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High on Fame: Michael Jackson and Enabling Doctors

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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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