Health,  Life

The Untold Story of Steve Jobs’ Battle with Cancer: Why Diet and Alternative Therapies Failed the Tech Icon

Why did Steve Jobs, a super-rich man with almost all medical resources, die from a rare but curable cancer: pancreatic neuroendocrine tumor?
October 5th is an important anniversary for Apple and Apple fans. Steve Jobs, the geek icon who created the Apple mobile phone, died of a rare pancreatic cancer-like cancer: Pancreatic Neuroendocrine Tumor twelve years ago today. The New York Times article stated that Apple did not launch a collectible mobile phone this year. This may represent that Apple, twelve years after Steve Jobs’s death, has won the market but lost Steve Jobs, their soul.

When Steve Jobs died of a rare and easily treatable form of a rare cancer of the pancreas in 2011 , no one knew why it happened. But in his successive recollections after his death, his attending doctor revealed why a super-rich man with so many resources at his disposal ended up with such an unnecessary death, that is, he could have survived.
If Steve Jobs was only regarded as a patient, what had this world-famous patient experienced? What disease did he have? Why would he ruin a good hand?
Like many people’s experiences, Jobs’s tumor was discovered through an accidental physical examination. Starting in the late 1990s, his kidney stones kept recurring. Jobs blamed working too hard at Apple and Pixar Studios. By October 2003, Jobs happened to meet his urologist, who noted that he hadn’t had a CT scan of his urinary system in five years and recommended that he get one.
He did, and the results showed he had a tumor on his pancreas, and in a 2005 speech to Stanford graduates, Jobs recalled that doctors told him, “This is almost certainly an incurable cancer, and life expectancy is It won’t take more than three to six months.”
The medical team acted quickly. After performing a CT scan at 7:30 in the morning, they arranged a biopsy that night to confirm the type of tumor. Jobs recalled his ups and downs at the time: “Later that night, I did a biopsy. They stuck an endoscope down my throat, through my stomach, into my intestines, stuck a needle into my pancreas and took some cells from the tumor. I was under anesthesia, but My wife who was there told me that when the doctors looked at the cells under the microscope, they started screaming because this was a very rare form of pancreatic cancer that can be cured with surgery.”

Jobs was diagnosed with pancreatic neuroendocrine tumor, a relatively rare cancer that affects about 3,000 patients in the United States every year. It only accounts for 1-5% of all pancreatic tumors, and its treatment methods and prognosis are also very different from typical pancreatic cancer. The main characteristic of this kind of tumor is that it secretes a large amount of certain hormones, which in turn affects digestive function and other functions of the body. To understand what kind of cancer this is, you must first familiarize yourself with the knowledge about the pancreas. The pancreas is essentially two different organs, which means there are two distinct tissues, and two distinct of cancer.
The most common is pancreatic cancer, which originates in the exocrine part of the pancreas, which is the main part of the organ. Scattered throughout this larger organ are thousands of small islands that secrete hormones into the bloodstream. Jobs’ tumor fell into the latter category, which was pancreatic islet cell carcinoma. This cancer grows slower and is easier to treat. “It’s not surprising to survive years or even decades with endocrine cancer, which is often measured in years, whereas pancreatic cancer is often measured in months,” Salz said.
There is little debate about the best treatment options. “Surgery has long been thought to lead to long-term survival, ” said Joseph Kim, MD, a surgeon at City of Hope Cancer Center in California. In a 2010 analysis of cancer registries, he and colleagues found that surgery resulted in significant outcomes and much longer survival for neuroendocrine cancer patients whose cancer had not spread beyond the pancreas.
However, from this point on, Jobs made an unusual choice.

Why didn’t Steve Jobs choose surgery? He prescribed a vegan diet, acupuncture, herbal medicine, and even took cow dung to treat his cancer. including a psychic

After learning of the diagnosis, Jobs’s first call was to Larry Brilliant, a physician and epidemiologist who later became the head of Google Philanthropies. The two have a long-standing friendship. They first met at an ashram in India.
“Do you still believe in God?” Jobs asked right away.
Brilliant talked for a while about religion and different faiths, then paused and asked Jobs if something was wrong.
“I have cancer,” Jobs replied.
Afterwards, Jobs called his favorite artist Yo-Yo Ma and asked him to agree to play at his funeral. Because he has always believed that Yo-Yo Ma’s performance “is like God coming, because I don’t believe that a mortal can do this.”
Jobs had been attracted to Eastern mysticism since his youth and spent a long time practicing spiritual medicine in India and Tibet. After falling ill, he almost naturally drew closer to alternative therapies rather than Western medicine. Although doctors agree that patients typically hope to have surgery the next day when they hear about it, Jobs first tried a vegan diet, acupuncture, herbal medicine, and a drug he found online. Other treatments included cow dung (taken in capsules) and even a visit to a psychic.
His biographer Isaacson also said that he was influenced by a doctor and tried drinking only pure fruit juice without eating any other food, colon cleansing and other unproven treatments.
A clerk at Greens, a trendy vegetarian restaurant in San Francisco, revealed that Steve Jobs had been a regular customer at the restaurant since 2003. They even had a strange feeling that “Steve wanted to cure cancer by eating vegetarian food.” He was not picky and usually only He ordered from the regular menu in the store, but he came up with some unacceptable ideas. Once he told the waiter, “Don’t use a pan.” The waiter asked him, how should he cook without a pot? Jobs replied that he didn’t know, repeating that he wished he could cook his meals without using a pot.

Jobs’ friends and family repeatedly urged Jobs to undergo surgery and chemotherapy, but Jobs delayed treatment. Jobs’ friend, mentor and former Intel president Andrew Grove, who had beaten prostate cancer, told Jobs that diet and acupuncture would not cure his cancer. “I told him he was crazy,” he said.
Even Dr. Dean Ornish, a pioneer in alternative and nutritional therapies, had several lengthy talks with Jobs and insisted that sometimes Western treatments were the right choice. “You really need surgery,” Ornish told him.
“I really didn’t want them to cut me open, I felt like it was a gross violation,” Jobs ruefully told his biographer years later.
Jobs’s friends and family also believe that his stubbornness reflects the reason why Jobs was so successful in the business world: his desire to “think different”, he always created a “reality distortion field” and pushed himself to success.

Should “alternative therapies” take the blame? Nine months later, Jobs’s tumor had metastasized and his right pancreas, gallbladder, stomach, bile duct and small intestine were removed.

But this time the reality force field did not distort for Jobs. In July 2004, nine months after he was diagnosed with cancer, a CT scan showed that the tumor “continued to grow and may spread.” Jobs finally took a sick leave. , underwent surgery on July 31 at Stanford University Medical Center in Palo Alto.

He underwent a procedure called a modified Whipple, or pancreaticoduodenectomy. The usual Whipple procedure is the most complex operation in abdominal and gastrointestinal surgery and involves extensive resection, but Jobs underwent a “less radical surgery,” according to his biography. The surgery removed parts of the right pancreas, gallbladder, stomach, bile duct and small intestine. During the operation, doctors discovered that he had three metastases in his liver.

Based on these three metastases, some doctors speculated that since the growth rate of insulinoma was not fast, it was possible that his tumor had already metastasized in 2003. This may mean that, contrary to what is commonly believed in the U.S. medical community, Jobs’ use of alternative therapies during the nine months did not necessarily delay his illness—that his fate was sealed before he was diagnosed.

Whether Steve Jobs’s use of alternative therapies was appropriate has also been a long-standing topic of debate in the American medical community. A study based on nearly 24,000 subjects found that 43-67% of patients in the United States had used alternative therapies after being diagnosed with cancer. , the problem is that many people don’t understand it, and some even use alternative therapies instead of regular treatments.

Dr. Andrew Weil, director of the Center for Integrative Medicine at the University of Arizona, said that of the various alternative cancer treatments he has studied over the years, none have been proven effective and can withstand scientific scrutiny, so relying on alternative treatments alone is Treating cancer is not an option.

But at the same time, he also believes that standard cancer treatments are imperfect. Weill also specifically mentioned his experience when he visited Beijing Guang’anmen Hospital in 2010, believing that “all cancer patients there received appropriate surgery, chemotherapy and Radiation therapy is administered by trained oncologists; acupuncture, Chinese herbal medicine and nutrition are also part of comprehensive cancer treatment, aiming to improve treatment effectiveness and quality of life.

Few American cancer patients have access to this kind of care. “In his opinion, it may be a better way for patients and their families not to refuse surgery, radiotherapy and chemotherapy, but to actively seek integrated treatment including alternative therapies.

Dr. Ashwin Mehta, medical director of the University of Miami Sylvester Cancer Center, also said that to improve health and reduce side effects including fatigue, chronic pain and sleep problems, therapies such as meditation, acupuncture and exercise can be combined with Used in conjunction with standard cancer treatments. If used appropriately, it could have a meaningful impact on the health of cancer patients. “The bottom line is that the human consciousness and psyche are so powerful that there’s every reason to include it as an ally in the fight against cancer during standardized medical procedures,” Mehta said.

After Jobs’ surgery, he refused chemotherapy and drank a single juice or fruit every day. In just about a year, he lost 40 pounds.

Jobs was so relieved after the surgery that he said in an email to colleagues at the company that the surgery “went very clean” and that he “didn’t need to undergo any chemotherapy or radiation” — something every cancer patient longs to hear. . If his surgeon did make such a promise, it was rash: Existing technology cannot detect micrometastases, let alone the millions of malignant tumor cells floating in the blood or lymph fluid. Waiting for an opportunity to invade a vital organ.

As an old Chinese saying goes, Whipple surgery is very “vital”. Complications are common. Patients generally suffer from gastrointestinal reactions and are unable to tolerate certain foods. They usually lose 5-10% of their body weight after surgery. Dilip Parekh, chief of the Department of Oncology and Endocrinology Surgery at the University of Southern California, said: “There will be a small number of patients who will continue to experience weight loss, but if they can stay active and manage their nutritional intake, they will continue to lose weight. There’s no reason why you can’t go on with your normal life.”

The problem was that Jobs was already very thin before the surgery, and he was not good at managing his diet and nutrition. Since his senior year in high school, he has often adopted an extremely simple diet, often eating only apples and carrots for a week (the name Apple computer was also inspired by his return home from an apple farm). He believes that this simple diet makes him light. Ruyan was full of energy and could remove body odor, so he could go a week without having to shower—an idea that Apple colleagues said backfired on Jobs.

After his illness and surgery, he still often ate only fruit and drank juice. He would spend weeks eating the same thing and then suddenly change his mind and switch to a new diet. But some research shows that his special way of eating is harmful to his condition rather than helpful. A November 2007 study published in the American Journal of Clinical Nutrition concluded: “There is evidence that high intakes of fruit and juice are associated with a greater risk of pancreatic cancer.”

And in the August 2010 issue of Cancer Research, Dr. Anthony Healy of the UCLA Jonsson Cancer Center proposed that abnormal fructose metabolism—not just abnormal glucose metabolism— — Possibly related to the pathogenesis of pancreatic cancer, it appears that fructose provides the raw material that cancer cells prefer to use to make the DNA they need to divide and proliferate.

Donald Abrams of the UCSF Osher Center for Integrative Medicine explains that drinking fresh juice releases large amounts of sugar into cells that would otherwise be regulated by the fiber in the fruit. “Cancer cells love sugar,” he said. From a cancer cell’s perspective, there’s no difference between fresh-squeezed juice and sugary cola. “Both drinks can promote inflammation and cause cancer cells to divide.”

Jobs’ wife Lauren Powell and son Reed were only vegetarians before, but after their loved one’s surgery, in order to stimulate his appetite, both Lauren and Reed started eating high-quality foods such as fish and eggs. protein.

But those efforts were in vain, and while he knew he should eat—his doctors had been pleading with him to consume high-quality protein—he admitted that his instinct since his teenage years had been to fast or eat fruit instead. meal. Lauren kept telling him it was crazy.

“I want him to force himself to eat,” she said. But sometimes, during dinner, he stared at the floor and completely ignored the various dishes on the long dining table. Lauren later proposed to find a psychiatrist for her husband to improve his eating problems, but this proposal received no response.

Working at Jobs’ home was a nerve-wracking experience for chef Bryar Brown, who recalled that one night Jobs suddenly said, “Maybe I could have a little pumpkin pie.” The good-natured Brown immediately spent a Made a pie in an hour. Jobs took one bite and put it down, but just one bite made Brown extremely happy.

Jobs lost weight at a speed visible to the naked eye. At the Apple Worldwide Developers Conference in August 2006 and April 2008, the audience noticed that he was emaciated – in fact, by 2008, he had lost 40% of his weight compared to before the surgery. pound. Apple said he simply had a “bad stomach” and was being treated with antibiotics. The New York Times said after communicating with Jobs over the phone: “His problem is not just as simple as a bad stomach, but it is not life-threatening and there are no signs of cancer recurrence.”

On August 28, 2008, Bloomberg made a mistake: it pushed a 2,500-word obituary of Jobs on the company’s news service terminal. Although various media companies have the habit of preparing obituaries for celebrities in advance, this incident has always been unknown, and it has deepened people’s speculation that Jobs was terminally ill. Jobs responded by marking a line of numbers on the last page of his PPT at a press conference: 110/70. Wanted to use his blood pressure count to respond to the world’s concerns about his health.

Liver transplant doubts: Chief surgeon Ethan believes that Steve Jobs may live longer without transplanting the liver

It turned out that in early 2008, Jobs’s tumor had spread further. His quality of life was very poor, he was in great pain, and needed anesthetics for pain relief. In January 2009, he again declared he needed medical leave and was placed on California’s liver transplant waiting list.
At this time, Jobs’s condition was already very bad, and some doctors even thought that he would not be able to wait for the day of liver transplantation. However, his wife Lauren discovered that if the recipient could meet certain conditions, such as arriving at the designated hospital within 8 hours, , then you can be registered on the transplant list in two states at the same time. 3% of liver transplant recipients in the United States do this. The average wait time for a liver transplant in California is more than three years, while in Tennessee, the average wait time for a liver transplant between 2002 and 2007 was just over four months. So, he also made the Tennessee roster.
March is a crazy month for young people in Memphis, Tennessee: St. Patrick’s Day is coming, and the local university is a regular in the college basketball league finals, which means that tragedies involving drunken car accidents among young people are more frequent. . On March 21, a young man of about 25 years old died in a car accident. At this time, Jobs had been promoted from the top of the liver transplant registry.
At 4 a.m. the next day, Jobs’ private jet landed at Memphis International Airport. The US$40 million Gulfstream business jet departed from California and crossed three time zones overnight, completing a 1,800-mile journey. He was immediately rushed to Memphis Methodist University Hospital, where he received a liver transplant.
Complications arose after the surgery. Jobs refused to use a feeding tube and suffered from severe post-operative aspiration pneumonia, and doctors at the time thought he might die. To make matters worse, although the transplant was successful, his original liver was riddled with metastases, and doctors noticed “spots on his peritoneum.” These “spots” may be metastatic tumor deposits. This raises the question, does a liver transplant make sense in this situation?

There are fewer than 48 cases of liver transplantation after metastatic neuroendocrine cancer reported in the medical literature. One of the first such studies was conducted in France. Among the first 31 patients, including three who underwent Jobs-like Whipple surgery, doctors calculated that 59% of the patients survived at least a year, 47 % of patients lived for three years, and 36% of patients lived for more than five years. For neuroendocrine cancers, the rate is even higher: 69% of patients with metastatic cancer survive five years.
But less extreme surgeries appear to be better for patients. In a 2003 study, Mayo Clinic surgeons found that after removing liver metastases, half of the patients lived 45 months or more. They concluded that tumor debulking “adds many months of symptom-free survival to the lives of most patients.” In contrast, liver transplantation “has overall costs and complications that outweigh its benefits.”
In fact, liver transplantation for metastatic cancer “has been largely abandoned” because patients continue to take immunosuppressive anti-rejection drugs after surgery, said John Chabot, a surgeon at Columbia University Medical Center. , which results in a very high cancer recurrence rate. In addition, it is also necessary to consider that combined with the spots on Jobs’ peritoneum, this may mean that there has been extensive metastasis. Liver transplant alone may buy some time for Jobs, but it is of little significance.
Although there are various indications that Jobs and his family did not use their power and money to jump in line for the liver transplant operation, the approval of such an untenable operation seems to imply that there may be something fishy in it. A few years later, the media revealed that James Eason, the surgeon in charge of Jobs’s liver transplant, had indeed benefited from him.
In order for Steve Jobs to recuperate after his transplant surgery, the family bought a house in Memphis. Ethan, who was divorcing his wife, had lived in the house since the early summer of 2009, but did not officially buy it until May 2011. Come down. In between, real estate taxes totaling $23,585 were paid by Jobs’ attorney George Riley via personal check, and water, electricity and gas bills totaling $8,770 were paid via Riley’s personal MasterCard credit card. Purchase order. In other words, Ethan had an operation and lived in the Jobs’ house for two years.

The top medical team behind Steve Jobs reportedly spent more than $300 million? Having tried nearly every state-of-the-art treatment, his wife felt the team lacked a general coordinator

As one of the richest and most powerful technology practitioners in the world at the time, Jobs actually had access to the most advanced therapeutic support. Once he decided to operate, respecting Western medicine, he became an expert, tirelessly researching every treatment.
In 2009, in addition to a kidney transplant, he also quietly went to Switzerland: the peptide receptor radionuclide therapy (PRRT therapy) provided by the University Hospital of Basel can play a dual role of biological therapy and intra-tumor irradiation in tumor lesions, and thus Achieve the effect of killing tumors. At that time, this therapy had not yet been approved by the U.S. FDA (the FDA had approved it in January 2019, and in China, Peking University Cancer Hospital was starting exploratory research on this therapy), so patients usually went to Europe, and Basel University Hospital was the first to receive this therapy. The best place to start.
In addition, after the operation, he decided to cooperate with teams at Stanford, Johns Hopkins, Harvard, and MIT, and became one of the first 20 people in the world to undergo DNA sequencing. By the time he met with the researchers, Jobs and his team had gone through all the molecular data, assessed the rationale for each potential therapy, and come up with a list of tests. After the meeting, the researchers gave a series of targeted drug treatment options aimed at “one step ahead of cancer.” Unfortunately, cancer sometimes outpaces even the most advanced oncology medicine.
Jobs’ tumor progressed at an unusually rapid rate. By the end of 2010, he lost his appetite and felt pain all over his body. However, the doctor did several rounds of examinations and the results were still good and there was no sign of recurrence. In early November, his condition began to deteriorate and he was unable to eat, so he had to ask a nurse to come to his home. Feed. It was not until early 2011 that doctors discovered that his cancer had indeed metastasized to the liver and bones. Targeted treatments worked for a time, but soon stopped working: This has always been a problem in cancer treatment; cancers can evolve resistance, as Jobs’s cancer eventually did.
In early 2011, Jobs had a premonition about everything. He sighed to his biographer Isaacson, “I will either be one of the first people to beat cancer, or I will be one of the last people to die from cancer.”

On October 5, 2011, Jobs died at home. The family later held a private funeral for him at Stanford University Chapel. As he had wished during his lifetime, Yo-Yo Ma played Jobs’ favorite Bach unaccompanied cello suite at the funeral.
Steve Jobs battled the disease for eight years, and his case provided many lessons in the complexity of cancer and the difficulty of decision-making regarding treatment. It is not difficult to see from the treatment process of Jobs that even a man with such wealth and resources often takes detours in the treatment of tumors.
The most striking point is that his treatment has been fragmented, with physicians, surgeons, pain specialists, nutritionists, hematologists, and transplant specialists all working on their own to manage one of his symptoms, but there is a lack of understanding. A general coordinator, which results in a single medical decision that is likely to be detrimental to the overall condition. The team reportedly spent at least $300 million. Laurene Powell, Jobs’s widow, pointedly noted: “One of the big problems in health care is the lack of dedicated managers or champions who should be the backbone of every team.”
During Jobs’s illness, his eldest son Reed, who was still in high school at the time, expressed his wish to become an oncologist when he participated in a national science competition. Today, Reed has graduated from Stanford with a degree in biology and history. The 28-year-old Reed looks very much like his father. He did not go into medicine, but entered the non-profit organization Emerson Collective founded by his mother. As a health project director, he is engaged in both cancer charity and cancer venture capital. The latest project is called “Count me in”, which is dedicated to providing more comprehensive support for research by sharing rare cancer patient data.
Reed said he is particularly concerned about research developments in pancreatic cancer, a cancer for which there are few effective treatments because most patients are diagnosed at an advanced stage. He said: “I don’t want other families to go through what we did. It’s really a tragedy.”

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