Was Apple 'Adequate but Late' on Jobs?

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Stephen Davis, a senior fellow at the Millstein Center for Corporate Governance and Performance at Yale University, told the Associated Press that the Jan. 5 announcement fits Apple's pattern of "releasing information to shareholders in dribs and drabs."

Odds of Full Recovery Are Good

"It's not a technique designed to win loyalty from investors over the long term," Davis added. "This is a public company in which millions of investors have entrusted their savings and in which millions of customers also have a stake."

Apple held off on going public with the news that Jobs in 2003 was diagnosed with islet cell carcinoma, a rare type of treatable pancreatic cancer, until he had undergone surgery to remove it six months later. Published reports have said that during the intervening months, Jobs resisted the repeated urging of doctors to have surgery, preferring instead to treat it with a special diet. Jobs relented and had surgery on July 31, 2004. Company representatives have declined to comment on the reports.

Medical experts familiar with pancreatic cancers and willing to engage in educated conjecture about the condition say the odds are good that Jobs will make a full recovery. While Jobs hasn't disclosed the full extent of his illness, his visible weight loss and description of a diagnosis of a "hormone imbalance" suggest that his cancer probably has not returned.

Three Possible Scenarios

According to published reports, the surgery Jobs had in 2004 is known as the "Whipple Procedure," named for the doctor who developed it. The surgery typically calls for the removal of the head of the pancreas, a part of the small intestine, and sometimes a part of the stomach, after which the patient's digestive tract is rebuilt.

That surgery cures the patient of cancer more than 90% of the time, says Dr. Robert Fine, director of experimental therapeutics and gastrointestinal oncology at New York Presbyterian and Columbia Medical Center, who specializes in treating this type of cancer. Fine says Jobs' weight loss can be explained by three possible scenarios, none of them life-threatening.

In the most likely scenario, Jobs would be suffering from a lack of enzymes produced by the pancreas to break down food. "It may be that he's not absorbing food properly," Fine said. In most cases like this, doctors will prescribe an oral supplement to replace the enzymes. One pill often given in this case is Creon, made by Belgium-based pharmaceutical company Solvay (SOLB.BR). This condition, he said, is often detected with a blood test. "In cases like this you give people the pancreatic enzymes they're missing and they do quite well," said Professor John Flynn, a professor of medicine at Johns Hopkins University in Baltimore.

A Promise to Speak Up

Another, less likely, scenario is that the weight loss is attributable to diabetes, a lack of insulin that produces high blood sugar levels and leads to loss of weight and muscle mass, Fine said. An even less likely explanation is that Jobs has suffered a recurrence of the cancer. But even if the cancer did return, there are new therapies that weren't available as recently as five years ago and have proven successful. "We have an oral chemotherapy regimen that has a 70% chance of shrinking the cancer substantially," Fine said. "It can add a substantial amount of time to the patient's life, even one who is in the late stage of this type of cancer."

Fine stressed that it's unlikely that the cancer is back. "Chances are excellent that he will return to health," he said.

In hopes of reassuring anyone whose doubts may linger, Jobs pledged to speak up quickly in the event he feels unable to do his job. "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," he wrote.

Hesseldahl is a reporter for BusinessWeek.com.