The Limits of Magical Thinking

Steve Jobs unveils the iCloud storage system at an Apple conference in June. (David Paul Morris/Bloomberg)

Probably the most-written sentence (or some variation of it) around the globe these last few weeks is: “Steve Jobs changed our world.”

No argument here (disclosure: I am a big fan, owning five Apple products, from computers to an iPad). Though once derided as a narrow visionary and maker of niche computers for artists and academics, he and his products now dominate and are emulated throughout the technology marketplace and beyond. The successes of Jobs and Apple cannot simply be measured in market share and capitalization. Indeed, Jobs’ vision seamlessly married design style with technological substance, making computer products as much a work of art as a catalyst for imagination and ideas. He brought the science fiction of Asimov and Roddenberry to life, and for that, his tragically shortened life will be remembered for a long time to come.

But not all of Steve Jobs’ decisions were good ones. While many have learned from his technological visions and business acumen, his decisions around his own health also hold important lessons for us all.

Diagnosed in October 2003 with an islet cell or pancreatic neuroendocrine tumor — a rare pancreatic cancer that can be cured if it is found early and is amenable to surgical removal — Jobs spurned the best medical advice and the pleas of his family and friends to pursue his own path. He sought out, according to Walter Isaacson’s new biography, a hodgepodge of alternative therapies including a diet of carrot and fruit juices, acupuncture, herbal remedies, and even the advice of a psychic.

Nine months after his initial diagnosis, his tumor was found to have grown and spread. But it was too late. His cancer was now incurable, and we are all sadly familiar with his slow decline. According to Dr. Steven Cohen, chief of Gastrointestinal Medical Oncology at Fox Chase Cancer Center, it is “conceivable” that if  a patient with a malignant islet cell tumor “had a localized and resectable cancer, waiting nine months could make the difference between cure and not being cured.”

Why would someone whose vision of life embraced technology fully, and who had every medical resource in the world at his disposal, reject a technology that might have saved him? Jobs is quoted in his biography as saying that he “didn’t want them to open up my body, so I tried to see if a few other things would work.” A friend believed that Jobs had “such a strong desire for the world to be a certain way that he wills it to be that way.” This magical thinking might have worked in his world of computers, but for his health, as one friend mournfully considered, “reality is unforgiving.”

Jobs’ decision follows several larger social trends in the United States. Among them are a general loss of faith in and diminution of expertise (just look at the 24 hour news cycle to see who is considered an expert and/or authority these days), and the decline of medical and scientific authority, even to the point where doctors, researchers, and their ideas are treated with outright hostility (the Daily Show did a great piece on this earlier in the week).

In the wake of these transformations, complementary and alternative medicine — a broad category that includes herbal medicines, acupuncture, massage, megavitamins, self-help groups, folk remedies, energy healing, chiropractics, and homeopathy -- has exploded in popularity in Western societies. The most recent available data, from 2007, show that annual out-of-pocket spending on them in the United States was nearly $34 billion.

Dr. Paul Offit, chief of infectious diseases at Children’s Hospital of Philadelphia, is currently writing a book on the history of alternative medicine. He ascribes its  rise to the more individualized approach and to the way it fits into the popular obsession with the “all-natural.” Medicine, with its pharmaceuticals, radiation, and chemotherapies, is now somehow seen as unnatural. Despite his mainstream medicine credentials, Offit believes that there is a place for alternative medicine, especially in understanding the mind-body connection and in eliciting an immune response driven by the placebo effect.

But he identifies three issues  to be aware of:

  • First, “when an alternative therapy is used when a better medical therapy is available.” (Jobs learned this lesson too late).
  • Second, “when you take things that are harmful.” (The news is filled with examples of alternative  therapies  harming or even killing their users).
  • Third, when practitioners bilk patients. The mission of the National Center for Complementary and Alternative Medicine, part of the National Institutes of Health, is to sort through all this “through rigorous scientific investigation.”

What lessons does it hold for public health? Well, for starters, public health education has failed when large swaths of the public become wary of science and medicine. The anti-vaccine movement, with its misbegotten claims of vaccine dangers, embodies this problem.

Second, alternative  and complementary practices  and products need better government regulation and oversight. Currently, many practices fall outside of regulatory purview. Manufacturers of dietary supplements, for example, including vitamins and herbs, do not have to prove safety and efficacy of their products before marketing them. The Food and Drug Administration and Federal Trade Commission do monitor the products – but only after they are being sold. Contrary to the anti-regulation fervor currently in vogue in certain political circles, government regulations are supposed to protect citizens from each other (in this case, those selling snake oil remedies) and from ourselves (so we make better decisions on our own behalf; think of seatbelt and antismoking laws).

Let’s hope that Steve Jobs’ inspirational life and legacy not only enable us to think differently about technology, but also remind us that decisions about our health should not be left to magical thinking.

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