【Native Speaker每日综合训练—36系列】【36-11】科技 Steve Jobs's Death

cherry6891

内容：cherry  编辑：铁板神猴

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提起 Steve jobs,有太多值得思考和讨论的话题，传奇的成功经历，特立独行的商业理念，甚至他的英年早逝都带给我们一些启迪，这期主要针对乔布斯的病情和治疗，为什么最初不愿接受外科手术治疗癌症？
关爱自己 每年体检 把疾病遏制在萌芽状态 （貌似有点不搭）
但借这个机会我想这个机会提醒女童鞋们，一定定期乳房检查，如果有条件可以注射宫颈癌疫苗，这两个是女性最高发的癌症，但是只要及时干预，都可以预防

Part I: Speaker

CBS 60 Minutes special on Steve Jobs, Part 2

注：part 2 由于提到了Steve的死因，作为今天的作业内容；part 1作为补充兴趣素材，可自选。

Source: Youtube/CBS
https://www.youtube.com/watch?v=1c_e6Oa21zE


[Rephrase 1, 13:00]

   



[If You'd Like]

cherry6891

Part II: Speed

Steve Jobs Regretted Wasting Time on Alternative Medicine

[Time 2]
Everyone else wanted Steve Jobs to move quickly against his tumor. His friends wanted him to get an operation. His wife wanted him to get an operation. But the Apple CEO, so used to swimming against the tide of popular opinion, insisted on trying alternative therapies for nine crucial months. Before he died, Jobs resolved to let the world know he deeply regretted the critical decision, biographer Walter Isaacson has told 60 Minutes.

"We talked about this a lot," Isaacson told 60 Minutes of Jobs's decision to treat a neuroendocrine tumor in his pancreas with an alternative diet rather than medically recommended surgery. "He wanted to talk about it, how he regretted it....I think he felt he should have been operated on sooner... He said, 'I didn't want my body to be opened...I didn't want to be violated in that way.'"

Ramzi Amri, a Fullbright scholar researching neuroendocrine tumors at the Harvard Medical School and at Massachusetts General Hospital, said the tumors of the subtype Jobs is believed to have contracted are "relatively mild" and very survivable if detected early. But Jobs delayed surgery for at least nine months, making it "sound to assume that Mr. Jobs' choice for alternative medicine has eventually led to an unnecessarily early death."

Says Isaacson:
He's regretful about it... Soon everybody is telling him, 'Don't try and treat it with these roots and vegetables and these kinds of things...' By the time they operate on him they notice it has spread to the tissues around the pancreas.
[253 words]

[Time 3]
To understand Jobs's prognosis, it is necessary to appreciate the precise type of cancer he had, and the subtype he is believed to have had. First, Jobs's neuroendocrine tumor, also called an islet cell tumor, put him outside the 95 percent of pancreatic cancer victims who have highly fatal adenocarcinoma.

Second, Jobs is believed to have contracted one of the more survivable neuroendocrine tumors. It had several characteristics weighing the initial prognosis favorably, had Jobs acted as doctors recommended:

•        It was apparently functional, meaning it produced hormones, hence the "hormone imbalance" that Apple eventually acknowledged. These sorts of tumors are more "differentiated" from other cells and are thus considered less progressed and easier to treat.

•        Jobs's tumor did not initially appear to have metastasized, as there were no outward signs of chemotherapy, though after being left untreated it did become metastatic and spread to his liver.

•        The tumor was in Jobs's pancreas, among the more survivable locations a neuroendocrine tumor can appear.

•        Insulinoma, the type of tumor Jobs was most often reported and speculated to have had, is also among the more survivable types.

•        The five-year survival rates on this chart give a good indication of the prognosis for insulinoma (88.7 percent) and tumors located in the pancreas (78.1). It also shows how much more lethal metastasic and non-function tumors—of the type Jobs is believed NOT to have had, at diagnosis—can be.

•        If you want more details, we've included some notes Amri sent us by email below. But suffice it to say, Jobs's instinct for defiant iconoclasm and his insistence on unconventional approaches did not, in the end, serve him as well as it served Apple's customers and shareholders. And it seems clear Jobs knew this, and wanted the rest of us to know it, too.
[304 words]

[Time 4]
Additional Medical Details

Here's how Amri explained things when we asked him on email about a particular type of neuroendocrine tumor with a lower survival rate ("non-functioning metastatic islet cell tumors," whose survival rate is only around five years):

That number could very well be true, but there are two reasons it doesn't apply to Jobs (and again, we're on the border of speculation but it's based on hard number and what Jobs said):

The metastatic part: Metastasis means the tumor spread outside its original site. His tumor probably wasn't metastatic until when Jobs spoke of that "hormonal imbalance", I believe in '08 (source is easy to google). That was also the reason for his liver transplant: his liver was probably invaded by metastatic disease. If he had mets before, he certainly didn't treat them as we'd have seen the obvious signs of chemotherapy appear.

The nonfunctional part, nonfunctional in those tumors means the cells degenerated to the point that they cannot carry out their original function, in this case, as I said in my first point, Jobs spoke about a "hormonal imbalance" when the disease recurred somewhere as late as '08/'09. This means the tumor was -even then- clearly still producing hormones, proving it was a functional one, which is far less deadly than the nonfunctional ones.

This so-called called loss of differentiation is actually a strong predictor of how bad the tumor is in many cancers. The less differentiated it is, the more reckless it will be in its growth pattern and its tendency to spread.

For instance, in my colon cancer patients, they're about 8 times as likely to develop or already have metastasis if their tumor is poorly differentiated as compared to well or even moderately differentiated tumor.

The subtype: so Jobs didn't have a nonfunctioning one, but from what I read (please google to double-check) he even had an insulinoma, which is actually the most common and best treatable type.

He also had it in the pancreas, which is known to have one of the best prognosis averages.

Combine the two in this table comparing the different kinds of neuroendocrine tumors, add up the extraordinary level of care a man like Jobs can access and afford and you can see what I mean about his considerable chance of cure, hope it helps.
[384 words]

[Time 5]
Amri also fielded questions (in italics) about this Slate piece:

1. "Islet-cell cancer, like Jobs and I had, is usually curable when caught early" - this seems to fit with what you wrote. Is "curable" the right word, i.e. it's gone and you don't die from it?

1 - Absolutely. If you're on time, you can resect the tumor (depending on the site) without even needing to remove the pancreas or any other organ.

And since you're early, the chances of it coming back as a recurrence from the original tumor are small.

There could always be an independent recurrence, if you have a familial disease that makes you at risk of developing these nasties (google MEN-1 for the most common example) but there's no indication this was the case for Jobs and -one again- seen the level of care he can afford, I'm pretty sure that has been checked on him. It you do not have a familial disease, it's like lightning striking twice at the same place. It happens, but with these tumors, that's really, really unusual.

2. "After I was diagnosed, I was told that modern medicine doesn't have chemotherapy or radiation to use against islet cells. ("We've got nothing that works" went the refrain.) " I noticed in your piece you mentioned Jobs seemed to eschew chemo; would he have had a choice?

2 - I think that was specific to his own case and his own subtype of islet-cell tumor.
[245 words]

[Time 6]
In general, and especially if Jobs had a well-differentiated insulinoma, there are many treatment options, but when you're early and the tumor is small enough, surgery is by far the best, in most cases you take the tumor out locally, check the local lymph nodes and if there is no spread in the nodes, you can confidently release the patient without any lasting side-effects, a low risk of recurrence and only a checkup consisting of a scan an labs every year or so as long as symptoms don't come back.

- Chemo doesn't always work and works in only about 10-20% of cases if the tumor is in the intestines or the stomach, but if it's in the pancreas, some agents have been FDA approved and can help much more often.

Also, these numbers might appear worse than they really are because only the worst cases actually get chemo because most won't need it at all. If you treat only the bottom, the average success will of course be low.

- There's also radiotherapy with special isotopes that will be absorbed by the endocrine tumor cells that helps a lot if the tumor is metastatic.

- If that doesn't help there's the option of partial resection of the liver instead of removing the whole thing. The liver has the amazing faculty to partially regrow so a lot of the liver can be resected before the patient actually has a problem. This option is only available to those cases where the tumor is confined to either the right or left lobe, or in milder cases, only one of its eight so called Couinaud Segments.

All of that is usually tried before one refers to a liver transplant. If only because livers are very scarce organs and transplants to cancer patients are not always a good idea because of the immune-system suppressing drugs used to prevent rejection. They also partly suppress the body's own immune reaction to any cancer growths, making the cancer more prone to spread.
[335 words]

Source: Gawker

http://gawker.com/5851835/steve-jobs-regretted-wasting-time-on-alternative-medicine

cherry6891

Part III: Obstacle

Harvard Cancer Expert:

Steve Jobs Probably Doomed Himself With Alternative Medicine

[Paraphrase 7]
Steve Jobs had a mild form of cancer that is not usually fatal, but seems to have ushered along his own death by delaying conventional treatment in favor of alternative remedies, a Harvard Medical School researcher and faculty member says. Jobs's intractability, so often his greatest asset, may have been his undoing.

"Let me cut to the chase: Mr. Jobs allegedly chose to undergo all sorts of alternative treatment options before opting for conventional medicine," Ramzi Amri wrote in an extraordinarily detailed post to Quora, an online Q&A forum popular among Silicon Valley executives. "Given the circumstances, it seems sound to assume that Mr. Jobs' choice for alternative medicine has eventually led to an unnecessarily early death."

Amri went on to say that, even after entering conventional medical care, the Apple CEO seemed to eschew the most practical forms of treatment. Addressing the period when Jobs began to visibly shed weight, Amri wrote, "it seems that even during this recurrent phase, Mr. Jobs opted to dedicate his time to Apple as the disease progressed, instead of opting for chemotherapy or any other conventional treatment."

When we contacted Amri at his Harvard Medical School email address to verify the post was his—he's a researcher in the department of surgery at the medical school and research fellow at Massachusetts General Hospital—Amri emphasized, "I wrote that on a PERSONAL title and it's my PERSONAL opinion." On Quora, Amri expressed his "profoundest respect" for Jobs and that "I do not pretend to know anything about the case on a personal level and I never participated in the care of Mr. Jobs. I base all my cancer figures on my own research or sources from biomedical research known to me... I have done 1.5 years of research on the type of tumor that affected Steve Jobs and have some strong opinions on his case."

According to a 2008 Fortune article, Jobs for nine months pursued "alternative methods to treat his pancreatic cancer, hoping to avoid [an] operation through a special diet." The Buddhist vegetarian took this approach from the time he was diagnosed in October 2003 until at least the end of July 2004, when he underwent surgery at Stanford University Medical Center.

By then the cancer was so far along Jobs had to lose his pancreas and duodenum in a "Whipple procedure." The cancer also spread to all the major parts of his liver. "The only reason he'd have a transplant," wrote Amri, "would be that the tumor invaded all major parts of the liver, which takes a considerable amount of time." Amri said the Whipple procedure and liver transplant were clear signs the cancer was out of control and should have been stopped earlier.
The condition might have been nipped in the bud if Jobs had acted right away. Jobs's cancer manifest in neuroendocrine tumors, which are typically far less lethal than the "pancreatic adenocarcinoma" that make up 95 percent of pancreatic cancer cases. Amri said neuroendocrine tumors are so "mild" that...

"In my series of patients, for many subtypes, the survival rate was as high as 100% over a decade... As many as 10% of autopsied persons in the general population have been reported to have one of these without ever having had any symptoms during their life. Up to 30% of detected GEP-NETs are so well differentiated they're strictly not cancers."

But even "the most innocent cancer" needs to be removed quickly, which is why older men are always being lectured about colon cancer screenings; colon cancer tumors are thought to begin as removable polyps. In Jobs's case, surgical removal may well have saved him if performed early enough, Amri implies. He wrote:

"In many cases, a simple enucleation (just cutting out the tumor with a safe margin around it) is enough and leaves no residual side-effects."
The cancer researcher made his comments about Jobs because he was looking for a lesson in his case. Doctors routinely face the ethical conundrum of being unable to treat patients because they've exercised their freedom to reject sound medical science.

But there is also, thankfully, a much clearer and easier lesson for patients in Jobs's experience: Do not waste time. Don't waste time by ignoring advice to get screened; don't waste time by drowning yourself in research about your condition; and don't waste time by delaying medically recommended treatment in the hops that something else will work.

"We saw the tumor slowly draining the life out him," Amri wrote of Jobs. "It was a horrible thing to see him lose weight and slowly turn into a skin and bones form of himself."

That, in the end, may prove the most compelling reason to forgive the brilliant CEO his many faults: Of all the people who suffered on the dark side of his headstrong, iconoclastic decisionmaking, it was Jobs himself who appears to have paid the biggest price.
[815 words]

Source: Gawker
http://gawker.com/5849543/harvard-cancer-expert-steve-jobs-probably-doomed-himself-with-alternative-medicine

hysteries

来占~~~~~~

【Speed】
time2 00:01:16.84
Everyone else wanted Jobs to move aganst his tumor, however, Jobs insisted not to be violated in the way that opening his body.
He was actually regretted about that the time when is was too late to have the surgery.  

time3 00:01:14.78
Things have been proved that the cancer is more survivable and easier to treat.

time4 00:01:47.55
The author speculates that the cancer is the most common one which can be cured with a high possibilities.

time5 00:00:46.21
Jobs seems to eschew chemo

time6 00:01:28.96

【Obstacle】
00：05：35

醒醒Shine

1- 额 木有找到播放钮
2-1:36
3- 2:25
4- 2“53
5- 3:56
6-5:10

今天的文章跟我的签名好符合……

疏离无罪

占~~~~~~~~~~~~·

Speaker: The comment of the life of Jobs,what he has achieved and what he brought to the world.Talking about his family and his daughter.Jobs refued the surgery because he did not trust it.And he continued to deny his liver cancer in the later years and kept working on his ideas and products.He still worked till he died.

01:32
Steve Jobs was trying to use alternative therapies to replace the surgery.But the delay of 9-month surgery lead him to death.

01:26
The cancer is caused by a kind of tumor that can be easily treated and has high survival rate.But the delay of surgery lead it spread to the liver.

02:19
According to a doctor,Jobs's tumor is the most common and best treatable type and is located in the most survivalable area.

01:18
The cancer is curable if the discovery is eraly and Jobs does not have a familial disease. Jobs seemed to eschew chemo.

01:26
It gives out many options that Jobs can choose to cure his cancer.

05:02
Main Idea: Jobs lead himself to death.
Jobs insisted on alternative remedies to avoid operations to cure his cancer,which lead him to unnecessary early death.But even he entered the conventional medical care,he would eschew most partical forms of treatment.He dedicated most of his time to Apple.
His alternative remedies and special diet to avoid operation gives cancer enought time to spread all his liver and other tissues,which let the curable cancer becomes fatal.If the tumor can be removed quickly,he can be still alive now.
His experience gives us a lesson.Don't waste time on treatment.

苏错

谢谢cherry~~~  
偶回来了~~学校终于定下来， 论文也差不多了，继续跟进小分队！Fighting!~

Speaker:The history of Jobs and iPhone.
all products such as hardware, software --> easier buy, the personality or passions
of Jobs attract us -->Life changed --> His family
Speed:
Time2:1'05
The surgey of Steve Jobs was delayed because he didn't not want his body to be opened.
All his family and friends had tried hard to get him an operation.
Time3:1'32
The reasons for Steve to pay less attention to his tumor
and why he want us to know how much he regreted.
Time4:1'55
More details about why the reasons mentioned don't apply to Jobs.
The metastatic part & The nonfunctional part.
Time5:0'55
Time6:1'37
Early treatments can increase the possiblities of curing cancer.
Obstacle:4'21
Jobs devoted all his time to his company instead of taking conventional medicine.
He wanted to avoid the operation through diet.
Experiences: All doctors and researchers approve that the patients are supposed
to take medical treatments.

xiaofan0205

我也来了……

Speaker:
This part is too long, so I just listened some of it. First, the host introduces Steve Jobs and his cancer, then there is a woman talks about Steve Jobs as a inventor, just like Thomas Edison. Although he was not a easy person to work with, he did contribute the most important creativity to Apple. Next, a reporter drop by a Apple store in Shanghai after his death to take some photoes, there were tons of people there and some of them even can't afford any product in the store, there was a guy said that he was inspired by Steve Jobs's speech and decided to do something he like.

Time2: 1'24"
Time3: 1'51"
Time4: 2'12"
Time5: 1'31"
Time6: 2'06"
Steve Jobs regretted wasting time on alternative medicine. To understand Jobs's prognosis, it is necessary to appreciate the precise type of cancer he had, and the subtype he is believed to have had.
First, Jobs's neuroendocrine tumor put him outside the 95 percent of pancreatic cancer victims who have highly fatal adenocarcinoma.
Second, Jobs is believed to have contracted one of the more survivable neuroendocrine tumors. It had several characteristics weighing the initial prognosis favorably, had Jobs acted as doctors recommended.
Additional medical details about a particular type of neuroendocrine tumor with a lower survival rate, that number could very well be true, but there are two reasons it doesn't apply to Jobs: The metastatic part and The nonfunctional part.
In general, and especially if Jobs had a well-differentiated insulinoma, there are many treatment options, but when you're early and the tumor is small enough, surgery is by far the best.

菜农人民

Time2 1:54
SJ rejected to have a operation against his tumor,althouth his wife and friends insisted him to have one. SJ was regretful. RA thought that SJ might not too early to die if he had the operation.

Time3 2:47
several characteristis about Jobs's tumor.....

Time4  2:29
some details about J's disease. the tumor is more survival, but there are two reasons that do not apply to Jobs.

Time5 1:41
the islet tumor is curable if they were checked early

Time6 2:23
why J eschew cheo? because of his subtype node, the chemo was unuseful.....

Obstacle 6:57

小蘑菇开始打怪

还有首页嘛！
-------------
谢谢楼主！~

speaker:

when SJ was dead, Apple is the second biggest corporation in the world

the invention of iPhone

it is easy for you to drown into the Apple world and buy all the products of Apple

SJ was abandoned by his biological mother

he did want his body to be opened, so he did not accept any operation to cure the cancer even there was a great possibility for him to live

but when he accepted the operation, it is too late, the tissue has spread

sometimes I believe in god, sometimes I don’t

time2:

SJ felt regretful not choosing to do the operation in the early stage of the cancer

it is too late after 9 months SJ decided to do the operation because the tissues have spread around the pancreas

time3:

because of some misunderstanding of the cancer, SJ chose an unconventional way to treat the cancer

however, we can see from the result that, the work SJ done contribute nothing to his desert and if he could choose the conventional way of operation earlier, he may live longer

time4

from the words SJ had said and the appearance of SJ, the author speculates that the tumor SJ had is the most common one and can be cured with a pretty high possibilities

time5:

the analysis of the possibility whether the tumor could be cured and the medicine he may need if the diagnosis is accurate

time6:

some treatments and the possibilities they will work

there are many choices before the transplant of the liver and the worry of SJ is unnecessary

time7:

SJ ushered along his own death by delaying conventional treatment

Amri said all the reports are in his personal view

nine months later, the situation is really serious

if SJ accepted the operation earlier, there is about 95 percent of possibilities he could live

surgical removal may well have saved him if performed early enough

do not waste time

Jobs himself appears to have paid the biggest price

想起一句话来 no zuo no die why you try知道这么说乔布斯不好，可是，为什么不早治疗啊~！！