Steve Jobs' Cancer, a Story from the Boston Common and "Politicklers #1"

How Steve Jobs Got the Short End of the Stick

The TV and newspaper stories about Steve Jobs’ death the other day indicated that he died of pancreatic cancer.  About 95% of pancreatic cancers originate in what are known as exocrine cells, and they are extremely aggressive malignancies with survival after diagnosis averaging less than a year.   Jobs’ cancer, however, fell among the 5% of pancreatic cancers which originate in what are known as endocrine cells.  Functionally, these cells perform different tasks (exocrine cells produce enzymes, endocrine cells produce hormones) but cancers stemming from endocrine cells, called neuroendocrine carcinomas, are much more indolent, growing much more slowly than those originating in exocrine cells.  This is why Jobs was able to survive seven years with his cancer and able to function well over much of this period.  Victims of neuroendocrine carcinomas usually look pretty good until the cancer is very far advanced and has metastasized to other parts of the body.

Neuroendocrine carcinomas usually originate somewhere in the area of the pancreas or the liver, leading to the term hepato-pancreatic to describe them.  Eventually, they spread elsewhere, but the liver is usually quickly involved.  Often the primary source, likely to be in the pancreas, is never precisely pinpointed even though the cancer has already spread.  Some physicians feel that if metastasis has already taken place, pancreatic surgery to locate and remove the "unknown" primary would do no good.  Others disagree.

Because neuroendocrine carcinomas develop slowly, they are often initially misdiagnosed and diagnosis is made only after the cancer has spread.  In medical schools, doctors are taught that “if you hear hoof beats, think horses.”  Well, the hoof beats of a herd of zebras make the same sound as a herd of horses does, but they are different!  And this is why the stripes of a zebra are often used as a symbol by organizations dedicated to neuroendocrine carcinomas.

Since its victims usually survive five or six years, not so much attention is paid to this type of cancer as is paid to other more aggressive malignancies.  Sometimes it is referred to as a “carcinoid," implying a lesser degree of severity since some neuroendocrine tumors actually may not be malignant, and those that are, as I have pointed out, are not  so aggressive as are other cancers.  Ultimately, however, they kill.  It just takes longer.  I have heard it referred to as "cancer in slow motion."

How do I know this much about neuroendocine carcinomas?  Well, that was the diagnosis of the tumor found in my wife, who passed away last year, back in 2005.  Initially found in her bones, but also present in the liver, it was treated from its onset as a hepato-pancreatic tumor, and ultimately had fatal hematological effects.

And this was the same kind of tumor that Steve Jobs had.  He looked good, as did my wife, and when his liver was severely compromised, he underwent a transplant.  Nevertheless, despite whatever good the transplant did, the primary malignant lesion still remained there somewhere in his pancreas.  He then went to Europe, as did my wife on four occasions, for molecular targeted radioactive therapy which temporarily forestalls the growth of neuroendocrine tumors but is not generally available in the United States.  It is a sad commentary that countries with socialized medicine such as the Netherlands, Germany, Sweden and Switzerland seem to devote greater resources to the study and treatment of neuroendocrine carcinomas than we do.

Why am I writing all of this?  Well, Steve and my wife got the short end of the stick because what they had was a relatively rare kind of cancer.  There are only a few thousand cases a year diagnosed in this country and not that much research is being done on it.  Drug companies and research centers are not bending over backwards to find a cure.  Their efforts are directed toward more common cancers that we hear about every day such as those involving breasts and lungs.  Often the chemotherapy used to fight neuroendocrine carcinomas is FDA approved for another type of cancer, but used “off label” for the neuroendocrine cancer because that is all that is available.  People like Steve Jobs and my wife, unfortunately, suffered from a rare disease, and that is the worst kind to get, because the knowledge and resources to cure it just aren’t there. 

I am sure Steve Jobs’ passing will result in a greater emphasis being placed on seeking a cure for pancreatic cancer, but I am afraid that most of it will be directed toward the very aggressive malignancies which comprise 95% of pancreatic cancers and not to the slower growing neuroendocrine carcinomas which claimed Steve’s life and that of my wife. It is logical, although unfortunate, that the limited resources available be directed toward combating a disease that is usually fatal in a year or less as opposed to one whose victims may survive half a decade or more, which both Jobs and my wife did.  For more information on this disease, check out the extremely comprehensive information found at www.carcinoid.org.

Jack Lippman

                        ***   ***   ***

Most readers of this blog are alerted by Email every time a new posting appears.  If you wish to be added to that Email list, just let me know by Emailing me at Riart1@aol.com.
JL


                        ***   ***   ***

The Professor

The professor continued to deposit his belongings into the brown shopping bag on the ground between his legs. He had just finished his daily presentation to the passers-by ambling through the pathways of Boston Common. As he bent forward sitting on the park bench, I was struck by the dichotomy between his shiny, thread-bare, black suit, frayed cuffs, and scarred shoes and the shiny, crisp bag with its Lord and Taylor logo. He was a swarthy man with slicked-back black hair, neatly dressed, about 40 years old. 

My friends, who had already begun to disperse after the professor’s performance, were anxious to begin our hike back to Boston English High School to be on time for the trolley-cars that would soon be arriving to transport us back to our homes in the outlying districts of Boston.

     

Today had been another one of our illegal holidays, playing hooky to visit Boston Common and the nearby Red Light district known as Scollay Square. After attending a movie and a strip-tease show at either the Old Howard or the Casino burlesque theaters, we always stopped in the Commons to attend the professor’s performance. We never did know if he was a real professor.  Everyone called him that because of his obvious intelligence and expertise in mathematics.

He performed feats of mental acumen that never failed to awe me, and my friends, who were struggling through the twists and turns of trigonometry and geometry.  Give the professor a number, and he would respond instantly with its cube root in the blink of an eye.

He was only one of a  cadre  of  weirdos who collected in Boston Common each day to preach, orate, argue, or perform in various ways ... much to the delight of the onlookers made up of shoppers, tourists, and homeless denizens who called the Common “home,” and, of course, my hooky-playing comrades and me.

After his performance I delighted in chatting with him.  He was soft-spoken, and his self-assured manner enhanced his wise old man image that I had formed of him.  He seemed so wise compared to my 15 year old’s understanding of the world.  I delighted in listening to him wax eloquently on a wide world of subjects.  He’s probably a prime influence in my later interest in philosophy and metaphysics.  I have never forgotten his best pronouncement that the secret to long life is to maintain a full mind and an empty bowel. 

Sid Bolotin

                                                       ***   ***   ***

Politicklers #1

I raised a question in the last posting about who you thought would get the Republican Presidential Nomination.  My guess is that is will be George Romney. While he has the least appeal to the right wing of the Republican Party ... from which almost all of the other candidates come ... he has the most appeal to independent voters.  Republicans know that these right wing candidates are unelectable.  That is why they tried so hard to get Chris Christie to run, since he was able to win the governor's chair in a Democratic state.  If Christie had decided to run, the G,O.P. would have had to close their eyes to the fact that he is for gun control and has a liberal policy toward illegal immigrants, but that's okay since a central plank of any Republican platform is hypocrisy. 

Romney presents a problem too.  When he gets the nomination, Conservative Republicans will just have to grit their teeth and support George, whose state-run health insurance program in Massachusetts included a mandate that provided that everyone be covered, like it or not.

It is very puzzling that all of the other candidates bitterly oppose this provision which is part of the Affordable Health Care Act too.  Why?  Actually it was a Republican idea, developed as an more palatable alternative to what the Democrats originally wanted, a single payer Federal option.  The Democrats adopted this G.O.P. concept in the hope it would garner some Republican support, since it originally was their idea.  Of course, since the word "compromise" does not appear in the G.O.P.'s lexicon, the Democrats were disappointed.

And speaking of candidates, Herman Cain is getting a lot of notice lately.  He won't get the nomination, of course, because his "9-9-9" would be the most inviting target the Democrats could wish for.

The American people will not agree to reducing everyone's income taxes to 9%.  Sure, everyone would pay less, but the wealthy would save far, far more in dollars than anyone else.  Imagine the glee in the salons of Palm Beach when someone with taxes due on an adjusted gross income of $2,000,000 finds his tax bite reduced from $700,000 to $180,000.  Those with an income of $50,000 might find their taxes reduced from about $9,000 to $4,500 but they would also see who really was benefiting most greatly from Cain's fantasy.  Americans are not blind.

And the 9% sales tax would hit the $50,000 earner who spends all of his or her money to live off of and would be taxed 9% for everything he buys.  The wealthy would also pay that tax, but since they are not living month to month, they would have a lot more income that they do not spend, and which would go untaxed.  Again, Americans would not be blind to the regressiveness of such a tax.  It would be a burden for the poor but just a barely noticeable nuisance for the wealthy.

Finally, while dropping the corporate income tax to 9% might bring a few overseas-based firms back to the United States, it would also drop a big bundle of cash into the laps of all corporationsl, reducing their tax bite by as much as 26%.  This would not go unnoticed either.  So Cain is not a viable candidate.

(I would be remiss if I didn't point out that the idea behind Cain's fantasy is that the money which corporations and wealthy individuals would save from his "9-9-9" plan would supposedly be invested in business and result in job creation, and with more people working, even with income taxes maximized at 9%, Cain believes tax revenues would be higher than they are now.  To augment this would be the 9% sales tax revenue he proposes.  We know that the infamous Bush tax cuts did not produce job growth and we have no reason to believe Cain's version of universally discredited "trickle down" economics would work either.  Neither the wealthy nor corporations "prime pumps" because doing so is not in itself profitable.  Only the government, which is not out to make a profit can "prime pumps" and create jobs.)
JL

                              ***   ***   ***

To send this posting to a friend, or enemy for that matter, whom you think 

might be interested in it, just click on the envelope with the arrow right below the 
dotted line at the very bottom of this posting.