High on Fame: Michael Jackson and Enabling Doctors

A tragic case like Michael Jackson's reinforces the recurring story of addicted celebrities and their enabling doctors. Being a celebrity does not change the simple fact that the user is a drug addict. And having an M.D. after your name does not change the fact that if you supply the addict you're still a drug pusher. But to be famous and addicted does make treatment much more difficult.

Whether or not Michael Jackson's sudden death was directly caused by prescription drugs, this tragedy highlights the need to crackdown on M.D.s who become enablers of addiction. It's no exaggeration to say that they are basically drug pushers or at least suppliers. Their role although perhaps well meaning can become genuinely sinister, for it's not just a matter of joining a star's entourage by virtue of a prescription pad. Physicians are quite aware of the potential for addiction with opiate/opioid pain medication. The same narcotics like Demerol and OxyContin that became a regular part of Michael's life also lead to high addiction rates among physicians themselves. In the celebrity culture, some doctors become co-dependent and enmeshed with the stars to whom they hitch themselves, creating a mix of compulsions for fame, approval, power, and self-indulgence. As with other enablers in their entourage, the doctor is unable to set limits, frustrate and confront the celebrity lest the physician be banished and another eager medical provider step in. But the bottom line is always the same: the standard of care has not been maintained; pain and potentially treatable conditions are overlooked. And their oaths as physicians have been violated. These doctors are doing harm.

Without a doubt, enabling M.D.s are hard to control, since they can hide behind any number of excuses, the favorite one being that the celebrity himself (or herself) deceived them. "I had no idea he was that strung out, and anyway, he had a dozen other doctors he was fooling." A familiar rationale and a credible one -- addicts who aren't celebrities devise contorted ways of getting drugs. Celebrities are better at it and can dismiss anyone who doesn't agree to play along with their addictive lifestyle. Merely because a drug is prescribed or even taken as directed does not mean the patient is not addicted. The community of physicians needs to show more vigilance when dealing with these difficult patients.

Serious medical issues must be faced, among them:

-- Celebrities are known to have higher rates of trauma in their childhood, whether physical, sexual, or emotional. Behind the glitter of fame they feel real pain and suffer from conditions that need serious medical and psychiatric treatment.

-- The narcissism of celebrities looks glamorous -- who wouldn't want to be the center of attention? -- but in fact it is actually a symptom of psychological damage. There's a frightened refusal to look at their problems and an inability to see how much they themselves are contributing to the turmoil that uproots everyday existence. (To make matters worse, the enabling doctors have their own narcissistic issues, which may be gratified by basking in the glow of celebrity. Doctors, too, may be defensive and manifest the same refusal to take responsibility.)

-- The use of short-acting painkillers isn't innocuous. These can cause changes in the brain that impair thinking and perception. After a certain point, the addicted brain sends the message that getting off drugs will be like committing suicide. Under heavy use, painkillers are in fact the cause of pain, a condition known as hyperalgesia. But reckless doctors keep supplying pills and injections because "my patient is in pain." This ignores the simple fact that pain can be managed in many ways. Even if narcotics are called for, that's not the same as saying they are called for at addictive or dangerous levels.

-- Opiates suppress respiration, but often this effect isn't noticed until suddenly the addict stops breathing completely. Subjectively they may not feel sedated even as larger and larger doses are given over time (known medically as drug tolerance or tachyphylaxis). A drug can stop producing the desired effect after only one dose. The addict wants subjective relief, but as larger doses continue to have no greater effect, the addict fails to notice that his body is suffering from serious side effects. This is one of the covert causes of sudden death.

The list of risks extends much farther, but the overall point is that trained physicians know of these dangers. Therefore, participating in an escalating daily regimen of opiates for any patient with probable addiction, much less a celebrity is indefensible. Ignorance is no defense if you have a medical license.

What can be done?

The public's attention span is short, but widespread awareness is the first step. The real target audience are the local licensing boards and peer review committees who handle medical practice. The culture of "just say yes" when a celebrity shows up in a doctor's office needs to be condemned. This condemnation needs to be followed up with serious consequences for enabling physicians. If they recklessly addict a patient, severe repercussions should follow. If they themselves are addicted, complete abstinence must be achieved before they are allowed to return to medical practice, and random drug testing should be required by all states. Computerized medical histories should be instituted, so that we know precisely how many prescriptions are being written by each doctor and filled by each patient. With a centralized database, celebrities won't be able to pull off the trick of fooling dozens doctors and pharmacists all over town. And we need to do a better job educating physicians about the nuances and difficulties of treating patients such as these.

These steps are a beginning. Realistically, celebrities will always be first in line in gaining easy access to drugs. They have the means, the excuses, the money, and the opportunity. But at the very least the culture of enabling physicians must be branded as shameful. The same image that fools the public has eroded medical ethics. The abuse of prescription medication is becoming an alarming problem in this country, It's not fun to take drugs, it is serious business as is our charge to care for patients, celebrity or not. Doctors that enable celebrities must be brought to justice or else we will continue to witness shattered lives and sudden death.

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Comments

[Maybritt]

Being an anaesthesiologist in a small European country with very strict opiod control, I was ingredibly shocked to hear (the rumors?) that the drug Propofol was found in MJ's home.
I have extended knowledge in using drugs for anaesthetic purposes and if anyone came up to me asking for Propofol because of insomnia, I'd probably recommend a psycologist....
And I can't help thinking that somebody some time under certain circumstances must have introduced the drug to MJ.
Most likely, I suppose, an M.D, since it is certainly NOT a drug the average addict in the street would turn to, as it is way too difficult to administer and control.
Anaesthetic drugs of any kind belong in ONLY the hands of well-educated anaesthesiologists, who knows how to handle the drugs - and what to do, in case things don't go according to plans.
I felt so ashamed with my fellow colleagues, who so willingly handed out medications of this kind to MJ, when I heard about it.
I feel so sorry for everything these doctors let MJ go through.
Mostly I feel so sorry that he died way too early for absolutely no reason....­...exepect maybe negligance from professionals, who ought to know better.
Celebrity or not, rich or poor, black or white, whoever : as a doctor the first and foremost priority is to try to HELP the patient in the most appropriate, honest and morally fit way - NOT to hand out whatever the patient ask for

[copestir]

I dare the Jackson Family to make Neverland Ranch into a Drug Rehab Center rather than an Entertainment Center like Gracelnad. That is right, the Jackson family reports efforts to help him in the past. Clearly that failed. So, help others rather than yourselves. Make Neverland Ranch into an affordable drug reb center.

[mac33z]

Pharmaceutical Research and Manufacturers of America (PhRMA) are the real pushers.
The doctors that over prescribe are just the next in line to keep the ball rolling. The proliferation of drugs that are marketed today is staggering.
The formula’s simple:
1) Create a syndrome, and give it a name. Try “Restless Leg!”
2) Scare the people
3) Issue statements in line with the advertisement that are truly classic, like the following: “The benefits outweigh the risks.”
4) Let the public know that among the myriad of side effects, and dilemmas, that death is included too. That way you’ve warned the people, so in case someone dies, you told them so, and maybe the drug company can wiggle out of a lawsuit. Even if a settlement is required you’ve made billions on the drug, so it’s easy to throw a few million out to shut people up.

Prescription drugs kill more people than street drugs do, and the lack of records to see who’s dispensing what, is what keeps the ball rolling.
Now with Michael Jackson in the spotlight, this horrible ongoing condition is getting exposed for the dire situations that evolve out of the prescription game.
Maybe increased awareness will change things, cause right now it’s a runaway train.

[hulagirrrl]

I saw a documentary on the Appalachian a while back, one thing that really struck me, with all of the poverty and sadness some of the people face every day, they have a thriving black market going for painkillers, $130 a pop, and they snort them up their nose. This was something totally new to me, and I then saw something on another channel about painkiller abuse amongst our youth. I believe that the pharma and medical industry is aware of this, there is no way they do not see their sales numbers. I believe it is all to create a "system", jobs for social workers, prison guards and so on... We should ask ourselves why are so many people turning to these highs.

[apoyo]

Pharmaceutical companies should not be allowed to advertise. It should be against the law to push their drugs on the general public. Neither should they be allowed to make the doctors pimp their drugs for them.

It's the same thing as the cigarette companies. They knew that their product was poison but the profit was too great. Look how long it took to regulate them.

Drugs can be poison too if you take them for the wrong reason or in the wrong amounts. There is a total abuse of the system and doctors need to look at themselves first. There are many ways to help the patients and help the system work smoother. Pediatricians can stop handing out antibiotics like candy for every sniffle and every earache. And doctors in general can stop writing prescriptions for over the counter drugs like Motrin just so Medicaid can pay for it.

[Boadicea]

I can tell you that at least my doctors at Kaiser Permanente are all over this issue.

About seven years ago, I took a very low dose of clonazapam for sleep problems. Wow, that stuff worked! But when I ran out, I was wide awake for days. I asked for more and the answer was an emphatic no. I was given some wimpy antihistamine instead. I had a terrible time sleeping for a while but I managed to overcome the problem and was finally sleeping. I thought that was the end of it.

Nope.

Fast forward to this spring, when I put my back out, making my chronic back pain even worse. A friend gave me a few doses of a highly effective pain killer. Her doc's been giving them to her for years for chronic pain. Why couldn't I have this?! So I went to my new Kaiser dr and asked for the drug, explaining that I knew it worked for me cause I'd tried it.

Well, all hell broke loose. I was thoroughly chastised for taking prescription drugs that were not prescribed for me, and was given ibuprophen and a half-day course about prescription drug addiction. I got calls from half the staff at Kaiser, I'm sure.

I'm guessing that I could get addicted to narcotics easily, and that my first doctor wrote it all over my chart in bright red letters.

I'm grateful.

[eXcommunicate]

Great story (and great name).

[Antifascist-08]

Whatever happened to "Do no harm?"

This is just one little corner of our failed medical system.

Money talks, health walks.

[Luvial]

Doctors are not subject to the law in America since they are part of the elite.

[Beaglelovers]

I think congress needs to have a complete investigation into over-prescribed prescription drugs.
Maybe some good would then come from Michael's death. Perhaps the "Micheal Jackson Prescription Drug Malfeasance Act" where bad docs have their licences pulled and receive harsh sentences for over-prescribing drugs that result in a person's death.

[mzzanthrope]

http://www.tmz.com/2009/07/02/jackson-drug-aliases/

As I speculated in a previous post, TMZ now reports that Michael Jackson used aliases and underlings' names for prescriptions.

[MICHELLEDIANE3]

Michael Jackson."You are not alone." Not anymore. I believe you are now, the angel in heaven you sought so hard to be here on earth. You were so misunderstood, vilified, and beat upon. There was so much mockery and hatred of you, for only one reason. You"re goodness; your luminosity into the beautiful heart you believed could be in every man. You had such generosity, and tried so hard to teach others, to look into the soul. And to not judge based on color, creed or class.
But darkness, doesn"t like beauty to shine. It detracts so much from what it is trying to do. Create dark human less souls of us all. To replace the radiance that was born within all of us, by God. You spoke of nothing, but love and peace. Your light through your words, and music shone so bright. You"ve brought so much too so many, but only sought pure love for yourself. Your sensitivity brought ridicule. When all you wished most of all was to be embraced and understood.
I think what personally stood out to me most of all; was your tender nature. Envy in other people mistook that for weakness, when in reality it is strength. The force of who you were was so strong. Many people wish to have that, but could never achieve it.
We are all afforded different opportunities in life. Instead of being envious, they should have rejoiced with you, in your life.

[bh4099]

It appears while some really need these drugs, and may have difficulty getting a dr. to prescribe them, others can get them way too easily. I've just seen too many ordinary people become addicted when these drugs were prescribed after surgery or an injury. These are dangerously addictive drugs. And need to be used with care.

[alansky]

It isn't just the drug habits of the rich and famous that are enabled by the many doctors who seemingly have nothing better to offer their chronic pain patients than a steady diet of narcotics that ultimately erode the basic foundation of a person's life. I've seen it happen, with devastating results. Doctors who allow their patients to take higher and higher doses of drugs like Percocet for not just months but years should be sued for malpractice and stripped of their licenses to practice medicine.

[DC]

Well said and thank you for writing this. I was sorry to see how you were shut off on Larry King of CNN, which is owned by Time Warner, which is is an elephant in the entertainment industry. No wonder you were shut out.

Yet this problem goes beyond simply supplying celebs and others with addictive drugs. The entire medical care industry is built around the pharmaceutical industry. Much of it dubious.

Why, for example, are cardiac stents used that are known to increase the incidence of clotting, requiring patients to remain on Plavix for the remainder of their lives?

Why do drug companies invest billions in senseless lifestyle drugs for an aging population?

Why are Children medicated out of childhood instead of parents and teachers dealing with it?

Physicians are trained to be drug pushers.

[Lassie1]

What does Dr. Drew mean, celebrities have "real pain" as a result of their upbringing? What IS it about the celebrity lifestyle that causes such pain that all of them have engaged physicians as stooges to supply them with all the painkillers they can handle? Or more?...Does this mean that we peons who are suffering from REAL pain will have to fight desperately, in the future, to get relief for ourselves? If I was in severe chronic pain like my cousin, I would want some relief, and if it killed me, well, so be it, death would be a welcome relief...I never heard of, say, Winona Ryder, checking into a clinic to learn how to "manage" her "pain" without drugs.

[Tristan9]

I don't quite understand. Didn't you assume that alot of the behavior you are now indicting in his enablers had been going on for years with M.Jackson? At what point would it have been appropriate and ethical to entervene on his behalf? You say you had him in your confidence. Why then didn't you move to intercept his addiction and confront him directly?