Steve Jobs: Larger than Life, Best-Seller in Death. Let's talk medical choices.

As you can see on the left, Steve Jobs was present with us at Doctors 2.0 & You 2011, in a larger-than-life image, with an amazing caption : "Apple announces the iPad, changes the course of history." Click to enlarge the photo even more!

The iPad taught us that the killer app  for physicians is in fact a killer device: doctors, hospitals, med schools have snapped them up as never before--hopefully ending some of the persistent skepticism around professionals and computers. But, Steve Jobs' legacy will not be limited to technology. It will be about the man, the man with a will to do things on a big scale, perfectly, a will to change not only IT but music as well and maybe other fields had he lived on.  I, like many if not most of you, knew very little about the personal experiences in his early years that helped shape him into the person he would become and certainly little to nothing about his medical choices during the final chapter of his life.

Steve Jobs' authorized biography will be launched on October 24th, 2011, in the US. The book is above all Steve Job's legacy to his family, his desire to tell them his innermost thoughts in a structured way. But there is every reason to believe that the biography will be a runaway best-seller for perhaps millions around the world who will be interested in knowing more about this visionary --  which is why I want to focus here on the medical side as did the New York Times in an article entitled "Jobs tried exotic treatments to combat cancer, book says."

We learn through this article two things of major importance. Steve Jobs first learned of his pancreatic cancer in October, 2003 and refused to accept surgery and medical therapy for around nine months,  

preferring "fruit juices, acupuncture, herbal remedies and other treatments — some of which he found on the Internet — and that infuriated and distressed his family, friends and physicians".

"When he did take the path of surgery and science, Mr. Jobs did so with passion and curiosity, sparing no expense, pushing the frontiers of new treatments (DNA sequencing to determine personalized treatments). According to Mr. Isaacson, once Mr. Jobs decided on the surgery and medical science, he became an expert — studying, guiding and deciding on each treatment."

So, some questions :

1° Do we attempt to censor communication about unproven remedies?

Steve Jobs may have lost precious time with ineffective herbal remedies, but this was his choice. His physician, his family, the CEO of Intel all told him  the facts, and yet he persisted, most likely with the same stubborn personality traits that led him and Apple to grandeur. Chances are that even without the option of those ineffective remedies, Steve Jobs would not have accepted the surgery sooner, because his issues with the disease led him to reject surgery at that point in time. So, the issue is not the presence of erroneous information. People know that they are taking the unrecommended path. Where we should spend our energy is in better understanding the patient's motivations and decision-making path....

2° What is the individual's freedom to decide about medical strategy?

Is it the ultimate sign of our humanity to be able to make medical decisions for ourselves? Or do we consider that bad decisions impact Society at large?

3° Steve Jobs ultimately spent 100 000 dollars to sequence his genome and favor more effective personalized therapies. What will we do when such opportunities to invest (literally) in one's own survival become common? Will the fabric of Western Society not be torn apart by the haves and have nots?

4°  Steve Jobs, after his period of denial, became an ePatient, participating integrally in the determination of the medical strategy that would apply to his very complex case. Do we not need to urgently increase our knowledge and research about ePatients ?