If an Apple a day keeps the doctor away, then Wednesday was an important test for Steve Jobs, chief executive officer and cofounder of Apple, who unveiled the company's tablet computer, the iPad, ending months of speculation.
But buzz about Apple’s newest product could not eclipse renewed rumors surrounding Jobs's current health. Along with detailed descriptions of the iPad’s $499 entry-level price and potential to make print profitable, numerous bloggers and journalists made note of how thin, though energized, Jobs appeared at the San Francisco announcement.
The intensely private Jobs, 53, has guarded his health status even more carefully than he did the secret of the iPad ever since his 2004 surgery for pancreatic cancer. Though he seemed to recover quickly, in 2008 his rapid weight loss sparked rumors. As word got out that he would send a replacement to deliver his 2009 keynote address, the famously private Jobs went so far as to send an open letter addressing the speculation. In it, he attributed his thin frame to a hormone imbalance " 'robbing' me of the proteins my body needs to be healthy." Soon after, Jobs took a five-month leave from Apple, calling his health problems "more complex" than originally thought and causing Apple stocks to immediately fall 7 percent. In June 2009 The Wall Street Journal reported that Jobs had undergone a liver transplant about two months prior. Jobs returned to work about a week after that, and speculation about his health was soon replaced with speculation about Apple’s next big launch.
And while the iPad itself consumed much of yesterday's media attention, reporters did thrown in a few lines about Jobs's gaunt appearance. The New York Post ran an entire article called JOBS LOOKS THIN, AGAIN. The New York Times live blog of the event noted that "he looks disturbingly thin … but there's a sparkle in his eye." The AFP wrote that Jobs looked "thin but healthy." But does a gaunt appearance mean ailing health—or is it just the look of a man under duress to meet a big deadline?
The exact nature of Jobs's present and past health concerns have not been disclosed, and medical experts discouraged diagnosis based on appearance—it's just impossible to tell by looking at someone whether or not they're sick. But based on what we do know about Jobs's previous health history, here a few things to consider.
Though limited to speculation, Dr. Steven Libutti, director of the Montefiore-Einstein Center for Cancer Care, noted that Jobs's diagnosis of neuroendocrine pancreatic cancer in 2004 is not to be confused with the more common and grim prognosis of the aggressive adenocarcinoma of the pancreas, which led to the death of actor Patrick Swayze in September.
Islet cell neuroendocrine tumors are largely treatable by surgical procedure, similar to what Jobs may have undergone in 2004, though they are still cancer, and cancer of any kind is no picnic.
In cases like these, say both Libutti and Dr. Joaquina Celebra Baranda, a gastrointestinal cancer specialist at the University of Kansas Hospital, continued weight loss can be the result of a number of factors: the nature of the original cancerous pancreatic tumor, which may secrete proteins or hormones whose side affects disrupt appetite or digestion (which would classify as a hormone imbalance); the surgery to remove the tumor, such as the common Whipple procedure, which may reroute part of the digestive system, or complications from other treatments; outside issues more related to age, though Baranda described Jobs as "not that old"; or, in a worst-case scenario, the recurrence of tumors.
Both doctors noted that even when neuroendocrine tumors do recur, they most commonly appear in the liver, providing a possible explanation for Jobs's 2009 transplant.
According to Libutti, physicians rarely conduct such a transplant for cancer that has metastasized, or spread, meaning it is likely that if a tumor formed in the liver, it was an isolated recurrence, whose danger would then be decreased by removal.
Baranda, on the other hand, speculated that it was unlikely that a patient would have had the liver transplant without a more active form of cancer. If that was the case, a patient who had the surgery in 2009 may have active cancer now.
Though development of an initial tumor puts one at risk for relapse, the further a patient becomes from diagnosis and therapy, the less likely a cancer will come back. Jobs was first diagnosed more than five years ago.
"The longer you live, the longer you live," joked Libutti. "Patients with these conditions can be treated very safely; many of them, if not the majority, can lead a healthy, productive life."
Instead of speculating about how well he fills out his jeans, both doctors say, the man should be judged on the merit of his work. "I think folks should base assessments in general on the person's ability to function and be productive," said Libutti.
In that case, after the launch of the iPad, Jobs is looking very healthy indeed.