Regarding the WSJ’s Report That Steve Jobs Had a Liver Transplant

Sunday, 21 June 2009

[This piece combines into a single narrative and expands upon three shorter pieces I posted immediately after this news broke Friday night.]

Friday night around midnight, The Wall Street Journal published a report headlined “Jobs Had Liver Transplant”¹ by Yukari Iwatani Kane and Joann S. Lublin. It stated:

Steve Jobs, who has been on medical leave from Apple Inc. since January to treat an undisclosed medical condition, received a liver transplant in Tennessee about two months ago. The chief executive has been recovering well and is expected to return to work on schedule later this month, though he may work part-time initially.

What’s intriguing about this story is not the question of whether Jobs actually had a liver transplant. I do not doubt that (although I’d like to see better sources for it). What is intriguing is the question of who leaked this information to the Journal and why.

The WSJ’s Unusual Lack of Sourcing

There are several highly unusual aspects to the Journal’s story. First is that they offer no source for the information — not even an “according to sources familiar with the matter”. But yet they state it flatly as certain fact that Steve Jobs had a secret liver transplant in Tennessee. Blockbuster news with no sourcing whatsoever. To call that curious is an understatement. And, coming in the opening paragraph of a page one story, it could not be a careless omission.

The basic tenets of journalism are simple. One reports facts and how one knows them. The principle is much like that of publishing scientific papers, where one describes not just the results, but also exactly how the results were obtained, so that others can reproduce them. This is why named sources are so much more valuable than anonymous sources; with a named source, other reporters can contact the source to verify the information.

But there’s an apt journalism adage from Lord Northcliffe: “News is what somebody somewhere wants to suppress; all the rest is advertising.” And so sometimes the only sources for certain information are those who cannot or will not allow their names to be used. Most publications, and certainly all publications of the stature of The Wall Street Journal, have strict guidelines covering the use of anonymous sources. My friend Matt Deatherage (publisher of the estimable MacJournals) quoted the following from the Journal’s own Wall Street Journal Guide to Business Style and Usage in a post to the MacJournals-Talk mailing list:

ANONYMOUS SOURCES: Accepting a source’s request for anonymity sometimes is the only practical way to obtain important information, but we must be circumspect. On-the-record sources are always preferable because they may be held personally accountable for what they say and are therefore generally more certain to be scrupulously accurate. Also, readers are able to make judgments about the reliability of those whose identities are provided.

In cases where the person’s identity is to be protected, take pains to indicate where his or her biases might lie: “an executive working for a competitor … an executive who left the company in a management shakeup … a laid-off employee …” or “a close relative of the plaintiff.”

Their story on Jobs’s purported liver transplant offers no sourcing for the reader to judge. It entirely hinges on the (admittedly significant) credibility of The Wall Street Journal itself.

Again, I point all this out not to say that I don’t believe their report. I’m as big a cynic regarding anonymous sourcing as anyone, but I believe that Jobs indeed had a liver transplant in Tennessee simply because The Wall Street Journal has placed its credibility behind the story. There is no hedging or fudging in their report. If it’s not true, it would amount to one of the biggest mistakes in their esteemed history.

But reputable news publications do not ordinarily report utterly unsourced news. (I cannot find another example of the Journal reporting completely unsourced page one news.) So: why?

Most major news publications have picked up the story, but only by sourcing the information to the Journal itself. For example: Bloomberg, The San Jose Mercury News, ABC News, and The BBC. Bloomberg’s report is indicative of this second-hand reporting:

Steve Jobs, co-founder and chief executive officer of Apple Inc., underwent a liver transplant two months ago, the Wall Street Journal reported, without disclosing the source of the information.

Even The New York Times has published a piece (“Apple Chief Reportedly Had Liver Transplant”) but they too have no source for the news other than the report in the Journal. (Surely the Times has reporters digging into this story; the aforelinked piece crediting only the Journal ran almost 24 hours after the Journal’s story, and as of this writing, four hours later, has not hit the front page of nytimes.com.)

The only publication claiming independent verification is CNBC, late Saturday night:

Two sources confirmed to CNBC that Jobs had the surgery and another confirmed that his plane flew from San Jose to Memphis in late March.

Further curiosity: whoever the Journal’s source, they didn’t give the WSJ any publishable information regarding why Jobs needed a new liver — that part of the article is pure speculation, quoting doctors who have never treated Jobs personally. Is it because the Journal’s source doesn’t know, or because the source wouldn’t tell? There’s a big difference.

Why Tennessee?

There have been rumors circulating for months that Steve Jobs had moved to Tennessee for some sort of medical treatment. Here’s a rumor Barron’s Tech Trader Daily published on April 15, which in turn cites a report by Alexander Haislip of the PEHub Blog (which does not have publicly available archives). Haislip wrote:

I spoke with a well-connected business person in Memphis this morning who says that there is a house in a swank neighborhood there that has been bought for a princely sum and is undergoing minor renovations in preparation for its new resident.

He says he has reason to believe Apple CEO Steve Jobs is moving to the city to treat his pancreatic cancer.

Several readers sent me this Barron’s link back when it was new, but I decided against linking to it because it was just so sketchily sourced. (And even now, if the WSJ report turns out to be completely accurate, the Barron’s rumor was wrong with regard to the treatment for which Jobs went to Tennessee.) I’ve ignored a slew of Jobs-related rumors over the past year because of the sourcing.

One thing that struck me as wrong at the outset regarding these “Jobs-in-Tennessee” rumors is the question of why he’d bother going to Tennessee in the first place. Tennessee may be a lovely state, but, well, it doesn’t sound like Steve Jobs country. You don’t need to leave the Bay area to get world-class medical treatment. The Journal’s report has a good answer:²

The specifics of Mr. Jobs’s surgery couldn’t be established, but according to the United Network for Organ Sharing, which manages the transplant network in the U.S., there are no residency requirements for transplants. Having the procedure done in Tennessee makes sense because its list of patients waiting for transplants is shorter than in many other states. According to data provided by UNOS, in 2006, the median number of days from joining the liver waiting list to transplant was 306 nationally. In Tennessee, it was 48 days.

But if the Journal knows that Jobs had a transplant, and knows that it was performed in Tennessee, why don’t they know which hospital? Again from their report:

Three hospitals in Tennessee — Le Bonheur Children’s Medical Center in Memphis, Vanderbilt University Medical Center in Nashville and Methodist University Hospital in Memphis — are designated as liver-transplant centers, according to UNOS. A spokeswoman for Le Bonheur said the hospital doesn’t perform liver transplants in adults. A Vanderbilt spokesman said it didn’t treat Mr. Jobs. A spokeswoman for Methodist University said Mr. Jobs isn’t listed as a patient there.

Reading between the lines, if Jobs had a liver transplant in Tennessee, it must have been at one of these three hospitals. Two flatly deny it, but the third, Methodist University, simply stated Jobs “isn’t listed as a patient” — present tense, not past tense. So it must have been performed there. But why can’t the Journal state that as fact as well?

Regarding the Timing and Source of the Leak

That this news broke months after the purported transplant, at midnight on the Friday of what appears to be the most successful new product launch in Apple history, strikes me as beyond coincidence. My first thought was that it must be a deliberate, timed leak from Apple. Assuming the story is true and that Apple felt the need to eventually release the news, when better to release it than on the very day when it most appears that Apple has continued to thrive while Jobs was on medical leave? MG Siegler at TechCrunch speculates similarly:

We’d be remiss if we didn’t note that the timing of this story appears favorable for Apple. This news breaks late on a Friday, after Apple has just held a successful launch of a very high profile new product, the iPhone 3GS, that sent the stock soaring today. Obviously, the market won’t be open again until Monday.

I don’t see how the leak could have come from someone with a competitive interest against Apple. The timing is completely favorable to Apple; if the leak had come from someone wishing ill against Apple, it would have come at some time, any time, other than in the wake of the extremely successful iPhone 3GS launch. Plus, other than the surprise that Jobs had a liver transplant in the first place, the gist of the article is largely favorable to Apple. It emphasizes that Jobs is recovering, is still set to return to work this month, and has already been seen on Apple’s campus recently. It is also the case that it would be unconscionable for the information to come from someone with a position against Apple and for the Journal not to describe the source as such.

Thus I see only three possible sources for the leak.

Theory 1: That the information came without Jobs’s permission or knowledge, from a healthcare provider with knowledge of Jobs’s medical situation. Presumably, given the Journal’s report, from someone at Methodist University Hospital in Memphis. Such a leak would clearly be a violation of HIPAA privacy laws. This might explain the utter lack of sourcing and the certainty as to the veracity of the information, but it would not explain the perfect-for-Apple timing of the leak, which timing I firmly believe is simply too convenient to be coincidence. It would also raise serious questions regarding the ethics of the Wall Street Journal. I therefore discount this possibility.

Theory 2: That the leak was authorized by Jobs himself. I doubt Jobs personally spoke to the Journal reporters (see below), but it could have been someone close to him (if so, I’d guess Katie Cotton or someone else high up in Apple Communications) doing it with his permission. The thinking behind this theory would be that if the information was going to become public eventually, why not control it and have it come out at the most advantageous time possible. This scenario would explain the certainty of the information, but not the odd lack of sourcing.

My thoughts then ran to the possibility that perhaps Jobs himself is the source — he has occasionally called reporters personally. And if he offered the information only on the condition that it not be sourced to him by name, perhaps the Journal couldn’t bring themselves to describe Jobs himself as merely “a source familiar with the situation” or somesuch. But the second paragraph in the Journal story seems to preclude Jobs personally as the source:

Mr. Jobs didn’t respond to an email requesting comment. “Steve continues to look forward to returning at the end of June, and there’s nothing further to say,” said Apple spokeswoman Katie Cotton.

That language leaves the clear impression that Jobs did not personally contribute to the report, and it implies that Katie Cotton did not either. It’s one thing for reporters to omit information; it is something else entirely to purposefully mislead readers.

There are also certain implications in the Journal’s story that cast Jobs in an unflattering light.

William Hawkins, a doctor specializing in pancreatic and gastrointestinal surgery at Washington University in St. Louis, Mo., said that the type of slow-growing pancreatic tumor Mr. Jobs had will commonly metastasize in another organ during a patient’s lifetime, and that the organ is usually the liver. “All total, 75% of patients are going to have the disease spread over the course of their life,” said Dr. Hawkins, who has not treated Mr. Jobs.

Getting a liver transplant to treat a metastasized neuroendocrine tumor is controversial because livers are scarce and the surgery’s efficacy as a cure hasn’t been proved, Dr. Hawkins added. He said that patients whose tumors have metastasized can live for as many as 10 years without any treatment so it is hard to determine how successful a transplant has been in curing the disease.

This is ugly business. They’re quoting a doctor who specializes in pancreatic and gastrointestinal surgery as saying (1) that it’s common for someone who had the cancer Jobs had to subsequently get cancer in their liver; (2) that liver transplants are not proven to help in such cases; and (3) obtaining a liver transplant in such cases is therefore controversial because it’s taking a liver that could otherwise have been put to better use by someone with some other type of liver ailment. There is no other way to read this than as an implication that Steve Jobs may have gotten a liver that should have gone to someone else. Keep in mind that this entire ugly implication is not stated as fact and is attributed as speculation from a doctor who admittedly has not treated Steve Jobs. But the fact that it is in the story at all makes me question whether any of the information in the story came with Steve Jobs’s permission, tacit or otherwise.

Theory 3: That a member of Apple’s board of directors leaked the information to the Journal without Jobs’s permission or knowledge, or perhaps, if the matter of public disclosure had been posed to and dismissed by Jobs at a board meeting, expressly against Jobs’s wishes. The scenario I am imagining here is that Jobs does not wish to reveal anything regarding his medical situation, but that a member (or contingent) of Apple’s board believes it is in the company’s interest to release the basic gist of the story, regardless of Jobs’s wishes. This scenario would explain the timing, the certainty, and perhaps even the lack of sourcing. (Although if this scenario is the case, certainly Jobs himself must suspect the source of the leak is from the board.)

Note also that some portions of Kane and Lublin’s WSJ report must have been sourced from someone on, or very close to, Apple’s board of directors:

When he does return, Mr. Jobs may be encouraged by his physicians to initially “work part-time for a month or two,” a person familiar with the thinking at Apple said. That may lead Tim Cook, Apple’s chief operating officer, to take “a more encompassing role,” this person said. The person added that Mr. Cook may be appointed to Apple’s board in the not-too-distant future. […]

At least some Apple directors were aware of the CEO’s surgery. As part of an agreement with Mr. Jobs in place before he went on leave, some board members have been briefed weekly on the CEO’s condition by his physician.

Who else other than a source on Apple’s board would know that Tim Cook may soon join the board, or that some board members were briefed weekly?³

This third scenario is my best guess as to the Journal’s source. It sounds sensational to speculate that there is conflict in this regard between Jobs and at least some contingent of Apple’s board of directors, but sensational or not, it makes more sense to me than any other scenario.

It also fits with my belief that Steve Jobs does not want to disclose anything about his health whatsoever.