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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.

>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".

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.

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.

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.

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".

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.

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'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.

     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.