What caused Steve Jobs’ death 6 Oct 20118 Oct 2011 Almost as soon as Jobs’ death was announced, a post went up on Twitter: http://twitter.com/#!/kzelnio/status/121762419075850242 referring to this post that stated that Jobs initially treated his pancreatic cancer using a naturopathic diet. I replied http://twitter.com/#!/john_s_wilkins/status/121764589657530368 It raises a philosophical question, and a sociological one: 1. What caused Jobs’ death? 2. Who is to blame? Let’s take the first question first. Steve Jobs died because pancreatic cancer spread through his body. Pancreatic cancer has a very low survival rate. [Late note: Jobs’ cancer had a much higher survival rate.]Â Cancer survival is not divided into “lives/dies”, because this is a statistical matter (strictly, a frequency matter): those who fall into the class of pancreatic cancer sufferers have a survivorship curve they will fall along, based on treatment rates and interventions. At some point (by convention, either 5 or 10 years survival rates) the causal influence of the cancer merges into the general noise of death-causing events and is indistinguishable. You might have died from the cancer after that date, but you might also have died from car accident, heart attack or domestic homicide; the statistics can’t say clearly enough to give a figure. We are fond of trying to identify the cause (let us call this the Uni-Causal Assumption or UCA) in everyday life. Usually this means that we presume a background of ordinary causes that do not bias outcomes one way or another, and identify the difference-maker that does. Suppose that getting nose cancer is due to eating peanuts (so far as I know they do not!). People who eat peanuts are some percentage per unit of time more likely to get cancer of the nose. If you do not eat peanuts, your likelihood is equal to the general populational likelihood. We assume under the UCA that peanuts cause cancer of the nose. Of course it isn’t that simple. Causation is a messy topic, and the first attempt to analyse that mess was done by Aristotle who famously distinguished formal, final, material and efficient causes (these are the Latin terms. In English we would be best calling them the structural, goal-based, material and change-making causes). We want to identify the efficient cause, and so we finger peanuts. They are the change-makers. Only, this cannot be right. If it were, everyone would get nose cancer if they ate peanuts, just like everyone who swallows sufficient cyanide dies horribly, as in detective novels. Instead, eating peanuts must act on some biological systems in such a way that the more sensitive or responsive ones develop cancer of the nose. So now we have this: Peanuts & Disposed Biology → Nose Cancer But in order to eat peanuts there needs to be a peanut industry. This involves the making and distribution of fertilisers, transport, currency, government regulations, education, and the historical causes of all these including (in post-imperial colonies) migration and colonisation. And in order to have a disposed biology you must have a biology, an ecology, and a planet for these things to evolve on. We might assign causal roles to selective, stochastic (chance), and contingent (historically unique) causal chains leading up to this one event. Now we have: Peanuts (and everything that leads to their being food) & Disposed Biology (and everything that led to it evolving and developing) → Nose Cancer In effect, any causal chain in the entire world line that converges upon this one event is “a” cause, because it makes a difference to this outcome. This is roughly the same as saying that those world lines in the prior light cone of an observer of this event that contribute to it is the sum total of causes. A light cone: Now this doesn’t help us with explanations because there are too many causes; we can never list even a fraction of them even if we know them. But this general point might prevent us from simple comments about “Woo killed Steve Jobs”. We ascribe agency to those aspects of the worldliness that strike us as significant relative to the background causes that kept the event from happening or do not influence it one way or the other. And it is not clear that Jobs’ cancer was caused by, or failed to be prevented by, the naturopathic treatment. At best, it merely hastened it. Jobs would still have died from this cancer, based on what we know already. He had whatever genetic and developmental predispositions to pancreatic cancer, and whatever immunological absences that might have fought it before it got detected. The naturopathic treatment did not in any way help him, and failing to get chemotherapy early on decreased his chances of survival. That is all we can say for now. I am sorry to piggyback this discussion of causal ascriptions on the death of a man I greatly admired and respected. However, we need to be very careful about blame in these cases. Naturopathy is a (mostly harmless) substitute for medical treatment, and since medical treatment is usually not needed (in the case of treating colds and the like) it doesn’t matter. But if it is a replacement for medical care when medical care can do some real good, then it becomes a serious sociological and political issue. When naturopathy causes people not to take medications or vaccinations that work, then we should attack it. When it keeps poor people from getting medical treatment for economic reasons and false advertising, then it is a political issue. In this case, however, Jobs, who had access to medical treatment and information of the best kind, chose to manage his illness in a manner that slightly hastened his death, probably. And that’s about all we can say. It was his right to do that, though we may lament the outcome. Philosophy
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Personally, I think that skeptoid post was inappropriate. I agree with you, that if Jobs chose a non-standard treatment, that is his choice and his right to choose. I have no criticism of people who make such choices. I do criticize those who try to persuade others to make bad choices.
If you are saying what I think you are here, then I think I agree with you. Aristotle notwithstanding, the whole concept of “cause” is in my opinion a lost cause, and most of the attempts to define it rigorously seem to be either superstitious garbage or so far removed from the common understanding as to be useless. So far as I can tell the word is not necessary for any scientific discussion, and because of its association with what you call the UCA it would be best avoided in common language as well.
The woo/naturopath industrial complex is already fighting back! See this ridiculous article on ‘natural news.com’: “Steve Jobs dead at 56, his life ended prematurely by chemotherapy and radiotherapy for cancer” http://www.naturalnews.com/033793_Steve_Jobs_chemotherapy.html Here’s a typical quote: “It is extremely saddening to see the cost in human lives that modern society pays for its false belief in conventional medicine and the cancer industry in particular. Visionary Steve Jobs died today, just months after being treated for cancer with chemotherapy at the Stanford Cancer Center in Palo Alto, California. In recent months, he appeared in public photos as a frail shadow of his former self. The thin legs, sunken cheek bones and loss of body weight are all classic signs of total body toxicity observed in chemotherapy and radiotherapy patients”. These people are evil fuckwits.
I love how natural news fails to mention that hair loss is a side effect of chemotherapy, probably because he didn’t undergo traditional proven chemotherapy regimens for any long stretch of time
I am hearing reports that Jobs became interested in Buddhism, simplicity and nature. That might have been part of his inspiration at Apple. And it might have been why he tried naturopathy.
I have watched several of my friends die a terrible death from undergoing chemo and radiation treatments for cancer. If this is a cure, then I want no part of it. It is a known fact that chemo only works for certain cancers…lukemia, hodgkins, lymphomas, and testicular. The rest are just the medical communities attempt to look like they are doing something for the patient and to make the family happy. I would go the alternative route and take my chances, and at least have some quality of life! I’m sure Jobs had done all the research and knew exactly what he was doing. He tried the chemo as a last resort and look what that did for him! May he rest in peace.
Let me say right now that attempts to hijack this blog for anti-traditional treatments will be deleted immediately. I have had cancer, and worked in a medical research institute that sought to understand and treat cancer. I will not countenance disinformation here. Of course people with cancer who get serious treatment and die do so after the treatments. But the treatments are not what kills them. Cancer is. The treatments kill the cancers, and sometimes they work extremely well – there are whole classes of cancers now, such as leukemias, which in my youth killed my best friend at age 6, which are now curable. The discoverer of colony stimulating factor, which permits people to survive what would otherwise be a fatal dose of chemo in order to kill all cancer cells, worked at my institution. If the cancer is inevitably going to kill you, then perhaps a quality of life route would be sensible. But Jobs and many others have cancers that are quite treatable (if not curable, since we don’t talk that way about cancers; all you can do is reduce the likelihood the cancer will recur before something else, like old age, kills you). Avoiding these treatments for some silly naturopathic treatment is plain stupid. This is the last word on this blog about that.
Yeah well I have psoriasis. It significantly contradicts much of what is said here. Ruined much of my life. Cures are worse than the disease. Natural remedies become accepted treatment. It’s a disease that cannot usually kill so it doesn’t qualify for disability although it can be completely debilitating. Good to hear some things work for cancer. I spent a lifetime learning to mistrust doctors. After my first colonoscopy and being berated for wasting his time etc ( yeah the psoriasis thing) and arguing with my family physician who had no sympathy or interest in checking me first or doing other tests … To hell with it.
I don’t agree raving. I also don’t have a very high regard for some doctors, treatment on the N.H.S is somewhat variable. I have had the same experience being berated by sloppy consultants employing mind reading and engaging in folk classification. G.P’s are worse. The figment of my imagination that got a number of ‘experts’ rather grumpy was cardiovascular, I was only properly diagnosed when it became rather serious and I was no longer able to walk properly. It has altered my life totally, I am not exactly happy with regard to the problems I had in getting diagnosed but I am quite grateful for the empirical testing and proper identification and treatment. I still have an unidentified problem that means I have to see a range of consultants some of whom engage even now in utterly stupid un-empirical assumptions. Fortunately I have one consultant and she is at the top of her game, if I have any issues she is rather good at sending a short sharp e-mail and things seem to get done very fast in an acceptable manner after that. I think doctors are little different from academics a mix of very good and very bad. Despite the issues I don’t see any alternatives. I think I will stick with doctors and science rather than ordering four gallons of liquid silver from one of the ads in natural news that LM linked to and crossing my fingers or rubbing a rabbits foot.
I too have had bad experiences with doctors (I lost a finger because no doctor would take a wart under my nail seriously and it converted into a squamous cell carcinoma), but that’s a matter of persons, not the science. I have yet to meet a cancer specialist who wasn’t assiduous, dedicated and careful. Even those who administer the chemo in suburban centres have been excellent. Now this might be an Australian thing, but the science of cancer medicine is well attested (possibly moreso than almost any other area of medicine) and as good as it gets. And there’s no credible evidence I have ever seen that they are some sort of money making enterprise. The fellow who discovered CSF, which allows an otherwise fatal dose of chemo to be recovered from, which means much more aggressive cancers can be killed, used to distribute his royalty checks among all staff at the institute where he worked, including the lab techs, administrative staff, and maintenance staff. He won the Japan Prize, which is like the Nobel, after he retired, and put it all into his research which he continues to this day (in his 80s) to do. That is not the activity of a man who’s in it for the money. By the way, he buggered his back from years of close optical microscopy. So I won’t allow people to malign an entire profession to sell fake “natural” treatments that literally do kill people. Not here.
Yes it is a people thing and when you get good people it draws you into the science. I get quietly amused when my Hematologist starts talking blood tests, her eyes light up and you can see the wonder and love she has for her subject shine. Mixed with a deep commitment to care and helping people. Its impressive and bloody reassuring.
My sister had cancer. She was treated conventionally and she lives. My father and his mother had colon cancer. They had surgery. Both died years later, not from cancer. My aunt had breast cancer. She and her husband were idiots. My aunt’s “treatments” were diets and “alternate medicine”. She suffered terribly with awful pain that ended with a miserable, early death.
ISlet cell cancer is not treated using radiation and chemo, but surgery. Possibly Jobs decided to try something else, instead of “go home and make your peace with God”. After watching several relatives die after treatment, I think that deciding whether an additional 6 months – 2 years of diminsihed life is worth it is a reasonable discussion to have. Using some forms of alternative palliative care may be desirable. And while you have a lot of the details correct, you gloss over the notion of mean time to progression, which is a moving goal post in the world of cancer. Even the so-called “cures” aren’t, really. And the idea that 5 year survival puts you back into the general statistical life span of the poipulation is a dream, at best.
I’ve had breast cancer. It was detected early enough that surgery might well have been enough, but I was offered radiation treatment and Tamoxifen as well to give me an even better chance and I accepted both. I can’t imagine refusing anything at all that evidence-based practice has shown will help, when the alternative is dying of cancer. But that doesn’t include magic. If Jobs had used a real treatment in the early stages instead of the naturopathic nonsense (or even as well as it), he would have improved his odds. Better still, have regular screening tests for any illness for which you are at risk, and if the tests come up positive accept whatever treatment is offered with properly-researched medical procedures. Nothing can prevent people getting cancer (yet), but people can improve their chances enormously of surviving it by treating it early with proven methods.
Lesley, I wish my aunt had made the smart choices you did. I forgot to mention that a cousin had non-Hodgkin’s lymphoma as a teen, responded well to chemo and is now a forty-something marathon runner. I get a colonoscopy every 5 years. I really, really hate it and am so glad that it is available.
John S. Wilkins: So I won’t allow people to malign an entire profession .. My father was a physician and the profession could definitely stand voluminous healthy maligning. Medicine is frequently an art more than a science. Most import are the very real predicaments which falls across all professions. It is difficult to respond in a critical manner without it being construed as a threat of liability or an attack on personal pride and ability. We give professionals the job of making educated bets where the choice will often be wrong and unpleasant. We easily hand over far more responsibility to choose than the professionals need or deserve. There are many issues in all this.
I don’t think it is the honour of science that is important here and I don’t think you’re right to criticise is either, it is people. I had to hold the hand of a terrified, bewildered and very vulnerable young girl 27 years ago and tell her everything would be ok. It was a lie. I was 19 my girlfriend was 22 and had just told me she had cancer. She had six months left of her life. I think I can be forgiven for not being truthful, but if I had held her hand, wiped her tears and told her I knew of some wonder cure and she did not need proper medical care, it would have been a despicable and deeply shameful act. I do not understand how anyone could face someone so desperate and trying so hard to cling to life and mislead them in such a way. Yet people do.
Jeb: I think I can be forgiven for not being truthful … + … I do not understand how anyone could face someone so desperate and trying so hard to cling to life and mislead them in such a way. Thirty five years ago you would have been forgiven. Thirty five years ago deliberate negligence regarding the Ford Pinto was acceptable conduct. Now you would be condemned by the tyranny of PC. Now companies pay a higher price for recklessness. Things change. Philosophies go in and out of style. Snake oil shilling is unconscionable . Nevertheless benevolent deception is often mundane. … NHS constitution ends era of ‘doctor knows best’. Benevolent deception can also predominate. …That the lower class were seen as unable to make responsible decisions on their own behalf is the essence of British cultural identity. The British response was a passive aggressive I’m all right Jack! defiance. The American response appealed for libertarian sentiment to resist the paternalism. Things haven’t changed much over the years … The summer riots were a very British affair. It was caused by hooliganism, criminality and ill behaved disregard of good manners. … a flagrant disavowal of being responsible for one’s own actions. Expertism has replaced paternalism. The deciders are now professionals and civil servants. The whole topic is complicated messy. It stifles the ability to give advice.
I dunno if we should immediately be looking for someone to blame but this is still a good article. For anyone who wants to see some in-depth tributes to Steve, check out : http://www.pixt.com/remembersteve Not trying to spam or anything but any fan of Apple or Steve should check out the crazy stuff there. RIP Steve!
I don’t see it as looking for someone to blame. I think that we all have a responsibility to ensure that the most vulnerable in society are treated in the best way we can and are not exploited by those who would sell you a rats arse for a wedding ring.