Sleepless Supernova: Propofol Lullabies In Neverland
Michael Jackson's death is already a fading memory despite an acute expression of global despair as we witnessed the untimely extinction of a supernova. For physicians, struggling against a climate of national examination in this era of healthcare reform, there is a distinctly darker anguish which must finally be examined, an anguish which has been little discussed in the public arena. What has become of a profession which repeatedly fails its most important client: the patient, all the while profiting from the hapless same? At a time when an entire industry stands accused of cavalier profiteering, this is an important question to consider.
Michael Jackson was a patient failed by those who attended him. Even though some (including Jack Kevorkian in a recent article here on HuffPost) may argue that 'he got what he wanted", the discovery of propofol in his home brought our profession to new levels of mercenary depravity. Physician colleagues expressed shock and disbelief. Patients in consultation talked about their fears of becoming dependent on sleep aids, sometimes even referring to Michael's cautionary tale. The cumulative pain from these decades of assaults on Michael's privacy, identity, and self, all contributed to the erosion of his identity. Was it any wonder the man would be in severe psychological pain from his first memories until perhaps his last hours? The accounts of a desperate insomniac entertainer craving propofol-induced 'sleep' were, to me, the most staggering salvo in the final, painful ballad of a dying star. Propofol lullabies in an unmonitored, non-sterile bedroom could be no more certain a prescription for death than a smoking gun.
A drug I have prescribed with due respect in the critical care arena when I was a practicing intensivist, propofol was a wonderful tool to induce sedation and facilitate difficult procedures which my patients needed. But using this agent required a team of monitoring professionals and devices in an advanced, high-tech environment to maintain both the safety of my patients and the peace of mind of their doctor. That an anesthesiologist could be on tour with Michael administering this drug for sleep onset is both baffling and repugnant. The King of Pop was effectively anaesthetized every night, while our profession was asleep at the wheel. Everyone recognizes the disability of the poor but few recognize how handicapping extreme wealth can be, holding its victims hostage to boundless access. In the world of the uberwealthy, doctors become enablers, dispensers, predators, little more than licensed pushers.
Michael Jackson had spent a lifetime entertaining us at late, adult schedule hours from the time when he was barely out of infancy himself. This was a man who never had the benefit of unscheduled time, never learned the first experience of parental discipline so fundamental to a child's development: a fixed sleep-wake routine. Instead, at five he was already performing during the evening. By the time he appeared at the Apollo in 1969, he was a veteran of late night entertainment. Peter Pan's insomnia was yet another feature of not being allowed a full and healthy childhood.
Entertainers often experience delayed sleep phase syndrome.....a delayed physiologic timing in the arrival of sleep which the patient experiences as sleep onset insomnia. Bill Maher has described suggestive features reporting in one interview in his own words that he 'keeps VERY late hours'. Unsurprising, if one thinks about this. A natural tendency to sleep later and stay up later, easily described as being a night owl, may be a draw to the professional nightlife. While some entertainers may gravitate to the industry because of their night owl tendencies, most are likely permanently rendered 'delayed sleep phase types' because of their exposure to late night bright light, stimulation, social interaction and stimulating substances including caffeine, nicotine or in some instances recreational drugs which all drive to delay the bedtime further.
Television itself can inhibit sleep onset because of the impact of ambient light from the screen on the body's intrinsic hormone of darkness, melatonin, Television watching, in a recent American survey published this spring in the Journal Sleep "Dubious bargain: trading sleep for Leno and Letterman' has been identified to be responsible for delaying sleep by up to 52 minutes in 68% of Americans. A dubious bargain indeed, when the nation is so frequently sleep deprived.
Out of desperation, insomniacs may problem-solve independently, most commonly resorting to alcohol as a self medication, not understanding that there is in this country, more so than anywhere else, a certified subspecialist sleep medicine community which exists to solve exactly these problems. Michael would have been exposed to this environment and these behaviors at an extremely early age, setting the scene for a lifetime of sleep disorders and drug dependencies.
The absence of response from the professional sleep medicine community to the abuse of propofol as a sleep aid in the setting of profound insomnia is puzzling to me but possibly intentional. Michael's insomnia, like that of Heath Ledger's was a lost teachable moment and in their lifetimes, a lost opportunity for intervention. Unrecognized insomnia has become a familiar motif in our most vulnerable icons, one which steals them away in the night. Too frequently insomnia is ascribed to 'drugs' without looking at why these individuals may have resorted to drug dependency in the first place.
Trouble sleeping is a serious multi-factorial disorder, one which needs careful evaluation. Insomnia is a disorder characterized by symptom focused definitions: trouble falling asleep, trouble staying asleep, waking up before socially desirable or sleep which is simply not rejuvenating, Insomnia patients can have several of these symptoms together. Insomnia however is no longer considered merely a symptom but seen as a viable disorder itself, requiring detailed evaluation, multidisciplinary approaches and sometimes long term therapies. Board certified sleep specialists can guide a patient to treatment, which often involves more than solving an isolated psychiatric disorder or drug addiction but actually involves the teaching of new behaviors, restructuring disordered beliefs relating to insomnia, examining medical conditions, searching for primary sleep disorders and exploring all the factors which are contributing to disrupted sleep. Many patients who are resistant to seeking psychiatric help which may be very much needed, can be coaxed to such aid through a sleep specialist. An ethical sleep specialist in the setting of Michael Jackson's insomnia could have been a life line into the chaos surrounding him, though agreed, Michael was recalcitrant to sensible intervention, as Dr. Deepak Chopra sadly relayed in his CNN interviews shortly after Michael's death.
Unrecognized sleep disorders are often a harbinger of coexistent anxiety and depression. We know that Michael could well have experienced major depression at being stripped of a childhood and compelled 'to be an adult' very early, in the words of Brooke Shields as she eulogized him. Finally, the last decade of his life punctuated by a punishing trial would be very likely to have triggered severe depression as a reaction whether or not it touched on the truth of his inner life.
Most of all this event speaks to the national culture of Sleep Machismo a phrase which captures American workaholism as a disordered belief system, almost uniquely American. Imagine a performer so desperate for sleep he resorts to anesthetic sedation and yet so pressured to perform he was committed to dozens of concerts in a compressed time frame. His doomed concert was even aptly named as 'THIS IS IT". For Michael at that point in his career it was 'Do or Die'. Unfortunately, this time it would be 'Die'.
In this country, we value, emulate and even laud sleep loss in the pursuit of achievement, accolade and advancement. Michael's lifestyle and his learned behaviors of self-medicating sleep disorders were an exaggerated form of Sleep Machismo which appears in my office every day in a number of guises. His loss leaves many questions and an agitated hunger to pin blame on a single miscreant. Indeed major responsibilities are borne by the clinicians prescribing and administering him drugs at the patient's whim, which ultimately would be likely to act as cumulative respiratory depressants. Yet to me his loss was, in sum, a collective responsibility of an unfettered culture which has become almost singularly oral and consumptive, a culture with an insatiable appetite for interminably 'more' at the expense of our icons, our sanity and often our sleep.
As physicians we would do well to remember the Hippocratic Oath of first doing no harm. Clearly in the misery of his sleeplessness, his physicians betrayed the most basic of ethical boundaries. They put self interest ahead of patient interest. Sadly, the icon had become the golden goose for failing careers. These physicians too suffered from the drive to consume and appease an insatiable appetite for cash, celebrity and personal gain. My profession failed a national treasure, no matter how disordered, and failed him in pursuit of personal greed. We failed in his diagnosis, in his treatment, in disengaging from the dance with a manipulative addict and ultimately failed in the recognition of a critically important sleep disorder. Let us not fail in his wake to examine the lessons to found in the debris of destruction and share them with Americans everywhere.
Follow Qanta Ahmed, MD on Twitter: www.twitter.com/MissDiagnosis
Rabbi Shmuley Boteach: Michael Jackson's and My Dream to Create a National Family Dinner Night
Michael's tragic life, in which he medicated away his loneliness until it finally consumed him, serves as a morality tale to the rest of us. Our children do not need fame and fortune but love and attention.
Jon Chattman: If Only This Is It Were It
Next month the much-hyped This Is It will hit theaters, and I have no doubt that it'll be a smash success, and more importantly, a fitting final chapter in Jackson's roller coaster legacy.
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3rd part:
but HAVE you watched the film " this is it"?.. he's wearing sunglasses most of time.. but he can sing and dance so well!!!!! and then in the background, there is a 50-year-old man being addicted to drugs??????? IT'S VERY DIFFICULT TO SEE THESE 2 faces!!!! :(
WHy did he choose propofol??? when did he get the idea of trying propofol from?? I've read he used propofol when he was on tour in the mid 90's.. so he knew propofol very well.. and if YOU haven't read those oficia documents, Murray accepted to give propofol 'cause he saw that another doctor used propofol and Michael could sleep! SO... Michael was very familiar with PROPOFOL!!!!
at least.. this is according to MURRAY!
IN conclusion, EVERYTHING IS VERY SAD... AND I'M very confused.. I wish I can reach out a unique conclusion about it... THE KING OF POP is gone.. and I find his death very very stupid..... if he had had GOOD doctors, the right drugs and a bit more help and less controversies from the MEDIA.. he would be alive!!!!!!!!!!!! so it's very stupid..
he was the kinG.. why did not HE recieve the BEST MEDICAL CARE??????
This madness and non-control situations related to drugs KILLED MICHAEL JACKSON....
IT'S STILL SO UNBELIEVABLE!!!!!!!!! Why nobody did things RIGHT?????? :(((((((
2N PART:
and then why did he start a comeback tour if in the bottom he was living a drug dependence situation??????
but of course, his doctors didn't help him very much either! They even gave him more drugs, as his dermatologist who gave him "demerol"... a very addictive drug and he was already addicted to it.. so for Michael, visiting KLEIN should be a party!!! :(
WE MUST Blame doctors: Murray, klein and the third doctor who prescribed him drugs for insomnia... and probably Michael is a litlle bit guilty... but just a litle bit!
I also agree that we are responsible for ascendent or descent.. but FANs gave him the opportuniy to be the king of pop again and finish his music career as the greatest singer!!! Fans didn't fail in his new comeback tourL so, fans were going to make him ascendent again... Maybe, it's the media the most responsable for his descendent!
IT'S REALLY SAD TO KNOW that his life was working well 'cause he took drugs every single day!!!!!
HiS FAMILY and close friends should have more insisted and make him realise what he was doing , it was not living in good quality!!!HE NEEDed help.. he was also in denial... but that's why family should be more focus on him!!
.. AEG didn't care aboout him... they could have provided Michel with a real doctor.. but they accepted the MICHAEL'S PETITION about having a personal doctor by his choice!!! IT WAS A BAD DECISION!!
Hello again!
Dr. Ahmed.. I read some of you replies and you has written that Michael Jackson didn't die only because a sleep disorder, but because a drugs dependence and something else ( including insomnia but not as the unique cause).. but It is not very strange he could be addicted... According to legal documents, Michael recieved prescription drugs from 3 different doctors.... so he had the chance to test very different drugs related to insomnia.. THAT'S VERY FRUSTATING.. in theory, he had a very "small" health problem tgat as everybody would have done, we would go to visit a specialist doctor in sleeping disorders.. and just one doctor.. not 3 doctors at the same time!!!
What you really mean is that INSOMNIA was only an excuse to be provided with drugs????
so his drug dependence turned into an insomnic?? .. the drugs he was taking were very addictive and I 'm sure these drugs were not working on him problem anymore.. so that's why he had to ask for propofol!!!!!!!!!! and I'm sure he didn't realise of what he was doing!!!!!!!!!
SO , the point is: when did Michael jackson start to show an independence to drugs???
but since the day he died, he was able to survive with this " drugs dependence".. since that tragic morning!!!
VERY TRUE, HONEST AND RIGHT WORDS!
I wish Conrad Murray could read this article so that he could realise about his mistake... and then he would probably never say again: " I did nothing wrong"... because in fact, HE DID NOTHING RIGHT!
I'm glad you have written this article!
Long live the king!
Thank you Dr. Ahmed - wonderful article.
This might be of interest to Dr. Ahmed and some of the commentators:
http://entertainment.timesonline.co.uk/tol/arts_and_entertainment/article534196.ece
Thank you Nanaama, that piece does indeed speak to some of Michael's deeper pyschological injuries. Pitiful and depressing.
Dr. Ahmed,
Thank you--great article.
So kind of you, and just had to ass, I am a Chelsea Fan too. Was once my local team...
That was a typo. Just had to ADD, I also am a fellow Chelsea fan. Miss Britain tremendously
You're very welcome.
I beg to differ about sleep specialists. They are an annoying and bloated industry. I don't say this lightly. As a grad student I studied with Wm Dement at Stanford and discovered my son had sleep apnea.
Fast forward many years and I am a chronic insomniac. Ambien doesn't touch me. Valerian makes me talk. I try everything. Finally, I meet an MD who Rx's me GHB. It normalizes sleep architecture. It is wonderful and I go to sleep at 11:30 and awake at 7:00. I thrive.
Then the govt goes on a disinformation campaign. Suddenly, this neurotransmitter (yes!) is banned. But it doesn't go away. It is resurrected as XYREM. It goes from $60 to $700.00 per month for narcoleptics.
A new profit center arises for insomniacs. A cookie cutter script, an uncurious bulldozer of a woman and voila, Stanford's sleep clinic for dummies, on par with a Sarah Palin Book Club.
REAL Insomniacs know that rising with the sun, sleeping in a room where the bed is only for sleep, and an occasional Ambien is to laugh at.
Enter low dose naltrexone. Sleep researchers and insomniacs: ldn is impacting my sleep - normalizing sleep architecture in a similar (but less dramatic) manner as GHB. I take it for autoimmune reasons; it increases endorphins thus regulating the immune system. Something is going on here - cytokines, tumor necrosis factor. This is important information for real insomniacs.
Dr. Dement if you are reading this, the year was Kentucky Fried Chicken
Answer me this?
Why didn't his physicians give him AMBIEN? or one of those other cheaper Sleep Meds?
Balancedsolution. We do not know if indeed these medications were also a part of his prescriptions. Michael had heavy duty drug addictions to pain agents by many accounts and it is likely most of them were controlled substances. He was probably accustomed to being altered, sedated and euphoric from narcosis related to opiates. It is in that circumstance unlikely that any agents in this class would for instance be able to address the severe rebound insomnia that is associated with the withdrawal of such agents. Though again this is all speculation and we may find these drugs too were part of his armamentarium
My Dear Dr. Ahmed,
Words cannot express my gratitude for the time you have taken to write this piece and respond so thoughtfully throughout the post. Your analysis of Michael's life and depth of understanding of his brilliance touches me deeply.
How tragically his life was shaped from the tender age of 6 on stage to the supernova he became. When natured intended for him to be "forming" he was "performing." He dazzled and entertained the world with his brilliance while the press, judicail system, doctors and lawyers took pieces of him. Did we really expect all that immense talent could be harnessed into anything remotely resembeling a "normal life?"
I have waited quite some time for a journalist or doctor to write a thoughtful account of Michael, his life, how he was failed, the gifts he gave and to make sense of this tragic loss. You have done so. I have been stunned by the words of people who called themselves Michael's friend. I watched countless news items for many week and saw only one friend who honored him, Marlon Brando's son.
You have honored him as well and for that I thank you.
Dear GroveGal10. Thank you for your comments. Your observation of Michael performing when he should have been forming is moving and empathic. I think you captured the essense of his demise- his unimaginable talent. Unfortunately our need to elevate ourselves or others to the levels of celebrity is rapidly becoming a national obsession. When I was a child, my classmates wanted to be lawyers or physicians or geologists or teachers. Now children of the same age want to be 'rich' and 'celebrities". We didnt even have that word when I was that age. Fame was understood, but that belonged to the Prince of Wales or perhaps Sean Connery. Now this is what everyman clamors for. Hence the arrival of reality television where we elevate likenesses of ourselves to the screeching heights of the cable network startosphere.
Thank you for you reply and willingness to continue these discussions. I sense your deep compassion and hope rises we have caring physicians. I remember MJ’s arrival on a black and white screen of Ed Sullivan's Show. Were you a child in the US?
In rapid short time, we progressed from black and white to non-stop video even available on my I-Phone (I do not use this). We are never at a loss for celebrity news furnished by chasing paparazzi paid for by magazines, TV industry and websites. Our children know a techno society of instant connection without depth or meaning.
Did we become a celebrity watching society or lacking a structured focus (influenced by instant technology) jump to connect with distant glitter? Major networks are catering to the techno society age through reality TV. It is far less expensive to produce but hardly entertaining unless you like witnessing debasing the human spirit. No one in my age group I know watches these shows lacking in value having moved on to cable networks.
Michael’s immense talent was spread across the world through these advances. He came of age in music as technology made amazing strides. He also made appearances in other countries. How ironic his harshest criticisms came from US while other countries adored and supported him. A bit of reading on DA, Tom Sneddon, uncovers a personal vendetta complete with previous entanglements that should not have been given the light of day in the judicial system.
Looking at these individuals, whether mother of multiple birth children or forgotten politicians dancing in ridiculous outfits, the national appetite is to elevate them in order to witness the inevitable downfall, disgrace and involution of that which 'we' have created. I see it as a macabre modern day Gladiatorial exhibition with the viewer at home determining when the thumbs down signal will extinguish the victim's instant fame. Then we watch, gripped by the unravelling and gory demise of those whom we have elevated. It gives a disengaged powerless and unguided mass audience a substitute for a sense of power, when many are struggling in powerless lives. Hence while many condemned Michael for his consumptions of excess, drugs, fame, few have taken a look at the incredible means with which we consumed his talent, consumed his unfolding death ( a photographer snatching his image intubated in an ambulance) and the endless autopsy, memorials, burial, and movie. Our culture is indeed orally fixated and at an extraordinary level of consumptive narcissism. While fans indeed rightly identify that we did not drive him to use substances, we did create the extreme climate that his fame burdened him with. So uncomfortable as it may be we did have a part to play in both his ascent and his descent.
I also wanted to say GroveGal10 that I also sensed the sincerity in Miko Brando. He did seem oddly out of place in the days immediately following the death. His was a genuine loss and I do agree that did indeed separate him. His clumsy, rumpled appearance spoke to a person who was not manufacturing an illusion but experiencing the loss of a genuine friend. Appropriate that they befriended one another. Both were orphans to lives derived of colossal fame and fortune - one through his talent, one through the Atlas like shadow of his demigod father - and they shared this in a collective, life-long bereavement which bound them.
I am reminded of Elizabeth Taylor’s honoring their friendship noticeable by her silence in the foray that followed. On the other hand, Deepak Chopra revealed intimate knowledge and diagnoses crossing professional and friendship lines. A so called friend and physician revealed possibilities of biological fatherhood unconcerned one day his children will read every word.
Rabbi Shmuley revealed intimate tapes diagnosing without appropriate medical degrees. Sans written proof Michael wanted the tapes published after his death, he violated their friendship and trust. Was Michael's family consulted? He states people have written thanking him and all profit goes to charities. That does not diminish the violation. Was nothing at all sacred in Michael’s life?
If the aftermath parade of friends' confessionals defines what surrounded him in life, it is a telling glimpse. The world lost a gifted, genius talent who entertained masses of people around the world. While it is true he knew a dysfunctional life from that talent and celebrity; nevertheless, he gave of himself and his wealth. Rarely are his vast financial contributions to charities mentioned in the press.
I hope his passing leads to a reassessment in every profession from medical, judicial, journalistic to those earning a living from the talent of celebrities. A return to ethics in every profession so needed in our 21st century society. Dare I mention staggering disrespect upon the office of the Presidency? Thank you again for your article.
What about insomnia with nightime panic attacks with a racing heart beat? The patient is very compulsive as a female professional and has been worked up by a sleep specialist who prescribed Klonapin - a benzodiazapine - for a few years. More recently, a 24-hours Holter monitor and an echo-stress test to rule out cardiogenic causes for the racing heart. No angina involved and these symtoms are occuring in an endurance athelete.
The test are pending about the cardiogenic theory but I'll wager that these tests are negative and a psychogenic cause will be diagnosed with a Klonapin-dependency problem, even though the dosages are not increasing.
Drugs change people. Success can be costly in terms of your health. It is better to change your life first. Was it more important for Michael to invent the Moonwalk or to conquer the inner battle? In retrospect I'd forget about the Moonwalk.
Cognitive behavioral therapy could have helped Michael Jackson; the drugs didn't.
The 24-hour Holter was negative, except for a few extra beats. The stress-echocardiogram was also negative. The advice from her doctor is to stop pushing herself so hard.
Michael was always pushing himself or being pushed as a child. I saw him at Disneyland when he was a child. He was surrounded by people who could make a few million off him.
Sleeping problems are hard to deal with but drugs are rarely the answer in the long run.
Dear outnow. Thank you for your comments. Success does indeed exact costs especially when experienced at the apex of modern American entertainment culture. I have often wondered of the attributable mortality of celebrity. I would gauge it to be very high because of all the accompanying comorbidities which such extreme lifestyles seem to attract.
As to the rest of your comment, I am not entirely clear on whether a response was expected. Please note I do not dispense any medical advice in this forum. My observations are general, not specific.
And as for the moonwalk. The world would be a less joyful place without it. I watched people Moonwalking here in Harlem outside the Apollo in memory of Michael. He would have very much liked that, I think. I believe the moonwalk will be one of Michael's joyful and indelible legacies. No one could do it better or with a lighter, more ethereal energy
Thank you for this article. Of all the articles about Michael Jackson, I've been most interested in those written by medical professionals. I was talking to my friend, an anesthesiologist, about this. He has practiced for 30 years and said he would have no clue as to how to get propofol outside of a hospital. He also equated the use of propofol by someone other than an anesthesiologist as "premeditated murder," given the lack of specialized training, the proper environment, and monitoring equipment. I know this sounds dramatic, but that's how strongly he feels about how dangerous it is for untrained doctors to do procedures that require highly specialized training. My sister, a cardiologist who received years of extra training to be an electrophysiologist, said she would never administer propofol. I hope that most physicians are shocked that MJ's doctor(s), had the hubris (and as you rightly point out, greed) to administer propofol when requested.
Then, as you allude to in your article, there's the question about whether or not it really allows a patient to "sleep." My understanding is that people come out of propofol with a sense of euphoria and that it's this feeling that makes patients believe that they've just awakened from a full night's sleep; however, the truly restorative properties of sleep aren't part of the bargain.
In any case, this has been shocking and sad on so many levels.
Thank you so much for this thoughtful and courageous post. A couple of years ago, I received a review copy of a Reader's Digest book titled, "Sleep to Be Sexy, Smart, and Slim." Can't help but wonder if that positive approach to the benefits of sleep would make a dent in sleep machismo. Happy to be your fan, Dr. Ahmed!
Dear MissInformation, Sleeping Well is indeed the route to being Sexy and Slim, if I can be playful. Insufficient sleep syndrome chronically can be associated with factors related to weight gain and aging. So, get that beauty sleep. Happy to have you as a fan MissInformation, MissDiagnosis is a fan of yours!
Thank you for all your vibrant comments. My day begins right about now. I will return to the page at the end of my own long American workday. I will comment about the function of dreams, useful go to references to learn more about sleep, the role of sleep in oncogenesis, and the reasons why the medical profession seems to 'apart' or 'insular' as one of you have described it. Keep the comments and questions coming. Thanks to you we have untapped an important discussion for the public space. And just incase you wondered because it is 0511 while I have posted this. I have had over 7 hours of sleep and am wide awake! Hopefully most of you are approaching your final REM sleep period
why didn't this guy just take ambien or sonata or lunesta?
Probably because those mild drugs don't work for chronic insomnia.
Dear NoSillyName, Actually all agents mentioned are effective in chronic insomnia if used in conjunction with educational, behavorial and other therapies. And No, I do not represent any of these sleep aids in any financial relationship. I have prescribed them to my patients with very positive results but always after initiating a comprehensive treatment plan and detailed evaluation for primary sleep disorders.
I am not a Michael Jackson fan, but do you really think he went straight to the general anaesthesia without trying more standard sleep medications? He made his own choices but he had a lot of help in making poor ones along the way.
And how did Jackson find out about propofol? Who could have recomended that Propofol could help him " sleep "?He made what choices? When his previous doctors failed to treat Jackson's insomnia successfully with usual sleeping tablets, they resorted to propofol, which brought Jackson the" sleep" that had eluded him for so long.Only propofol is NOT a sleeping drug, Jackson was not sleeping, he was in an induced coma. Any doctor choosing an anaesthetic drug, to treat insomnia, and in a domestic environment, is guilty of medical malpractice. Since when does a patient decide what treatment a doctor should give and since when is it OK for the doctor to agree to a treatment which could KILL the patient? Forget Jackson, it is obvious you don't like him, but if a doctor is unable to treat severe insomnia with the usual sleeping tablets, he needs to refer him to SPECIALIST CLINIC FOR SLEEPING DISORDERS,with experts who KNOW how to treat this condition. Not for money nor anything is a doctor expected to risk KILLING a patient because the patient chose and paid for a specific treatment. Even doctors have to obey LAWS, which give patients PROTECTION. Think about it.I cannot believe that a doctor, not only breaks all the rules, but makes a series of MISTAKES, which kills a patient, and still there are people who say the patient deserved it. Jackson, like most patients trusted his doctor to help him, and not kill him.
Hard to say. I doubt he went straight to 'anesthetics"-strictly speaking Propofol is a sedative and doesn't relieve pain which is what anesthetics too but it is used as part of a GA induction protocol often times. I would say YES. He had a lot of poor choices which were unfortunately made in collaboration. I also very much doubt that he encountered a single person who could really say NO to him. Evidently when some of his sincere supporters did so, he cut them off, typical of an addict who uses people like his substances, consumes them for a means to an end and then discards them like a empty capsule.
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