What’s going on with Steve Jobs’ hormones?
Steve Jobs’ letter to the Apple community about his health problems seems to have reassured investors — the stock closed up 4.22% in Monday trading.
But medically, Apple’s (AAPL) CEO raised more questions than he answered.
His eight paragraph message contains remarkably few health-related facts. They’re all contained in these three graphs:
“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.” (link)
“Cryptic,” is how Dr. William Sherman, a medical oncologist at the Pancreas Center of New York Presbyterian and Columbia University, described Jobs’ breezy summary of his medical condition. “Delightfully vague,” says Dr. Andrew Ko, a medical oncologist at the University of California-San Francisco. That phrase — “hormone imbalance” — tells us neither what hormones are involved nor why they’re misbehaving.
Moreover, Jobs, who is 53, has left several relevant facts out of this account, starting with the malignant tumor that was removed from his pancreas in 2004 — along with his gallbladder, part of his stomach, the lower half of his bile duct and part of his small intestine. See the Whipple procedure diagram below. The details of this operation were first reported by Peter Elkind in Fortune. (See also Why does Steve Jobs look so thin?)
Several experts, none of whom are involved in his treatment, have speculated that the hormone imbalance Jobs describes may be caused by a recurrence of the original cancer — an islet cell neuroendocrine tumor, one of the few forms of pancreatic cancer that can be successfully treated. If Jobs’ first surgery missed some of those cancer cells, that’s not necessarily a death sentence, says Dr. Ko. With proper treatment — using injectable drugs designed to block key hormone receptors — patients with these cancers can live for years.
Jobs told Apple employees four years ago that his cancer was “cured.” And last year, according to a report in the New York Times, he told several associates — including members of Apple’s board — that he was cancer-free. (See here.) He letter Monday said nothing about cancer, one way or the other.
According to the New York Times, Jobs also told the board that he had a second surgery in 2008 — most likely a surgical “revision” or rearrangement of his internal plumbing to address complications stemming from the original procedure (see here.) The purpose of this second procedure, according to the Times, was to correct ongoing digestive difficulties.
Jobs’ open letter suggests that those digestive difficulties have continue to plague him and offers a new theory — confirmed, he says, by sophisticated blood tests — about what might be going on: an easily treated “hormone imbalance.”
There are several problems with this explanation. Not only is it frustratingly imprecise, but it suggests that Jobs’ hormone issues are something his doctors only just discovered — prompted by his decision a few weeks ago to finally get to the root cause of his weight loss.
Hormones — a broad term for any chemical released by cells that affects cells in other parts of the body — perform a wide variety of functions, from stimulating growth and regulating mood to triggering physical changes like puberty and menopause. They interact in complex ways — through cascading reactions and elaborate feedback loops — and are known to get out of whack now and then, most familiarly in post-menopausal women.
Hormones also regulate digestion and metabolism. In fact, the main function of the pancreas is to produce metabolic hormones (chiefly insulin and glucagon) and digestive enzymes that break down food. Given that Jobs lost a large portion of his pancreas in his 2004 surgery, one would expect his digestive enzymes to be affected — a condition that can be effectively treated with enzyme replacement therapy. Hormone deficiencies are also common after a Whipple procedure, but they are usually detected and treated early. The mystery, says UCSF’s Dr. Ko, is what — besides a tumor — could cause a hormone imbalance this late in the game.
“If someone is losing weight, you do a workup of his pancreas, you do a workup for diabetes, a workup for hyperthyroidism,” says Columbia’s Dr. Sherman. “Maybe it wasn’t abnormal enough to say so at first, and maybe now it is so a diagnosis can be made.”
What strains credibility — and sounds too good to be the whole story — is that the issue was first raised and the cause discovered only a few weeks ago. If it is something as simple and straightforward as a nutritional problem caused by a hormone imbalance, says Dr. Ko, “I doubt his doctors would have missed it all this time.”
What seems more likely is that Jobs, a man who knows something about controlling the message, is telling us a story as carefully crafted as any Apple product. He has said as little as possible about his medical condition — just enough to calm the waters roiled by his decision to skip this week’s Macworld. And he said it before the markets opened on the eve of Apple’s last Expo — just in time to allow the thousands of reporters, analysts, developers and fans descending on San Francisco to “relax,” as he writes, “and enjoy the show.”
What’s really going on, we still don’t know.
–With reporting by Alyssa Abkowitz.
[Diagram courtesy of the Mayo Clinic]
Mr. Jobs’ “hormone imbalance” probably results from removal of a significant portion of his pancreas for his tumor removal, with the subsequent loss of either hormone production (specially insulin, but also glucagon, which counters insulin) or digestive enzymes (which his docs may have oversimplified by calling them “hormones” too. I vote for the latter, since he suggests in his statement that it is easily treated, and one only has to take pancreatic enzyme supplements in pill form to correct the loss of the enzymes. It also explains why it’s taken “so long” to figure it out– a California man his age who exercises regularly and eats well would be happy to stay “trim” until the press and blogosphere start ranting about his imminent death from cachexia. This “hormone (enzyme)” deficiency acts in much the same way as the drug Alli works– and people pay money to get that effect.
Neither of the 2 “experts” Fortune quotes are likely familiar with pancreatic insufficiency, since they see mostly the bad pancreas cancer cases. And to suggest that this is a recurrence of his original cancer would mean that the multiple CAT and MRI scans I’m sure he’s gone through have missed a BIG mass, which is unlikely. Starting “proper treatment” with chemotherapy would not make Mr. Jobs too sure of his future.
One does not need sophisticated or expensive tests to figure it out, just a good doctor. He probably hasn’t seen his pancreatic surgeon since 2004, and his other docs probably haven’t seen this complication enough to think of it–after all, most patients with run-of-the-mill pancreatic cancer die too quickly to develop long-term side effects from the operation.
Does the author require an in-depth analysis on the state of Mr Jobs’ health? It certainly seems that way, given the medical consult. I asked Dc Gregory House who told me he couldn’t give an exact diagnosis because “I’m a fictional character.” Needless to say, that really riled me: I simply cannot continue to use Mac products without knowing the PRECISE details of the Apple CEOs physical well-being.
If there is idle speculation afoot the blame rests mostly with Mr. Jobs. If he had wanted to protect his privacy he would have released a statement to that effect, rather than one which gives obfuscatory information about his condition. He can’t have it both ways. In any case, it is better for Apple — and especially its stockholders — if Mr. Jobs is forthcoming about his illness. Many billions of dollars and the future of Apple are at stake.
Mr. Jobs is reported to be a vegan and likely eats lots of soy. Check out the web site dogtorj.net and discover the “soy myth” and how this “food” (and others) adversely affects our hormonal systems. It projected me into almost a vegetable state, but the information presented on the site mentioned above saved me just in time.
This is a tasteless invasion of privacy. Shame on you!
I’m going to bypass all of the controversy and just state that you have likely misquoted Dr. Sherman. If someone is losing weight, one would suspect hypERthyroidism (too much thyroid hormone which speeds up metabolism), not hypOthyroidism (lack of thyroid hormone, resulting in slowed metabolism).
Let me guess ya want Jobs to say more of what he might not know for sure since he’s not a freggin Doctor so ya can come up with all kinds of expeculations, ya really are Sick
This really is no one’s business. Name one other CEO held to this standard. I’m glad I don’t have a press release every time I have a bowel movement. Leave him alone, or please do cover Larry Ellison’s hemorrhoids.
People make me laugh. Obviously, Jobs has put the right people in place to take over, soon you goofballs will say how great this transition is and his word “relax” will finally be heeded. He knew this would come one day. Everyone acts like Apple will be no more when he is gone. Then everyone complains about CEO/President pay but every newspaper in the world talks about how lost Apple would be w/o him. So do CEO/Presidents make too much or what or is Jobs this priceless??? I will pray for his good health.
Real intelligent, insightful, comments. I feel like I’m on the Craigslist Apple forum…..
Apple’s marketing really blows my mind. It’s amazing how they can get users of their products to act as bulldogs for their PR department.
Good article btw.
Oh, for crying out loud!
You know: Steve could have a hand growing out of his back, too. Have you _seen_ him with his shirt off? Do you realize that it _might_ be possible? I think you need to demand that he strip down on stage somewhere.
(I should know: I’ve been covering Apple Inc since 1978!)
Steve Jobs will be heading up Apple for years to come. Get used to it.
Now can we get back to talking about something meaningful?
Welcome back FudWit
For a little while there I began to think you had found some credibility
This will soon be posted on http://www.dumbanalysts.com
Perhaps you can write your next article on Larry Ellison’s Hemorrhoids-complete with illustrations.
I’m afraid the author will never be satisfied with any explanation of Jobs’ health until he personally sees the results of Jobs’ blood tests and x-rays or their equivalent. So, it is easy for him to suggest that more questions are raised by Jobs’ statement.
Maybe the author would like a full-blown interview of Jobs’ doctors. Even then, he would probably interview other doctors to disagree. So, what is his purpose in planting further seeds of doubt about Jobs’ health?
Perhaps the author won’t ever be satisfied until his “suspicions” are confirmed. I don’t think the writer is really looking for the truth anymore. He chooses to ignore it and act as if the Jobs’, Apple’s entire board of directors and Jobs’ doctors are engaged in some sort of conspiracy to mislead the public about Jobs’ condition. His pondering are unsupported by any factual evidence, only by mere speculations and stubbornness to accept any factual account from the Apple perspective as true.
This is not reporting, nor is it even misguided speculation. It is nothing more than a cowardly way to call everyone involved a liar. Maybe the author should look himself in the mirror to see if he is manipulating the actually known facts for his agenda. Oh, I almost forgot to mention that if Jobs et al. were lying or withholding material information that would subject all of them, including Apple itself, to massive liabilities. Does the author think that the accountants and the lawyers are also in on some scam.
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Silicon Valley veterans like to joke that Steve Jobs must be surrounded by a reality distortion field; if you get too close to him, you start to believe what he's saying. Thanks to the success of the iPod, the launch of the iPhone and the renewed interest in the Mac, Apple has made believers out of millions of customers - and made a lot of investors rich. But Philip Elmer-DeWitt believes that an ounce of skepticism never hurts when writing about the company. He should know. He's been covering Apple - and watching Steve Jobs operate - since 1982, first for Time Magazine, then for Business 2.0, and now for Fortune.
As a successful 29 month survivor of pancreatic cancer, who is doing very well (without the Whipple surgery), I have two comments:
1) I sincerely wish him good health and continued success in winning the battle …. and
2) Since this disease (4th largest “killer” among all cancers — 95% die within 5 years of diagnosis) needs more spotlight due to it’s very limited survival rate, it would actually be beneficial if someone of Mr. Jobs’ prominence would be wiling to be the “face” of the disease. I’m not suggesting that he is still plagued by pancreatic cancer, but we sure could use his help at the national level via the Pancreatic Cancer Action Network (www.pancan.org).