- We are interrupting programming this evening because an American Edison has died. Steve Jobs, the chairman of the board of Apple Computer Company, passed away a short time ago. The company says that he had been battling pancreatic cancer. (audience applauding) (solemn piano music) - Steve Jobs, the visionary product designer, creator of the much-loved products the iPod, iPhone, and iPad, revolutionised the computer world and our relationship to it. - These are not three separate devices. This is one device. (audience cheering and applauding) - He's almost the demi-god of the product design. - You can get a feel for how thin it is. - His instinctive understanding of what the public wanted made Apple the highest valued company in the world. - Steve's right up there in the pantheon of great industrial successes. - iPhone is like having your life in your pocket. - He was after the goal of changing the world. - It's the ultimate digital device. - He was trying to make it a better place. - It works like magic. - But on October 5th, 2011, Steve Jobs' life is tragically cut short. - When Steve passed away, it was like a punch in the belly. - It was devastating. It was horrifying. - It's clear from the medical information that Steve Jobs died directly as a result of pancreatic cancer. But it was a type that was very treatable. He had a very good chance of surviving it. So, why did such a wealthy and talented man with so many resources at his disposal seemingly die unnecessarily? (dramatic music) - Renowned forensic pathologist Dr. Michael Hunter is the chief medical examiner in one of America's biggest cities. He has conducted over 4,000 autopsies. - I have here Steve Jobs' medical information, together with first-hand accounts which will allow me to identify the significant factors that ultimately led to his untimely death. - October 16th, 2003. Apple Headquarters, Cupertino, California. - Do it the way I said. - Eight years before his death. Steve is the world-renowned CEO of Apple Computer, the company he founded 27 years earlier. - OK. - A family man, he has been married to wife Laurene for 12 years, and has four children. (audience applauding) Today Steve is launching a new version of the iTunes music store. - This is the second-generation iTunes Music Store and Jukebox on Mac and on Windows. - It was a huge success. - (audience applauding) - And it is free. - Over the past six years, Steve Jobs has brought out one successful product after another. To the world, he has the Midas touch. - We wanna sell 100 million songs by April 28th, 2004. - Apple under Steve was flourishing. - Thank you very much. - (audience applauding) - But backstage,... - (Steve groaning) - (dramatic music) ...out of sight of colleagues and shareholders, Steve Jobs is doubled over with pain. (Steve panting) - Abdominal pain can be caused by a number of different factors, but it's normally associated with mild gastrointestinal problems such as constipation or indigestion. But when the pain is acute, it requires immediate medical attention because it has the potential of being something much more serious. (solemn music) - Steven Paul Jobs was born on February 24th, 1955. His parents, John Jandali and Joanne Schieble, met in college. When Joanne became pregnant, her Catholic father forbade her from marrying Jandali, a Muslim, so she put the baby up for adoption. Steve was adopted by a couple in San Francisco, Paul and Clara Jobs, a loving family, but the fact that he was adopted was always an issue. - When he was maybe five or six, the girl down the street said, 'Oh, you're adopted. That means your parents didn't want you.' Steve said he ran home crying. And it stayed with him throughout life. - Steve's intelligence and determination were apparent from an early age. He skipped a grade, and at the age of 12, insisted on changing schools. - He came home and told his parents he would not go back to that school or he would drop out. And they actually, they came from a very modest background. They actually scraped together what they had and they moved to a higher-income neighbourhood so that he could go to a better school. He was that kind of demanding kid. (exciting electronic music) - Inspired by the burgeoning tech industry on his doorstep, Steve became interested in computing. He met and befriended tech whiz kid Steve Wozniak when he was still at high school, and in 1976, the two young men started Apple Computer, working out of the Jobs family garage. - Apple is right there on the cusp of this brand new technology industry. - In 1977, they launch the Apple II computer, one of the first highly successful mass-produced microcomputers, and the first consumer product sold by Apple. It took the company into the major leagues. - At the time, Apple's huge success was not like a fait accompli. It's like, oh, my gosh, we have a successful product here. - Good evening. - (audience applauding) I'm Steve Jobs from Apple Computer. We're very glad to be here tonight. - By the time the '80s arrived, they were selling tens of thousands of these a month. - Apple II has become the world's most popular computer, and Apple has grown to a $300 million corporation, becoming the fastest-growing company in American business history. (audience applauding) - By the time Steve encountered severe stomach pains during the launch of iTunes in 2003, Apple was well on its way to becoming the world's most valuable company. (Steve panting and groaning) Late October 2003. Stanford University Medical Centre, California. Less than eight years before his death. Steve Jobs tells his doctors about his recent abdominal pains, believing them to be from kidney stones. They insist he has a CAT scan, and the results are devastating. - Steve, who seemed like the luckiest man in the world, all of a sudden had the worst news you could possibly get. - Cancer? - Yes. - Steve was diagnosed as having pancreatic cancer, and the pancreas is an organ that sits within the abdomen. It produces enzymes that help break down food soon after it leaves the stomach. It also produces hormones such as insulin, which helps regulate blood sugars. In general, pancreatic cancer is lethal. 95% of people die within 12 months of being diagnosed. - Are you sure? - Steve is informed that he hasn't long to live. But just as he's processing this devastating news, they discover something very unusual about his tumour. - There are two types of pancreatic cancer, those that arise from the endocrine glands and those that arise from the exocrine glands. More than 95% of sufferers have the exocrine-type tumour, and these are highly aggressive with a very low chance of survival. But Steve had a rare and treatable form of an endocrine tumour. And these are hormone-producing cells in the pancreas called islet cells, and they are much less aggressive. - Lo and behold, it's one of those rare instances where they could possibly deal with it with surgery, snip it out. - OK, gentlemen. - Steve's tumour had been caught early and doctors discovered that they could treat it. So, this was an excellent prognosis for someone who is diagnosed with pancreatic cancer. - But Steve makes a surprising decision. - I'm gonna take a different course of action, OK? - He didn't want them tinkering with his body. He didn't want to be opened up. - I'll sort this out myself. - His first reaction was to try to find a way to deal with it with alternative methods rather than surgery. - Thank you, gentlemen, thank you very much. - Steve tried following a strict vegan diet, ate fresh organic herbs, and drank fresh carrot and fruit juices. - He attempted different kinds of diets, he consulted a psychic, he did all sorts of things. He did everything except what the doctors told him he needed to do, which is to have this procedure. (dramatic music) - The organic herbs and fruit juices would have provided nutrition, and this is thought to boost the immune system. This could have made Steve's body stronger, more resilient, and more capable of fighting off his cancer. And I can see from Steve's notes that he also tried acupuncture. Acupuncture practitioners believe that energy, or life force, flows through the body in channels called meridians. By stimulating sensory nerves under the skin and in the muscles of the body, acupuncture encourages the flow of this energy and promotes health and well-being. Although acupuncture has been known for managing chronic pain, and it is used by cancer patients to treat the side effects of therapy, it is not considered an effective cure for cancer. * - Steve, we need to talk about this. - January 2004, Palo Alto, California. It's been three months since his diagnosis. His wife, Laurene, is still desperately trying to persuade Steve to have the surgery, but he still refuses. - This is not an option. This is a lifestyle choice. - I know he went on this macrobiotic diet, probably did meditation, probably did a lot of things, but what would it have hurt to have had that surgery? You know, the sooner you catch a cancer, the better. - Please, think about me. (blender whirring) - Steve, what if it doesn't work? - Honey, I don't wanna talk about this right now, OK? - He's one of those people that's sometimes wrong, but never in doubt. He's very sure that his way is the right way. - Despite Steve's belief that he could fight his cancer with alternative therapies, a scan nine months later showed that his tumour had significantly increased in size. So, if he had any chance of survival, he would have to have surgery immediately. (dramatic music) - July 31st, 2004. Stanford University Medical Centre, California. Seven years before his death. Steve Jobs finally agrees to surgery to remove the tumour from his pancreas. (monitor beeping) - The operation is called a Whipple procedure. This involves removal of part of the pancreas, part of the small intestine, and the gallbladder, and it's the only known effective cure for pancreatic neuroendocrine tumour. Steve's procedure appeared successful, but during the surgery, doctors found three spots on the liver, and this is not a good thing. It meant that his cancer had spread. Although cancer is unpredictable, it's more likely, had Steve elected to have surgery when he was first diagnosed, that they could have stopped his tumour's development. Since the cancer was now spreading, Steve elected to undergo chemotherapy to fight the malignant cells. I want to understand what led him to make this unusual and potentially deadly decision to delay his surgery. - Steve was well known as an obsessive who had to be in absolute control. - He was famous for calling people at 7 in the morning on a Sunday for a business discussion, right? - Can you guys catch me later? - He was a control freak, there's no question about it. - When a child's adopted, it can affect significantly the way they see themselves. In Steve's case, he felt that his perception, his view of things, and his ability to control things was much more important than anybody else's. (upbeat psychedelic music) - If Steve's need for control began early on after being adopted, his single-minded belief in alternative diets and therapies began as a teenager growing up in San Francisco in the 1960s and '70s. - Starting in college, he begins reading about different ways of living, including vegetarianism, veganism. - He went to live on a commune that was an apple farm along with some other people who had very strange fruit-oriented diets. So, he experimented with that. - For a while his favourite dinner was just raw carrot salad with raisins and lemon juice. - A vegan diet involves cutting out all animal products, such as meat, eggs, and dairy. And although the nutrition that one needs is difficult to get, it's not a dangerous way to live. I can see here that at times in his life, Steve followed a more extreme fruitarian diet, sometimes eating only apples or carrots for weeks at a time. The body does not get sufficient nutrients when only one food group is consumed, and fruitarians are known to have deficiencies in a number of things, such as vitamin B12, vitamin D, iodine, omega-3, and this can lead to a number of abnormalities such as anaemia, tiredness, lethargy, immune dysfunction, and osteoporosis. In the long term, this can put undue stress on the body's organs. - Steve's interest in alternative lifestyles and search for enlightenment took him to India. In 1974, he dropped out of college and headed east to study Hinduism with roommate Dan Kottke. (exciting exotic music) - The two of us were going to the Kumbh Mela, the biggest religious gathering in the world. Happens only 12 years, and it was happening that summer. - His seven months in India were to have a profound effect on Steve. - I think his study of Hinduism was part of a continuum for him of trying to reach enlightenment of some sort. He continued to practise meditation much of his life. (dramatic music) - Spiritual exploration, extreme diets. I'm starting to build a picture of what led Steve to undergo alternative therapies rather than follow the advice of his doctors. And I've located another intriguing piece of evidence. I have here an FBI statement that was signed by Steve, in which he claims to have used LSD regularly in the 1970s. (upbeat psychedelic music) - We were reading about auras and chakras, and psychedelics makes that all seem way more interesting. And we did a little tree-hugging. - It did have a lasting impression on him. He thought it was good for the soul. - His use of LSD continued during the early days of Apple. - Hi. - Hi. - What's your name? - He liked LSD so much, he would often ask job applicants. - Do you take acid? - He just liked to put people off their comfort zone. - What? - Acid, do you take acid? - That was one of his tactics. - No, I don't. - Thanks. - He once told me. I said, 'If you would tell Bill Gates one thing that he should have done that he hasn't done,' he said, 'I would have told him to drop acid. 'He would have probably been an even better businessman.' (dramatic music) - I can see from biographical accounts that Steve stopped using LSD in his early 20s. And although I don't believe his use led to any long-term health problems, this, combined with his interest in Eastern philosophy and extreme diets, certainly paints a picture of someone who was willing to challenge the establishment. - I think he had a mistrust of everything conventional. You know, he had a mistrust of conventional business. He had a mistrust of the conventional way technology was done. And he felt like he was different. - People like rebels, people who can flaunt the establishment and get away with it. And Steve very much had that going for him. - I'll sort this out myself. - From statements and reports, it's clear that Steve considered himself a rebel, and this is something that made Apple so appealing and successful. But it seems this determination to do things differently could have also seriously jeopardised his health. - He trusted his own way of thinking and he thought he knew more than everyone else. Certainly, he knew more than everyone else in the technology world, so why wouldn't that extend to his own health? - Steve Jobs ignored medical advice and waited nine months to get the surgery that he needed to rid himself of the cancer that was growing in his pancreas. And I can see that Steve's refusal to follow medical advice continued after his surgery. - August 2004. Stanford University Medical Centre, California. Two weeks after the surgery, Steve is still recovering in the hospital. - The pancreas provides the enzymes that allow for the digestion of food and the absorption of nutrients. Since Steve had part of his pancreas removed, it was harder for him to absorb the nutrients that he needed. The doctors advised Steve to consume animal and fish proteins as well as full-fat dairy. Now, given the fact that he was a vegan since his early 20s, this would have been a huge challenge. (audience applauding) - June 2005, Stanford University, California. - Thank you. - A year after the operation, Steve delivers the commencement address at Stanford University. Keen to fend off media intrusion into his private life, and concern from Apple shareholders, he puts a positive spin on his prognosis. - About a year ago, I was diagnosed with cancer. This was the closest I've been to facing death, and I hope it's the closest I get for a few more decades. - Although Steve was giving the impression that he had his disease under control, the reports tell a different story. In fact, behind the scenes, Steve was exploring every possible approach, both conventional and experimental to help fight his cancer. Steve becomes one of 20 people in the world to try a radical new form of medical technology. - Using innovative techniques, Steve had his own DNA and the DNA of his tumour analysed so his medical team could decide what therapy was most effective. And for a while, he did go into remission. (monitor beeping) - January 9th, 2007. Moscone Centre, San Francisco, California. Feeling stronger, Steve prepares to launch the biggest product of his career. - Today Apple is going to reinvent the phone. - The iPhone. - iPhone is like having your life in your pocket. It's the ultimate digital device. - The iPhone was the engine of Apple, growing to become the most valuable company in the world. - The iPhone is a worldwide hit. But something else at the launch competes for the audience's attention. - He had lost a lot of weight. - Once again Steve was defying the advice of his doctors. While losing weight is not unusual for cancer sufferers, Steve rejected the protein-rich, fat-rich diet which was recommended. Instead, he continued to eat mainly fruits and vegetables. Because he had a portion of his pancreas removed, his body had to fight harder to get the nutrients that it needed. Steve simply wasn't giving his body the nourishment that it required. - After the operation, he mostly embraces conventional medicine, but he still is reluctant to agree to a diet that is high in protein, that has got a mix of foods in it. - He said, 'I've even tried eating some meat, and I cannot.' - Because our intestinal flora adapts to our diet, eating meat would have been uncomfortable for Steve, likely resulting in bloating and nausea. But this would have quickly passed. - It was really a struggle. His lifelong bizarre eating habits got in the way. - June 2008, Palo Alto, California. Steve has lost a further 40 pounds at a time when he badly needs to build his strength. At the launch of the iPhone 3G, Steve looks so emaciated, it shocks the audience. - We've learned so much with the first iPhone. - I just remember how incredibly frail he looked. - And it's beautiful. - He gets very gaunt and then it starts a lot of rumours. People are very concerned. He just doesn't look good. And he says it's a hormonal imbalance. - I'm fine. I've started the treatment, I'm seeing that through. I'm doing everything these doctors are telling me. - It's clear that Steve is now seriously ill, and investors start to panic. Apple's share value falls by almost 50%. - He would have tried anything at this point. - Late 2008, Steve flies to Basel in Switzerland for experimental treatment. And in January 2009, he finally announces he's on medical leave. - Steve Jobs underwent an experimental procedure called peptide receptor radionuclide therapy at the University Hospital in Basel, Switzerland. Swiss researchers there had developed a groundbreaking process where they attached radioactive isotopes to a drug that targeted specific cancer cells. This was expensive and therefore exclusive, but it was known to get results. And in about 1/3 of patients, the tumour shrunk significantly. - January 2009. Stanford University Medical Centre, California. 2 1/2 years before he died. Steve has further tests. Despite the experimental process done in Switzerland, it seems the cancerous spots on his liver have spread. He is now dangerously weak. * - By 2009, the medical investigation showed that his extreme weight loss was actually due to his disease. Steve's cancer had spread throughout the liver. And with this degree of metastasis, he only had months to live. His now cancerous liver was secreting high levels of glucagon, and this would have made it more difficult for him to keep on weight, and it would have caused pain. He was rapidly declining. Steve's doctors had told him that he needed to have a liver transplant in order to survive, and he needed it soon. But it's a long and risky operation, and with Steve's body already compromised by spreading cancer, there's a chance that he wouldn't survive the operation. But this was a risk that Steve was willing to take. But finding a matching donor in time was not gonna be straightforward. (dramatic music) - Even for one of the richest men in America, getting a donor liver was not going to be easy. It was now a race to find a donor in time. - So, what we're looking for is a liver transplant. Yeah, I appreciate that. I'm just working my way through all the options. - Some medical centres didn't want to provide a transplant because of where the stage of his disease was. - Is there anything you can do? OK. No, I've tried there. - And there's another problem. The waiting list in California is too long, and Steve's health is rapidly declining. - If we can get on that list too, that would be really wonderful. Thank you, I really, really appreciate it. - So, Laurene manages to get him on a list in Tennessee. March 21st, 2009, Palo Alto, California. With Steve Jobs given only weeks to live, the call they've all been waiting for finally comes. A donor has been found. Steve flies to Memphis to have the transplant. The operation takes close to 10 hours. (suspenseful music) All the family can do is wait and pray. (monitor beeping) - Despite Steve's weakened state, he survived the operation. But he was not out of the woods yet. The next three months are critical for a because this is the time in which the body is most likely to reject a new organ. To combat this, Steve was placed on powerful immuno-suppressant drugs which stop the body from attacking the new organ. But these drugs also increase the risk of infection, and if there's residual cancer, cancer growth. - May 2009. Apple Headquarters, Cupertino, California. Although Steve is still struggling to recover from the surgery, he surprises his colleagues by appearing at a board meeting just a few days after leaving the hospital. - (board members applauding) - (gentle hopeful music) - As soon as he's able, he shows back up at the office, because that's really his first and true love. His true passion is the work at Apple. (audience cheering and applauding) - Apple's share price almost doubles, getting near to the level they were before Steve's illness became public. - If one imagines that you are so valued in your company that reports of you being unwell send stock prices plummeting, imagine what that must have felt like for him in terms of his own sense of importance, of his own sense of value. - Steve had survived the transplant and his body didn't reject his new liver. But during the surgical procedure, his medical team identified a tumour that had spread from his liver to the peritoneum, and this is the lining of the abdominal cavity. Although Steve was still a very sick man, he returned to work surprisingly quickly. - January 27th, 2010. Apple Headquarters, Cupertino, California. 18 months before his death. Once again Steve impresses the world with another ground-breaking product. - This is what it looks like. - The iPad. - I happen to have one. - In just nine months, it sells 15 million units. (audience member whistles) - That's what it looks like. - In the middle of all that, he was dying, literally dying, and he still managed to make that happen. - Steve knows that his days are numbered. Now it's really just a matter of gaining some extra time, for his work and for his family. He is thrilled that he's managed to hang on until his son, Reed, graduates from high school. - It was very important to him to be there for his graduation. This was the happiest day of his life, to be there and to be able to celebrate with his son, who he was very close to. - He's reached a major milestone. But it's clear towards the end of the year that Steve's cancer is in an advanced state. - Even as he grew very sick, he still had food issues, and eating was still a challenge both for him and for his wife and for his family. - Darling, will you eat something, please? - Dad, do you want to go to bed? - (Steve grunts) - By Christmas, Steve is down to 115 pounds, 50 pounds below his normal weight. (solemn piano music) He is unable to eat with his family, and has to be fed intravenously. January 17th, 2011, nine months before his death. Steve decides he must take medical leave. - By July of 2011, Steve's cancer has spread to other parts of his body, including his bones. TV: - (audience applauding) - OK, welcome back. - And this would have been extremely painful, requiring high doses of painkillers. TV: That he has a four-year-old child. - As he got sicker and sicker, friends came to pay their respects, to talk to him, and that had to have been emotionally wrenching. - How are you guys doing, OK? - Steve becomes prone to extreme mood swings, with bouts of anger and depression. - We have learned this evening that Steve Jobs, the visionary CEO of Apple, has resigned. Jobs has been fighting pancreatic cancer since 2004. - August 2011, two months before his death. Steve steps down as Apple's chief executive. - In his resignation letter, he wrote, I have always said if there ever came a day when I could no longer meet my duties and expectations as Apple's CEO, I would be the first to let you know. - October 4th, the day before his death. Steve calls his sister Mona Simpson in Washington D.C. and asks her to come quick. - I'm fine, I'm fine. - Mona Simpson talked about how the family gathered. His sister Patty, who he grew up with, and his children and other family members all gathered with him. (solemn piano music) - Until about 2:00 p.m, Laurene is able to wake him when someone comes to see him. After that, he can no longer be roused. - By now, Steve's organs were failing, his body was shutting down, and he slipped into unconsciousness. These are usual signs that he doesn't have long to live. - Mona and Laurene sit with him through the night, listening to his laboured breathing. (Steve gasping) Fearing each breath may be his last. - When Steve stopped breathing for a few seconds, he was experiencing something called Cheyne-Stokes breathing. This is an abnormal breathing pattern that once again is a sign that death was imminent. - (monitor beeping) - (Steve wheezing) - October 5th, 3:00 p.m. Steve opens his eyes for the last time. - Mona describes his last minutes of consciousness as looking around the room and looking at his wife and at his kids one by one, and then looking beyond them and saying, 'Oh wow, oh wow. - 'Oh wow.' - (monitor beeping rapidly) (flatline trilling) - We are interrupting programming this evening because an American Edison has died. - News of Steve's death shocks the world. (solemn piano music) - It was devastating. - It was like a punch in the belly. - People were heartbroken because he had done more than just make products. He had made products that really changed our world in some way or another. (dramatic music) - I've already established that Steve's steadfast belief in doing things his own way delayed him from receiving appropriate cancer therapy. And this delay may have cost him his life. - But Dr. Hunter has discovered something else about Steve's life which could explain why this extremely fit and health-conscious man developed a potentially fatal disease in the first place. - In 2010, a medical paper was published looking at the effects of fructose, the naturally-occurring sugar found in fruit, specifically its relation with pancreatic cancer. The researchers from UCLA found that pancreatic cells use fructose to activate a key cellular pathway that drives cell division, and this causes cancer cells to grow and spread more rapidly. This revelation, that a high fructose diet may cause pancreatic cancer and accelerate its growth, could be hugely significant when investigating Steve Jobs' death. - Two years after his death, living proof emerged of the impact a fruitarian diet can have, even on a healthy body. Actor Ashton Kutcher was preparing to play Steve Jobs in a film of his life. Immersing himself in the character, Kutcher adopted his fruitarian diet with dire consequences. He ended up being rushed to the hospital where doctors found his pancreas was dangerously swollen. - I was doubled over in pain and my pancreas levels were completely out of whack, which was really terrifying. (dramatic music) - Ashton Kutcher was suffering from an extremely painful condition called pancreatitis. Prolonged, severe cases have been linked to an increased incidence of pancreatic cancer. - Even when the tumours were found to be spreading and Steve was advised to change his eating habits, he stuck to his strict regime. - We need to talk about this. - This man so trusted himself, had such a strong sense of control over his world, that he refused to change his diet, even though doctors were advising him. - Steve, what if it doesn't work? - Honey, I don't wanna talk about this now. - So, could Steve's extreme fruitarian diet have caused the cancer cells in his pancreas to grow and spread around his body? - The deeper I look into the study, the more that I doubt this is the case. The study focuses on fructose's effects on the common exocrine-type pancreatic cancer, and not the rare neuroendocrine type that Jobs had developed. Although both cancers are from the same organ, they are two distinct types of tumours which act entirely differently from each other. So, it's impossible to directly link Jobs's diet to his cancer. As for Ashton Kutcher, the details of his illness are scarce. But it's likely that after years of eating a normal diet, switching to a high-sugar, fruitarian diet overnight was just too taxing to his organs, particularly the pancreas, which is responsible for the regulation of sugars in our body. The truth is, cancer is unpredictable. You cannot be certain of how and when it will strike, and if it will spread. But I still maintain, had Steve not delayed his treatment, his changes of beating his cancer would have improved significantly. - This is a guy that's always done things his way, and it's precisely because he trusts himself more than anyone else. (solemn piano music) - The tragic irony of Steve Jobs's life is that the same uncompromising single-mindedness and total belief in doing things his way that enabled him to change the world with his products could have led to his untimely death. - Steve is a mix of contradictions that are hard to reconcile, but his brilliance is unmistakable. - It works like magic. - (audience laughing) - He captured computing power, and put it on your lap, on your desk, in your hand. (audience cheering and applauding) - It's the ultimate digital device. - There's no question Apple is one of the greatest success stories of the 20th and the 21st century. - There is one more thing... - (audience cheering) - ...that I want to talk about. - He absolutely wanted to change the world, and he did, in fact, change the world. - Thank you very much. - (audience applauding)