Steve's Health: Can We Please Move On Now?

Posted by: Arik Hesseldahl on January 06, 2009

Finally we have some clarity on the subject of Steve’s health from Steve himself. I have disliked this line of inquiry for a long time, mainly because I wouldn’t want people speculating in public about the condition of my own health from a distance. I have long maintained the health story is one that has been blown out of proportion, and that frankly there are more important Apple issues to talk about.

There had been so much uncertainty, ill-informed speculation, and dead-wrong rumors about this that I finally decided to go to one of the world’s leading experts on pancreatic cancer for some expert guidance, and based on the facts as they are known to the public.

For today’s story I talked with Dr. Robert Fine. His full title: Director, Medical Oncology, The Pancreas Center
Columbia University College of Physicians & Surgeons/New York-Presbyterian Hospital. His specialty is treating people with pancreatic cancers, and is an expert on the long-term effects of the Whipple procedure, which Jobs is believed to have undergone in 2004.

Fine laid out for me three possible scenarios. I’ll get into them in a bit more detail than I did in the story here. And then, hopefully, this tasteless story will be put to rest.

First off there’s the cancer itself. The type of cancer Jobs is said to have had - an islet cell carcinoma — progresses much more slowly than the garden-variety pancreatic cancer. “From the beginning he had a very good prognosis,” Fine said. The classic Whipple procedure, done correctly, completely cures the patient more than 90% of the time in these cases, and it has an even higher success rate if the cancer is in early stages, he said.

Statistically speaking the most likely cause of the weight loss Fine said, is that Jobs has a lack of certain enzymes that aid in the digestion of food. “The pancreas does a number of things, one of which is that it makes enzymes that break down food,” Fine said. “It could be that his body is not absorbing food properly.” The enzyme can be easily replaced by an oral supplement that replaces the missing enzyme. One commonly prescribed example is the drug Creon, and it is a drug often given to people who have had the Whipple procedure. Additionally, this deficiency is a condition that might be detected by a blood test.

The second scenario, this one less likely than the first, is type 1 diabetes. Its not uncommon, Fine says, for patients who have had the Whipple procedure to experience an insulin deficiency. Symptoms include high blood sugar levels and weight loss. It’s easily treatable with insulin injections, he says. If this were the case, it might lend some credence to rumors of doubtful provenance that Jobs has had to give up a favorite drink: Grape juice from a local winery.

The third, and least-likely scenario involves a return of the cancer. This would be a worst-case scenario, but even so, it would carry a much better prognosis than it did as recently as five years ago. There are, he says, new types of oral chemotherapy that shrink the cancer, have low incidence of toxic side effects, and which can extend life substantially. This chemotherapy treatment, he says, is successful more than 70% of the time, even if the cancer is at an advanced stage.

All things considered, the chances that Jobs will regain his weight and begin to appear more healthy-looking when seen in public are excellent, Fine says. Jobs himself said it will take some time, but that the treatment is “simple and straightforward.”

Has Apple handled this in the right way? I can’t really answer that because it’s not clear to me how much he’s been telling people in his inner circle. When Katie Cotton was quoted as saying Jobs had “a common bug,” it may very well have been the truth as best she knew it, or she may have been covering up for her boss. Jobs said in yesterday’s letter that the weight loss had been a mystery both to himself and to his doctors. When does that become material? It’s hard to say, but there’s little evidence that Jobs has been missing work or in any way incapable of doing his job as he sees fit.

Looking back, the clamoring for disclosure on the matter seems misplaced. I’ve always argued that Apple’s board of directors could easily put an end to the issue with a one- or two-line disclosure in a 10K or 14A filing saying it had asked the CEO if there were any reason he thought he might be unable to carry out his duties for the foreseeable future. By asking the question and disclosing the answer, it would show itself to be on top of the situation, while at the same time sidestepping any privacy concerns.

Finally there’s been the call for disclosure on succession planning at Apple. Why would any company with a healthy, living CEO disclose its succession plans? Since Apple is a company that brings its own share of needless drama, every move Steve makes would be seen against the backdrop of whether or not the designated successor, whoever it might be, agrees. Outside observers like the rumor sites would start to read tea leaves for any hint of disagreements between Jobs and that successor, and these rumors would feed on themselves and grow into bigger stories like this health situation has over the last year.

Others have criticized Apple for not having a succession plan, but that’s simply false. Apple has a succession plan and mentions it in its corporate governance guidelines (it’s a PDF file). Here’s the relevant text from the bottom of page 5:

MANAGEMENT REVIEW AND SUCCESSION PLANNING:

The Compensation Committee should conduct and review with the board an annual evaluation of the performance of all executive officers, including the CEO. This review is used by the Compensation Committee in the course of its deliberations when considering the compensation of the CEO and senior management. The CEO performance evaluation is also reviewed by the board to ensure that the CEO is providing effective leadership for the Company. As part of the annual CEO evaluation, the board and the CEO should conduct an annual review of management development and succession planning for senior management, including the CEO.

So now that we know most of the necessary facts, and now that Steve has gone above and beyond the call of duty and disclosed a little about the relatively simple medical troubles he’s dealing with, can we talk about something else?

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