
Biographer: Jobs refused early and potentially life-saving surgery - MichaelApproved
http://www.cbsnews.com/stories/2011/10/20/60minutes/main20123269.shtml
======
tremendo
I really dislike all these after-the-fact rationalizations and second-
guessing, and wish we could simply let the man rest in peace.

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...](http://www.sciencebasedmedicine.org/index.php/the-death-of-steve-
jobs/)

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.

~~~
MichaelApproved
I'm sure he's resting just fine. This is a biography that is for us to
contemplate and discuss. It's quoting his own words.

Edit: removed "authorized" from biography since I don't know for sure.

~~~
Flenser
You could have left authorized in. Walter Isaacson was his official
biographer.

------
bh42222
I recall Stephen Fry's great comments on Steve Job's "Apple stands at the
intersection of technology and the liberal arts." statement.

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.

~~~
asmithmd1
Jobs may not have acted irrationally. Have you looked into the procedure that
he needed? It is not a tonsilectomy. Here is the latest I found about the
surgery:

"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.

~~~
algorithms
Which is still a much better chance than trying to defeat the cancer with
alternative medicine...

~~~
adammichaelc
It depends. If you look at the peer-reviewed research, you'll see that
pharmaceuticals and surgery are not the only option (depending on the disease,
of course).

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).

~~~
seabee
"Non-pharmaceuticals" and "alternative medicine" are distinct but overlapping
sets. In any case, to quote Tim Minchin: "Do you know what they call
'alternative medicine' that's been proven to work? Medicine."

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...](http://www.reuters.com/article/2011/10/07/us-antioxidants-
idUSTRE7965X6)

~~~
adammichaelc
From what I understand, your main point is that there is no need to call it
"alternative" medicine because something is either medicine or it is not.

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...](http://www.sciencedirect.com/science/article/pii/S0039128X99000124))
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!

------
MichaelApproved
I found this interesting too: _"he saw Apple staffers turn into "bizarro
people" by the riches the Apple stock offering created. Isaacson says Jobs
vowed never to let his wealth change him."_

I wonder what he'll consider to be _bizarro_.

~~~
alanfalcon
I've always wondered about Steve's decision to severely limit stock
distribution at Pixar when it had its IPO. What he did was apparently legal,
but many staffers there felt like they were treated unfairly. A theory I've
been considering is that Steve did it to avoid changing the people who made
Pixar what it was[1]. I mean, Steve certainly didn't seem like he cared about
having the money, except maybe to say "told you so" to all those who doubted
him after his removal from Apple. Just something that seems to fit with the
facts that I'm aware of.

[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.

~~~
gamble
Didn't he do the same thing during Apple's IPO? I was under the impression
that Apple employees only received stock because Woz voluntarily gave up some
of his own to form an employee pool.

It's this tight-fisted aspect of Jobs that makes it difficult for me to
appreciate him on a non-professional level.

------
acabal
I was extremely surprised to read that the guy in charge of a company that
almost exclusively produces highly expensive 1st-world gadgetry was himself
disdainful of conspicuous consumption.

~~~
hugh3
Aw c'mon, Apple products don't count as "conspicuous consumption". They're
fairly small and unobtrusive. Sure, they're a bit self-marketing (white
earphones and big illuminated Apple logos on the back of your laptop) but
that's not conspicuous consumption.

Gucci is conspicuous consumption. Bugatti is conspicuous consumption. Diamonds
in your teeth is conspicuous consumption. Personal electronics are just plain
ol' regular consumption.

~~~
borism
seriously? even if those personal electronics are priced at a hefty premium
over their counterparts?

~~~
randomdata
We really don't know how much Apple charges for their hardware because they
bundle their software with it, and they don't tell us how much the software
costs either.

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.

~~~
borism
_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.

~~~
randomdata
Hey, why even buy a luxurious PC? Just throw some parts together and install
Linux. There couldn't possibly be any reason to choose a difference operating
systems except status, right?

------
alatkins
There was also a detailed answer related to this a few days ago on Quora:
[http://www.quora.com/Steve-Jobs/Why-did-Steve-Jobs-choose-
no...](http://www.quora.com/Steve-Jobs/Why-did-Steve-Jobs-choose-not-to-
effectively-treat-his-cancer/answer/Ramzi-Amri)

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...

~~~
pella
[http://www.quora.com/Steve-Jobs/Why-did-Steve-Jobs-choose-
no...](http://www.quora.com/Steve-Jobs/Why-did-Steve-Jobs-choose-not-to-
effectively-treat-his-cancer/answer/Ramzi-Amri/comment/567595)

------
rickmode
Side comment: The mobile version of that link was exceptionally painful. A
short article was split to 5 pages. Wow.

~~~
palish
So click "next" 4 times. It was annoying, but not a big deal...

~~~
lukeschlather
In actual usage, it can often end up being significantly more than 4 times,
especially in mobile where you might end up going through a tunnel, or leaving
cell reception entirely before you finish the article.

~~~
palish
Oh, good point! Thanks!

------
itsnotvalid
I thought a much detailed explanation was found in another article that was
posted to HN earlier this month [1].

The article referred to a 2008 blog post about that.

\---

[1] [http://www.skepticblog.org/2011/10/06/steve-jobs-succumbs-
to...](http://www.skepticblog.org/2011/10/06/steve-jobs-succumbs-to-
alternative-medicine/) and HN discussion:
<https://news.ycombinator.com/item?id=3080176>

------
kno
I don't think his decision to refuse surgery was a 'stupid decision', he was
just being human. Steve's success in tech should not make him in the eyes of
people be super human. Even in tech, successful people make lot of mistakes;
history just records successes.

~~~
hugh3
_I don't think his decision to refuse surgery was a 'stupid decision', he was
just being human._

I'm afraid I don't see the distinction between "being human" and "making
stupid decisions".

~~~
kno
In the context of Kroft asking "how such an intelligent man could make such a
seemingly stupid decision", human are naturally afraid of surgery, no want
want their body open unless they have no choice; Steve too.

~~~
Fliko
Just because he is a human doesn't mean that it's not a stupid decision, it
will always be a stupid decision nothing will change that.

~~~
dextorious
That implies that living at all costs is the "smart" thing to do.

------
twainer
Maybe there is more to the actual story but the article provides zero support
to the headline as per the the surgery being 'life-saving'. It is even
referenced as a 'stupid decision' to have put it off.

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.

~~~
gabyar
Steve Jobs had an extremely rare form of pancreatic cancer that has a very
good 5-yr survival rate if caught and treated early. The article is likely
accurate.

~~~
twainer
Thanks to all for the clarification.

------
tripzilch
This was also discussed in this blog post, shortly after his death:

[http://www.skepticblog.org/2011/10/06/steve-jobs-succumbs-
to...](http://www.skepticblog.org/2011/10/06/steve-jobs-succumbs-to-
alternative-medicine/)

------
CamperBob
A nicely written article. However, this point:

    
    
       "In retrospect, we can now tell that Jobs clearly had 
       a tumor that was unusually aggressive for an insulinoma."

... seems to undermine the author's own argument that Jobs's nine months of
ineffective dieting and dithering was not necessarily a problem. Was it an
aggressive tumor, or not? If so, then the early CAT scan was a lottery win,
and it was incredible that Jobs failed to cash in the winning ticket. If not,
then sure, maybe nine months more or less didn't matter.

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.

~~~
b0rsuk
I think Steve Jobs acted _stupid_.

"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...](http://www.searchlores.org/realicra/basiclawsofhumanstupidity.htm)

------
ary
Surely I can't be the only person that wants to just read the book without
having Isaacson spill all the beans before my copy comes in the mail. With
each one of these excerpts he teases I lose more and more respect for the man.
He's riding this thing pretty high and it's starting to be in bad taste.

This is already one of the most anticipated biographies ever. There's not
really any need to seek more attention.

~~~
alanfalcon
It's not exactly fair to put that on the author. Authors have publishers and
it's my understanding that publishers require publicity. It's in the contract.
Maybe Walter could try to take a moral stand, but I'm not going to blame him
for not rocking the boat here.

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.

~~~
ary
To be fair I agree with the notion of publisher driven publicity. Perhaps he's
obligated.

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.

------
powertower
And if Jobs cured his cancer they would be saying how much of a smart man he
was to try this alternative cure.

It's easy to pretent you have 20/20 hindsight on other peoples lives.

~~~
ceejayoz
> And if Jobs cured his cancer they would be saying how much of a smart man he
> was to try this alternative cure.

Not really. "Spontaneous remission is rare but it happens, lucky man!" would
be the far more likely response.

