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Comment by dchest | Hacker News Reader

Lied?

Steve Jobs, January 5, 2009 (http://www.apple.com/pr/library/2009/01/05sjletter.html):

As many of you know, I have been losing weight throughout 2008. The reason has been a mystery to me and my doctors. A few weeks ago, I decided that getting to the root cause of this and reversing it needed to become my #1 priority.

Fortunately, after further testing, my doctors think they have found the cause—a hormone imbalance that has been “robbing” me of the proteins my body needs to be healthy. Sophisticated blood tests have confirmed this diagnosis.

Some random article on hormone imbalance (http://www.thefamilyhomestead.com/hormoneimbalance.html):

A second factor that leads to hormonal imbalance is liver health.

View on HN

That's like a pilot saying there's slight turbulence and forgetting to mention that the turbulence is a result of a dying motor, severe fuel leak, and rapid decrease in cabin pressure.

That's a poor metaphor, because turbulence is an environmental condition. Of course saying there's turbulence when the plane is no longer stable is a lie.

Or he didn't know how bad it was yet when he said that. In any case, it's not a lie in any strict legal sense.

An omission of fact is a lie in a "strict legal sense" or any sense for that matter. Explaining the perfume smell on your clothes to your wife while leaving out the part about fucking someone else is an omission of fact... aka a lie. Try doing it under oath in a court of law and see what happens if caught.

So you think in a span of 6 months, they conducted more tests, waited for the results, analyzed them, concluded Steve needed a new liver, put in the papers for the liver, received it, and finally gave him the transplant?

Yeah, that is how it usually works...

No. No thats not how it works. Not when you already had a form of slow-metastasizing pancreatic cancer that usually shows up in other organs... like the liver, within your lifetime.

They knew he had cancer. They knew he needed a liver. They lied. So be it.

To be honest, when he started talking about 'nutritional imbalance' and sounding alternative mediciney... I assumed he was terminal. Thats how people get when medical science gives them VERY bad news.

I've thought he was dead, or nearly dead, for six months. I am very pleased to be wrong.

What? What part of what I wrote is wrong? That's exactly how it works.

I have liver problems. It's not liver transplant liver problems but it's a problem nonetheless. Here is how I found out about it: I felt vaguely crappy for 6 months but just thought I was fatigued because I stay up late and don't have a very good diet. I finally went to the doctor for something else, they did some tests which initially signaled some problems that could be related to my liver or could be from something else. Then they do some more tests and I waited 3 weeks and they say "yeah it's your liver."

So Jobs loses weight through 2008, he goes to the doctor in January and they say "whoa initial tests show you are messed up, you need more tests." They make that announcement to the press. Then he gets more test results, he announces a week later that the problem is way worse than he thought, he needs a transplant, time for a leave of absence.

Of course if you're the kind of ghoul who plays death pool games it's more fun to imagine corporate conspiracy theories hiding his problem for months or years to keep the short sellers at bay. However, Occam's Razor would suggest that a typical male relationship pattern with the doctor's office is a more likely explanation.

I think you underestimate the effect of his previous cancer on his diagnosis. That type is a ticking time bomb that usually spreads. I think if you had that form of cancer, they would have immediately been all over your symptoms. At no time do I think any doctor would have said anything about nutrition being the problem. That was a lie.

I don't think your experience is the same as his. For your symptoms, as a healthy guy... sure, six months is reasonable. For him? Not at all.

I just don't buy it. I don't think it makes him a bad person or anything, but I don't think I'm stating some kind of conspiracy theory either. He knew he was sick and lied about it. I still like the guy. :)

I said that could have happened. I have no idea if it did or not. It sounds possible to a lay person like me. Six months is a long time! Is the medical profession really so slow that that stuff can't happen within 180 days even for rich people who spare no expense? If you know the industry and say it's too slow to do that stuff in 6 months I'll believe you, but don't be too surprised that lay people don't already know it's like that. How long does an average medical test take if a team works on it as a top priority?

Uh, yeah, all that happening within six months is fucking rare, no matter how much money you have.

Because of transplant waiting lists. You don't get higher on them just because you're rich, thankfully.

Jobs had the transplant in Tennessee, which has shorter wait lists for livers:

"According to data provided by UNOS, in 2006, the median number of days from joining the liver waiting list to transplant was 306 nationally. In Tennessee, it was 48 days."

48 is significantly lower than 180. http://daringfireball.net/2009/06/wsj_steve_jobs_liver_trans...

I wondered how long he was on the waiting list ever since the news broke. From my own naive lack of understanding, I wouldn't have guessed you could get a diagnosis, get on the waiting list, get a transplant, and be back to work in 6 months. It's hard to google up what the average wait time for a liver transplant, but it does sound that the worse you are, the higher you get moved on the list.

You may not get moved up the list by being rich, but it does help your increase your odds. With access to the best doctors to help make a good diagnosis quickly, knowledge of the transplant list criteria and the latest medical advances, and the ability to refer you to the best of the best surgeons and specialists, I'm sure he has a leg up over people like me with a crappy PPO insurance policy, let alone someone on Medicare.

OK. Could all the steps other than waiting for a liver be done within, say, a month?

What is the wait time for a liver transplant? I googled and it says it varies a lot by chance and also how sick the patient is. Would Steve have gotten a liver transplant quickly due to the severity of his illness, or are lots of people worse?

This article (1) from Macworld says: "According to the hospital release, Jobs had the highest MELD score—Model for End-Stage Liver Disease—among patients of his blood type at the time of the procedure".

1) http://www.macworld.com/article/141336/jobs_transplant_confi...

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