Tuesday, January 18, 2011

What's wrong with Steve Jobs

(Image: Justin Sullivan/Getty)
Steve Jobs's sick leave has generated the sort of news coverage normally reserved for a member of the first family. The speculation is of two types: what might be wrong with him, and the implications for Apple.
Most likely, as explained in the San Jose Mercury News is one of two possible outcomes: first, as backed by ABC News, that a rare form of pancreatic cancer diagnosed and successfully treated in 2004 has returned; second, as articulated by the San Francisco Chronicle, that his body is rejecting the liver transplant he received in 2009.

Beyond that, there are numerous other possibilities relating both to the original cancer and to likely complications of the transplant, each with its own implications for his future health.
In 2003 Jobs was diagnosed with neuroendocrine cancer, a rare but unusually treatable form of pancreatic cancer affecting the islet cells, which manufacture insulin. Unlike orthodox pancreatic cancer, which usually kills rapidly, neuroendocrine cancer is treatable provided the tumours are removed before they spread to other organs.
Although the treatment appeared successful, Jobs returned to hospital in 2009 for a liver transplant. It may be that some pancreatic cancer cells had survived surgery and spread to the liver in such large numbers that the only option was to completely replace it, but Jobs has never confirmed this.
Irrespective of why the transplant was done, the new organ's arrival introduced a whole catalogue of new complications, not least the necessity for him to take immunosuppressive drugs to prevent rejection. 
Whenever the immune system is suppressed, pre-existing cancers can spread unchecked and completely new ones, such as skin cancer or lymphoma, can arise, and previous studies have shown that having a transplant can treble the risk of cancer.
Some doctors commenting on Jobs's condition are more optimistic, saying that even if the cancer has returned, he could survive for many years.
Gagandeep Singh, a liver surgeon from the City of Hope hospital in Duarte, California, is quoted in the Los Angeles Times as saying that liver transplants to treat neuroendocrine tumours are extremely rare, with only 20 such cases recorded in medical literature. For those few cases, the one-year survival rate is about 80 to 85 per cent, and the five-year survival rate about 40 per cent, Singh told the newspaper.
John Neoptolemos, a pancreatic cancer specialist from the University of Liverpool in the UK, told The Guardian that it may have been a "mistake" to have the transplant, because of the complications of immunosuppression. He said that the cancer reaching the liver could have been kept in check instead either through radiotherapy or with new drugs.
With luck, the complications forcing Jobs back to his sickbed may turn out to be less serious than recurrence of cancer or liver rejection. They might include blockage of the bile duct, a common complication of liver transplants, or possibly blood clots or excessive bleeding in the organ. Alternatively, it may be that he's simply finding food hard to digest because of the wild hormonal fluctuations that result from neuroendocrine pancreatic cancer, comments Bloomberg.
Whatever the truth, the uncertainty over whether and when such a talismanic figure will return to the helm may harm Apple's prospects. And although the company has a successor in the shape of Tim Cook, who "knows Jobs's mind", according to the Sydney Morning Herald, the paper wonders whether he has the charisma and creative genius of his boss.

Andy Coghlan, reporter (new scientist magazine)

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