Steve Jobs' surgeon talks, again
Dr. James Eason. Video clip: Bloomberg
Dr. James Eason, the surgeon who performed Steve Jobs' liver transplant earlier this year, came close to — but did not actually confirm — that Jobs' cancer had spread to his liver.
It was Dr. Eason who, with his patient's permission, issued a four-paragraph statement in June confirming reports that Apple's (AAPL) CEO had received a new liver. Eason, the head of transplantation at Methodist University Hospital in Memphis, also revealed that Jobs was suffering from end stage liver disease and was, in fact, the "sickest patient on the waiting list."
This week, as part of a long profile published Friday by Bloomberg News, Eason spoke to Bloomberg's John Lauerman about his career, his medical practice and his most famous patient.
Jobs is “a special person,” he told Lauerman. “He’s really a genuinely nice person.”
The closest thing the doctor came to saying anything about Jobs' particular form of pancreatic cancer was in these two passages:
Michael Jackson, Steve Jobs and Apple's share price
As I see it, Apple's crack public relations team stage-managed the news last week of Steve Jobs' liver transplant pretty well on its own, somehow making it appear in the Wall Street Journal after the markets had closed for the weekend and in the middle of what was probably the company's biggest product release of the year.
By the time Monday rolled around and traders could react to the fact that what Jobs had initially described as a hormone imbalance was actually end stage liver disease, Apple was able to soften the blow with the news that it had just sold 1 million new iPhones.
The stock took a 3.9% hit — dropping from 139.48 to 134.01 in the space of two days. But by then Jobs had been spotted back on Apple's Cupertino campus walking on his own — without cane or wheelchair — and his surgical team had declared that he was "recovering well" with an "excellent prognosis."
But there's nothing to help you forget the illness of one celebrity like the passing of an ever bigger one, and when Michael Jackson died on Thursday, all bets were off. The flood of searches on Jackson's name just before 3 p.m. PDT (6 p.m. EDT) was so abrupt and intense that at first Google thought it was under attack.
Meanwhile, interest in Steve Jobs, as gauged by Google Insights, flatlined, and pressure on Apple's shares lifted. Whoever was shorting Apple (AAPL), it seems, had moved on to better things.
The stock closed Friday at 142.44, higher by 2.52 points than it opened on Monday.
See also:
- Steve Jobs, the sickest patient on the waiting list
- Inside Steve Jobs' liver transplant
- Steve Jobs: Apple sold 1 million new iPhones
- Steve Jobs is back at Apple
Michael Jackson photo: Rusty Kennedy/Associated Press; Steve Jobs photo: Getty Images
Steve Jobs: The sickest patient on the waiting list
After three days of ducking the press — and telling the Wall Street Journal that Steve Jobs was not listed as a patient there — Methodist University Hospital in Memphis finally admitted Tuesday that Jobs did in fact receive a new liver at their transplant facility.
It the process, the faith-based hospital revealed more than we knew about just how sick Apple's (AAPL) CEO had been.
With Jobs' permission, Methodist's chief transplant surgeon, Dr. James Eason, issued a four paragraph statement designed to counter the impression — apparently widespread — that Jobs had jumped to the top of the transplant waiting list on the strength of his wealth and celebrity.
Judging from our comment stream, most readers believe Jobs' new liver should have gone to someone who had been waiting longer, needed it more or had a better chance of survival.
Eason flatly denies that. His statement reads, in part:
"Mr. Jobs underwent a complete transplant evaluation and was listed for transplantation for an approved indication in accordance with the Transplant Institute policies and United Network for Organ Sharing (UNOS) policies.
"He received a liver transplant because he was the patient with the highest MELD score (Model for End-Stage Liver Disease) of his blood type and, therefore, the sickest patient on the waiting list at the time a donor organ became available. Mr. Jobs is now recovering well and has an excellent prognosis."
This is revealing.
MELD is the numerical measure used by transplant centers to assess the severity of chronic liver disease. It was developed to predict the odds that a patient will die within three months based on a scoring system that ranges from less than 10 (4% mortality) to 40 or more (100% mortality).
The MELD algorithm takes values from the patient's blood and urine tests and spits out an answer. In a hospital's computer, it looks like this:
Where
- INR, or international normalized ratio for prothrombin time, is a measure of how fast the patient's blood clots
- Bilirubin levels tell doctors how well the patient's liver is functioning
- Creatinine levels provide a measure of the patient's kidney function
- Dialysis treatments, which do the work of the kidneys, affect creatinine readings
We don't know whether Steve Jobs was getting dialysis twice a week, but if his MELD score was higher than every other liver transplant candidate with his blood type in Tennessee — which has a relatively short waiting list but still averages 48 days — he was very sick indeed.
Jobs had a cancerous tumor removed from his pancreas in 2004 and went on a medical leave January to deal with continuing health issues that he initially described as an easily treated hormone imbalance.
Although he was spotted on Apple's Cupertino, Calif., campus Monday, his spokespeople continue to say only that Jobs looks forward to returning to Apple at the end of June.
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Steve Jobs' liver transplant: The second-day stories
When major news breaks, like the report that Steve Jobs' got a new liver, there's always a scramble among competing reporters to find what they call the second-day lede — an angle they can use to spin the story forward ("lede" is by tradition deliberately misspelled).
Our modest contribution Saturday was a medical piece describing the liver transplant procedure, but there were plenty of other threads to follow. Here are the second-day stories that got our attention:
- Where was Steve Jobs hiding? Leander Kahney, former managing editor of Wired.com and author of Inside Steve's Brain, did some first-rate legwork and identified what he believes is the Memphis mansion where Jobs has been convalescing. You can trace the detective story at his Cult of Mac blog and even take a Google-map street view drive down the cul-de-sac where Kahney thinks Jobs spent much of his six-month medical leave.
- Who leaked the story? Daring Fireball's John Gruber, remarking on how unusual it is for the Wall Street Journal to run a front page news item without offering any information about its source, suggests three theories: 1) A healthcare provider, without Jobs' permission, 2) Apple's (AAPL) public relations department, with Jobs' permission, or 3) someone on Apple's board of directors, without Jobs' knowledge or permission.
- Did the press get played? Several reporters are pursuing this. The Loop's Jim Dalrymple believes Apple moved up the release of the iPhone 3G S from mid-July to mid-June in order to draw attention away from Jobs' health problems with "a bright and shiny object." Joe Wilcox's "Steve Jobs' Return Is Still Vaporware" takes it one step further. "The timing," he writes, "helps protect Apple’s share price and deemphasize an important fact: Steve isn’t really coming back this month."
- Where are the Memphis media? Rex Hammock pointed out that 12 hours after what should have been a huge local story, no Tennessee newspaper or TV station had done anything with it. I can confirm that 30 hours after a New York City paper broke the news, there was nothing about Apple or Steve Jobs on the websites of the Memphis Daily News, the Memphis Commercial Appeal or the the Memphis Flyer. The Memphis Business Journal's site does have a Steve Jobs item, but it's just their "Partner News" link to a Fox Business story.
It says something about the state of the news media today that it was a blogger in San Francisco, not a reporter in Memphis, who seems to have tracked down Steve Jobs' Tennessee whereabouts.
If you spot an interesting second-day story, let us know and we'll add it to the list.
See also:
Inside Steve Jobs' liver transplant
On Friday the Wall Street Journal reported, without indicating its source, that Apple (AAPL) CEO Steve Jobs underwent a liver transplant operation in Tennessee about two months ago.
This would seem to confirm a report in mid-January that Jobs — who had a tumor removed from his pancreas in 2004 and took a medical leave earlier in January to deal with continuing health issues — was considering such an operation, as well as rumors in mid-April that he was having the surgery in Memphis.
Two hospitals in Memphis are designated liver transplant centers: Le Bonheur Children's Medical Center and Methodist University Hospital. Le Bonheur does not perform liver transplants on adults. A spokesperson for Methodist told the Journal that Jobs was not listed as a patient there, which leaves open the possibility that he was registered under another name.
About 6,000 liver transplant operations are performed in the United States each year at more than 100 hospitals, according to the Organ Procurement and Transplant Network, but the waiting list for donors is considerably shorter in Tennessee than it is in most states.
The operation usually takes five or six hours. The surgeon makes a large incision in the upper abdomen and removes the damaged liver by cutting all the attached ligaments and severing several vital ducts and vessels, including the common bile duct, the hepatic artery, the hepatic vein and the portal vein that carries blood to the liver from the spleen, stomach, pancreas and intestines.
Blood from the liver is replaced by an ice-cold solution until the organ can be replaced.
The new liver — usually rushed from a recently deceased donor in the kind of race against time regularly featured in TV medical dramas — is then placed in the empty cavity and attached to those vessels and ducts. [A growing percentage of hepatic transplantation procedures, as several readers have pointed out, are partial liver transplants from living donors.]
Recovery can take many weeks and the survival rate is good. 80% to 85% of patients live for at least a year; about 75% live for five years or more. (Recent studies report that the five-year survival rate at experienced transplant centers is over 90%.) To prevent rejection, most patients take immunosuppressive drugs for the rest of their lives.
Liver transplants are well-accepted treatments for end-stage liver disease and acute liver failure. The situation with Steve Jobs, who is recovering from a rare form of pancreatic cancer — called islet cell neuroendocrine tumor — may be a different story, as a key passage in the Journal piece suggests:
William Hawkins, a doctor specializing in pancreatic and gastrointestinal surgery at Washington University in St. Louis, Mo., said that the type of slow-growing pancreatic tumor Mr. Jobs had will commonly metastasize in another organ during a patient's lifetime, and that the organ is usually the liver. "All total, 75% of patients are going to have the disease spread over the course of their life," said Dr. Hawkins, who has not treated Mr. Jobs.
Getting a liver transplant to treat a metastasized neuroendocrine tumor is controversial because livers are scarce and the surgery's efficacy as a cure hasn't been proved, Dr. Hawkins added. He said that patients whose tumors have metastasized can live for as many as 10 years without any treatment so it is hard to determine how successful a transplant has been in curing the disease. (link)
If Jobs' cancer did spread to his liver, the fact that he had this procedure suggests that it may not have gone any further. Most hospitals will not perform a transplant on patients with metastatic cancer that has spread outside the liver.
Apple continues to say that it looks forward to Steve's return to Apple at the end of June, which is 10 days away. It has not yet returned a request for comment on this report.
Transplant image courtesy of Tulane Medical Center.
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