Steve Jobs Succumbs to Alternative Medicine | Hacker News Reader

Steve Jobs Succumbs to Alternative Medicine

skepticblog.org

239 pointsexit130 comments

First, Steve's family asked us to respect their privacy. They never made his fight with cancer a public matter and it's terribly rude to speculate like this. That aside, I did have some thoughts on the alternative treatments this article is talking about.

With close family members having fought cancer more times than I can count on one hand, my honest impression is that for several forms of cancer the current state of "orthodox" treatment (typically chemotherapy and radiation) is a joke worth skipping in exchange for what quality of life you have left.. which in one case has turned out to be 15 years and counting (following two surgeries.)

What makes a lot of alternative methods appealing to me is not their anecdotal evidence. It's that many of them (at least the ones I'm familiar with) don't have such torturous and long lasting side effects. For folks like my wife and I who have already come to the conclusion that we would not pursue chemotherapy and radiation treatments for many forms of cancer, we've got nothing to lose. We've already decided we'd rather die what we consider gracefully than suffer the side effects and slow, agonizing death of a long drawn out battle.

Not trying to convince anyone here, just trying to explain this from the other side.

It depends on the type of cancer. For some classes of cancer, there are now treatments which dramatically improve the prognosis, with relatively mild side-effects. This is summarized well in the book The Emperor of Maladies.

Pancreatic cancer is particularly intractable. The survival rate is extremely low. I don't blame him for trying everything. He had nothing to lose.

i can agree that once the question becomes how you will die of cancer instead of whether, then gentler (perhaps "alternative") treatment may be acceptable.

the issue here though is that some people reject conventional treatment from the very beginning.

He had nothing to lose, perhaps, but maybe he did have something to lose if he was foregoing conventional treatments in favour of something that was of dubious efficacy. "If" is the key word, as I have no idea what was going on with regard to his very private (as was his right to be) medical treatments.

According to the article, most pancreatic cancers are intractable, but islet cell neuroendocrine tumors have excellent survival rates.

Compared to other forms of pancreatic cancer perhaps, but none of the 10-year survival rates for any of the pancreatic cancer variants I am familiar with is "excellent" no matter how you look at it. Given that Jobs lasted at least eight years after initial diagnosis it seems he was already on the upper end of the survival curve. Claiming, as Dunning did, that were it not for actions taken during the first months after diagnosis Steve Jobs would be alive today is a claim that Dunning is woefully unqualified to make.

As I understand it (and I'm only going by what he said in his Stanford commencement speech here) he had a rare form of pancreatic cancer which is treatable:

The doctors told me this was almost certainly a type of cancer that is incurable, and that I should expect to live no longer than three to six months...

I lived with that diagnosis all day. Later that evening I had a biopsy, where they stuck an endoscope down my throat, through my stomach and into my intestines, put a needle into my pancreas and got a few cells from the tumor. I was sedated, but my wife, who was there, told me that when they viewed the cells under a microscope the doctors started crying because it turned out to be a very rare form of pancreatic cancer that is curable with surgery. I had the surgery and I'm fine now.

Ouch.

What about the possibility of remission?

Well yeah, that's what happened afaik

Whether the nine month delay before getting surgery increased the likelihood of remission is a question I'm not qualified to answer. But until contradicted by an oncologist I'm going to go with "probably".

>my honest impression is that for several forms of cancer the current state of "orthodox" treatment

Unless you're a specialist with an expert opinion in islet cell carcinoma, your comment is 100% meaningless. Look, Steve was a human. He was flawed. He had a relationship with alternative medicine. He's not perfect. No one is. A lot of people give in to the woo for some many reasons. He was a billionaire, educated, had access to the world's experts, and known for his amazing horse-sense, yet he gave in.

I like this story because Steve is so high profile. I can pull this out and mention it next time a friend considers these approaches instead of going to a real doctor.

"He had a relationship with alternative medicine."

Naturopathy isn't really alternative medicine, although some of the schools do teach things from alternative medicine. For the most part it's just as evidence-based as anything else. The N.D. curriculum isn't all that much different than that of the average M.D. program:

http://www.bridgeport.edu/academics/graduate/naturo/programr...

The big exception being perhaps the 5 credits on homeopathy, which seems overkill to me, but then again the average M.D. doesn't learn nearly enough about homeopathy considering how important it was in popularizing evidence-based medicine and introducing all sorts of other reforms that have saved millions of lives over the past 150 years. (Even JAMA publicly credits homeopathy with introducing evidence-based medicine: http://bit.ly/qqU59B)

Dangerous misinformation.

"Naturopathy, or Naturopathic Medicine, is a form of alternative medicine...." - http://en.wikipedia.org/wiki/Naturopathy

Digital maoism.

Not a counterargument.

Please check your facts. Naturopathy may or may not equate Naturopathic Medicine legally. Naturopathic doctors who graduate from accredited programs can be licensed as primary care physicians, for example in Washington state. States which do not regulate naturopathic medicine will often have charlatans advertise themselves as NDs. Unaccredited correspondence schools offering various flavors of diploma mill fare have been extremely vociferous fighting regulation of naturopathic medicine. More information at http://en.wikipedia.org/wiki/Doctor_of_Naturopathic_Medicine Term 'naturopath' itself may or may not be protected depending on the state. California licensed naturopathic doctors starting in 2003. However, title 'naturopath' is not protected. See P.3645 http://www.leginfo.ca.gov/pub/03-04/bill/sen/sb_0901-0950/sb....

Legal status is irrelevant.

Sort of. They cannot prescribe medications, which is a pretty big part of being a physician, primary care or otherwise. http://www.doh.wa.gov/hsqa/professions/documents/Prescribing...

According to your link, they can write out prescriptions with the exception of controlled substances other than codeine and testosterone: "Controlled substance prescription are limited to testosterone and codeinecontaining substances in Schedules III-V." More on controlled substances: http://en.wikipedia.org/wiki/Controlled_Substances_Act

"By definition, alternative medicine has either not been proved to work or has been proved not to work. You know what they call alternative medicine that has been proved to work? Medicine."

- Tim Minchin via hugh3 (http://news.ycombinator.com/item?id=3080438)

"evidence-based as anything else" != "5 credits on homeopathy"

Homeopathy is not just alternative, it's downright crazy. I didn't realize how weird it is until I read the wikipedia article on it during an argument. Take a look at some of this genuine 19th century wackiness!

http://en.wikipedia.org/wiki/Homeopathy

Yeah, but if you don't understand homeopathy then you can't really understand modern medicine. Our entire medical system today is a byproduct of the clash between homeopaths and allopathic doctors that happened in the late 19th century.

You have it backwards. In order to understand why homeopathy doesn't work, you have to have at least a little knowledge on why modern medicine actually does work.

The lack of that knowledge is what homeopaths prey on.

To the downvoters: Downvoting is not supposed to be used to express disagreement.

The comment was submitted with constructive intent. Alex3917's beliefs are very different from yours -- I get that. Debate is appropriate here; downvoting the comment to oblivion is not.

Sorry, but I disagree. I don't want to see alternative medicine advocacy here; as superstition it is antithetical to the hacker philosophy.

Would that I could downvote in meatspace and relegate this nonsense to oblivion, where it belongs.

So you don't believe in medical research? After all, anyone who participates in a new drug investigation is by definition a consumer of 'alternative medicine', assuming you're going by the definition that others have been posting in this thread.

For my money, I don't see what could possibly be more in the spirit of the hacker philosophy than being a medical researcher, trial candidate, or early adopter. The reason the average person is able to walk into a doctors office today and usually get at least decent advice is because of the millions before them who have been willing to do the research, think for themselves, weigh the balance of evidence, make rational decisions, and document their findings.

The fact is that if Steve had died while taking part in a new drug trial as part of a clinical investigation then no one would be giving him shit; that folks are so dismissive of 'alternative' medicine has nothing to do with proven vs unproven, as if it were black and white, and everything to do with ignorance of how medical research, approval, and treatment actually work.

There are hundreds of thousands of drugs that have been studies in vitro, in animals, and in humans, but only ~1,500 new chemicals total that have ever been FDA approved. Treating FDA approval as being synonymous with evidence-based thinking just shows that people don't actually understand either. Some people don't use a drug unless it's been on the market for 20+ years, other people will try something based on a single anecdote. There is no one right answer, it depends on the balance of the evidence, ancillary beliefs, preferences, the context, etc. The right decision is different for every person and every situation, so all this purely speculative criticism of Steve Jobs' decision-making process is completely unwarranted.

I think that's a mischaracterization of medical research. New drugs and treatments don't spring forth from the ether. Progress in modern medicine is incremental and based on the methods we already know to be effective.

I expect that a trial participant would be provided a damned good, evidence-based, research-backed rationale, along with "also, there's also a good chance this won't work at all", not the promises and hand-waving proffered by the alt-med community.

Edit: Oh, Lord, you've edited your comment. Future readers, my response pertains to the first two paragraphs.

"nothing to do with proven vs unproven, as if it were black and white,"

Things are rarely black and white. But many things are #010101 and #fefefe. At best, homeopathy can work its way up to #010101 with a strong tailwind, lots of luck, and a practitioner who screws up their concentrations and accidentally delivers a dose of some substance that is actually effectual for some purpose... but that would be a banner day for homeopathy, not the normal outcome.

Your beliefs appear to require an awful lot of goalpost hiking. Why don't you rest for a bit after a long day of that and take a more careful look around the field when you're not burdened with all those goalposts on your back?

The funny thing is, he hasn't once advocated homeopathy as far as I can tell. As I read it, he seems to be saying we should learn about homeopathy to see how we got where we are (i.e. what mistakes were made in the past, how can we recognize when we're looking in the wrong places, all the benefits one gets from studying history).

Where he advocates "alternative medicine" he seems to be using the definition of "alternative medicine" as "things that seem to work but are not approved by the FDA".

Given that presumably none of us have Job's medical records (or the expertise to interpret them, in most cases), and known little about his treatments, I hesitate to speculate on his particular case.

If it was the case that Jobs could've prolonged his life using conventional medicine, then it probably is relevant to those who are currently battling that kind of cancer. The choices that Jobs himself made are his own, regardless of what I might personally think about them. But for those who want to do everything possible to live, it helps to be aware of what works, versus what probably does not work.

According to the more in depth article linked to in exit's comment:

'There is virtually no debate about the best treatment. “It has long been held that surgery can lead to very long-term survival,” says Kim.'

So this would not have been what your family has faced, and makes the criticism of alternative medicine valid.

     With close family members having fought 
     cancer more times than I can count on one hand

Sorry for this question, but how did that happen?

I'm asking because I know of nobody in my family to have had cancer. My grandpa did have a brain tumor diagnosed at age 80, but it was benign.

Are you living in a polluted city? What are you eating?

EDIT: I'm sorry if I offended with this question. The thing is I'm worried that I'm living in a polluted/crowded city, and hearing from others that cancer is really not that uncommon, it kind of makes me freak out ... not necessarily for me, but for my baby boy.

Really, I just want to know what is to be done for prevention.

Genes man. Genes.

Genes and chance.

Chance? Behavior? I've had 3 close relatives die from cancer (Grandpa, Grandpa, Grandma - Lung, Lung, Brain). Adding 3 more people to a list like that isn't far fetched. In developed countries - Cancer is a huge killer, worldwide - it kills 13% of people.

Also note that the poster said close family members fought cancer a double-hand number of times. That could mean over 5 people, though it could also mean one or more family members had multiple run-ins with cancer, surviving at least the first few times.

This is rather common in my personal experience.

It's a tough one. There are many people who fall into the group you describe, but there are also people for whom chemotherapy and radiation therapy has been very successful and allowed them to continue living a healthy, happy life.

We're talking about two separate issues here, and you're mixing them up. There's nothing in modern medicine that teaches you how to prepare for death, or how to balance an extra 1% chance of survival with the pain of chemo. Take comfort in philosophy, religion, go hold last lectures.

But modern medicine can sure do a lot for some types of cancers that are caught in an early stage. There are lots of people out there who can benefit from this. These people are usually in a state of psychological vulnerability, and telling them anecdotes about how refusing chemo can turn out OK is about as nasty a thing as you can ever do to them.

"There's nothing in modern medicine that teaches you how to prepare for death, or how to balance an extra 1% chance of survival with the pain of chemo. Take comfort in philosophy, religion, go hold last lectures."

Sounds a lot like end of life counseling, which is part of modern medicine.

https://en.wikipedia.org/wiki/End-of-life_(medical_treatment...

That's "medications and treatments to control pain and other symptoms". It doesn't cover dealing with the philosophical issues.

Read the rest of it.

"Either way, services are available to help patients and their families with the medical, psychological, and spiritual issues surrounding dying."

All that aside, the focus is on making the end of life comfortable, which would naturally involve that sort of thing. Modern medicine takes what works from traditional and otherwise, and counseling is part of it.

There's a good saying: traditional medicine that works becomes modern medicine.

> traditional medicine that works becomes modern medicine.

This excludes the "help with spiritual issues" from being included within modern medicine, simply because there is no way to tell whether it works. The way the "help" probably works is that the hospital sets you in contact with a third party, since AFAIK medical school doesn't teach spiritual advice.

Referrals are part of modern medicine.

There is plenty of this in modern medicine, as a matter of fact my wife is on a palliative care rotation in Med School right now, and this is a major focus.

However it must be said that it seems that this bit is considered very 'newfangled' and touchy-feely by much of the medical community.

Careful now, this is a rapidly changing field. There are already treatments available today, that were not available the previous decade, with much less impact on overall well-being - and also better outcomes.

I understand what you're saying - but what I'm saying is, just keep your eyes open.

> we'd rather die what we consider gracefully

I assure you a death from many (most?) forms of cancer is anything but graceful, treated or not.

First, Steve's family asked us to respect their privacy. They never made his fight with cancer a public matter and it's terribly rude to speculate like this.

Discussing a possible injustice that may have cost him his life seems like a worthwhile reason to drag his name into the conversation. And though the individual ultimately has a right to privacy and choice over their own treatment, I worry that such politeness helps create the bubble in which misinformation can go without scrutiny.

my honest impression is that for several forms of cancer the current state of "orthodox" treatment (typically chemotherapy and radiation) is a joke worth skipping in exchange for what quality of life you have left

If you know of a better cancer treatment, then the scientific community eagerly awaits evidence of your discovery. If you think that current best practices do not act in the best interests of the patient, that too can be supported with evidence. There is no reason to conflate disruptive theories with abandoning rationality by pigeonholing scientific medicine into an orthodoxy.

Skepticism and prejudice are easily confused. Skepticism is harder, but it's also correct.

Here is part of the abstract from "Use of CAM results in delay in seeking medical advice for breast cancer" (1)

"On average, [Women who discovered a lump] took 8.7 weeks to inform the family and 17.2 weeks to first physician visit. Fifty three percent delayed seeking medical advice. Common reasons were;

antecedent use of complimentary/alternative therapies (34%), lack of significance attached to the lump (23%), fear of surgery (22%), conflicting personal commitments (7%), fear of cancer (5%), and others (8%).

Twenty nine percent practiced CAM before visiting any physician.

Common methods used were

homeopathy (70%),

spiritual therapy (15%) and

Ayurvedic medicine (13%).

CAM use was associated with delay in seeking medical advice (OR: 5.6; 95% CI: 2.3, 13.3) and presentation at an advanced stage of disease (OR: 2.2; 95% CI: 1.01, 4.6). Patients who delayed seeking medical advice more often had positive axillary nodes and stage III/IV disease. Breast cancer patients in Pakistan frequently (53%) delay seeking medical advice. Antecedent practice of CAM is widespread and a common underlying reason. The delay results in significant worsening of the disease process."

tl;dr - people delay medical treatment, and part of the reason is that they try alternative treatments, and only go to the doctor when the problem gets worse. This worsens the progress of their disease.

This is why alternative medicine is bad. Because it kills people. Imagine how mad you would be if someone you loved delayed treatment for a real problem because they were following advice to try alternative, "natural" medicine they'd received from a friend.

We are responsible for the outcomes of what we do, not just the sentiment behind it.

1) http://www.springerlink.com/content/k8p0400u2u77242l/

Those 29% who "practiced CAM before visiting any physician" would be better served visiting a physician who utilizes CAM as an adjunct to his practice, who would recognize their concerns, and encourage those patients not to delay any required treatments.

Unfortunately, though, few homeopaths would give this type of advice. Most homeopaths actively recommend people not use scientific medicine.

The following quotes are from an investigation of what type of advice real homeopaths give when asked to recommend treatment for someone planning to visit areas exposed to malaria.

"... I tried to find out what homeopaths would offer to a young traveller seeking protection against malaria. Working with Alice Tuff and the charity Sense About Science, we developed a storyline in which Tuff would be making a ten week overland trip through West Africa, where there is a high prevalence of the most dangerous strain of malaria, which can result in death within three days. Tuff, a young graduate, would explain to homeopaths that she had previously suffered side-effects from conventional malaria tablets and wondered if there was a homeopathic alternative."

...

"Next Tuff found a variety of homeopaths by searching on the internet, just as any young student might do. She then visited or phoned ten of them, mainly based in and around London. In each case, Tuff secretly recorded the conversations in order to document the consultation. The results were shocking. Seven out of the ten homeopaths failed to ask about the patient's medical background and also failed to offer any general advice about bite prevention. Worse still, ten out of ten homeopaths were willing to advise homeopathic protection against malaria instead of conventional treatment, which would have put our pretend traveller's life at risk."

http://www.1023.org.uk/whats-the-harm-in-homeopathy.php

So how exactly does this article square up with Steve's 2005 Stanford Commencement address?

http://www.roj.com.np/life-inspiration/steve-jobs-how-to-liv...

"About a year ago I was diagnosed with cancer. I had a scan at 7:30 in the morning, and it clearly showed a tumor on my pancreas. I didn’t even know what a pancreas was. The doctors told me this was almost certainly a type of cancer that is incurable, and that I should expect to live no longer than three to six months. My doctor advised me to go home and get my affairs in order, which is doctor’s code for prepare to die. It means to try to tell your kids everything you thought you’d have the next 10 years to tell them in just a few months. It means to make sure everything is buttoned up so that it will be as easy as possible for your family. It means to say your goodbyes."

"I lived with that diagnosis all day. Later that evening I had a biopsy, where they stuck an endoscope down my throat, through my stomach and into my intestines, put a needle into my pancreas and got a few cells from the tumor. I was sedated, but my wife, who was there, told me that when they viewed the cells under a microscope the doctors started crying because it turned out to be a very rare form of pancreatic cancer that is curable with surgery. I had the surgery and I’m fine now."

He had the surgery. Successfully, as far as the doctors were concerned. And he lived the median number of years for those diagnosed with pancreatic cancer. This information was not hard to dig up.

Stay classy, exit.

* And he lived the median number of years for those diagnosed with pancreatic cancer *

The median number of years for those diagnosed with pancreatic cancer, or the median number of years for those diagnosed with this particular type of rare, operable pancreatic cancer?

The median number of years for those diagnosed with islet cell carcinoma. For the regular kind it's 3-6 months.

According to The Daily Beast:

The cancer was detected during an abdominal scan in October 2003, as Fortune magazine reported in a 2008 cover story.

October 2003 + ~9 months of alternative medicine + the ~12 months in his lecture brings you to June 2005, the commencement address.

As discussed in the comments, he lived a little bit less than the median number of years, but he was expected to live for much longer than the median because he was diagnosed so early.

Yes, he ended up having the surgery, but he wasted a crucial nine months on alternative medicine first. Here's a CNN article from 2008:

http://money.cnn.com/2008/03/02/news/companies/elkind_jobs.f...

"to the horror of the tiny circle of intimates in whom he'd confided [...] Jobs decided to employ alternative methods to treat his pancreatic cancer, hoping to avoid the operation through a special diet. [...] For nine months Jobs pursued this approach [...] In the end, Jobs had the surgery, on Saturday, July 31, 2004"

Perhaps the speculation is instead whether or not Jobs skipped chemotherapy and radiation after his surgery in lieu of alternative medicine (to eradicate the micrometastasis)? Although this changes the original argument, it still suggests a cause for concern for alternative medicine.

And as many others have mentioned in this thread, if even ONE person avoids alternative medicine and instead utilizes evidence-based medicine to save his or her life, this kind of discussion is worthwhile.

A more in depth discussion:

http://www.thedailybeast.com/articles/2011/10/05/steve-jobs-...

And taking a contrary position, here's the editor of Natural News saying that Chemotherapy and Radiotherapy killed him:

http://www.naturalnews.com/033793_Steve_Jobs_chemotherapy.ht...

(For clarification, I think the article is bullshit, I just put it out there as part of the discussion about Steve's medical treatment and about people jumping on his death to further some view or other).

The reports of Jobs' treatment elections are conjecture.

"although neither Apple nor those close to Jobs were willing to discuss the treatments he elected or the course of his disease," the community continues to assume that rumors about Job's health coming out of financial publications (Forbes) are somehow accurate.

This post is trite and condescending no matter how long it came after Jobs’ death. Dealing with death is a personal matter. You have no right to demand that anyone submit themselves to the cold, alienated approach of aggressive medical treatment. Let people pass with dignity, however they choose.

The purpose of life is not to be a mobile mass of cells for as long as technologically possible. In fact, the statistics show that people who skip the N+1th round of chemo and switch to hospice care have better outcomes. http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_...

>This post is trite and condescending no matter how long it came after Jobs’ death. Dealing with death is a personal matter. You have no right to demand that anyone submit themselves to the cold, alienated approach of aggressive medical treatment. Let people pass with dignity, however they choose.

Don't know why you're taking it this way but (assuming that it's true, need more facts from reliable sources) this is more of a warning to people not to get taken in by alternative medicine alone and to be a little skeptical of it as a cure-all.

We're not talking about the N+1th round of chemo here. According the article, it was the 1st round of treatment he skipped, the one that probably would have saved his life. More than just saving his life, it should have given him a good quality of life for many years.

The general public cannot be expected to make a responsible decision concerning alternative 'medicine' if they are not aware of the facts and situation. If this article is to be believed, it's rather clear that Steve Jobs wasn't content to 'die in dignity' (how is it dignified to reject medicine? baffling...), and turned to science based medicine towards the end. Had he been more aware, he could perhaps be alive today.

The best legacy Steve Jobs could possibly have is to raise awareness of woo and it's woo-isms, so that perhaps just a few more people don't die unnecessarily.

I wholeheartedly agree, but want to point out that for him to do so is to cast doubt on the cult of personality and product that he created.

Once a cancer is metastatic, I guess it's just a question of quality-of-life vs extending-the-time-you-have. Last-ditch chemo is pointless if you have to go anyway. But people who get an operation immediately, then get chemo survive much better than the ones who wait for the tumor to get big and / or metastatic.

You don't want to do what many people do - prevaricate till it's too late, then try the heroic (but sometimes counter-productive) last-ditch measures.

Let's just say: if this causes a few of us to see a doctor earlier, and thus saves a few lives (well, improve the quality and quantity of the days we have left), wouldn't that make it worthwhile?

> Once a cancer is metastatic, I guess it's just a question of quality-of-life vs extending-the-time-you-have.

Not anymore (and not always, anyway). There are some forms of cancer that can currently be kept in check indefinitely, with next-gen chemo.

Great reply. I thought the OP toxic enough to make one ill.

The thought of bullshit fake medicine taking another life should be enough to make anyone feel ill.

Speak for yourself.

I am. "Should be enough" is very clearly an opinion.

My opinion is that it should be enough to make anyone fill ill, because everyone should approach the matter rationally.

The fact is that alternative 'medicine' is not rational.

You are welcome to your opinion.

"By definition, alternative medicine has either not been proved to work or has been proved not to work. You know what they call alternative medicine that has been proved to work? Medicine."

- Tim Minchin

Absolutely brilliant :)

For those not familiar with Tim Minchin's work: http://www.youtube.com/watch?v=HhGuXCuDb1U

see this journal:

"Evidence-Based Complementary and Alternative Medicine (eCAM) is an international, peer-reviewed journal that seeks to understand the sources and to encourage rigorous research in this new, yet ancient world of complementary and alternative medicine."

http://www.hindawi.com/journals/ecam/

The point being made here is that if something has been proven to work, it is no longer alternative medicine. "Evidence based alternative" is a contradiction.

Alternative medicine is any healing practice: "that does not fall within the realm of conventional medicine." http://en.wikipedia.org/wiki/Alternative_medicine

"Conventional medicine" being "medicine for which there actually exists evidence of it working."

source ?

don't forget : 51% Unknown effectiveness ..

http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp

one example "Unknown effectiveness"

"Pancreatic cancer New option(s) added for: Chemoradiotherapy for resected pancreatic cancer One long-term follow-up study added. It found no significant difference between adjuvant chemoradiotherapy and surgery alone for overall survival or progression-free survival at 11.7 years' follow-up. Categorisation unchanged (Unknown effectiveness), as the evidence is not strong enough to draw definitive conclusion."

So you're defending the idea that cancer can be halted by diet. Anyone who speaks out against that is toxic?

If all people had to do to halt cancer is vary their diet, far fewer people would succumb to the malady. The only way you can make that work is by taking a derisive and dismissive attitude to everyone, saying they must be too stupid and stubborn to want to live; moreover you must also posit that all doctors involved in oncology are evil and ignoring the facts.

This seems like a far more toxic worldview than quiet regret that Steve isn't still with us that I get from this article.

INTENSIVE LIFESTYLE CHANGES MAY AFFECT THE PROGRESSION OF PROSTATE CANCER

http://www.abundantwellbeing.com/Nischala/CancerStudyOrnish....

"Purpose: Men with prostate cancer are often advised to make changes in diet and lifestyle, although the impact of these changes has not been well documented. Therefore, we evaluated the effects of comprehensive lifestyle changes on prostate specific antigen (PSA), treatment trends and serum stimulated LNCaP cell growth in men with early, biopsy proven prostate cancer after 1 year

...

Conclusions: Intensive lifestyle changes may affect the progression of early, low grade prostate cancer in men. Further studies and longer term followup are warranted." DOI: 10.1097/01.ju.0000169487.49018.73

===== and ....

"Clinical Events in Prostate Cancer Lifestyle Trial: Results From Two Years of Follow-Up"

http://www.sciencedirect.com/science/article/pii/S0090429508...

"Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention"

http://www.pnas.org/content/105/24/8369.short

"Increased telomerase activity and comprehensive lifestyle changes: a pilot study"

http://www.sciencedirect.com/science/article/pii/S1470204508...

"Can lifestyle changes reverse coronary heart disease?: The Lifestyle Heart Trial"

http://www.sciencedirect.com/science/article/pii/01406736909...

Please show me where in these documents it recommends ignoring other treatments and I will upmod your post.

The idea that "diet" is alternative is ludicrous. What's alternative is "curing cancer" with diet. The science of how diets affect cancer—and the resulting medical advice that falls out—is an open and somewhat understood topic and a good part of a whole spectrum of treatment; one that all indications suggested were ignored in this case.

I always think it's funny that naturopaths say they're treating the "whole patient" but almost inevitably they focus on ONE THING that CURES EVERYTHING, whereas doctors come at the problem with a whole spectrum of tools ranging from diet and lifestyle to chemical interventions.

The idea that "diet" is alternative is ludicrous.

Diet is largely considered alternative medicine in America. Obviously pancreatic cancer cannot be cured with diet. However, some conditions respond favorably to diet and other lifestyle modifications.

Hypertension can be reversed through weight loss and diet, the Mayo Clinic even publishes books about how to do it. However, in the USA, it's largely considered a secondary line of treatment because doctors assume (correctly) that most Americans won't change their eating habits, even if it's a matter of life and death.

Eh, your experience will of course vary, but when it was determined that I had hypertension the first thing my (american) doctor told me is that I had to knock off the activities that.. err... inspired my HN handle ;)

I think doctors probably make a judgment call based off your described lifestyle and age. In my case diet and weight loss were easy, since I've been vegetarian at various points in the past and am fairly young.

Most people don't think twice when their doctor tells them to change their diet. They just ignore it.

It's only when a diet is some outrageously expensive and super-implausible idea like "only eat berries and uncooked food" that it enters the realm of alternative medicine. "Diet & Exercise" is even in the American vernacular.

The only people who want to co-opt diet is alterantive are the CAM proponents who are attempting to use it as the thin edge of a wedge to get themselves funding and legitimacy.

I have to disagree here. The author might be insensitive for raising this point so soon, but that doesn't diminish the point's validity.

There's a difference between "Steve Jobs survived with cancer for 5 years" and "Steve Jobs barely reached half the median survival rate for his type of cancer." No one has reported on this point.

> the statistics show that people who skip the N+1th round of chemo and switch to hospice care have better outcomes.

Have you even read the article? This was not a case of choice between living two months with chemo or one month without. The cancer was detected early enough and the treatment prospects were excellent. But, no doubt influenced by irresponsible propaganda about the "cold, alienated approach of aggressive medical treatment", Jobs decided to wait a few crucial months while trying alternative medicine (and had the surgery anyways, except with less favorable prospects, due to the delay).

Actually, the damage is deeper than the [direct] loss caused by Jobs' (what I consider poor) judgment.

Remember that when his Plan A didn't work, he needed to fall back to a liver transplant. Transplantable livers don't grow on trees; it's likely that by using this liver, someone else didn't get it.

It's quite conceivable, then, that Jobs' decision cost not only his own life, but another person's as well.

UPDATE: clarify first sentence by adding "direct".

What if the next person on the list was also using alternative therapy to treat cancer?

I suspect in a few more decades it will be revealed that the true cause of death was failure to cryopreserve. Pretty much all our current medicine can do is buy a few decades at the most. With his wealth, Jobs could have hired his own team of superbly qualified surgeons and perfusionists, and started an apple-themed cryonics vault that would (supported by his fame) last hundreds of years. He would have inspired thousands, perhaps millions of Apple fans to come along for the ride. What a wasted opportunity.

Harsh words, but valid point. The first cryoperservations could be billionaires in the hight-tech industry.

All I can say is that I hope we did not lose a visionary due to a reliance on alternative medicine.

... because conventional medicine has cured pancreatic cancer.

It very likely would have cured his particular form of it.

...he had a liver transplant. I hardly think you can say he 'avoided' conventional medicine...

No, he didn't avoid it, but according to the article, he also didn't avail himself of it until it was clear to him that his "alternative therapy" was not having an appreciable effect. The delay in effective treatment incurred by this poor judgment could easily have cost him his life, or at least prevented him from enjoying several more years of relative comfort.

The article suggests he avoided doing it until it was obvious his body was failing; this removing any advantage that early detection brought him.

Don't look at things in a negative way. Should this be true I'd prefer to believe that it was because of his alternative vision on life that he was capable of producing such innovative product lines.

No "alternative" way of thinking in medicine == no "alternative" way of thinking in life.

(Obviously just one point of view to consider)

I wasn't aware that Steve favored alternative medicine, sad to hear that, but I wouldn't judge him for it. The reality is, despite its proven efficacy, western medicine's answer to cancer is still painful/debilitating and sometimes borders on humiliating, especially for someone with such a ubiquitous public image. For many, alternative medicine finds its appeal as an escape from the grim and down right scary inevitability of chemo and surgery, it's a way to feel like you're doing something without having to sacrifice your hair, lunch, and dignity. It's a self delusion that I can't blame anyone for indulging in.

The proper term for 'western medicine' is 'evidence based medicine'. The term 'western medicine' can incorrectly imply an equal footing for so called 'eastern medicine'.

(I did not downvote you)

You're absolutely correct, good point.

not true .. 'western medicine' is NOT 'evidence based medicine'

"What percentage of the around 3000 treatments included in Clinical Evidence fall into each category:

- 11% Beneficial

- 23% Likely to be beneficial

- 7% Trade off between benefits and harm

- 51% Unknown effectiveness

- 5% Unlikely to be beneficial

- 3% Likely to be ineffective or harmful"

http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp

=============

and "Evidence-Based Complementary and Alternative Medicine (eCAM) is an international, peer-reviewed journal that seeks to understand the sources and to encourage rigorous research in this new, yet ancient world of complementary and alternative medicine."

http://www.hindawi.com/journals/ecam/

Evidence-Based Complementary and Alternative Medicine (ECAM) and Pancreatic Cancer:

http://www.hindawi.com/search.aspx?startindex=1&field0=9...

I understood vectorpush to be mistakenly using the term 'western medicine' when he in fact meant 'evidence based medicine'.

My understanding was correct.

So your comment is a non sequitur.

>when he in fact meant 'evidence based medicine'.

Are you an evidence based mind-reader?

and again:

'western medicine' is NOT 'evidence based medicine'

"Are you an evidence based mind-reader?"

I made a guess, he confirmed I was correct.

I suggest you read the entire conversation tree when you consider responding.

I don't understand. This post claims that the median survival period for this form of cancer is 10 years.

So therefore, his survival (7-8 years), whether or not alternative medicine was used, lasted close to the average one could expect.

So what is unexpected here?

Did you not read the next 1.5 sentences?

> but it depends on how soon it’s removed surgically. Steve caught his very early, and should have expected to survive much longer than a decade.

Given how young Steve Jobs was when he was initially diagnosed in 2003, how good his health was, his ability to pay for the best treatment, his large support network and his insatiable drive, I would have expected better than median survival.

Yes, though there's still a lot of chance involved.

Young age does not necessarily help with fighting cancer. Younger people have a faster metabolism, and that often allows the tumour to grow faster than in older people.

The author argues that Steve's expected survival time was actually much higher than the median, because his cancer was detected early--and that the delay in pursuing traditional treatment (surgery) may have been responsible for the poor outcome.

Basically, the article would have been clearer if the author had just left out the median in the first place, as he doesn't think it's relevant.

It would be one thing if we were talking about rubbing crystals all over your body. I would not consider a modified diet "alternative" medicine. There is legitimate science around diets and how it affects cancer growth (see TED video):

http://www.ted.com/talks/lang/eng/william_li.html

There's a few big steps from a good theory with solid science to a good theory that's been proved via large scale studies to a possible cure to a cure that shows promise in small targeted studies to a cure that's been validated via large scale studies. The vast majority of possible cures get discarded at each of those steps.

But going to a naturopathic doctor for a diet prescription is rubbing crystals all over your body. William Li (the speaker in that talk) is an MD bringing evidence-based medicine (i.e. science) to bear on the question.

On the other hand, as naturopathic doctors themselves explain, "tradition-sensitive naturopathic practitioners ... which have tradition-based paradigms articulating vitalistic and holistic principles, may have significant problems in relating to the idea of EBM as developed in biomedical contexts." http://www.liebertonline.com/doi/abs/10.1089/acm.2006.12.323

Counterpoint: Having been irrevocably harmed by modern medicine, I encourage everyone to always be a skeptic and a self-advocate when undergoing any approved or alternative therapy. Do research. Get multiple opinions. Be a strong, vocal participant in your plan of care.

Confirmed Steve Jobs did Chemo and Rad. Now think.

http://www.marksmarketanalysis.com/2011/02/steve-jobs-on-che...

http://gawker.com/5737092/steve-jobss-cancer-secret-revealed...

On the one hand, Steve Job's opinionated and stubborn nature helped craft some of the most successful consumer products in history, but tragically it may be that that same stubbornness and free thinking could very well have led to his early demise.

Nonsense Steve, your diet "just works".

Way too early for this, and quite frankly, it's none of your business.

Normally a cold lasts 7 days, but with aggressive medical treatment it only lasts a week.

Once again, more intellectually dishonest 'arguments' from the self-labeled skeptics. How about actually discussing what Steve Jobs did, why he thought it might be effective, and his logic about the pros and cons.

You know, actually doing some work instead of just trying to rack up some cheap page views off of the man's death while contributing nothing of value.

If awareness of alternative 'medicine' gained from this incident cause a single person to go to a real doctor and have their life saved, it will be Steve Jobs' greatest legacy.

Stop thinking about gadgets for one minute and consider human life.

Alex3917 did not say anything about gadgets.

It was not my intention to imply that he had.

What was the point of bringing it up, then?

I was anticipating protest, and addressing it before the fact.

I don't understand what kind of protest you were anticipating. Calling for deeper discussion of the motives or thought process behind a mistaken action is in no way an endorsement of gadgets over human life. It sounds more like you were trying to twist this into something about Apple.

I was anticipating this: http://news.ycombinator.com/item?id=3080812

S.Jobs legacy is his creativity, his passion to 'think differently'. Not flaccid dogmatism.

I believe you may have missed the last sentence in my post.

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