The real lesson about Steve Jobs’ cancer

steve_jobs135148Since Steve Jobs’ death almost a month ago, much has been written about his approach to dealing with his pancreatic cancer.

However, David Gorski over at Respectful Insolence here and here has provided the most level-headed analysis of Jobs’ ordeal that I’ve read anywhere to date.

The bottom line is that we simply do not know enough about Jobs’ circumstances with this particularly pernicious form of cancer to know whether his nine-month flirtation with quacks before submitting to the Whipple surgical procedure made any difference in his death. The Whipple procedure can save the lives of a very small percentage of pancreatic cancer patients, but we do not know if Jobs’ tumor was of the specific type that can be effectively eradicated through that procedure. About the only sure thing that can be said about Jobs’ foray into the ephemeral field of “alternative medicine” is that it didn’t help his situation.

The optimistic view of therapeutic intervention in medicine that post-World War II doctors embraced has resulted in enormous advances in our understanding on how to cure, or mollify the effects of, disease.

But the real lesson of Steve Jobs’ cancer is that there remains much more that we simply do not know.

The Unintended Consequences of Prohibition

The futile and damaging nature of drug prohibition is a frequent topic on this blog, so check out this Nick Gillespie interview of Ken Burns on the unintended consequences of prohibition and then review this Radley Balko/Freedom Daily article on the enormous collateral damage of drug prohibition.
A truly civil society would find a better way.

Physical Exercise – Preventive treatment for Dementia?

Dr. Eric J. Ahlskog of The Mayo Clinic’s Department of Neurology discusses his article appearing in the September 2011 issue of Mayo Clinic Proceedings on the effect of physical exercise as a disease-modifying treatment for dementia and the aging brain (H/T Art DeVany).

Thinking about Jobs

steve_jobs_apple_iphoneWe are quickly approaching overload on articles about the late Steve Jobs, but Martin Wolf’s post in the Financial Times on what Jobs’ career teaches us is definitely worth a read.

In short, Wolf explains that Jobs was the quintessential American entrepreneur who was able to marry form with function while bringing a showman’s bravado in promoting Apple products. Not a bad prescription for success.

Meanwhile, David Gorski provides this interesting analysis of Jobs’ bout with the pernicious disease that killed him, pancreatic cancer. Inasmuch as that cancer deprived Houston of one of its greatest teachers, I have followed the clinical research on the disease with interest over the past several years. Dr. Gorski does a masterful job of explaining the complexities involved in treating pancreatic cancer, while also taking a well-deserved swipe at the snake-oil salesmen who were quick to seize upon Jobs’ tragic death to hawk their “alternative treatments” for this deadly disease.

One of many good points that Dr. Gorski makes is the risk that patients such as Jobs take in delaying surgery on cancers such as this while exploring alternative medicine treatments:

If there’s one thing we’re learning increasingly about cancer, it’s that biology is king and queen, and that our ability to fight biology is depressingly limited. In retrospect, we can now tell that Jobs clearly had a tumor that was unusually aggressive for an insulinoma. Such tumors are usually pretty indolent and progress only slowly. Indeed, I’ve seen patients and known a friend of a friend who survived many years with metastatic neuroendocrine tumors with reasonable quality of life.

Jobs was unfortunate in that he appears to have had an unusually aggressive form of the disease that might well have ultimately killed him no matter what. That’s not to say that we shouldn’t take into account his delay in treatment and wonder if it contributed to his ultimate demise. It very well might have, the key word being “might.” We don’t know that it did, which is one reason why we have to be very, very careful not to overstate the case and attribute his death as being definitely due to the delay in therapy due to his wanting to “go alternative.”

Finally, Jobs’ case illustrates the difficulties with applying SBM to rare diseases. When a disease is as uncommon as insulinomas are, it’s very difficult for practitioners to know what the best course of action is, and that uncertainty can make for decisions that are seemingly bizarre or inexplicable but that, if you have all the information, are supportable based on what we currently know.

In short, despite the advances of modern medicine, there is still much that we do not know about how disease attacks our bodies.

Patients beware.

Obama’s hypocrisy on drug prohibition

drug-warThere are many reasons to be disappointed about Barack Obama’s presidency, but arguably no reason is more galling than Obama’s failure to back up his campaign promise to re-evaluate the federal government’s dubious drug prohibition policy.

Jacob Sullum sums up Obama’s hypocrisy on drug prohibition in this masterful Reason.com op-ed:

It is not hard to see how critics of the war on drugs got the impression that Barack Obama was sympathetic to their cause. Throughout his public life as an author, law professor, and politician, Obama has said and done things that suggested he was not a run-of-the-mill drug warrior….

[But] Obama’s drug policies … by and large have been remarkably similar to his predecessor’s. With the major exception of crack sentences, which were substantially reduced by a law the administration supported, Obama has not delivered what reformers hoped he would. His most conspicuous failure has been his policy on medical marijuana, which is in some ways even more aggressively intolerant than George W. Bush’s, featuring more-frequent raids by the Drug Enforcement Administration (DEA), ruinous IRS audits, and threats of prosecution against not only dispensaries but anyone who deals with them.  “I initially had high hopes,” says Marsha Rosenbaum, “but now believe Obama has abdicated drug policy to the DEA.”

It would be going too far to say that Obama has been faking it all these years, that he does not really care about the injustices perpetrated in the name of protecting Americans from the drugs they want.  But he clearly does not care enough to change the course of the life-wrecking, havoc-wreaking war on drugs….

We know how Obama responds when the question of marijuana legalization comes up in public: He laughs. The highest-rated questions submitted for his “virtual town meeting” in March 2009 dealt with pot prohibition. “I don’t know what this says about the online audience,” Obama said with a smirk, eliciting laughter from the live audience, “but…this was a fairly popular question.”

Obama’s dismissive attitude was especially galling in light of his own youthful pot smoking, which he presents in Dreams From My Father as a cautionary tale of near-disaster followed by redemption.  “Junkie. Pothead,” he writes.  “That’s where I’d been headed: the final, fatal role of the would-be black man.”  Judging from the reports of friends interviewed by The New York Times in 2008, Obama exaggerated his brush with addiction for dramatic effect.  More important, he has never publicly acknowledged the plain truth that people who smoke pot rarely become junkies or suffer any other serious harm as a result — unless they get caught.

As Richard Nixon’s National Commission on Marihuana and Drug Abuse pointed out when Obama was all of 10 years old, the biggest risk people face when they smoke pot is created by the government’s attempts to stop them.  In 1977, when Obama was a pot-smoking high school student in Honolulu, President Jimmy Carter advocated decriminalizing marijuana possession, telling Congress that “penalties against possession of a drug should not be more damaging to an individual than the use of the drug itself.”

That is hardly a radical position.  Polls indicate that most Americans think pot smokers should not be treated like criminals…

In New York City, where marijuana arrests have increased dramatically since the late 1990s, blacks are five times as likely to be busted as whites.  The number of marijuana arrests by the New York Police Department (NYPD) from 1997 through 2006 was 11 times the number in the previous 10 years, despite the fact that possession of up to 25 grams (about nine-tenths of an ounce) has been decriminalized in New York….

Obama attended Columbia University in the early 1980s, well before the big increase in marijuana arrests that began a decade later.  There were about 858,000 pot arrests nationwide in 2009, more than twice the number in 1980, and the crackdown has been especially aggressive in New York City under Mayors Rudolph Giuliani and Michael Bloomberg (another former pot smoker).  “The odds are not bad,” observes Ethan Nadelmann, “that a young Barry Obama, using marijuana at Columbia, might have been arrested had the NYPD been conducting the number of marijuana arrests then that it is now.”

A misdemeanor marijuana conviction could have been a life-changing event for Obama, interrupting his education, impairing his job prospects, and derailing his political career before it began.  It would not have been fair, but it would have spared us the sorry spectacle of a president who champions a policy he once called “an utter failure” and who literally laughs at supporters whose objections to that doomed, disastrous crusade he once claimed to share.

Inasmuch as I do pro bono work in the juvenile justice system, I experience first hand the absurdly destructive effects of the drug prohibition policy on young people and their families. We get the quality of political representatives that we deserve, but Obama’s disingenuousness and insensitivity with regard to the government’s drug prohibition is reprehensible even by the low standards by which we evaluate U.S. politicians. That no Republican Presidential candidate other than Ron Paul is willing to take Obama to task for his hypocrisy is a reflection of the sad state of political discourse in this country.