Getting the kind of information about Steve Jobs' health that Apple's (AAPL) investors and customers deserve is tricky, as tech reporters discovered to their peril this week.

The sources in the best position to talk about Jobs' medical condition — which forced him to announce Wednesday that he taking a six-month medical leave — are his physicians, and they're prevented by doctor-patient confidentiality from disclosing what they know.

Everybody else is either speculating, spinning or being spun.

Even Jobs' own statements are suspect. He has issued two e-mail medical dispatches in the past two weeks that are not only vague and lacking in hard medical information, but contradictory — moving in the space of 10 days from a confirmed "simple and straightforward" remedy to health issues that are "more complex" than originally thought.

The best piece of reporting on the Jobs' health problems is still Peter Elkind's March 2008 cover story in Fortune "The Trouble with Steve Jobs." It was Elkind who first reported that Jobs delayed treatment for his pancreatic cancer for nine months while he pursued alternative medicine approaches. And it was Elkind who identified the type of surgery Jobs underwent in August 2004 — a particularly brutal and complex operation called the Whipple procedure — opening the door for other reporters to fill in the blanks. (See here.)

It's been downhill from there. One low point was the interview Jobs gave Joe Nocera of the New York Times last July in which he called the Times columnist (and former Fortune editor) a "slime bucket" before going off the record to reveal that his health problems went well beyond the "common bug" an Apple spokeswoman had offered as the reason for Jobs' sudden weight loss last June. (See here.)

Nocera kept Jobs' remarks out of his piece, but he did report what he and his colleague, John Markoff, had learned independently — that Jobs had told associates that he had a second operation earlier in the year to correct ongoing digestive problems, but that his cancer had not returned. (UPDATE: Nocera posted a new piece today on the Times blog, calling for Apple to come clean.)

This would not be the first time that the mainstream press reported — secondhand, from unnamed sources — that Jobs is cancer-free. Both the New York Times and the Wall Street Journal did it Thursday, the Times citing two sources "familiar with his medical condition," the Journal just one.

Note that no one at Apple has ever directly addressed the issue of recurrence. The closest anyone came was the e-mail Jobs sent to his staff in Aug. 2004 informing them that his operation was successful and that he was "cured." None of Jobs' subsequent statements have said anything about cancer, one way or the other.

Jobs' most recent e-mail set off the usual flood of journalistic second guessing (see Techmeme here). The most painful was CNBC correspondent Jim Goldman's TechCheck column Wednesday.

Goldman had gone out on a limb three weeks earlier, citing "sources inside the company" who assured him that Jobs' surprise decision to skip Macworld had nothing to do with his health. On Wednesday, he took it all back, calling the latest twist in Jobs' story "tantamount to fiduciary, ethical and financial whiplash."

Goldman went on to say that he has known since late last week that there was something wrong with Jobs — based on interviews with two "well known [but unnamed] tech industry executives … very close to Jobs."

"One said, based on his contact with Jobs personally, that he was in 'serious denial' about just how bad the circumstances had become. The other explained to me that he was 'deeply concerned' about Jobs, and the sudden lack of communication, the non-return of emails, ignoring chat requests, unreturned phone calls was a strong indication to him that Jobs was in 'dire' shape." (link)

This was quite a turnaround, and it led to perhaps the most embarrassing moment in the whole affair: a live segment on CNBC Wednesday afternoon in which Newsweek's Dan Lyons (a.k.a Fake Steve Jobs) confronted Goldman and accused him of "sucking up" to Apple to get access to the company and, as a result, getting "played and punked." The five-minute segment is the equivalent of a journalistic car wreck — you can't stop watching it — and has reportedly resulted in Lyons getting banned from CNBC for life (a report that a CNBC spokesman has since denied, although nobody has called Lyons to clear things up).

We've pasted the clip — in its entirety — below the fold.

More

Apple (AAPL) shares dropped 7.56% to $78.88 in after-hours trading in New York on news Wednesday that COO Tim Cook was taking over day-to-day operations — a $6.7 billion hit on Apple's market capitalization.

This is not the first time Cook has stepped in while Steve Jobs dealt with a serious medical condition.

Cook ran the shop for a month in 2004 while Jobs recovered from surgery that removed a malignant tumor from his pancreas (see here). The stock fell then too — down 2.3% on Aug. 2, 2004, the day after Apple announced the news — a loss that widened to nearly 8% by week's end.

But by Sept. 1, 2004 the stock had not only recovered, but gained 10.9% on its July 30 price — closing at what now seems an impossibly low $35.86.

Some of that bump may be attributed to investor relief that Jobs was due back at the helm. But whether or not Jobs returns from his latest medical leave, the fact is that Tim Cook has been running day-to-day operations at Apple for some time, as Adam Lashinsky's long profile in Fortune makes clear. (See The genius behind Steve.)

In July 2004, two weeks before Jobs' operation, Apple reported earnings of $61 million on sales of $2.014 billion and was holding just under $5 billion in cash.

In its last quarterly statement, Apple reported earnings of $1.14 billion on sales of $7.9 billion, with nearly $25 billion in cash.

In other words, it's the same company, only four or five times bigger.

Oppenheimer & Co.'s Yair Reiner turned heads on Wall Street three weeks ago — in the wake of Apple's surprise announcement that Steve Jobs would be skipping Macworld 2009 — when the analyst downgraded the company and refused to set a price target for its shares until he got some answers. (See Analyst sounds warning.)

On Tuesday, Reiner reinstated Apple (AAPL), upgrading the stock to "outperform" and setting a 12 – 18 month price target of $135 a share. (The stock closed Monday at $94.58, up 4.22% for the day.)

But in a long note to clients, Reiner made it clear that while Jobs' open letter Monday offered some reassurance, he remains skeptical.

"We don't know what ails Apple's CEO, and we're not ready to assume that a problem with a 'relatively simple and straightforward' remedy is a problem that is itself 'simple and straightforward.' Still, it seems unlikely that Jobs, the board, and its counsel would disclose the prognosis of a six-month recovery if it were at odds with doctors' expectations."

Reiner describes Jobs' note — and the board's accompanying statement — as an "attempt to balance the protection of Jobs' privacy with the board's fiduciary responsibility to disclose significant risk factors to the company."

Apple's lawyers must have vetted the letters with care, he says, so it's incumbent on investors "to parse the missives with equal care."

In Reiner's parsing, the letters say that the board considers the risk to Jobs' health to be "grave" — or in SEC parlance, "material" — although Jobs leaves the strong impression that the most likely outcome is a return to relatively normal health.

At the least, Reiner writes, the prognosis of a six-month recovery buys Apple some time. "'The Apple community' is now due an update in late spring, but until then the recovery will be allowed to run its course without undue prying."

Meanwhile, however, Reiner has a long list of things we still don't know, among them:

• Whether Jobs is currently engaging in his normal CEO duties
• What suddenly prompted him to seek out the root cause of his condition a few weeks ago
• What the long-term prognosis of his condition is.

In short, Reiner concludes, the leadership risk has not gone away, but it has become less acute, allowing investors to refocus on what he calls the heart of the Apple story:

• The Mac share gains
• The iPhone revolution
• The cash in the bank
• And the cash that's still flowing.

For more on Jobs' medical condition, see What's going on with Steve Jobs' hormones

Steve Jobs' letter to the Apple community about his health problems seems to have reassured investors — the stock closed up 4.22% in Monday trading.

But medically, Apple's (AAPL) CEO raised more questions than he answered.

His eight paragraph message contains remarkably few health-related facts. They're all contained in these three graphs:

"As many of you know, I have been losing weight throughout 2008. The reason has been a mystery to me and my doctors. A few weeks ago, I decided that getting to the root cause of this and reversing it needed to become my #1 priority.

Fortunately, after further testing, my doctors think they have found the cause — a hormone imbalance that has been 'robbing' me of the proteins my body needs to be healthy. Sophisticated blood tests have confirmed this diagnosis.

The remedy for this nutritional problem is relatively simple and straightforward, and I've already begun treatment. But, just like I didn't lose this much weight and body mass in a week or a month, my doctors expect it will take me until late this Spring to regain it. I will continue as Apple's CEO during my recovery." (link)

"Cryptic," is how Dr. William Sherman, a medical oncologist at the Pancreas Center of New York Presbyterian and Columbia University, described Jobs' breezy summary of his medical condition. "Delightfully vague," says Dr. Andrew Ko, a medical oncologist at the University of California-San Francisco. That phrase — "hormone imbalance" — tells us neither what hormones are involved nor why they're misbehaving.

Moreover, Jobs, who is 53, has left several relevant facts out of this account, starting with the malignant tumor that was removed from his pancreas in 2004 — along with his gallbladder, part of his stomach, the lower half of his bile duct and part of his small intestine. See the Whipple procedure diagram below. The details of this operation were first reported by Peter Elkind in Fortune. (See also Why does Steve Jobs look so thin?)

Several experts, none of whom are involved in his treatment, have speculated that the hormone imbalance Jobs describes may be caused by a recurrence of the original cancer — an islet cell neuroendocrine tumor, one of the few forms of pancreatic cancer that can be successfully treated. If Jobs' first surgery missed some of those cancer cells, that's not necessarily a death sentence, says Dr. Ko. With proper treatment — using injectable drugs designed to block key hormone receptors — patients with these cancers can live for years.

Jobs told Apple employees four years ago that his cancer was "cured." And last year, according to a report in the New York Times, he told several associates — including members of Apple's board — that he was cancer-free. (See here.) He letter Monday said nothing about cancer, one way or the other.

According to the New York Times, Jobs also told the board that he had a second surgery in 2008 — most likely a surgical "revision" or rearrangement of his internal plumbing to address complications stemming from the original procedure (see here.) The purpose of this second procedure, according to the Times, was to correct ongoing digestive difficulties.

Jobs' open letter suggests that those digestive difficulties have continue to plague him and offers a new theory — confirmed, he says, by sophisticated blood tests — about what might be going on: an easily treated "hormone imbalance."

There are several problems with this explanation. Not only is it frustratingly imprecise, but it suggests that Jobs' hormone issues are something his doctors only just discovered — prompted by his decision a few weeks ago to finally get to the root cause of his weight loss.

Hormones — a broad term for any chemical released by cells that affects cells in other parts of the body — perform a wide variety of functions, from stimulating growth and regulating mood to triggering physical changes like puberty and menopause. They interact in complex ways — through cascading reactions and elaborate feedback loops — and are known to get out of whack now and then, most familiarly in post-menopausal women.

Hormones also regulate digestion and metabolism. In fact, the main function of the pancreas is to produce metabolic hormones (chiefly insulin and glucagon) and digestive enzymes that break down food. Given that Jobs lost a large portion of his pancreas in his 2004 surgery, one would expect his digestive enzymes to be affected — a condition that can be effectively treated with enzyme replacement therapy.  Hormone deficiencies are also common after a Whipple procedure, but they are usually detected and treated early. The mystery, says UCSF's Dr. Ko, is what — besides a tumor — could cause a hormone imbalance this late in the game.

“If someone is losing weight, you do a workup of his pancreas, you do a workup for diabetes, a workup for hyperthyroidism,” says Columbia's Dr. Sherman. “Maybe it wasn’t abnormal enough to say so at first, and maybe now it is so a diagnosis can be made.”

What strains credibility — and sounds too good to be the whole story — is that the issue was first raised and the cause discovered only a few weeks ago. If it is something as simple and straightforward as a nutritional problem caused by a hormone imbalance, says Dr. Ko, "I doubt his doctors would have missed it all this time."

What seems more likely is that Jobs, a man who knows something about controlling the message, is telling us a story as carefully crafted as any Apple product. He has said as little as possible about his medical condition — just enough to calm the waters roiled by his decision to skip this week's Macworld. And he said it before the markets opened on the eve of Apple's last Expo — just in time to allow the thousands of reporters, analysts, developers and fans descending on San Francisco to "relax," as he writes, "and enjoy the show."

What's really going on, we still don't know.

–With reporting by Alyssa Abkowitz.

[Diagram courtesy of the Mayo Clinic]