Steve Jobs had a kind of pancreatic cancer with an excellent long-term prognosis, but he delayed his surgery for 9 months, instead taking alternative therapies like vegan diets, coffee enemas, herbal remedies, accupuncture, juice fasts, bowel cleansers, and other such unproven treatments. When assessed months later, it was found that his tumour had grown and spread. He then had the surgery, but by then the cancer was in his liver.
http://www.sciencebasedmedicine.org/index.php/steve-jobs-medical-reality...
Yeah, but at least those "alternative therapies" didn't do him any harm!
You realize the article doesn't exactly support the conclusion you trumpet in your thread title?
pancreatic cancer survival rates
If you think the article contradicts what I said, you didn't read the whole thing. Actually, as the article says, Steve Jobs had a good prognosis. Most pancreatic cancers, 95%, are adenocarcinomas, highly aggressive fast-growing cancers associated with a poor prognosis like what Bill Hicks had. Jobs had a neuroendocrine tumour, which has a good prognosis if the surgery is done soon enough.
On the Science-Based Medicine blog, some of the posters were predicting that alt med practitioners will start proclaiming a victory for complementary medicine given Steve Jobs' survival for so many years, on the basis of this misunderstanding between adenocarcinomas (poor prognosis, rapidly fatal), and neuroendocrine tumours (good prognosis if caught early enough). I see it's already happening.
No, they did not. The problem wasn't with the alternative therapies, it was with his refusal to seek proper medical treatment in the first place.
I was being sarcastic. Of course the alternative therapies were the problem - they were the reason he delayed getting real medical treatment until it was too late.
That's how interpreted your post, M. Spector.
David Gorski is one of my favourite writers on the topic of science-based medicine; he's an oncologist specializing in breast cancer treatment, but despite his vast scope of knowledge he's thoughtful, careful not to leap to conclusions. So he says that alternative medicine did not kill Steve Jobs, and states his disagreement with other writers on the topic like at skeptic blog, and a research associate at Harvard Medical School.
Though it could be argued that alt med did kill him, as he placed his faith in it, resulting in the fatal delay. I personally don't land hard on one side or the other.
If it weren't for the existence of phony "alternatives", why would Jobs - or anyone else with cancer - delay getting proper treatment?
But Gorski claims that the nine-month delay in getting proper treatment might not have increased the odds against Jobs, because we don't have actual data on his condition at all points in time to be able to say with certainty that his condition was worsening during those nine months. I guess there's the possibility that Jobs's pancreatic cancer went into some kind of magical stasis for nine months as a result of his acupuncture and bowel cleansing, etc. and that's good enough for a skeptical Gorski to say the delay might not have killed him.
Seems like a funny kind of skepticism, though, that discounts scientific evidence that delay in medical treatment increases the risks, in favour of the possibility that pseudoscience might have worked magic.
I think Jobs understood his odds of surviving a rare form of pancreatic cancer. Radiation and chemo are a lot like using a sledge hammer to set finishing nails in fine wood.
There's a couple of factors at work here: first, as you can see, Gorski is a hard-core science-based medicine guy who is temperamentally reluctant to draw conclusions unless all the data are there. Second, there's the nature of cancer, a multi-faceted disease. I'm no oncologist, but I've studied oncology, and there are some cancers that just stop and don't grow any more, doing no harm to the host. They find these when doing autopsies on people who have died for other reasons. A common example is ductal carcinoma in situ, a microscopic breast cancer that has not spread beyond the milk ducts.
Even though it seems obvious that the nine-month delay resulted in a spread of the disease, Gorski is being scrupulously correct when he says we can't conclude the cancer spread during that time because there are no data. The cancer could have sat quiescent for 8 months. Or it could have been an entirely new cancer. These possibilities are less likely, but for Gorski, you can't jump to conclusions without the data to back them up.
Speaking of therapy
50,000 Life Coaches Can’t Be Wrong
Inside the industry that’s making therapy obsolete
http://harpers.org/archive/2014/05/50000-life-coaches-cant-be-wrong/
NR, that article is behind a subscriber firewall.
i don't understand this thread at all!!!! wasn't it his life to do what he wanted with it? i mean really i think comments about his choices fails to accept human rights
good point quizzical.
Dallas Buyer's Club, anyone?
Good point quizzical.
Dallas Buyer's Club, anyone?
Nobody is talking about coercion here. Jobs made a choice out of his own free will to delay his cancer treatment for nine months. In that time, the cancer spread to his liver and elsewhere. Jobs was a public example of an all-to-frequently repeated tragedy that is the false choice presented by complementary and alternative medicine. There are many other examples:
http://whatstheharm.net/alternativemedicine.html
http://edzardernst.com/2013/04/cancer-patients-who-use-alternative-medic...
The only one who violated Jobs' human rights was the Grim Reaper.
Dallas Buyer's Club has been debunked in a few places. I like this article because it also discusses the pitfalls of the "Right to Try" laws being considered south of the border:
Ron Woodruff's rejection of AZT is particularly unforgiveable given the thousands of lives it eventually saved as a part of the "HAART" therapy that turned AIDS from a death sentence to its current status as a chronic condition.
http://edzardernst.com/2013/04/cancer-patients-who-use-alternative-medic...
Never mind that he admits there isn't any demonstrated causation (and takes a backhanded swipe while saying so) they make hash of the article in the comments.
I couldn't find the actual meta-study. I notice that the first one was limited to patients with terminal diagnoses, and that cancer is not just one disease, but did they really just limit it to prayer, vitamins, mushrooms and tea?
(edit)
Along with many factors, It all depends on the cancer, and the vitamin:
http://www.ncbi.nlm.nih.gov/pubmed/17533208
And yes, I know the conclusions have to do with prevention.
Prevention and cure are apples and oranges. For instance, there's a correlation between obesity and a greater risk of breast cancer, but nobody would suggest that weight loss is a breast cancer treatment.
Here's a nice article on the lack of effectiveness of vitamin C in cancer treatment. It's fairly long and technically complex, but here's some of the main points:
http://www.sciencebasedmedicine.org/the-return-of-the-revenge-of-high-do...
Except that the study was about vitamin D, not C, and as I posted, I know prevention isn't the same as treatment. My point was that the tone of the blog post, and the headline in particular was so broad as to make it almost meaningless. He admits himself there is no demonstrated correlation. And some fo the responses call him on that a good deal further.
And it doesn't seem to be clear what he's actually talking about. Again, is it just terminal patiends who use prayer and supplements who die sooner, and is that the case for all cancers? But then again, that's only of concern to those of us who might be interested in what might have effect on certain conditions and what might not, not just to be used as something to make sweeping and baseless charges.
I don't know much about the last few years of Jobs' life. I haven't read the book or seen the movie. Did he delay his treatment for nine months because he was trying alternative therapies, or because he was a workaholic? I only ask because delaying treatment in order to prioritize other things is also an all-to-frequently repeated tragedy, so not sure if that's what you were implying.
That isn't clear. Even the most staunch defenders of science-based medicine concede that we cannot conclusively say alt med killed Jobs, but rather, the delay in treatment.
According to the book, Jobs spent a lot of time after his diagnosis using alt med, like coffee enemas, juice fasts, accupuncture, herbs. The book paints a vivid picture of an obsessive and controlling man, suggesting that he would have found it difficult to concede control over his body to others.
Here's the link to the full study.
http://annonc.oxfordjournals.org/content/24/2/489.long
The users of CAM did not differ significantly in demographic characteristics from non-users. CAM users reported a clinically signficant worsening in cognitive functioning, fatigue, and insomnia.
Thanks.
Did I read that wrong, or did the study actually not say that people who used CAM died sooner (among a groups who were all going to die within a few months)? From that graph there is no difference. Also, I couldn't seem to find what they mean by body-based therapies.
It looks like all the difference has to do with pain, insomnia, and quality of life. There are some interesting points in the discussion section. I guess the question I see unanswered is why people opt for those therapies, and what might be cause of those differences.
Given the diagnoses, one presumes not everyone is hoping for a miracle cure, and that for some it is palliative. Also, people might not want to take medication because of side effects; of course that might result in harsher symptoms, but it is a matter of choice.
Sineed,
You are probably on the money here, from what little I know about him as well.
I guess that begs the question of what actually hastened his death - the therapy, or his attitude.
I ask mainly because I know a few people who have faced a cancer diagnosis who were open to different treatment modalities. Not all opted for the same thing, and not all opted for different therapies for the same reason. After all, if that stem cell transplant looks like what is going to do it, that's how it is. It doesn't necessarily mean you reject other treatments to help support you in other ways.
I might be more inclined to buy the black and white approach if I didn't also know, and have read opinions by therapists, including MDs and an RN, who manage to incorporate these different methods.
Evidence-based medicine isn't black and white. There's a nice piece over at Science-Based Medicine published today, that uses the example of one Dr. Katz, who uses homeopathy and accupuncture, as well as evidence-based modalities. The author of the article states that it's Dr. Katz who is creating a false dilemma, insisting that if a patient can't be cured, we have no choice but to turn to quackery, or abandon the patient.
http://www.sciencebasedmedicine.org/false-dilemma-of-david-katz/#more-31325
Dr. Gorski states what is my basic ethos:
I suppose that accusation is not as bad as Gorski comparing him to Michael Corelone.
But I'd turn his other example around - the claim that Q10 isn't alternative at all. Practitioners are pilloried for using methods and substances until they are actually proven to work. Once they are shown to work the claim becomes that they aren't alternative at all.
Sorry, but it can't be both; if it works, it works, and if it worked at a time when it was undermined by the medical establishment, that represents a vindication of therapists took risks to who use that treatment.
And the scare tactic in his other article about not using natural ingredients was absurd - most people aren't stupid enough chew foxglove. And are we seriously supposed to be worried about dosage or contamination of honey, lemon, papaya seeds, or other things that are a cheaper, milder substitute for drugs?
The problem with the loaded "expert consultant" term is that it is based on an idea of medicine that is static and absolute. You should know better than me that even among treatments and drugs that have been subjected to research, results are not always absolute.
And you and I have discussed before treatments that simply aren't offered by most doctors - not because they don't work, but because they aren't taught in their schools.
So sorry, I don't think Gorski's assessment - abandon the patient or abandon science - is a fair one at all.
And to take it back to the OP, I'd agree that Jobs may indeed have shortened his life by his decision. But pointing out an anecdote of someone making the wrong decision says nothing about those who use different methods in a more appropriate way.
There was something on the radio this evening about a book entitled ""Missing Microbes"
There is a a connection.
Has anyone heard about it?
There is a certain amount of what I believe to be healthy skepticism of the drug industry. For example the author Dr Blazer, Professor of Medicine at NYU, discovered that Sweden uses 60% less ant-biotic drugs than we do, and yet the Swedes are as fit as us. Maybe they are more fit.
Can we save our body’s ecosystem from extinction?
This helix-shaped bacteria called Helicobacter pylori is disappearing from our modern stomachs. Once thought of as a “bad bug”, doctors are learning that this bacteria influences our immune system, our weight, and even our height. Photo courtesy Flickr/AJ Cann
The sheer amount of bacteria in the human body weighs three to four pounds combined, as much as the human brain. Microbial species live on the surface of our skin, in our stomachs and in our noses, outnumbering our cells 10 to 1. Our bodies are host to some 100 trillion bacteria – this is known as the human microbiome. And while the human genome has 23,000 unique genes, the human microbiome has 2 million.
Some bacteria are indisputably bad. But others boost our immunity, protect us from infection and produce the enzymes we need to digest our food. Without these bacteria, we wouldn’t survive, says Dr. Martin Blaser, author of the new book “Missing Microbes.”
“They are kind of a part of us,” Blaser said. “And my fear is that some of them are going extinct.”
Humans in the U.S. have lost a third of their microbial diversity, mostly on their skin and in their stomachs and digestive tracts, said Maria Gloria Dominguez-Bello, associate professor of medicine at NYU.
The problem is due in part to the overuse of antibiotics, C-sections and modern sanitation, Blaser says. And he believes that microbe extinction may be at the root of modern plagues like asthma, allergies, diabetes, obesity and even some forms of cancer.
Scientists are just starting to catalogue the human microbiome, said Lita Proctor, director of the National Institute of Health’s Human Microbiome Project. Understanding how these microorganisms interact inside our bodies is shifting the way medicine views the bacteria, she said.
http://www.pbs.org/newshour/updates/theres-extinction-happening-stomach/
There was something on the radio this evening about a book entitled ""Missing Microbes"
Did anyone catch it?
There is a a connection.
There is a certain amount of what I believe to be healthy skepticism of the drug industry. For example the author Dr Blazer, Professor of Medicine at NYU, discovered that Sweden uses 60% less ant-biotic drugs than we do, and yet the Swedes are as fit as us. Maybe they are more fit.
Can we save our body’s ecosystem from extinction?
This helix-shaped bacteria called Helicobacter pylori is disappearing from our modern stomachs. Once thought of as a “bad bug”, doctors are learning that this bacteria influences our immune system, our weight, and even our height. Photo courtesy Flickr/AJ Cann
The sheer amount of bacteria in the human body weighs three to four pounds combined, as much as the human brain. Microbial species live on the surface of our skin, in our stomachs and in our noses, outnumbering our cells 10 to 1. Our bodies are host to some 100 trillion bacteria – this is known as the human microbiome. And while the human genome has 23,000 unique genes, the human microbiome has 2 million.
Some bacteria are indisputably bad. But others boost our immunity, protect us from infection and produce the enzymes we need to digest our food. Without these bacteria, we wouldn’t survive, says Dr. Martin Blaser, author of the new book “Missing Microbes.”
“They are kind of a part of us,” Blaser said. “And my fear is that some of them are going extinct.”
Humans in the U.S. have lost a third of their microbial diversity, mostly on their skin and in their stomachs and digestive tracts, said Maria Gloria Dominguez-Bello, associate professor of medicine at NYU.
The problem is due in part to the overuse of antibiotics, C-sections and modern sanitation, Blaser says. And he believes that microbe extinction may be at the root of modern plagues like asthma, allergies, diabetes, obesity and even some forms of cancer.
Scientists are just starting to catalogue the human microbiome, said Lita Proctor, director of the National Institute of Health’s Human Microbiome Project. Understanding how these microorganisms interact inside our bodies is shifting the way medicine views the bacteria, she said.
http://www.pbs.org/newshour/updates/theres-extinction-happening-stomach/
I listened to that piece, NR. I think the doctor has made some hypothesis-generating observations, but to attribute a wide range of illnesses to the disappearance of microbes felt like an oversimplification.
The rise in asthma, obesity, allergies, diabetes and cancer could be a consequence of not dying from other things, like infectious diseases. In countries where people have access to modern medicine and sanitation, we live twice as long as we did in the 19th century.
Personally, I'd rather have asthma (which I do) than die in childbirth (which I would have, prior to modern obstetrics).
Fortunately it's not an either/or thing - like all of this.
I caught a little bit of it - the bit where he was talking about H. pylori and about more specific rather than general antibiotic use. Thing is, he's absolutely right about overuse of antibiotics. And when you have most of it being done by the meat industry, and to produce more food, not actually fight disease - and largely unregulated - that's overuse.
And if he was being a bit too speculative he's also absolutley right in the general sense that we are surrounded by microbes (we have many times more microbial than human cells in our bodies) and that our relationship with most of them ranges from the benign to the symbiotic.
Certainly it was looking at things that way that made someone realize that our appendix actually does serve an important function - one that can turn against us when we are in a not-so-natural modern environment.