then i think questioning his methods would be more appropriate, at the very least more factual. as it stands, though - this is no better than talking about whether or not jessica simpson is pregnant based upon some rushing through the airport photos.
posted by nadawi at 11:57 AM on October 13, 2011 [2 favorites]


So working with your doctors for a few months to see if there's any alternatives to surgery is, "woo,"

If your doctor is telling you that you can treat your cancer with a special diet, that's so "woo" that I suspect they'll eventually loose their license to practice medicine. Unless someone has a control Steve Jobs running in the basement somewhere, nothing anyone can say about this individual case is science. But we can apply epidemiology to cancer and come up with some best practices for long term survival and recovery, of which eating nothing but bran flakes (or whatever) is not one.

Will you be saying "Go for it!" the next time someone says they're feeling suicidal or "good for them" after the fact? Because the reasoning in this discussion suggests that absolute unwavering support for any decision that anyone makes no matter how much it might hasten their demise is the only ethical response. I disagree completely.

Also, IANAD but can say with absolute certainty that if Jobs was on Interferon or a whole host of other drugs with very nasty potential side effects, he would be no more dead than he is right now despite said potential nasty side effects.
posted by Kid Charlemagne at 12:03 PM on October 13, 2011


Will you be saying "Go for it!" the next time someone says they're feeling suicidal or "good for them" after the fact?

Personally, yes. I would recommend therapy and treatment and I would try to get them some support, but if someone truly wants to die, "go for it" and "good for them" about sums it up. It hurts those of us left behind, but it's not our life to live... and as far as I'm concerned that's the very meaning of bodily autonomy.
posted by vorfeed at 1:15 PM on October 13, 2011 [1 favorite]


"Because the reasoning in this discussion suggests that absolute unwavering support for any decision that anyone makes no matter how much it might hasten their demise is the only ethical response."

So at what point, and who, should have stepped in and taken over Jobs' care? You are implying that there's an ethical failure here. Who's to blame? It sounds like Jobs failed himself ethically. And who else? Perhaps we should have someone, maybe you, as an ethical arbiter, step in in such cases.

Me, I blame the fucking cancer. You seem to want to place blame in other places. And I'm telling you now, that's 99% bullshit.

And you seem pretty naive about what constitutes "best practices" in cancer care. Patients are complicated. Cancer is complicated. The path is often uncertain, and often, the only possible outcome is death. As a son who lost a mother despite her having gotten 100% aggressive care, I can tell you this is certain.

Medicine is not the hard science you seem to think it is. The goal is quality of life, not length of life. So even moreso, I stand behind Jobs' decisions. He had a very nice end of life run, from what I can tell from my imperfect knowledge of the situation.
posted by artlung at 1:48 PM on October 13, 2011 [2 favorites]


As someone who has lost a grandmother, two aunts and a father to varying sorts and types of cancer, it's rather disturbing to see a number of people on here make self-assured assumptions about what should or shouldn't have been done to treat Steve Jobs' cancer. Seriously. I'm not even going to finish reading the comments, but I do want to say something.

Once you've been through this - once you've been through it so many times, with so many people you love, once you've watched all of them eventually wither away even with treatments, once you've had conversations like "we could do this and it might prolong your life for another few years or not at all, but it will definitely make you so sick in the meantime" and then they have to decide, and you know that the best case is still not that great, and you see people go into remission and you see them get sick again, and you never know how much time is left, maybe 9 months, maybe over a decade, and you see them in the hospital more than you see them at home and one day you get that call and it's almost over with and you get one more chance to see them again - once that happens, it's never so clear, it's never so easy, and it is never anyone's choice what anyone does or doesn't do in treatment, and you don't so much feel like pointing fingers, you just feel like crying.

The peace and acceptance in those who are facing an inevitable death and their final release from this world is the only comfort I have seen in it. Thank you for posting that commencement speech.
posted by nTeleKy at 2:09 PM on October 13, 2011 [3 favorites]


I'm not sure, but it seems to me a pretty big straw man has been constructed in this thread. I don't think anyone is saying definitively, that they know exactly what Steve Jobs did for treatment. I suspect that anyone in this thread that SOUNDS like they're saying that is more suggesting that IF he ignored science-based treatment AND had science-based options AND they wouldn't have been massively invasive, then it probably would not make a good role model for others going through the same process.

As a cancer survivor, I'd be the last person to suggest flatly that Steve Jobs made a mistake, because of course I don't know what his specific circumstances were. But it is fair to say that Jobs is a high-visibility example of someone who (if the reports are true) chose to employ alternative healing methods and thereby may have delayed effective treatment for the better part of a year. That's generally a bad idea without very high correlation to positive outcomes.

So no, no one here knows exactly Steve Jobs' situation. But many folks in the thread are taking it as an opportunity to note that alternative therapies, when employed to the exclusion of science-based medicine, don't generally work well. WITH the caveat that we don't know what Steve Jobs' situation was, WITH the caveat that we don't know what he was thinking, WITH the caveat that we don't know whether the report is accurate, WITH the caveat that we don't know what kind of side-effects his particular procedue would have had, WITH the caveat that some people would rather die sooner than later if it means a trade-off in side-effects of treatment, etc., etc.

But seriously, does someone really have to write thirteen different caveats to a statement when those caveats should be pretty obvious? Can't we still use the thread to communicate something general about alternative therapies without some folks being so pedantic and GRAR that the thread becomes another useless indignation-fest about how dare you this and why-I-never that? Because seriously, a lot of people get fucked over by so-called alternative medicine and maybe this is a teachable moment about that, even if it is imperfect.
posted by darkstar at 3:52 PM on October 13, 2011 [1 favorite]


yes, you have to use those caveats if you're in a thread about the health decisions steve jobs made. if you want to talk about the general danger of foregoing western medical treatment, then make that post. my problem is people using gossip to push forward their own agenda on the back of someone who just died, especially since that agenda is supposed to be fact and science based.
posted by nadawi at 3:57 PM on October 13, 2011


Fine. Consider the caveats explicitly stated.
posted by darkstar at 4:00 PM on October 13, 2011


The ethical failure is an endless stream of straw men and false dichotomies. I'll give you that the guy who wrote the "answer" linked in the FPP was pretty much a colossal prick, but come on. In this conversation it has pretty much been argued that:

1) We have to ignore everyone who suggests anything Steve Jobs might have done about his cancer was the very best standard of care because we don't know every single detail about everything that went on and two and a half million Google hits for (Steve Jobs alternative treatment) that came out more than a year ago might all be wrong.

2) Even if he opted for the not very best treatment and he decided to employ a lucky astrology mood watch instead, then that was for the best too because he's dead now and gave a good commencement speech at .

3) If you believe that Jobs made a bad decision you clearly believe he should have been declared mentally incompetent and loose the right to decide when he needed to go to the bathroom!
posted by Kid Charlemagne at 5:22 PM on October 13, 2011


and two and a half million Google hits for (Steve Jobs alternative treatment)

are there any of those that don't link back to the original Forbes article? because, to me, it seems like someone who claims to be a trusted source said something, implied that the board of apple agreed, and then everyone wrote blog articles and posts and opinions about that. there are no primary sources. there is only second hand information by someone who wouldn't even say their name.

there are three million results for 'kerry war crime' but we all know that was an astro turf campain. just because people trump up page views with false information doesn't make it true.

the funniest thing about all of this to me is that i largely agree with group that is gleefully sullying Steve Jobs in this thread - i think homeopathy is by and large a criminal enterprise. i think people should listen to their doctors when cancer is involved. i think that astrology and runes and tarot cards and acupuncture and healing crystals are all bunk. i'm just not willing to castigate someone on bad information. again, if you want to talk about alternative medicine, make a post about it. if you want to take third hand gossip as fact, i'm not with you on that.
posted by nadawi at 5:32 PM on October 13, 2011


I just don't feel like the world has the evidence I feel like is required of the claim "Steve Jobs is dead now because he did nothing for 9 months because he believed alternative medicine would help him before getting the most aggressive care possible."

a) we don't know the staging and severity of the cancer at the time of his diagnosis
b) we don't know the staging and severity of the cancer at the time he started more aggressive therapy
c) we don't know the duration of time between a) and b)
d) we don't know jobs' beliefs about conventional medicine other than speculation
e) the course of cancer is highly variable anyway. patients are routinely given X months to live and life years, or are given lots of time and die sooner. This is not an exact science.

I feel like this thread is spinning its wheels and getting GRAR-y given the lack of facts. I expect Jobs' biography to come out, and perhaps it will contain a bit more insight into details of his cancer and health at the time, and the decisions and participants of his care.

We know little. Jobs was secretive, and medical laws and codes of conduct mandate privacy.
posted by artlung at 5:55 PM on October 13, 2011


I'm just curious why you believe that those who disagree with you have to explicitly state every assumption that they are making, despite the fact that the FPP itself is about those very notions, while you are allowed to assume whatever you would like without explicitly stating those assumptions or providing any evidence for them.

How many hits for Kerry war crime were there before he was a presidential candidate?

Also, if we're going to go all Sun Tzu about this, perhaps these were not the best moves:

"per his linkedin profile he's looking for ways to finance the scale and duration of the project. i wonder if this is meant to raise his google profile."

"this guy on his twitter also claims that Jobs went after alternative medicines for years. sounds like he has an axe to grind...
posted by Kid Charlemagne at 6:05 PM on October 13, 2011


Because the reasoning in this discussion suggests that absolute unwavering support for any decision that anyone makes no matter how much it might hasten their demise is the only ethical response.

The reasoning in this discussion mostly seems to be that ignoring the best medical science and gossiping about a dead man's treatment decisions based on rumors in the media are both really stupid.
posted by straight at 7:26 PM on October 13, 2011 [3 favorites]


I'll go along with that.
posted by darkstar at 9:11 PM on October 13, 2011


As an update, Jobs' biographer was interviewed on 60 minutes. It hasn't aired yet but you can watch a preview here.

An excerpt from the preview video (copied/pasted):

"I've asked [Jobs why he didn't get an operation then] and he said, "I didn't want my body to be opened...I didn't want to be violated in that way," Isaacson recalls. So he waited nine months, while his wife and others urged him to do it, before getting the operation, reveals Isaacson. Asked by Kroft how such an intelligent man could make such a seemingly stupid decision, Isaacson replies, "I think that he kind of felt that if you ignore something, if you don't want something to exist, you can have magical thinking...we talked about this a lot," he tells Kroft. "He wanted to talk about it, how he regretted it....I think he felt he should have been operated on sooner."
posted by kyp at 3:06 PM on October 20, 2011 [3 favorites]


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