Wednesday, January 07, 2009

TIme Magazine on Steve Jobs

BB NOTE: As folks at the Cafe know, we've been following Apple Icon Steve Jobs since his his Keynote Address at the last MacWorld in June 2008. We've grown up with Steve and Woz being central talking points of family conservation around the dinner table in those early days when we had the Apple II back in those high school days in Honolulu. Steve hasn't been looking so good of late and Apple has not been piling on the drama as they usually do, appearing to desire to quell other drama instead.

This past week, Steve Jobs put out a letter where he appeared to explain what's going on. But did he? Not really. Here's the letter:

January 5, 2009

Letter from Apple CEO Steve Jobs

Dear Apple Community,

For the first time in a decade, I’m getting to spend the holiday season with my family, rather than intensely preparing for a Macworld keynote.

Unfortunately, my decision to have Phil deliver the Macworld keynote set off another flurry of rumors about my health, with some even publishing stories of me on my deathbed.

I’ve decided to share something very personal with the Apple community so that we can all relax and enjoy the show tomorrow.

As many of you know, I have been losing weight throughout 2008. The reason has been a mystery to me and my doctors. A few weeks ago, I decided that getting to the root cause of this and reversing it needed to become my #1 priority.

Fortunately, after further testing, my doctors think they have found the cause—a hormone imbalance that has been “robbing” me of the proteins my body needs to be healthy. Sophisticated blood tests have confirmed this diagnosis.

The remedy for this nutritional problem is relatively simple and straightforward, and I’ve already begun treatment. But, just like I didn’t lose this much weight and body mass in a week or a month, my doctors expect it will take me until late this Spring to regain it. I will continue as Apple’s CEO during my recovery.

I have given more than my all to Apple for the past 11 years now. I will be the first one to step up and tell our Board of Directors if I can no longer continue to fulfill my duties as Apple’s CEO. I hope the Apple community will support me in my recovery and know that I will always put what is best for Apple first.

So now I’ve said more than I wanted to say, and all that I am going to say, about this.


Time Magazine speculates on what Steve said and what it could - and could not - mean. From here.
The letter that Apple's iconic executive, Steve Jobs, released Monday to quell concerns about his ailing health and increasingly frail frame — which recently caused a dip in Apple stock — had reporters across the country scrambling for answers. What condition could cause the "hormone imbalance that has been robbing [him] of the proteins [his] body needs to be healthy" and result in such dramatic weight loss? And in what scenario would that condition entail a "nutritional problem" whose cure is "relatively simple and straightforward"?

* Why Is Steve Jobs Skipping MacWorld?

As their phones began lighting up — Dr. Robert Lustig, an endocrinologist at the University of California at San Francisco, said he had fielded a dozen calls by midafternoon — medical experts nationwide postulated myriad reasons for Jobs' withered appearance: a thyroid problem, a deficiency of human growth hormone or perhaps the lasting effects of Whipple surgery (which involves removing portions of the stomach, pancreas, bile duct and small intestine, and can inhibit digestion), which is a common treatment for pancreatic cancer. The last theory seems to be the leading one at this point (Jobs had surgery to remove a pancreatic tumor in 2004, but he did not say what kind of surgery); even years after a Whipple procedure, it's possible that damage to the intestines could limit absorption of nutrients, a deficiency that can be remedied with a change in diet and enzyme treatments. (See the top 10 medical breakthroughs of 2008.)

While many of these explanations are possible, no diagnosis neatly accounts for the scarce information provided in the letter. "[It] doesn't make a lot of sense," says Lustig. "There are three medical threads that run through this e-mail, but unfortunately those threads don't make a very strong cable." No illness involving a combination of a hormone imbalance and a loss of proteins that causes dramatic weight loss could be remedied with a simple nutritional fix, Lustig says.

Dr. Walter Willett, chair of the department of nutrition at the Harvard School of Public Health, agrees. "They don't fit together for me," he says, while adding, "Nothing is that simple." The two most common hormone imbalances that would result in weight loss, according to Willett, are hyperthyroidism, in which an overactive gland ramps up metabolism, and type 1 diabetes. But while nutrition may certainly play a role in diabetes treatment, it has little to do with curing hyperthyroidism, Willett says.

A hormonal imbalance would indeed suggest an endocrine problem, like diabetes, says Lustig, but many of the conditions that cause the body to lose vital proteins are not endocrine in nature. If a patient were losing the proteins through urine, diabetes could be an explanation, but so could other conditions, including multiple myeloma, a cancer that causes symptoms ranging from bone pain to weight loss.

Pancreatic cancer could also cause protein loss during the digestive process, Lustig says, which would suggest a recurrence of the malignant tumor that Jobs battled 2004. It is unlikely, however, that Jobs' original cancer has spread, Lustig says. Since pancreatic cancer is so swift and deadly, "We have to assume he was cured of that," Lustig says. "If he weren't, he would have been dead years ago." But having developed one endocrine tumor increases the patient's risk for developing a second.

Another explanation for a protein deficiency is that the body is simply not producing enough of them — a symptom of conditions including hypothyroidism, in which the body underproduces necessary hormones, or Cushing's syndrome, Lustig says. But both conditions cause weight gain, not loss. Another possible cause is celiac disease, in which a gluten intolerance diminishes the body's ability to absorb nutrients, but that's a digestive order, not the result of a hormone imbalance, Lustig says. What's more, almost none of the hypothesized disorders involving hormone imbalance and protein deficiency can be treated with a basic change in nutrition. "There is no one disease process that encompasses these three medical threads," says Lustig.

Whether or not the cryptic information in Jobs' letter buoys Apple stock, one thing's certain: it's sparked a new conversation about how much the public deserves to know about the health of CEOs — who are semi-public officials, perhaps — particularly in the midst of an economic crisis. It's one thing to probe the medical records of presidential candidates and other public officials, but "at some point we need to respect people's confidentiality," Willett says.

"This is a puzzle," Lustig says. "And I'm sure Mr. Jobs meant it to be."
Read it all here.

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