Michael Jackson: A Victim of Conflict of Interest

The tools of an anesthesiologist rarely make headlines. We are one of the invisible specialties, performing our best work while our patients are unconscious. But these days a lot of people ask me if I'm planning to use that "Michael Jackson Drug" to put them to sleep. I usually answer "yes," and then start explaining.

I make my living helping people safely sleep through painful events. Michael Jackson's probable mode of death, propofol, is a drug I use everyday in the operating room. In a full dose propofol induces general anesthesia in less than two minutes, and when drizzled slowly through the veins it causes a lovely sedation famous for spinning pleasant dreams with very few nasty after affects -- a big improvement over biting bullets, whiskey, and every other drug that came before it. The most prized characteristic of this milky white chemical is its quick action; in moderate doses propofol is in and out of the system in about ten minutes. This roller coaster ride through the body and brain means patients can stay soundly anesthetized for short surgeries, but be awake and on their way home an hour after they leave the operating room.

It's that same quick onset and disappearance, however, that makes propofol so dangerous. The line between a light, pleasant nap and asphyxiation is perilously narrow, and it takes training and experience to use it judiciously. Remarkably, the drug isn't closely monitored by the Drug Enforcement Agency, though it is now under discussion. Anyone with access to a procedural suite or operating room can walk out with handfuls of the stuff and no one would be counting the lost vials. That wouldn't be possible with tightly controlled drugs more famous for abuse, such as narcotics like morphine, fentanyl or Demerol, whose long history of addiction dates back to opium dens.

When I treat a patient with narcotics I am required to sign out each dose and account for its use or disposal. It isn't a perfect system, even the best governmental oversight won't stop a determined, troubled individual, particularly when they have sufficient influence over a doctor with easy access. But in Michael Jackson's case better regulation would have imposed one more layer of safety between his desires and his doctor's irresponsible acquiescence. Unfortunately the only point of control lay with the cardiologist on Jackson's personal payroll, who apparently forgot his Oath when he cashed his check.

Jackson is only the most recent victim of medical judgment apparently blinded by the bright lights of stardom. But a doctor's ethical imperative is to be paid for advice and skill, not drugs or an ill-advised, patient-designed plan of care. Demerol, Adderall, oxycontin and propofol aren't stocked on Rite Aid's shelves because the margin between a therapeutic dose and a toxic overdose for these potent medications is not financially negotiable. The cardiologist who treated Michael Jackson succumbed to a blatant conflict of interest: dangerous practice in exchange for dollars. Such conflicts bleed through many layers of healthcare today, from pharmaceuticals to scientific studies to durable medical goods and, yes, even the protected realm of the doctor-patient pact. It is a shadowy cost of healthcare -- in both lives and money -- that few lobbyists are likely to decry, but a cost Congress needs to examine before finalizing our next healthcare financing scheme.

I will continue to reassure my patients that propofol is an excellent drug, safe when used in the controlled environment of an operating room or ICU. Like the vast majority of doctors, I will promise to listen to my patients' requests and concerns, and then make the most educated and objective decisions for their care -- regardless of their ability to pay me.

I wasn't a huge Michael Jackson fan, but I still mourned for this talented man who seemed so tortured by early fame and money. Maybe for that reason I found it even more tragic to surmise that Jackson's death resulted from his own desperate search for an artificial pathway to that most natural state of healing: sleep. Like millions, I wish I could know what music we lost when his doctor helped him slip too deeply into that dream.

Follow Carol Cassella on Twitter: www.twitter.com/carolcassella

Comments

[ammazzed]

Since I had not been a fan of MJ, I became very much symphatethic to MJ after his death. I realized how our media had swayed away from writing closer to truth articles. It is such a pleasure to hear a balanced or unbiased writers.
Although media are pushing for their ratings, I guess we - the people - should do something to change the habits of media from writing biased articles. Otherwise those who are kind, and gentle would loose or be eliminated. We all still remember what happened to Pricess Diana...
In MJ's case we have lost someone who have a greater message to our world, especially saving children. All speculations became news, whilst his humanatarian efforts are totally deleted. In the end opinions became judgements, and we all lost the greatest and gentlest artist.

[popsicle820]

Thank you for this article, Ms. Cassella. It has enlightened me about so many things. I especially appreciate what you said about the music we lost since his death. I'm a fan and I wish I don't have to feel the way I do. I feel like I had been robbed of something so precious. May there be no more doctors who think more about the contents of their pocketbooks rather than the integrity of their actions.

[Sandra Figueredo]

If I could I put in jail not only the doctor but everyone who contributed to his death, he didn't deserve having his image destroyed.
Sandra
Brazil - Rio de Janeiro

[pebbles29]

When I looked at some of the medications MJ was taking some of the side affects were lose of sleep. He seemed to be taking at least two or three medications that would cause him to loose sleep. So if the drugs had the side affect of lose of sleep wouldn't it have made more sense to change the medications instead of giving a drug that would help him sleep. Conrad Murray deserves punnishment for his negligence and greed. He doesn't deserve to be called a doctor because he did not hold up to his oath as a doctor. Due to his reckless behavior there are three children without a father and parents, brothers and sisters who will be missing a family member during family get togethers. Conrad Murray has turned the Jackson family upside down due to greed and lack of ignoring his oath as a doctor. A so called friend would have made sure his friend was in good hands or consulted family when they saw danger instead of playing counselor.

[pebbles29]

You hit a very important point. The problem is many people are not doing the jobs that they are held to do. It seems that it is easier, like you said, to give a prescription instead of finding out what the real causes of the illnesses are. It is sickening to see professionals in important positions who take their jobs lightly. A doctors job is to save lives and do what ever they can make patients well. Now it seems it is mostly about how many patients you can get and how many claims you can cash in on. This seems to be common with many doctors. I can't tell you how many times I would see my doctor or take my child to the doctor and explain symptoms and walk out the office with 2 or three prescriptions, then told to come back in a month, I guess to see if the meds are working. If they aren't working I guess they'll up the dose or add another. It is so common for a person to go to the same doctor or different doctors for years for the same problem in search of the real causes of the problem, and never find out what is the cause. You wind up finding what triggers the problem on your own or you have to google search through blogs to find out if anyone else has the same problems.

[Elaine Fields]

Our laws are built to protect these Doctors. Until those laws change this will continue to happen. Doctors are rarely held accountable for mistakes or misjudgements. The only reason this is such a big deal is because it was Michael Jackson and even he may not get justice. You don't have to be rich to get mamed and raped by so called doctors these days.

[Wildweezle]

Here is the link to the photos of the Neverland activities on Saturday,, Michael Jackson's birthday.
The brave souls were out in 106 degree temperatures.
http://wildweezle.wordpress.com/

[Laura Panunzio]

(cont.d)

He was a cow-cash for anybody and these criminal doctors won the lottery when some MJ associates and assistants called them to ask for diprivan,d­emerol,xan­ax etc... when they could help him in a smoothest way, not plagiarizing him on using such dangerous and powerful drugs that could lead him to death, as it happened. Murray is the of the iceberg, of something wrong in health care system in USA and the smooth laws against the crimes regarding prescription of illegal or dangerous drugs, using different aliases too.
I hope nobody will die anymore for similar bad practices and your job, articles and possible conferences can convince other doctors and people to push governors and lawmakers to make everything in their power to change things right away.
Take care
Laura

[Laura Panunzio]

Thanks Carol for your article which is very important because you're an expert on this.

I was a friend and I still can't believe he's no more among us, today is a very sad day 'cos all over these years we were around him, celebrating his birthday and enyoing ourselves very much...

Murray and other enablers who gave him these drugs since years illegally must be persecuted, but also the Congress should make and approve new laws about illegal use of dangerous drugs because it's unacceptable how these so-called doctors can order, steal and prescribe such drugs in the smoothest way possible. It's unacceptable that a doctor who was exonerated from professional docs list for misconduct , was still there entering hospitals and ordering drugs to various pharmacies in USA. These people must be thrown in jail, such serial killers or terrorists, because they use their profession to kill and harm patients seriously. US laws at the moment are too light and enable these criminals to do such awful things. Michael Jackson was led to insomnia because of all the FAKE allegations made to him since 1993 to 2003, who damaged his soul and his mind almost irreversibly and instead of helping him to heal and give him so good advice to care his feeble body, they were there to earn million of dollars on his shoulders.

[nisha]

All of this brings us to the question, what was keeping Michael Jackson from sleeping? He told Paul Theroux long ago that he had trouble falling asleep after concerts.
http://www.telegraph.co.uk/comment/5664968/My-trip-to-Neverland-and-the-call-from-Michael-Jackson-Ill-never-forget-by-Paul-Theroux.html

Did AEG factor that problem into his rehearsal and performance schedule?

[VNJ]

Thank you, Dr. Cassella, for a well-written article. I have been drawn to this conversation about Michael Jackson only because his death made no sense to me from the very beginning. This, not because I am a die-hard Michael Jackson fan, but because when there is a wrong, we must stand up and fix the problem. Thanks for sharing how you think we should go about it, but first we have to bring those physicians that aided Michael and all the other "Michaels" in obtaining drugs to trial. We have to start somewhere, letting those in very high positions and who the general public trusts know ... we are not going to stand for you taking advantage of the helpless for your own gain. A premature death, be it Michael Jackson or John Q. Public cuts short the gifts that we could have all been the benefactors of and in the case of Mr. Jackson .... music and dance.

[IndependentD]

"Maybe for that reason I found it even more tragic to surmise that Jackson's death resulted from his own desperate search for an artificial pathway to that most natural state of healing: sleep."

Having read a lot of "Michael Jackson" news, I believe that this sentence is probably the most poignant lines written about the the way this sad man lived and died.

Is there any way possible for Dr. Murray to escape judgment here? His recklessness is so obvious and extreme. Now that we know what drugs were given and when, will his lawyer continue to insist that Dr. Murray didn't give Mr. Jackson any drugs that "should have" killed him. Everything I have read from people in the know, like Ms. Cassella, says otherwise. Far from being anything that shouldn't have happened, death appears inevitable when this combination these dosages are given in a short period of time. Dear God in Heaven!! How can people be SO FOOLISH!!?!!!

[lionel1]

Your blog on "Michael Jackson: A Victim of Conflict of Interest" was a very interesting post. Thank you for taking the time to share it with us, your work is really appreciated.

I run a related blog about Michael Jackson and was recently quoted saying…

There were so many things Michael Jackson did that could be listed as firsts in the industry, but in most cases he gave and offered his support because this was an extension of who he was.

Feel free to check out the full blog post on my related blog over at…

http://lionel1.com/blog/entertainment/michael-jackson/

Peace,
Lionel.

[Carol Cassella - Huffpost Blogger]

Hi Lionel, Very considerate article about MJ. Too bad more about his generosity was not highlighted during his lifetime.

[situationcritical]

Ms. Cassella -

I congratulate you on the most insightful and best-written piece I've read about about what really happened to Michael Jackson since this event broke.

Thank you for not launching into some misinformed tirade about alleged drug addiction.

Anyone who chooses to write about Jackson, should carry it around for quick reference.

[ignorantwillyharper]

If it hadn't been this doctor it'd been the next one. When you start spiraling down the drain it's hard to swim back up. It was coming from a long time a go, but people always seem to go along with a cash cow and they will end up killing the goose that lays the golden eggs, then there is no more eggs.
Sounds kind of like the Animal Farm.