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iPods and Cancer: Thoughts on being smart in the areas that matter most

October 20, 2011

We at Sonoran Spine (SSC) joined the rest of the world in sadness at the passing of Steve Jobs, the brilliant Apple Computer founder. Our world would not be the same without our iPads, iPods, iTunes, and Mac computers. My colleague, Terrence Crowder, MD may be Apple's biggest devotee among the SSC surgeons, but I can't imagine performing spine surgery over the past several years without my iPod playing just the right selection of music to smooth away tension and provoke a smile at just the right moments. My patients have benefited from Steve Jobs' genius in their ability to choose their favorite music to go to sleep to. A few studies have shown that patients who drift under anesthesia while listening to their favorite Tony Bennett music have lower blood pressures, which is very helpful for both the anesthesiologist and the surgeon (Effectiveness of different music-playing devices for reducing preoperative anxiety: A clinical control study.Lee KC, Chao YH, Yiin JJ, Chiang PY, Chao YF.Int J Nurs Stud. 2011 Oct;48(10):1180-7. Epub 2011 May 11). Of course, once the patient is asleep, we put on the music we want to hear! Thank you Steve Jobs. Your inventions have made spine surgery even more enjoyable.

But apparently, Steve Jobs did not have to die so young. I was very sad to read a few articles over the weekend that suggested he had a completely curable form of cancer, which was found early enough, but he chose "alternative medicine" for many months (a Buddhist vegetarian diet) which delayed his needed chemotherapy. Even after he relented and pursued science-based treatments, he ignored the guidance of his doctors in issues of timing of treatments, leading to an unnecessary early death. Tragic. (http://gawker.com/5849543/harvard-cancer-expert-steve-jobs-probably-doomed-himself-with-alternative-medicine) How could such an intelligent man make such an unintelligent decision? Wishful thinking? Emotionalism? Predatory sales tactics on the vulnerable? Or was it just the ostrich with his head in the sand?

Steve Jobs is certainly not alone. I have treated several seemingly intelligent patients who, for whatever reason, insisted that "you doctors don't know everything..." as they raced off to pursue some form of alternative treatment for cancer spread to the spine. It is discouraging, even heartbreaking to watch their slow demise as they come in for office visits. I have even seen it in personal friends. In all of these cases, I try to remain supportive and nonjudgmental after the "alternative" decision has been made. The outcome has always been certain in my experience: an unnecessary early death. The "I told you so" doesn't have a role here. 

When the stakes are not so high, such as in the common non-life threatening conditions of scoliosis, disc herniation, or spinal arthritis, some seemingly intelligent patients are also vulnerable. I am amazed at the amount of money people spend on creatively imagined explanations about their spine conditions from self-promoted "experts". They willingly drain their bank accounts to pay cash for "new", "natural", or "non-invasive" treatments sold on testimonial appeals, without any basis in research data or fact. When I ask for research (www.spineresearch.org) showing the effectiveness of the treatments, I get the "Oh Doctor!" look, and I know to move on. Though some of my patients have only themselves to blame for their delay in getting relief from back or neck pain, I also blame the shameful predatory practitioners who surely know better.

I don't know this for a fact but I would be willing to bet that any time Steve Jobs was presented with a new idea for a new technology, he would say, "show me the data". What did the research show? Was the idea consistent with what was known to be possible? Was the idea realistically achievable by the means described? What did the research show? If only he had approached his own healthcare with the same insistence on excellence! Can we learn from this?

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