January 14, 2009: Steve Jobs’ cancer worsens to the point that he takes a medical leave from Apple.

He is reluctant to take the time off. When he does, he keeps quiet about exactly how unwell he actually is. He calls “the curiosity over my personal health” a distraction caused by prying bloggers and reporters. Nonetheless, he acknowledges that his health problems “are more complex than I originally thought.”

Steve Jobs’ cancer diagnosis

By 2009, Jobs’ pancreatic cancer diagnosis had been known by himself and his family for more than five year.. This in itself was something of a miracle. According to the American Cancer Society, for all stages of pancreatic cancer combined, the one-year relative survival rate is 20 percent. The five-year rate drops all the way down to 7 percent.

Jobs, however, suffered from a less aggressive form of the cancer called islet cell neuroendocrine tumor. If he had sought treatment immediately,  he might possibly have survived. However, Jobs rejected doctors’ recommendations to undergo surgery for nine months. Instead, he treated the cancer with alternative therapies. These included vegan diets, acupuncture, herbal remedies and even consulting a psychic.

He ultimately underwent surgery in July 2004, with Tim Cook temporarily assuming the role of Apple CEO for the first time. During the surgery, doctors found liver metastases, which prompted Jobs to begin chemotherapy.

Reality distortion field applies to Jobs’ health

Jobs returned to Apple in 2005, and told everyone he had been cured — which is the same thing he told students during his famous Stanford commencement address in June 2005. Sadly, he wasn’t. This became obvious to everyone by Apple’s Worldwide Developers Conference in August 2006, where Jobs appeared much thinner than before.

For the next several years, Jobs remained quiet about his cancer. He told everyone that it was cured, but it was clear from looking at him that this was wishful thinking. Behind the scenes, Jobs pursued a range of treatments. These included an experimental, hormone-delivered radiotherapy in Switzerland, and peptide receptor radionuclide therapy in the Netherlands.

A ‘hormone imbalance’

At least from an investor perspective, things got worse on January 5, 2009. That’s when Jobs wrote a misleading open letter saying he suffered from nothing more serious than a “hormone imbalance that has been robbing me of the proteins my body needs to be healthy.” He said “sophisticated blood tests” backed up this diagnosis, and described the remedy as “relatively simple.”

In reality, hormone imbalance was one of the problems Jobs was facing. This was a minor side effect of the cancer, which had now metastasized to his liver. Even The New York Times repeated the inaccuracy, saying Jobs’ problem stemmed from improper food absorption and not a recurrence of cancer. One report noted that:

“Two people who are familiar with Mr. Jobs’s current medical treatment said he was not suffering from a recurrence of cancer, but a condition that was preventing his body from absorbing food. Doctors have also advised him to cut down on stress, which may be making the problem worse, these people said.”

One of the issues with Jobs misleading people in this way was that, as the miraculous CEO who had turned around Apple, his wellbeing was viewed as critical to the company’s valuation. A lack of transparency, and a willful misrepresentation of his health condition, put Apple in a difficult situation.

Steve Jobs’ leave of absence

In the end, after a week of sustained legal recommendations, Jobs wrote a second letter, dated January 14 — this time announcing his leave of absence.

Team,

I am sure all of you saw my letter last week sharing something very personal with the Apple community. Unfortunately, the curiosity over my personal health continues to be a distraction not only for me and my family, but everyone else at Apple as well. In addition, during the past week I have learned that my health-related issues are more complex than I originally thought.

In order to take myself out of the limelight and focus on my health, and to allow everyone at Apple to focus on delivering extraordinary products, I have decided to take a medical leave of absence until the end of June.

I have asked Tim Cook to be responsible for Apple’s day to day operations, and I know he and the rest of the executive management team will do a great job. As CEO, I plan to remain involved in major strategic decisions while I am out. Our board of directors fully supports this plan.

I look forward to seeing all of you this summer.

Steve