What can we learn from Steve Jobs about complementary and alternative therapies?
What can we learn from Steve Jobs about complementary and alternative therapies?
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关于补充和替代疗法，我们可以从史蒂夫·乔布斯身上学到什么？
DOI：
10.1016/j.ypmed.2011.12.014
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发表时间：
2012
影响因子：
5.1
通讯作者：
Ernst,Edzard
中科院分区：
文献类型：
--
作者：
Greenlee,Heather;Ernst,Edzard
史蒂夫·乔布斯于2011年10月因胰腺癌英年早逝，享年56岁，这一消息引起了广泛关注（Kane and Fowler，2011; Markoff，2011）。乔布斯是苹果电脑的两位创始人之一，被认为是个人电脑的革命。在2003年确诊时，乔布斯做了大多数癌症患者都会做的事情：他根据当时可用的最佳证据决定如何治疗。乔布斯被诊断出患有一种罕见的胰腺癌，称为胰岛细胞瘤或胃肠胰腺神经内分泌肿瘤（GEP-NET），这是一种不同于高度侵袭性且通常迅速致命的胰腺癌的胰腺癌。GEP-NET是生长缓慢的肿瘤，如果肿瘤在转移前被切除，则有可能通过手术治愈。关于GEP-NET的临床试验数据有限，并且尚未确定治疗GEP-NET的高效化疗药物。面对诊断时的医疗不确定性，乔布斯仍然必须做出如何继续治疗的决定。许多记者提到甚至关注乔布斯最初决定放弃常规治疗，而是使用补充和替代医学（CAM）疗法，包括针灸，植物药和饮食变化（Grady，2011）。这一点在他的传记中有记载，并通过对他的朋友和同事的采访得到证实（Isaacson，2011）。然而，许多记者没有注意到的是，支持GEP-NET的任何特定常规治疗方法（手术，化疗，放射治疗）的证据包括一个微薄的文献，并且使用CAM治疗GEP-NET的证据基础几乎不存在。在确诊后推迟了9个月后，2004年，乔布斯选择了手术。七年卒。
The untimely death of Steve Jobs from pancreatic cancer at the age of 56 in October 2011 was highly publicized (Kane and Fowler, 2011; Markoff, 2011). Jobs was one of two founders of Apple computers and is credited for revolutionizing personal computing. At the time of his diagnosis in 2003, Jobs did what most cancer patients do: he made a decision on how to approach his treatment based on the best evidence available to him at the time. Jobs was diagnosed with a rare form of pancreatic cancer, called an islet cell tumor or gasteroenteropancreatic neuroendocrine tumor (GEP-NET), which is a different form of pancreatic cancer than the highly aggressive and often rapidly fatal pancreatic adenocarcinoma. GEP-NETs are slow growing tumors that have the potential to be cured surgically if the tumor is removed prior to metastasis. There are limited clinical trial data on GEP-NETs and highly effective chemotherapy agents to treat GEP-NETs have not been identified. In the face of medical uncertainty at the time of his diagnosis, Jobs still had to make a decision on how to proceed.Many journalists mentioned and even focused on Jobs’ initial decision to forego conventional treatments and instead use complementary and alternative medical (CAM) therapies, including acupuncture, botanicals, and dietary changes (Grady, 2011). This was chronicled in his biography and corroborated via interviews with his friends and colleagues (Isaacson, 2011). However, what many journalists failed to note is that the evidence supporting any specific conventional treatment approach (surgery, chemotherapy, radiation therapy) for GEP-NETs comprises a slim literature, and the evidence base for use of CAM therapeutic approaches for GEP-NETs is virtually non-existent. After a delay of nine months after diagnosis, in 2004, Jobs opted for surgery. He died 7 years later.