Steve Jobs hastened his death by delaying cancer treatment, using alternative therapies instead

Sat, 2011-10-22 16:17

#2

M. Spector M. Spector's picture

Yeah, but at least those "alternative therapies" didn't do him any harm!

Sat, 2011-10-22 19:19

#3

jas

You realize the article doesn't exactly support the conclusion you trumpet in your thread title?

Quote:

As Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society has pointed out, people “live with these tumors far longer than nine months before they’re even diagnosed.” I suggest going back and read my post on the early detection of cancer, particularly the part about lead time bias, for an explanation of why the nine month delay might not have mattered much.

pancreatic cancer survival rates

Sat, 2011-10-22 19:58

#4

Sineed

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.

Sun, 2011-10-23 00:38

#5

Aristotleded24

M. Spector wrote:
Yeah, but at least those "alternative therapies" didn't do him any harm!

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.

Sun, 2011-10-23 02:30

#6

M. Spector M. Spector's picture

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.

Sun, 2011-10-23 12:24

#7

Sineed

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.

Sun, 2011-10-23 15:28

#8

M. Spector M. Spector's picture

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.

Sun, 2011-10-23 15:34

#9

Fidel

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.

Sun, 2011-10-23 20:08

#10

Sineed

M.Spector wrote:
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.

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.

Mon, 2014-04-28 12:55

#11

NorthReport

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/

Sat, 2014-05-03 12:54

#12

Sineed

NR, that article is behind a subscriber firewall.

Sat, 2014-05-03 15:50

#13

quizzical

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

Sat, 2014-05-03 15:56

#14

NorthReport

good point quizzical.

Dallas Buyer's Club, anyone?

Sat, 2014-05-03 15:56

#15

NorthReport

Good point quizzical.

Dallas Buyer's Club, anyone?

Sun, 2014-05-04 11:03

#16

Sineed

quizzical wrote:

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

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...

Quote:
In a recently published study, Korean researchers evaluated whether CAM-use influenced the survival and health-related quality of life (HRQOL) of terminal cancer patients. From July 2005 to October 2006, they prospectively studied a cohort study of 481 cancer patients. During a follow-up of 163.8 person-years, they identified 466 deceased patients. Their multivariate analyses of these data showed that, compared with non-users, CAM-users did not have better survival. Using mind-body interventions or prayer was even associated with significantly worse survival. CAM users reported significantly worse cognitive functioning and more fatigue than nonusers. In sub-group analyses, users of alternative medical treatments, prayer, vitamin supplements, mushrooms, or rice and cereal reported significantly worse HRQOL. The authors conclude that “CAM did not provide any definite survival benefit, CAM users reported clinically significant worse HRQOLs.”

The only one who violated Jobs' human rights was the Grim Reaper.

Sun, 2014-05-04 11:23

#17

Sineed

NorthReport wrote:

Dallas Buyer's Club, anyone?

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:

Quote:
I haven’t seen the movie, and I really don’t want to, given that, from everything I’ve heard about it, it’s basically the story of a “brave maverick” who bucks the FDA, complete with all the tropes about uncaring bureaucrats who don’t care if these brave patients die. That might not be so bad if it weren’t also riddled with inaccuracies and misinterpretations of the AIDS crisis in the 1980s. Worse, the real Woodruff rejected the one truly promising drug at the time, AZT as hopelessly toxic and instead smuggled drugs like Peptide T, which never panned out. Basically, what Woodruff appears to have smuggled as part of his activities for the “Dallas Buyers Club” was a mixture of useless supplements, experimental drugs that panned out, and a handful of experimental drugs that showed promise. Meanwhile, the movie portrays the FDA as the implacable enemy of theses sorts of activities, jackbooted thugs not unlike the stereotype promoted by “health freedom” quacks who don’t like the FDA preventing them from selling their quackery. As far as I can tell without actually seeing the movie is that the overall message is a typical uplifting story of an underdog who fights the power and in doing so finds redemption.

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.

Sun, 2014-05-04 11:42

#18

6079_Smith_W

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.

Sun, 2014-05-04 13:06

#19

Sineed

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...

Quote:
Of course, I’ve written fairly extensively about vitamin C and cancer before, using it as an example of how even a two-time Nobel Prize winner like Linus Pauling could fall prey to bad science when he wandered outside of his area of expertise. Every so often these stories come up suggesting that Linus Pauling has somehow been vindicated and how vitamin C is the greatest thing for cancer patients since surgeons first discovered that some cancers could be cured by cutting them out. Inevitably, I have to throw cold water on such claims. No, Linus Pauling has not been vindicated, and, no, vitamin C for cancer is not all that great.

<snip>

Given the ridiculously high concentrations and doses required in preclinical models to demonstrate a hint of antitumor activity, that pharmaceutical company would probably retire that compound before even the animal model stage because, as I like to put it, getting any useful anticancer activity out of it would be such a long run for a short slide. A good drug for cancer is, at the very minimum, active at low or reasonable concentrations against the cancer cells being targeted, and vitamin C fails miserably on that count. Worse, there are at least indications that in some cases vitamin C might interfere with chemotherapy.

Sun, 2014-05-04 14:09

#20

6079_Smith_W

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.

Sun, 2014-05-04 15:11

#21

wage zombie

Sineed wrote:

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:

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.

Sun, 2014-05-04 15:45

#22

Sineed

wage zombie wrote:
Did he delay his treatment for nine months because he was trying alternative therapies, or because he was a workaholic?

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.

6079_Smith_W wrote:
I couldn't find the actual meta-study.

Here's the link to the full study.

http://annonc.oxfordjournals.org/content/24/2/489.long

Quote:
We used the definition of CAM adopted by the US National Center of Complementary and Alternative Medicine (NCCAM): ‘CAM is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine’ [15]. NCCAM named five major CAM categories: (i) alternative medical systems (oriental herbal medicine, acupuncture, ayurveda, and homeopathy), (ii) mind–body intervention (yoga, meditation, prayer therapy, music/dance therapy, art therapy, and horticultural therapy), (iii) biologically based therapy (medicinal herbs, vitamin supplements, hydrotherapy, dietary supplements, etc.), (iv) manipulative and body-based therapies, and (v) energy therapies. In this research, we investigated participant's use of all five categories and focused on specific therapies within each category.

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.

Quote:
While patients often use CAM in the hope that it will lead to tumor growth suppression and cure [5, 22], our study showed that CAM users did not have better survival than nonusers. Moreover, among mind–body interventions, those who prayed showed marginally worse survival. Although no reliable, well-designed clinical trials on the efficacy of CAM in cancer patients have been carried out, earlier studies have also shown complementary therapies to be associated with worse outcomes [23, 24].

Sun, 2014-05-04 17:03

#23

6079_Smith_W

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.

Sun, 2014-05-04 17:15

#24

NorthReport

Sineed,

You are probably on the money here, from what little I know about him as well.

Sineed wrote:

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.

Sun, 2014-05-04 19:13

#25

6079_Smith_W

Sineed wrote:

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.

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.

Mon, 2014-05-05 19:14

#26

Sineed

6079_Smith_W wrote:
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:

Quote:
...a major role of the physician is as expert consultant and that morally we are obligated to provide recommendations that are rooted in evidence and science, not magic and superstition.

Mon, 2014-05-05 20:36

#27

6079_Smith_W

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.

Wed, 2014-05-07 01:13

#28

NorthReport

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/

Wed, 2014-05-07 01:15

#29

NorthReport

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/

Wed, 2014-05-07 08:16

#30

Sineed

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).

Wed, 2014-05-07 08:43

#31

6079_Smith_W

Sineed wrote:

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.