Few celebrities or public figures have had their personal medical choices so ardently debated posthumously as Steve Jobs. In the weeks after his death, sparked by intimations from Walter Isaacson’s biography, there seemed to be a growing consensus that Jobs had screwed up his own medical treatment by shunning modern medicine, at least initially, in favor of alternative treatments. If he hadn’t done so, say critics, he might still be alive today. Whether this is true or not, of course, we’ll never know, but people love to debate it.
So it’s a year later. And we’re still speculating over his choices, regarding his health and his personal life (and, of course, if he were alive today, what he’d do with Tim Cook). The truth is that cancer treatment is not straightforward for anyone, and pancreatic cancer is the most difficult to treat of any. Computer technology and cancer treatment are both moving forward, though perhaps not at exactly the same rate. Where we are with our understanding of cancer – and our understanding of Jobs – is still a work in progress. But here’s what we do know.
Updates in Pancreatic Cancer Research
Jobs was “lucky” in that he had the rarer, but less deadly, form of pancreatic cancer – a neuroendocrine tumor. The other type, pancreatic cancer proper, or adenocarcinoma, often takes people’s lives in the first six months after it’s diagnosed, according to Dr. Leonard Saltz, Chief of the Gastrointestinal Oncology Service at Memorial Sloan-Kettering Cancer Center in New York.
Neuroendocrine tumors can vary widely, producing higher or lower levels of excess hormones. How altered the cancerous cells become is, in some way, related to the patient’s prognosis. “Some people can live for many years, even decades, after discovering they have a neuroendocrine tumor,” says Saltz. “Understanding why these differences exist would be critically important. Why do these cells become cancer cells, and then once they do, what makes them behave the way they do? Why does one cancer decide to spread to the liver and another to the lung? Why does one go the brain and one to the bone?”
These are the kinds of fundamental questions with which researchers are still grappling. Much like fixing a broken car, says Saltz, cancer researchers first have to understand how the car works, and only then can they address what’s wrong with it. The answer to cancer, and much of the thrust of the research these days, seems to lie in genetics. “Some genes become mutated, some are silenced, and still others are activated. Some combination of these changes must be factor that controls the development of cancer,” he adds.
Detecting pancreatic and neuroendocrine tumors earlier, rather than after they’ve metastasized to other organs, would be a great help, but whether it will happen any time soon is unclear. “Right now the answer is ‘no,’ but in the future it may be possible,” says Dr. Michael Lieberman, Director of Surgical Oncology and Director of the Pancreas Center at NewYork-Presbyterian/Weill Cornell Medical Center. “Unfortunately, there’s no equivalent of a colonoscopy, or a pap smear, for pancreatic cancer. And it’s not feasible financially to CAT scan or MRI everybody routinely.”
One thing we do know about medicine is that more information isn’t necessarily better – you have to find the right way to apply it, says Saltz. “One thing that got some press with Jobs is that he had his genome analyzed. This didn’t appear to help much. There are 20,000 genes in the human genome, and we just don’t know what to do with all that information right now. We have to be careful about assuming that all information is actionable.” Mapping out genomes may be crucial for the long term, but at this point in time, and for the individual patient, it may not be.
Where we put our money and our efforts is an extraordinarily complex – and touchy – issue, because it brings into question the “worth” of a life. Spending hundreds of millions of dollars on a researching a treatment that only extends a person’s life by a few months may not be the best way, says Saltz. “Small advances are blown up into ‘groundbreaking’ developments, and this is actually not serving us well at all,” he adds.
It’s impossible to tell whether Jobs made wise choices with his own treatment, or whether another path would have been better. He’s been widely criticized for putting off conventional treatment for months. Since neuroendocrine tumors are less lethal than true pancreatic cancer, doing so may not have made much difference. “Still, Jobs had the liver transplant, which is not done very commonly,” says Dr. Jack Welch, head of Gastrointestinal and Neuroendocrine Cancers Therapeutics at the National Cancer Institute. “Doctors may have told him one thing, and he, being Steve Jobs, may have done something else.” But again, it’s hard to tell from this vantage point.
And Updates on Jobs
Since his death, the media have seemed to take delight in revealing the “real” Steve, the mercurial bastard of a CEO who fired people in elevators or humiliated them publicly – but all for the sake of the growth of Apple, and of course, the revolution of technology. Leander Kahney, author of Inside Steve’s Brain, told CNN, “Everyone knew he was a taskmaster, but his cruelty — his relentless, humorless pursuit of corporate perfection — wasn’t so widely acknowledged. It’s certainly put some people off. Some see his life as a warning. It’s a lesson in how not to devote your life to your work.”
One thing’s for certain: Jobs was a shrewd decision-maker. According to his own self-analysis in the Lost Interview from 1995, he was always one to admit when he was wrong – it was growth he cared about more. “I don’t really care about being right. I just care about success,” he mused. “You’ll find a lot of people who will tell you that I had a very strong opinion, and they presented evidence to the contrary, and five minutes later I completely changed my mind. ‘Cause I’m like that; I don’t mind being wrong. And I’ll admit that I’m wrong a lot. It doesn’t really matter to me too much. What matters to me is that we do the right thing.”
Perhaps shunning medical treatment for nine months was not the right decision, but it was his decision – perhaps it was a way to stay in control, and to apply his revolutionary and wildly successful business vision to his own health. Last year, Job’s biographer, Walter Isaacson, said in an interview, “I think that he kind of felt that if you ignore something, if you don’t want something to exist, you can have magical thinking. And it had worked for him in the past.” It just didn’t work in medicine.
One thing’s for sure, Jobs was a dynamic person, and his energy drove others to succeed. Randy Adams, a software engineer for Jobs, told Forbes, “His charisma, was like electricity – he was giving off this incredible force. It was inspirational. He lifted you. I used to believe when I was with Steve, you could do anything. You could change the world. When he died, a little bit of that feeling left me. There’s no one like him.”
Cancer research will continue to move forward, and so will technology, though they may do so at different speeds. Hopefully both industries will see more Jobs-like revolutionaries in their futures. As Jobs said himself, “the only way that we’re going to ratchet up our species is to take the best and to spread it around to everybody, so that everybody grows up with better things.” This goes for technology and medicine alike.