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.

Leave a Reply