Biographer: Jobs refused early and potentially life-saving surgery
cbsnews.com
cbsnews.com
That said, for those interested, an actually well reasoned and knowledgeable piece on the subject comes from Science Based Medicine: http://www.sciencebasedmedicine.org/index.php/the-death-of-s...
Some quotes:
"Did Jobs significantly decrease his chance of surviving his cancer by waiting nine months to undergo surgery? It seems like a no-brainer, but it turns out that that’s actually a very tough question to answer.
... So, is it possible, even likely, that Jobs compromised his chances of survival? Yes. Is it definite that he did? No, it’s not... 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,”
Now, let's hope this thread dies instead.
Edit: removed "authorized" from biography since I don't know for sure.
But it has always bothered me that the age of reason also means the age when the scientific principle and liberal arts not only split but often end up with an "us vs. them" relationship.
This may be one of the least coherent and strangest things I've ever tried to express on the Internet. But I suspect that if we as a civilization were not capable of making a distinction between the hard sciences and the liberal arts, then Steve Jobs would have sought early medical treatment and would be alive today and for many years more.
Allow me to try and explain. The leading smart people used to be expected to know both the "science" of the day and the arts.
But then we get the age of reason and people start to specialize in one or the other, but rarely both. And we do end up with two separate and often defined against each other areas of knowledge.
Does this make sense? Just google image search for Millau Viaduct and tell me that product of engineering isn't also art.
I think the world has lost something by this split. I think engineering and science have lost a bit to. But I also suspect the liberal arts have lost a lot by not requiring a thorough knowledge of the hard science as a foundation.
Hell, I wish doctors were required to learn and know A LOT more math and statistics.
Somewhat ironically math is still considered an art at our universities.
But by not requiring a deep, and I mean deep knowledge of hard science for any liberal arts degree, our great institutions have created an artificial separation between learned people.
And there's also this distinct sense of mystique, an accidentally created legend about non-science "knowledge". This sense that the demon haunted world contains nuggets of powerful knowledge which would be evaporated if the light of the candle that is science would shine on them.
This mythical belief plagues society in surprising ways.
I think Steve Jobs decision to first try "alternative medicine" is party because of this.
And while every typical western (North America and Europe) university has "core" requirements, I think that's a joke. I think if instead everyone had to learn an almost equal share of hard science and liberal arts for any degree, then we'd have a better civilization.
"Over the last 15 years major pancreatic centers in the United States have developed excellent results for the Whipple surgery. In almost all the major centers the death rate from this surgery is now less than 5%."
That is a 1 in 20 chance of dying on the operating table - makes base jumping seem safe.
roll a D20, if you don't get 20 roll again to see how many years you live.
Or
Roll a D8 to see how many years you live.
He chose the D8 and then tried the first choice when he realized he had rolled a 3
Those are our odds. His odds, considering his vast wealthy, would be potentially better (better doctors, hospitals, etc). So in other words he chose a the best high-risk naturopath approach over the best low-risk surgical approach. He found the best woo merchants out there and he paid for it with his life. I'm not sure why so many are defending him. Yes, he made consumer goods slightly better than his competition, but he's still human and made a pretty terrible mistake. If anything, we should publicize this so other people don't make this mistake.
Having seen that and if I knew that I had a cancer which was very unlikely to be cured I would definitely consider not going through with the surgery. Better to die quickly than live in constant pain for another 5 years?
Its easy to make the stretch to trying a bit of alt medicine. It's is not going to make things any worse than they are, if anything the placebo effect of feeling you are in control is probably quite strong.
I don't think it's easy for a healthy person to understand what's going through someones mind when they're faced with this.
A risk of going immediately, or the guarantee of a few more nows with the potential of going sooner than "normal" later?
It's not a trivial decision.
I started http://www.reddit.com/r/altmed/ (non-pharmaceutical medicine based on peer-reviewed research) because in the cancer lab I work in we review this stuff all the time but it doesn't seem to have sunk in to the mainstream yet. Based on my understanding of the research, there are some things everybody with cancer should be doing which research suggests may raise survival rates (eg. proper vitamin D levels, high magnesium intake, lots of antioxidants, etc).
And peer-reviewed research is great and all, but it's unrealistic to expect things to sink into the mainstream when research can only currently suggest rather than actively recommend. Antioxidants are one of the most mainstream "cancer-protectors" in the UK, but among positive studies you will also find negative studies; particular antioxidants that are good, and some that actually lower survival rates![0] Certainly they're easy steps that people can take which are unlikely to have a negative impact, but it is not an option on the same footing as pharmaceuticals and surgery. Not even close.
[0] http://www.reuters.com/article/2011/10/07/us-antioxidants-id...
I agree with your sentiment. The problem lies with our current crop of medical professionals. Many doctors do not continue learning after residency. They tend to get stuck in their habits and stay there. Those that do continue to learn often will not look at anything unless it is a traditional pharmaceutical drug.
To give you an example, if a woman presents with menstruation issues most doctors will prescribe a progesterone product of some sort. This will jump-start a woman's cycle. On the surface, the problem is solved.
Dig deeper, and you find studies like this one (http://www.sciencedirect.com/science/article/pii/S0039128X99...) which present clear evidence that simply getting vitamin D levels normalized might solve the deeper problem, with essentially zero side effects, and restore the menstrual cycle.
Many doctors would never think to do this, because it simply doesn't fit into the current traditional-medicine paradigm. This paradigm is basically, "Find symptoms, diagnose, prescribe pharmaceutical drug." Even if non-pharmaceutical drugs (such as vitamin D) exist for the disease, doctors won't use them.
AFAIK, Europe and Japan are light years ahead on this front. They act more according to your philosophy, "If it's medicine, we will use it." But in the US, almost all traditional doctors fit into the pharmaceutical mold.
This, in my opinion, is what is meant by "alternative" in alternative medicine. It is an alternative to the paradigm of "pharmaceuticals only," and not what you imply, an "alternative to medicine."
The next thing you said is "but it's unrealistic to expect things to sink into the mainstream when research can only currently suggest rather than actively recommend."
All drugs (pharmaceutical or otherwise) fit into this category. The research comes out, which suggests a certain outcome. Doctors look at the research (or in many cases they read pamphlets or marketing material from pharmaceutical companies or follow recommendations from their hospital employer), and if they find the research compelling they will recommend the drug based on that. This is true of all medicine, and peer-reviewed research is the best way to get a good picture of what the science currently says. You seem to suggest that peer-reviewed research only carries a small amount of weight, and I respectfully disagree.
Finally, hand-picking antioxidants and setting it up against surgery and pharmaceuticals is a straw-man. For every disease, you will find a variety of potential treatments. You will find treatments from the world of surgery, from pharmaceutical medicine, and from non-pharmaceutical medicine. A good doctor (or a motivated and intelligent patient) has the task of sifting through the research to find out which option is best, or if a variety of options should be combined.
To use your example on cancer, popping some antioxidants isn't the alternative to pharmaceuticals and surgery. A complete solution that takes into account the whole picture is the reasonable answer.
That will probably include things like the following:
* Surgery if it is the type of cancer that can be treated with surgery
* Pharmaceutical drugs that have shown promise in treating that particular cancer
* Checking and maximizing vitamin D blood levels (helps the cells express p53, among other things, which helps cancer cells begin apoptosis aka suicide)
* Checking and maximizing intracellular magnesium levels (very important co-factor for vitamin D)
* Ensuring powerful anti-cancer antioxidants are in the diet (spirulina, chlorella, resveratrol, etc.)
Anyway, that's my 2 cents. :-) I'm pre-med, and I feel quite strongly about the subject. Sorry for the essay!
That implies the worst major centers have a maximum of 5% death rate. Steve Jobs would certainly go to one of the best hospitals, which I assume would have a much lower rate.
"A Whipple involves removing the head of the pancreas, the duodenum, the common bile duct, the gallbladder, and often part of the stomach (see illustration). Surgeons then seal off the end of the small intestine and reattach what's left of the bile duct, pancreas (body and tail), and stomach."
It sounds like something Dr. Frankenstein would do.
It is a major rearranging of your guts, with potentially severe dietary restrictions for life.
To each his own though -- whatever drove Jobs to seek alternative medicine first is part and parcel of the personality that gave us all he did.
"But by not requiring a deep, and I mean deep knowledge of hard science for any liberal arts degree, our great institutions have created an artificial separation between learned people."
But I think it goes both ways; I'd like to see more hard scientists with a strong background in the liberal arts.
Reminds me of how Oxford (it might still do so) calls their Physics degree/certification a degree in Natural Philosophy.
Exactly, I actually kind of have a little bit of sympathy for a guy like Oppenheimer that cited John Donne and the Bhagavad Gita after the first nuclear test (even though even the thought of nuclear bombs almost makes me sick to my stomach), but I suspect that today's scientists are not that versed in "liberal arts".
There are very few rewards for it, though, apart from a smug feeling of superiority to everybody and a massive further decrease in the number of people with whom I have anything in common. :)
I don't think I've ever seen this, but maybe I did and forgot it wasn't my idea. So I fully admit I've never had an 100% original thought.
A talk I listened to a few weeks ago that was delivered at BYU (Meaning some of it is spoken in a religious context) called "Why Scientists Should Read Shakespeare and Why Humanists Should Understand Einstein" covered this same/similar principle.
Okay, but how? 10-year Bachelor's degrees? Part of the reason why the world is getting more specialized is that there is more knowledge out there to be known. A thorough knowledge of the hard sciences is not something you can squeeze into a semester.
I wonder what he'll consider to be bizarro.
"Another aspect of Jobs' character revealed was his disdain for conspicuous consumption."
I definitely see some incongruency there!
Jobs was NOT a conspicuous consumer. At all. All of his purchases were justified based on utility - albeit as someone who appreciates art, he considered beauty to be a utility. Psychologists like Maslow would agree with that.
Beauty leads to good feelings as surely as food and shelter do. He bought stuff for himself, not to show off.
[1] Of course, John Lasseter, for one, ended up with a load of money and nobody could argue that he changed. He just went from collecting toy train sets to having actual train sets installed in his backyard.
It's this tight-fisted aspect of Jobs that makes it difficult for me to appreciate him on a non-professional level.
Gucci is conspicuous consumption. Bugatti is conspicuous consumption. Diamonds in your teeth is conspicuous consumption. Personal electronics are just plain ol' regular consumption.
Which has ceased to be the case for Apple products for quite a while now.
Open a Dell and a MBP though, and take a peek.
Have the same money been spend on the Dells internal case design? Is the Dell assembled with the same attention to detail? Does the Dell sport various small and big innovations, from the mag safe adapter to auto-inverted Ethernet port, non protruding camera, lid magnets, etc? Does the Dell have a unique in industry machined aluminum "concrete" case design? Is it as light? Is it as thin? Is is as sturdy? Was even the industrial designer designing the Dell as well paid and respected by his peers as Ives? Oh, and does the Dell hold its resale value just as well?
Now, if you take a high-end Sony or Lenovo laptop, with comparable construction, it's often the case that the Apple laptop is cheaper or same price.
Oh, and regarding tablets, media players and phones, Apple completely smoked the competition in pricing. Wasn't the Samsung tablet for example like $799 for a version competing (badly) with the $499 iPad?
you prove my point. To you computer isn't just a piece of commodity. It IS a status symbol, a thing to revere.
I guess it is the same to me since I write this from my MBP.
My father was a mechanic who bought tools from a specific supplier that was regularly 3-5x more expensive than generic tools. The reason? They would last 10x longer and work twice as well.
I see my MBP as a tool. It is worth the premium for quality.
A "status symbol" means I use it to increase my social status. Which I do not, or don't even care about. I do, however, care about the small (and large) details though, because they make my life better.
Is wanting a less heavy laptop wanting a "status symbol"? Or thinking that a magnetic lid is better than an ugly protruding prone-to-break piece of plastic? Or wanting a laptop with a nice case design? By your logic, anyone wanting a beautiful spouse is because he wants to use him/her as a status symbol. How about appreciating beauty for what it is and how it makes US feel?
"Commodity" does not mean that you are equally satisfied with anything as long as it does the basics of what you want. Food is a commodity too, but I prefer a nice restaurant to a fast food joint, because it is better there, even if both can equally take care of my hunger.
Wikipedia sez: "Conspicuous consumption is spending on goods and services acquired mainly for the purpose of displaying income or wealth." That's not a very good description of why people buy Apple products. They're just not expensive enough or pointless enough to make a good target for your conspicuous-consumption dollars.
This is what conspicuous consumption in the consumer electronics field looks like:
If we assume Windows and OS X took similar developer efforts, the smaller market for OS X means it is going to cost a lot more than Windows in order to recoup the costs of development. That is simple economics. Looking to iOS, it has a much larger market and Apple's mobile devices are quite competitive price wise, which supports the software cost factor.
You might find a higher sticker price on a Mac, but it is a pretty safe assumption that the added cost is to get you into OS X. Which just so happens to be the only reason why you would consider purchasing a Mac in the first place.
You might find a higher sticker price on a Gucci, but it is a pretty safe assumption that the added cost is to get you into Gucci. Which just so happens to be the only reason why you would consider purchasing a Gucci in the first place.
If you get a real pair of gucci shoes from the store (not from the department stores), you really feel like you are walking on air, and you can walk for miles in these dress shoes without forming boils on your feet.
I don't have a bugatti yet :P But BMW and porsches drive effortlessly and brake effectively, which really help when a taxi cab tries to cut you off.
Now, tying this back to apple, the macbook airs are lighter than most netbooks yet still perform better than many monster dell laptops. It's somewhat nonsensical to try to argue that apple products aren't as lavish as gucci or bugatti.
Seriously though, I concede that there's a gradient from "sensible consumption" to "conspicuous consumption". I'd classify a Mercedes as "sensible" rather than "conspicuous", unless you plate it in gold like this guy:
http://www.autoblog.com/2009/01/23/gold-fingers-mercedes-c63...
I also concede that Gucci shoes (which aren't that expensive or that ostentatious) aren't the best example. I was thinking more of a Gucci t-shirt. But I probably should have chosen a different brand.
Jobs has said himself (I'm referencing his 1997 WWDC keynote) that it's not necessarily better to "think different". He said he didn't care about being different, he wanted to be better. And if being better was being different, then so be it.
No true. Increased availability of a product certain reduces the status associated with it, but products serving the purpose of conspicuous consumption exist at almost every level of affordability. There are some product which only the top 0.1% can afford and others which 90% of the population can afford. (Even the homeless community has a hierarchy partially defined by possessions.) Further, the degree to which a product exists to be conspicuously consumed is a continuum, in which the iPhone sits around the middle (although falling, due to it's sales).
Do you really think people, when deciding whether to buy an iPad, don't factor in the fact that all of their friends will ooh and ahh over it when they first see it?
EDIT: Please see the link to the answer comment below, which I hadn't seen until now. As always, a grain of salt and all that...
The article referred to a 2008 blog post about that.
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[1] http://www.skepticblog.org/2011/10/06/steve-jobs-succumbs-to... and HN discussion: https://news.ycombinator.com/item?id=3080176
I'm afraid I don't see the distinction between "being human" and "making stupid decisions".
Pancreatic cancer has a dismal 5-yr survival rate - much less a 'cure' rate. This feels like a tabloid-y headline given the apparent lack of reality behind that statement.
"Jobs sought to assure colleagues that he was not suffering from a more common -- and more deadly -- cancer of the pancreas."
Jobs: "I had a very rare form of pancreatic cancer called an islet cell neuroendocrine tumor, which represents about 1 percent of the total cases of pancreatic cancer diagnosed each year, and can be cured by surgical removal if diagnosed in time (mine was)."
If he really had an "islet cell neuroendocrine tumor" he really had the chance to live much longer than he lived, had he accepted the operation earlier. Note he also didn't have to lie in "mine was." It was diagnosed in time, but he waited with the operation the nine months.
Jobs had a rare form of the cancer, known as neuroendocrine cancer, which grows more slowly and is easier to treat, explains Leonard Saltz, acting chief of the gastrointestinal oncology service at Memorial Sloan-Kettering Cancer Center. "Survival for many years or even decades with endocrine cancer is not surprising." For that type, the sort that Jobs had, "survival is measured in years, as opposed to pancreatic cancer, which is measured in months."
http://www.skepticblog.org/2011/10/06/steve-jobs-succumbs-to...
"In retrospect, we can now tell that Jobs clearly had
a tumor that was unusually aggressive for an insulinoma."As one of the commenters emphasizes, what's truly incredible is that he even considered waiting nine months before seeking state-of-the-art treatment. An intellectual environment where smart people make decisions like that is not healthy for any of us. That's the real reason why we should fight woo where we find it, as if it were a cancer in itself.
"The first 90 percent of the task takes 10 percent of the time. The last 10 percent takes the other 90 percent."
Do you see where I'm going ? If you believe there's some truth in this saying (quote, murphy law, whatever it is) then you should fix problems as early as possible. Granted, you don't always have time for that, and this saying applies mostly to such situations. Software projects, for example. But if you have an opportunity to fix a complicated problem/task early, don't procrastinate. There are often unexpected complications. Solve them early. If you start earlier, the chance you into the deadline is smaller.
I think it's perfectly possible that Steve Jobs acted brilliant in some situations and plain stupid in this case. There are no 100% brilliant and 100% stupid people. It's not binary, a smart person is not immune to stupid actions.
http://www.searchlores.org/realicra/basiclawsofhumanstupidit...
This is already one of the most anticipated biographies ever. There's not really any need to seek more attention.
(Yes, I know they won't really sell 6 billion copies.)
Anyway, I've been able to relate some of the book excerpts to friends who previously weren't planning to read the book but now plan to. And as for this 60 minutes interview, I'm truly looking forward to hearing some of the excerpts in Jobs' own words on tape, which isn't something that could be included in the book anyway.
I suppose my real problem is that the contents of the book are being pieced out to the media before it is available. From my past reading about Jobs this kind of frenzy wouldn't seem to suit his tastes, and you can be damn sure he'd be pissed about information leaking prior to release. I stand by the "bad taste" statement as there is strong evidence that the subject of Isaacson's work wouldn't appreciate what he's doing.
I think the attention-people (media) are begging for his early words and competing intensely for his time/words. The publisher may also have some stipulation in Isaacson's contract about how available he is to make himself to interviews with media outlets. Not saying I have evidence that's the way it's going down - just that such factors are at least as arguable as a hypothesis that Isaacson is an attention-monger.
It's easy to pretent you have 20/20 hindsight on other peoples lives.
Not really. "Spontaneous remission is rare but it happens, lucky man!" would be the far more likely response.