Friday, December 19, 2008

The Deal on Steve Jobs' Health

One thing you quickly learn when you've been part of an operation drawing coverage from reporters and pundits is that reporters and pundits aren't all they're cracked up to be. I have extra insight into this, having worked as reporter and pundit, myself. I noticed how few checks and balances are in the system.

The "Steve Jobs is Dying" rumor mill, which has been moving markets and making headlines for months now, is pure ditz. Same for the latest iteration: Jobs won't be speaking at Macworld this year, so he's feared dying.

Cancer, as a general hazy constellation of afflictions, is indeed scary. And, yup, Steve Jobs had it once. But in spite of possession of critical faculties and a huge pool of medical information, the chattering classes seem unable to reach more nuanced conclusions than "Steve Jobs Ooh Scary Cancer Dying"

Why hasn't anyone thought to, duh, ask a doctor? I had to dive down into the comments section of a Mac geek site to find the sole intelligent analysis of the issue (the following are his words, not mine):
As a physician (in internal medicine), I will attempt to explain some of this, which I hope will satisfy at least the readers of MacInTouch. While what I have to say is more informed, it is still based on speculation and ties together many things which have been said before but "conveniently" ignored by bloggers and financial analysts because again, the rumors as they currently stand are more damaging to the stock than the truth warrants. 
First, people are worried because Jobs had pancreatic cancer, which carries one of the worst prognoses of all cancers. But what people are overlooking is that there are two types of pancreatic cancer. One type is adenocarcinoma, which is 95% of all pancreatic cancer. This is the one with poor survival rates. Less than 5% of people with adenocarcinoma survive to live five years after the diagnosis. This is *not*, I repeat, *not* the kind of pancreatic cancer Jobs had! (Emphasis because many financial analysts and bloggers seem to keep ignoring this). The type that Jobs had was a neuroendocrine tumor, which accounts for the other 5% of cancers. This type has a *much* more favorable prognosis. In fact, he did not even need chemotherapy or radiation after the surgery. This generally means that his doctors were highly confident that his cancer was cured by the surgery.
Second, the surgery that Jobs underwent to remove the cancer is the reason for the way he looks today and it is the reason that he is always going to look very thin. Jobs had what is known as a Whipple procedure. In this procedure, most of the pancreas (the head), part of the stomach (the pylorus), and the first portion of the small intestine (the duodenum) are removed. This has drastic consequences for a patient's nutritional status afterwards.
With the head of the pancreas gone, many digestive enzymes needed for absorbing nutrients are gone, and must be supplemented. Also, with the pylorus gone, food does not pass through the GI tract normally, and finally, the duodenum is the part of the small intestine where the bulk of the nutrients are absorbed through the body. So, Jobs has had all the parts that do most of the absorption of nutrients removed. In fact, some people have to undergo an additional surgery to help improve absorption (basically involves going back in and connecting up what is left of the digestive tract in a different way). Jobs had this additional surgery, too, but it still doesn't make up for all the effects.
People who have had the Whipple procedure must take pancreatic enzyme supplements, eat a modified diet, and take lots of vitamin and mineral and calorie supplements for the rest of their lives. Most people can live long, relatively healthy lives after a Whipple procedure, but they will always be undernourished and thin.
Has Jobs' cancer returned? I can't answer that. It's possible, but I think that if it had returned, Apple would have said so by now. But what I explained above is a lot more likely to be the truth, and if Jobs would go on the record and explain this much of the speculation would be ended once and for all. But, as others here have stated, his health is a private matter and he has no obligation to disclose any of it, no matter how much others think otherwise. I honestly think that if Steve was in a poor health as the rumors make him out to be that he would not be saying that he's fine even off the record.
I realize that this is a long post, but I felt it necessary to explain these things that I feel have been ignored by the media and by financial analysts. I would be interested to hear if Ric Ford and any other MacInTouch readers find the information I have provided helpful or reassuring about Jobs' health. Likewise, if anyone would like to add anything or point out any mistakes or tell me that I'm completely wrong, go ahead. I'm only human, and I make mistakes like anyone.
John D. Broughton
Stavros Karatsoridis, D.O.:
As for the news that Jobs won't speak at the upcoming Macworld - which precipitated a plummeting stock price and flurry of dramatic press speculations about Dear Leader's health, it should be noted that Apple also announced that the company will no longer appear at Macworld shows, period, after this one. It's an obvious move, if you'll think about it, though no pundit seemingly has. 

Macworld has a fully ingrained image as a computer show, and Apple Inc is no longer a computer company. They've even stripped the word "computer" from their name. Apple tends not to make major iPod announcements at Macworld, because iPods are consumer electronics, not computers. Instead, they mount "special iPod events", slick dog-and-pony shows which have done quite well. iPhones, technically computers but occupying a whole other niche, have been a poor fit for Macworlds, and deserve the Special Event treatment, as well. And, when you come down to it, Apple no longer sells Macs as computers, either. They're branded-up designer lifestyle hubs. Or something like that. At this point, big Macworld announcements would be a poor choice for Apple - sort of like Steve Martin showing up for book readings with an arrow through his head. 

So: Apple committed to this year's show, but needs to save big announcements and big guns for the proper time and place. So what do they do? Have another exec speak to the trade show, and keep the star on the sidelines until later.


Anonymous said...

Careful out there. Steve Jobs' neuroendocrine tumor is called islet cell, and it is one of the less aggressive kinds of neuroendocrine cancer. But there are other kinds of neuroendocrine cancers that are VERY aggressive. Wouldn't want to mislead anyone.

Jim Leff said...

Thanks, David!

I received a similar correction via email, and am hoping my respondent will post a comment here.

Obviously I, myself, am not a doctor...I was just quoting one. And the doctor was speaking specifically about Jobs' case, not about broader issues.

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