Alternative medicine

Did alternative medicine prolong or shorten the life of Steve Jobs?

Exact details of the natural and traditional alternative therapies Steve Jobs tried before he underwent surgery in 2004 and ultimately died of pancreatic cancer earlier this month have not been disclosed. (An Apple representative declined to comment on any aspect of the Apple co-founder’s illness.) He reportedly limited his diet to fruits or fruits and vegetables, tried something called hydrotherapy, and consulted psychics. Regardless, a growing body of scientific and anecdotal reports provide compelling evidence of the potential impact, both positive and negative, of so-called complementary practices on the health and longevity of cancer patients after their diagnosis. . And, while Jobs’ unconventional early treatment choices may have done little to prevent the spread of deadly cancer cells in his case, they provide an opportunity to discuss what makes cancer grow. and how to stop it.

Jobs had a rare form of pancreatic cancer known as pancreatic neuroendocrine tumor (pNET). Representing approximately 1% of all pancreatic cancers, pNET is a cancer of the endocrine cells, known clinically as islets of Langerhans, which exist in small clusters throughout the pancreas. These cells produce hormones such as insulin, which lowers blood sugar, and glucagon, which raises it.

Unlike the vast majority of pancreatic cancers (called pancreatic adenocarcinomas) of the ductal part of the pancreas, pNET is not always fatal. These cancer cells tend to grow slowly, so the cancer does not spread as quickly to other sites in the body. This means that surgical removal of the tumor can sometimes be curative. For patients whose disease is detected while still confined to the pancreas, the five-year survival rate is 87% – in other words, the majority of patients live long enough.

For patients in whom this cancer has spread outside the pancreas, the median survival is 27 months. “That said, there are groups of patients with metastatic disease who can live much longer,” says James Yao, associate professor and vice president of gastrointestinal medical oncology at the MD Anderson Cancer Center at the University of Texas, “some even up to 5 to 10 years.”

It is impossible to know if the surgery would have been curative if Jobs had undergone the procedure at the time of his diagnosis. But what about the role of acupuncture and other naturopathic approaches he tried? Could they have prolonged his life and improved his health or had the opposite effect?

Acupuncture has gained ground in Western medicine as a useful adjunct to cancer care. Some clinical studies have confirmed the effectiveness of this traditional Chinese medicine approach, in which needles are inserted shallowly into different points of the body, to decrease the nausea, pain and fatigue that often follows chemotherapy, radiotherapy and surgery, pillars of modern cancer treatment. .

But while it may have contributed to general well-being, acupuncture is unlikely to have had any impact on the tumor itself. “It’s not enough to change the course of disease,” says Lowell Kobrin, a physician who now focuses on acupuncture and herbal medicine at Northbend Medical Center in Coos Bay, Ore. “It couldn’t affect the cancer itself.”

As Tim Birdsall, vice president of integrative medicine at the Cancer Treatment Centers of America, explains, cancer is a disease in which cells become less and less sensitive to their external environment. Multiple mutations in DNA, specifically abnormalities in the p21 and p53 genes, among other changes, stop the process of apoptosis, or programmed cell death, that normal cells undergo. In addition to becoming immortal, cancer cells invade surrounding tissues, rendering them non-functional.

But, says Birdsall, natural therapies such as those allegedly taken by Jobs focus on altering the bodily environment, not the tumor itself. “Once a cancer is established, in the vast majority of cases, simply changing the environment will not be enough to eradicate that established tumor,” he says. “Cancer requires surgery, radiotherapy or chemotherapy to [be eradicated].”

Could Jobs have put himself in greater danger by delaying surgery in favor of alternative medicine? Because pNET grows so slowly, it’s unlikely much damage has been done either, says Yao, who often monitors pNET patients before recommending therapeutic intervention. “Nine months is not long in this disease,” he adds. “It’s safe to say that you can observe things very carefully.”

Yet at least one treatment embraced by some in the alternative care community, namely juice fasting, may be counterproductive for cancer patients, says Donald Abrams of the Osher Center for Integrative Medicine at the University of California to San Francisco (UCSF). Drinking pressed juice delivers an intense burst of sugar to cells that would otherwise be moderated by the fiber in a fruit. “Cancer cells love sugar,” he says. And from the perspective of a cancer cell, freshly squeezed juice is no different from sweet cola. Either drink delivers a shot of sugar that increases insulin and insulin-like growth factor, “both [which] promote inflammation and both lead to cancer cell division,” says Abrams, who is also a professor of clinical medicine at UCSF and chief of hematology/oncology at San Francisco General Hospital. He now offers consultations to cancer patients undergoing traditional treatment who wish to incorporate complementary (or alternative) approaches into their care.

No evidence is available showing whether the juice fast Jobs allegedly tried accelerated the spread of cancer cells in his pancreas, and possibly other organs, but Abrams notes that he rarely recommends juice to cancer patients. which he advises. In addition to producing potentially dangerous levels of insulin, the process can also harm the whole body. “The basis of these extreme dietary manipulations is to starve the tumor of the nutrients it needs,” says Abrams, “but healthy cells in the body are also nutrient depleted.”

Instead, Abrams generally recommends an organic diet that’s mostly plant-based but includes deep cold-water fish (for their omega-3 content); mushroom mixtures for the improvement of the immune system; vitamin D and other supplements, depending on the patient; and vitamin C for wound healing, as well as physical activity and acupuncture to treat side effects of treatment. He also stresses the importance of decreasing stress because it produces cortisol, a steroid hormone that suppresses the immune system.

Many news outlets reported that Jobs suffered from insulinoma, meaning that it was the insulin-producing endocrine cells that had turned cancerous. If true, cutting out sugar, as a macrobiotic diet would have done, “could be very dangerous,” Yao says, because his body may have already been depleted of insulin by cancer, rendering cells that would have produced this vital element. hormone.

Yet it turns out that the idea of ​​starving cancer cells turns out to be a key mechanism behind some of the latest medical treatments for pNETs. The growth of malignant pNET cells is closely linked to a cellular pathway known as mTOR (mammalian target of rapamycin). As Yao explains, one of the functions of the mTOR pathway is to detect if a cell is not getting needed nutrients. When this happens, mTOR can trigger the production of proteins, including several that promote cell proliferation and blood vessel growth. In normal cells, the mTOR pathway can be turned on and off, but in some cancers, mTOR becomes impossible to turn off and cells grow unregulated. A class of drugs called mTOR inhibitors blocks this pathway. It’s thought that one way they work is to “trick the cancer cell into thinking it’s starving,” says Yao. As a result, the cell begins a process known as autophagy, in which it begins to digest parts of itself to try and survive, but it doesn’t.

A dietary change alone is insufficient to trigger autophagy, as the human body can simply switch to converting muscle and amino acids into energy. The introduction of this concept into biomedical research led to a breakthrough: last May, everolimus, an mTOR inhibitor, was approved by the United States Food and Drug Administration for the treatment of advanced pNET, first drug in this class approved for this disease.

With few facts available, we can only speculate as to whether the approach Jobs took early on had any impact on his survival. Medical and TCM professionals tend to agree that they are unlikely to have caused any real harm, and in another context – as part of a prevention regimen or recovery, or alongside medical care – some of these measures can improve overall health.

Kobrin says scientific evidence confirming this benefit can be elusive for philosophical reasons at the heart of conventional and alternative medicine, both of which offer an “understanding of the human through [a different] paradigm.” For now, the evidence remains anecdotal and alternative practitioners tend to refer to thousands of years of Eastern medical history and individual patients. Or as Abrams puts it: “The evidence is that so many of my colleagues continue to refer their patients to me.”