Did propofol, or Diprivan, kill Michael Jackson?

As predicted, the details surrounding the singer’s death continue to get more bizarre.

Did propofol, or Diprivan, kill Michael Jackson? Recent reports have stated that the powerful anesthetic Diprivan, generically known as propofol, was found in the singer’s house. Apparently, according to a nurse, Jackson “was begging for the powerful sedative to help him get over insomnia.”

There are zero circumstances where propofol should ever be used for insomnia. This medicine is used for general anesthesia or to sedate patients in the intensive care unit who are intubated and on a ventilator. In fact, patients have to be monitored very closely when on the drug because the risk of respiratory arrest is so high.

And that’s why I find it incredible that, again according to reports, Jackson had “claimed to have received the drug before, but didn’t disclose who had injected him with it.”

It’s against FDA guidelines to have propofol in the house, and as an anesthesiologist puts it, “Using this drug for insomnia is sort of like using a shotgun to kill an ant.”

That is some serious malpractice, bordering on criminal, if any doctor had indeed injected Jackson with Diprivan simply to help him sleep.

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  • samuraidoctor

    There are 2 hospitals in our town. Colonoscopies are performed by the same gastroenterologists at both hospitals. One of the facilities has the highest colonoscopy costs in the state. Why? Because they talk the patients into Propofol anesthesia, and then need anesthesiologists there to monitor the patients BECAUSE THE DRUG IS SO DANGEROUS!

    I had wondered why there was a cardiologist right there in the house at the time of his death, but if this was related, he picked the wrong specialist to aid him in his criminal misuse of medication.

  • unremarkable patient

    On CNN last night, this nurse dominated all the programs by “revealing” Jackson’s request for these drugs. This morning, many doctors commented on the rumor also. My question is why nobody in the medical field has been bothered that the nurse violated patient privacy, maybe even HIPAA, if indeed her story was true. Could it be that by addressing this breach of trust, ethically the conversation would have to stop, and all these medical experts would have lost their 15 minutes in the limelight. I don’t think this medical media circus will be lost on other people of note.

  • http://www.anesthesiologynews.com/index.asp?ses=ogst&section_id=1&show=dept&article_id=7579 Evan Burke

    “There are zero circumstances where propofol should ever be used for insomnia.”

    This doesn’t change the fact that nearly every propofol addict started injecting to overcome persistent insomnia, according to directors of addiction treatment clinics, in an article published on Anesthesiology News back in May 2007.

  • http://vendorMD.com vendorMD

    Propafol is used to induce medical coma, and the only place I have ever seen it used is the OR or in ICU !!! In many hospitals you need to have special sedation privileges to be able to use it. If this is true, then it is ludicrous.

  • http://vendorMD.com vendorMD

    Oh BTW…Dead People are not protected by HIPAA

  • Dr. Mary Johnson

    Oftentimes, rather than protect patients, privacy laws obscure & cover-up bad behavior.

    Arguably/ethically, the most profound “breach of trust” would be a doctor or nurse prescribing or giving Jackson something that killed him (no matter how badly he wanted it). I would think that sort-of-thing needs to see the light of day, and not be covered up in order to preserve a superstar’s “image” (such as it was).

    People/professional (medical, legal & otherwise) who were not directly involved in Jackson’s care are free to speculate. Lots of them will have their “fifteen minutes” as a talking head or even author – some will make lots of money doing it (that’s “entertainment”). HIPAA laws are not going to stop any of that.

    Moreover, the Feds (DEA) are in on the MJ party now: translation, the post-mortem drug screen must have been really interesting.

    I think the privacy bird just flew out the window.

  • paul

    propofol addicts? how is that even possible?

  • unremarkable patient

    Thanks Dr. Mary for your realistic explanation of the patient privacy issue.

    This case has to be a wake-up call for VIPs. I wonder if this group will now ask for a separate privacy clause from their medical caregivers to cover the grey areas of HIPAA.

  • Dr. Mary Johnson

    Respectfully, “up”, the point I was trying to make is that HIPAA laws often interfere with good medicine (not to mention increase its cost) – and cover up bad medicine – and I think we all could use a reality check.

    And I certainly don’t think “VIP’S” (pray tell – talk about “the Two Americas” – how does one qualify for “this group”?) should have any special standing under the law.

    As an example, Farrah Fawcett was (I would assume) an American “VIP”. If memory serves, she successfully sued a hospital over a privacy violation. Yet, at the same time, she was filming some of the most intimate/private aspects of her battle with cancer for TV.

    I don’t get it. I really don’t.

    In his lifetime, Michael Jackson (particularly as it pertained to what he did to his face) could’ve used some doctors saying, NO! Indeed, he might be alive today had there been MORE scrutiny and LESS privacy of what was going on medically behind the scenes.

  • Dr. 10021

    As a doctor, it disturbs me that MJ may have been able to obtain propofol for home use; however, his being a celebrity, I’m sure that many people are willing to do extra favors for him.

    As an anesthesiologist, I can tell you that the action of propofol is very short, so in order to be used for insomnia it would have to be given as a continuous infusion. Additionally, it has to be dosed very carefully to provide sedative effects without causing the patient to become apneic (no longer breathing). Thus, the logistics of it being used at home are impractical, not to mention dangerous.

  • Michael Rack, MD

    Was the nurse directly employed by MJ, or was she under the employ of an agency? IF she was directly employed by MJ, HIPPA might not apply.

  • unremarkable patient

    I’m surprised Jackson didn’t have the nurse sign a confidentiality clause like his household was reported to have signed. Unless it’s void if the person dies. Interesting to see if there was a violation.

    As for vip’s in hospitals, my hospital has a special section on the top floor for “important patients”. The elevator won’t go there unless you punch in a code. This elevator brings up people from a restricted parking area in the underground, and can deliver them directly to the top floor without stopping at the other floors. Needless to say, no med students can participate in their care. NIce, huh.

  • Tiffany

    As a non medical person who has had personal experience with propofol (in an OR-not for abuse), I know exactly what this drug does. Not pharmacology or anything, but I know that 15 seconds after you feel the burn in your vein, you are OUT. The rest of you seem to be doctors, so here’s my question- how is it possible that my ADD meds are a schedule II, on the level of morphine, fentanyl and the like, but propofol isn’t even considered a controlled substance? Something like that that has such a low threshold should be scheduled like its barbiturate counterparts. Does anyone know why it’s not?

    On a completely unrelated note, how do you tell your doc that conscious sedation isn’t the best route for you? I woke up during a colonoscopy and it was horrible. Their response was to give me more demerol (they do the demerol/versed cocktail). I was so sick for the rest of the day. I would rather pay for an anesthesiologist than go through that again. My next scope will probably be in August.

  • MelroseDoc1

    I think the goal here was not to remain sedated for the entire sleep period, but rather to have a brief period to use the drug to feel refreshed afterward. Apparently, there are some studies that suggest that propofol has the ability to erase one’s overall feeling of cumalative sleep deprivation. If that is truly what his goal in using it was, in fact, he may not have had more than a couple of hours of sleep daily in many years, due to the artificial feeling of refreshment.

  • Anon

    “Thus, the logistics of it being used at home are impractical, not to mention dangerous.”

    Leaving dangerous aside, he might have had the right hookup, that ~ $50 million ($30 million more than he made) he spent a year could have bought him nice gadgets, not to mention doctors willing to risk everything for a fat payout.

  • Schrodie

    I’m a veterinary tech, and we use propofol a lot for anaesthesia induction at our practice. It’s a very common veterinary anaesthetic (we use sevoflurane or isoflurane gas for maintenance) and quite useful for the quick anaesthesia of fractious surgery patients. Further, we keep our propofol “readily accessible” for just such an occasion, when the excitatory phase of gas mask-down would pose a risk to the restraining staff (large or very aggressive dogs, etc.)

    Further, MJ had some pets, I believe. If so, he would have had a veterinarian at his call, I’m sure.

    Is it possible that MJ’s propofol hookup is a veterinary worker (either the vet or one of his technicians), and actually not in human medicine at all?

    Intriguing…

  • http://richiedonahue@msn.com boston bound and tied

    all bets are off when the patient dies. in regard to dr.johnsons comment about farah fawsett and her successful law suit vs. her film about herself; a patient has every right to expect their medical file to be confidential and not at the disposal of hospital employees who seek to profit from providing information about patients to media.
    it is the perogative of the patient to do with what they please regarding their own facts of life.
    do you get it now dr johnson?
    regarding michael jackson, surely his medical files did not contain any reference to illegal substances that he or his agents acquired for him. i realy doubt that there is any medical records that show he was issued an iv set up or the drug propofol to be administered at home for his alleged insomnia. also where would the prescription be filled, at the local drug store? if it was filled at a retail store wouldn’t it set of alarms that would indict the pharmacist as well?
    so, really dr. johnson your comments don’t really make sence coming from someone who calls themselves” doctor”.
    HIPAA laws are here to protect though they may be cumbersome, they make it a crime to leak them as was the case in los angeles where so many “VIP” celebrity types had their personal information splashed over the media while those who did it padded their pockets. patients have a right to expect privacy, and, a right to view every item in their medical files.
    there will always be drug addicts and drug pushers like the michael jackson group who fly under the radar until they crash and burn. HOWEVER
    i do see your point to a certain degree though; americans are sheep like when it comes to giving up their rights under the guise of the dangerous homeland security act. but, when it come to “whats” in your medical file it’s hands off.
    maby it’s only a matter of time before medical files will be handled by homeland security becoming public fodder to protect us from the evil doers.

  • W

    Same thought as BBT regarding the earlier take on Farrah Fawcett and privacy. Seems pretty obvious — in one instance she controlled what information went out, when, and in what context; in the other, consent and control were taken from her.

    I’m sure there are ways around HIPPA. Its language is, like all laws, open to the interpretation of whoever can afford the most aggressive and ethically unfettered attorneys. Common sense ought to be the rule, if only it were more common.

  • Dr. Mary Johnson

    Chuckle, it’s a free country and your perogative to decide whether or not my comments make “sense”.

    In the wake of her documentary, Farrah’s point does not seem to have been as much about “privacy” as it was about control. Respectfully, I “get” that her records should not have been released, but if “privacy” was really the issue, I do not understand why is was so imperative to subsequently film-for-public-broadcast herself vomiting into a pan.

    But I’m just a simple country girl-doctor. I don’t worship at the altar of celebrity, and I practice in the real world. I liked Michael Jackson’s music – more I think than I was willing to admit – mostly because I could not get past the hovering ghost of his “alleged” pedophilia. But did Michael’s unique gifts & talents really give him the “right” as a patient to carve up his face into something surrealy inhuman or doctor-shop for powerful narcotics and sedatives?

    WIth that in mind, in the real world, I playfully asked an anesthesiologist I work with, “Hey, Doc! How can I score me some Diprovan?” “What backwoods pharmacy do I hook up with?” “Where can I get it online?”

    The gas-passer chuckled, but had no answers for me. He is as dumbfounded by all this as I am.

    I must confess, those questions came from the naivette of the average, ordinary physician who goes about their day-to-day life trying to do the right thing for his/her patients. If Jackson did indeed die from an injection of this powerful sedative – a sedative that no-doctor-with-a-brain would consider for home use, then that does indeed open up an ugly can-o-worms about how and where he got it – and WHO administered it. And/so. I agree with you. All bets are off. It’s a potential homicide – albeit a “lesser” one for all that MJ (I’m going to have to stop using those as initials) was the King of Pop.

    As for HIPAA, while I’m not up to a debate on Constitutional law this morning (or the pros and cons of the Homeland Security Act;), the “right” to privacy, like many other “rights” in our uber-entitled society is not specifically protected in the U.S. Constitution (do a two-second Google if you have any questions about that). It is implied and inferred.

    HIPAA could use a whole lot of tweaking – just like medicine could use a whole lot of reform.

    I’m not holding my breath.

    You have a nice 4th of July.

  • http://www.uremicfrost.com Simon Prince

    Wow… that is out of control. We use Diprivan (“dip”) in the hospital for ICU patient sedation.

    Diprivan is not something that you can easily self administer hmmm.. Colonel Mustard in Neverland with the Dip Drip?!

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    Simon, my original prediction was the doctor in the bedroom with a needle.

    I was assuming that Jackson only had access (through one of the leech-concierge-MD’s in his entourage) to more commonly-abused things like Demerol or Dilaudid – and his death was due to an overdose – maybe in conjunction with Ambiens or a benzodiazepine.

    The “Dip” is not a “D” I even imagined – it’s just so over the top.

  • Doctor Rocktor

    The (it appears alleged, yet quite unsubstantiable as fact at the present) cornucopia of opiates and benzos that the media vultures are spouting to have been found at MJ’s (themselves) present plenty of possibilities for respiratory depression (alone, or particularly in combinations).

    It’s not at all surprising that any person of means could have amassed such a stash of goodies in their time (irrespective of the status of fame). It’s also not at all surprising that anybody (and not any physician(s)) could easily have orally self administered such agents leading to respiratory depression.

    There appears to be no indication that Diprivan (or propofol itself – barring exotic analogue-form mentioned in some US Patents to be found) would be (even in the slightest) effective via an orally administered route.

    A cursory review of the ingredients of Diprivan in the professional literature indicate that the professionals themselves (please put your 2 cents in, alleged professionals having posted here …) recognize that the soy and lecithin components are a fertile breeding ground for bacteria – thus the (once opened) drug container itself (as well as any secondary delivery hardware) is considered essentially contaminated and unusable within a matter of hours (due to bacterial contamination).

    Such contamination (if injected) would cause “sepsis” (bacterial proliferation within the bloodstream), nearly guaranteeing fatality itself …

    It just seems unlikely that people as intelligent as MJ or *any* physician would attempt such corn-pone actions.

    If propofol was present, the coroner’s autopsy within 24 hours should well be able to identify the presence of the drug (or it’s metabolites). Modern toxicology is incredibly sensitive and accurate.

    The nature of the toxicity could easily be far less exotic than our imaginations seem to be courting in the current frenzy of the media/theraputic-whore cluster-f**k.

    Elvis died of a heart attack trying to take a bowel movement while constipated (likely from opiates). Jerry Garcia died of a heart attack (trying to *withdraw* from opiates!). Yet we obsess like moral nannies over their lifestyle choices – as if we the public owned these peoples souls as well as their bodies. Just who is sicker here?

    Thus, the bible-thumping media/theraputic-whore state may do a 180 degree on us … deifying MJ for his valiant “battle” against “addiction” (“he died with his boots on” in the never-ending moral crusade against pleasure and relaxation that speciously wears a medical mask).

    Perhaps one day our society of pontificating busy-bodies will abandon the “war upon ourselves”, and simply judge people on the objective merits of *how they treated other human beings* – and cease from the obsessions of imagining that we could/should protect adults from *themselves*.

    The entourages of bloodsucking opportunistic parasites that swarm around the famous (in life) are not limited to those who might be said to have cruelly encouraged their self-destruction (by the free-will exercised by the adult celebrity, it is noted).

    Sadly, the pontificatious swarms of “Dr. Drews” who de-humanize these folks post-mortem (as if this equally repugnant crowd of “doctors of the universe” were themselves any less human) are no less phony or parasitic in their sanctimonious condescensions.

    What a load of phony do-gooders they are! Judge a human being on what they did or did not contribute to the world – and call of the tired old practice of “self-deifications” that lead to moral judgments surrounding the private matters of (any) adults choices of sexuality, pleasure, and/or absolutely human desire to find peace of mind. Such matters are up to the individual, and every bit as personal (thus, “sacred”) as anybody’s personal beliefs.

    Call off your tired old nanny-state ethics, get your own house in order, and refrain from judging that which no mortal has a right to adjudicate over another mortal.

    Just because *you* may think that you understand the “shape of the sky” or the “nature of the heavens” does not entitle you to play god. Give up the sanctimonious nonsense, and focus on keeping your own feet on the ground.

    The only exception exists in the case of your own children (brought into the world by your own acts). No title, degree, or certificate endowed of any sort morally entitles us to judge or interfere with the (victimless) “thought-crimes” of other adults. In other words, take off the “pope-hats” and live your own damn life. That *in itself* is hard enough – sit in judgment of yourself and your own, and leave the rest of the adult world alone. Judge not, lest *ye* be judged …

  • Dr. Mary Johnson

    Wow! Looks like it’s time to bow out of this one.

    Respectfully (with my feet on the ground), I think I’ll wait on the official post-mortem results (as opposed to trusting the quickie 24-hour turn-around) . . . even a decent blood culture (looking for that sepsis) takes at least 48 hours. Moreover, like Elvis, even if MJ had an underlying medical condition, the drugs he apparently was taking did not help.

    Michael Jackson, DEAD at fifty – in large part from what was arguably the unfettered/unlimited pursuit of individual whim & child-like excess advocated previously (you could say it was the ultimate judgment), proved one thing if he did not prove anything else: The medical customer is not always right.

    Think about it Rocktor. Rail against the “pope-hats” . . . the traditional, societal values & limitations all you like. But “anything goes” just doesn’t cut it. It most certainly didn’t cut it for the King of Pop.

    If more MD’s had just exercised the professional judgement to tell the gloved one, “NO!” . . . if more of MJ’s entourage/family/friends had exercised better judgment and gotten him the psychological help (do you think someone should have said NO to his father, Joe, when he was beating his child?) & set the boundaries he so clearly needed (especially with regards to the children who slept in his ADULT bedroom), things might have turned out much differently for Michael Jackson.

    I wish it had. But Peter Pan is a fairy tale and wishing does not make it so.

    Alas, it’s all woulda, coulda, shoulda, now.

  • Dr. 10021

    Regarding the infectious nature of propofol, you are correct. Once opened, a vial of propofol should only be kept for use for 3-6 hours, less bacterial seeding of the solution occurs and the fat emulsion in which propofol is prepared becomes a good medium for bacterial growth. As far as the oral bioavailability, I am unsure. It is only administered intravenously in the clinical setting.

  • Doctor Rocktor

    Dr. Johnson,

    My reference to a “24 hour time period” relate to the metabolic half-lives of the original substance and metabolites from the technical standpoint of the delay in collecting samples for toxicological analysis – and not the comprehensiveness or duration of such an analysis … :)

    Your thoughts as fellow human being in a moral sphere ( in addition to yourself being one standing in a particular role between patient and State in your professional practice) bear merit, and find some resonances within my own mind. It is not a good thing when anybody becomes embroiled in their obsessions to the point of mortality (if such might turn out to even be the case upon hindsight).

    The details of who rightly decides the course of a life of another adult, and the dependencies (of sort) that the gamut of industries surrounding the saving of persons from their own willful decisions in the employ in the rhetoric of judgment are less straightforward, indeed.

    In addition to crowd who directly profits from (indeed, could not exist, were it not for) societal perceptions of personal downfall, (I think) that structure of physician caught between the individual and the State has profound, and less than ideal, implications, where a just and moral course of action is not by any means a simple proposition (as perhaps you yourself may appreciate).

    The physician in the middle, when faced with a request for medications which may relieve pain and/or anxiety is free to accept or reject it. Either choice is perfectly legitimate. What is morally illegitimate is the physician allowing themself to be seduced by economic and political enticements (which we can see clearly may arise out of the patient’s, as well as arising out of the State’s, specific interests) into abandoning their role as healer and betraying their ethical obligation to the patient, and assuming instead the role of referee – arbitrating the conflict between the patient who wants a powerful analgesic and the state who wants to withold it from them.

    The doctor who assumes this Solomonic role – and most practicing physicians do, the practical circumstances of their lives leave them little other choice – victimizes his client qua patient, and compromises their own integrity as a healer. The physician is pulled and pushed, with blandishments and threats, to abandon his traditional allegiance to the patient, stop their hopeless struggle to to stem the onrushing tide of the alliance between medicine and the state, and become a double (or triple) agent – allegedly serving the patient, actually taking orders from the state, and still looking out primarily for themselves.

    We (should rightly be) rewarded and punished for the behaviors we display – not for the virtues or vices that others attribute to our character, or the drugs they detect in our urine. We have a choice about how to judge another person’s: we can reward or penalize their performance as a human being because we are interested (only) in it, and eschew entering uninvited into his life; or we can reward or punish them for the drugs that they avoid or seek because we are obsessed with their drug using habits, whether they like it or not.

    It is less than clear to me how I personally might have chosen to handle such requests in this situation (were I the one holding a prescription pad). I (believe that I) can appreciate and respect the ethical conundrums that may render such decisions to be less than a moral “slam-dunk”. How one construes and may thus interpret the tenet of “doing no harm” is not a trivial or obvious matter.

    Most sadly, while our society lives, breathes, and morbidly craves the “theater of notoriety, wealth, and power”, we as a culture hungrily digest the innards of the most personal aspects of the mere humanity of those who we also freely choose to elevate (or denigrate) to the polar realms of “panacea” or “pana-pathogen”. Additionally, we apply such unrealistic binary judgments to the vast array of molecules that the ruled beg the rulers to control and supervise the administration of to competent adults.

    While pompadoured and coiffured masters of the universe within government and media sanctimoniously shake their heads for a living as they sit in pompous character judgments of others, children of the world physiologically destroy their brains at very early ages by use of extremely damaging solvents in the most human of endeavors, that is – seeking to shield their hearts and minds from the pain and sufferings of what life is like for a large majority of this world’s population. We don’t necessarily begrudge ourselves for pursuit via our own lifestyles of that which brings us joy and relieves our own personal sufferings.

    The answers to such tragedies may well lay in the very inequities under which our world is structured – and not in societies obsessively placing what are some of the least physiologically damaging molecules under virtual lock and key, while standing by as the untouchables among us self destruct by ingesting those which are the most damaging.

    These are not simple ethical matters to consider or address, indeed. However, for those not endowed with title, wealth, or power within this world, the fear of the exercise of human autonomy that we (the most privileged) favor, has, for decades, resulted only in an unsuccessful war upon ourselves and human nature. While it may spawn and employ an industry of self appointed experts in the policing of whatever the mores of the societal time and place may choose to dictate as acceptable mental hygiene, perhaps those who bear the anti-title of social and economic invisibility do indeed have basis for decrying, “… they don’t care about us … “.

    Respectfully (and *hopefully* with the humility in opining upon social policy that such complex matters deserve),

    Doctor Rocktor :)
    .

  • Aura

    What about those bacterial filters – wheel filters – for reducing the chance of septic outcomes.

    I wouldn’t have thought the D would be Diprivan either but with all the money he had, he could have had as much medical equiment and expertise standing by as he needed or wanted.

    As for how he obtained the Diprivan in the first place, there have been enough examples in the media lately of people diverting drugs from the perioperative areas. I’m sure there are people who will divert it for a price.

    They probably started off taking the waste and got so confident they ended up walking out with boxes of the stuff….. People just keep going until they hit rock bottom (or beyond) – just look at MJ.

  • Dr. Mary Johnson

    I’m following this one in my Inbox.

    From Rocktor: . . . “What is morally illegitimate is the physician allowing themself to be seduced by economic and political enticements (which we can see clearly may arise out of the patient’s, as well as arising out of the State’s, specific interests) into abandoning their role as healer and betraying their ethical obligation to the patient.” . . .

    And this one . . .

    “. . . It is less than clear to me how I personally might have chosen to handle such requests in this situation.”

    Rocktor, my man, it is crystal clear to me. Eleven years ago, I honored my ethical obligation to a patient and saw my life turned upside down . . . it’s been a legal nightmare from which I have yet to wake up . . . an amoral clusterscrew of the highest order. I still have a hard time wrapping my head around it and I lived it! I did the right thing . . . what ANYONE ANYWHERE would argue I was supposed to do. Yet I fell through all of society’s checks and balances . . . and I’ve yet to see a law enforcement official or political reformer hop on their white horse and rescue me.

    Yet, I would do it again.

    Likewise, a few years back, I said NO to a teen-aged doctor-shopping drug-seeker . . . who then reported me to the Medical Board for saying NO. I spent six months defending a bogus charge of “abandonment” . . . which was ulitmately dropped (because I had had the foresight to do some detective work – i.e. pick up the phone and call the pharmacies – and document the hell out of all of it).

    And I would say NO again.

    Respectfully, it’s not hard to do these things. It IS straightforward. It IS simple right and wrong (or as MJ would say, black and white). Do you let the newborn baby die because someone has threatened to fire you? NOT NO, BUT HELL NO! Do you give the entitled teenager bucking for faux-disability-status the very drugs that disable her? Again, NO.

    But it IS hard to live with doing these things because the world we live in is so fundamentally corrupt, warped and sick.

    At a number of points in his life, Michael Jackson, arguably the most musically talented man of his time, needed someone to say, NO . . . be it to the Father who beat him and the Mother who let it happen (the Mother who now has his childern) . . . to the older brothers who had groupie-sex withing listening distance of their baby brother . . . to the plastic surgeons who carved his face into something unrecognizable . . . to the beyond-dysfuntional family & friends that never insisted he get psychological help . . . to the soul-sucking fawns and sycophants who did not tell him to close his bedroom door at night and play with the children in the morning . . . to the concierge doctors who prescribe from back allies that probably put that last nail in the coffin he built for himself.

    Autonomy is a fine thing. But I am one of those foolish/imperfect people with a moral code who believes that with rights come responsibilities . . . and that following rules keeps us out of trouble and actually sets us free.

    It’s in the breaking & tweaking of so many of society’s traditional rules and mores that we, as a nation, now find ourselves in the mess we’re in.

    And it’s the reason the King of Pop is dead.

  • Jim Tighe

    What! Michael Jackson is dead? Are you serious? Was this on the news? I must have missed it.

  • Doctor Rocktor

    Dr. Johnson,

    It’s commendable that you have a personal moral code. That is more than can be said for some. Certainly, responsibilities accompany rights, though the interpretation and arbitration of such matters by any individual within their life sometimes tends to engender a certain humility (in the realization that our perceptions of absolute concreteness may mature into a more measured – and less self assured – viewpoint in retrospective view).

    I take it that your reference to yourself as a “foolish/imperfect” person is intended to be in jest, as your statements:

    “… it is crystal clear to me.”; and

    “… it’s not hard to do these things. It IS straightforward.”; and

    “… following rules keeps us out of trouble and actually sets us free.”

    seem to imply that you have a high degree of confidence that your personal judgments are arrived at simply, and possess a moral infallibility beyond question for all time.

    It’s been interesting conversing with you. I leave you with an interesting and thought provoking quote in the spirit of humility, from one of us who consider themselves to be mere mortals:

    “We call first truths those we discover after all the others.”
    -Albert Camus

    Cheers :)
    .

  • Dr. Mary Johnson

    Rocktor, none of what I said was in jest.

    If you still need to interpret anything, I suppose we could ask the parents of the baby whose life I saved (they send me a Christmas card with just her picture on it every year), if I should have any confidence in my personal moral/professional code/judgments (based on a silly “pope-hat” thing called faith) . . . as opposed to the code of the oh-so-charitable “non-profit” hospital executives who would have had me roll over, go back to sleep and let a child die.

    We mere mortals are capable of extraordinary things if we have the courage of conviction and principle.

    Here’s one for you (courtesty of George Orwell):

    “In a time of universal deceit, telling the truth becomes a revolutionary act.”

    It’s the story of my life.

    And Jim, don’t feel left out. I’m fairly certain you can get all the details tomorrow.

  • Doctor Rocktor

    Dr. Johnson,

    It’s truly an all too rare state of affairs when some of us mortals demonstrate courage and conviction in the face of powerful adversities and limitations imposed upon fellow mortals by the world. It sounds like you have exercised such admirable courage on behalf of others in certain situations in your life – it would be unfortunate (but not necessarily unheard of) if such good deeds were rewarded with, “a legal nightmare from which I have yet to wake up . . . an amoral clusterscrew of the highest order.”, as you put it.

    The sagely Mr. Orwell (a personal favorite) also said:

    “If liberty means anything at all, it means the right to tell people what they do not want to hear.”; and

    “Orthodoxy means not thinking – not needing to think. Orthodoxy is unconsciousness.”; and

    “Being in a minority, even a minority of one, did not make you mad.”

    Thus, perhaps we both can appreciate the potential suffering that may come along with the honest exercise of individual conscience. Enduring such slings and arrows as may arise as a consequence is a worthwhile endeavor (whether or not recognized in one’s time by other mortals).

    As a note: I do not endorse the exploitation of, or the striking of, or the molestation of, children.

    However, I have tried to raise what I believe are some reasonable questions as to whether (in the case of adult patients) the physician should be required by the State to assume the additional roles of priest and/or policeman.

    The “war on drugs” has proven (in my opinion) to be a fundamentally flawed and entirely unsuccessful war upon ourselves, and human nature itself. As Mr Orwell quipped:
    “The war is not meant to be won, it is meant to be continuous …”. I question the motives and integrity of those who profit from such juggernauts of specious moral crusades wearing a medical mask (and not necessarily the physician who finds themselves embroiled within such societal policies as exercised and enforced by the State).

    Such a state of affairs tends to destroy honest communication between doctor and patient in an atmosphere of ritual stigmatization, demonization, and dehumanization of adults who have (and likely will continue to) exercise their free will, relegating them to a phony childlike status, perceived to be in need of eternal supervision. Indeed, a new dependence of sorts, itself.

    Some people seems to welcome such intervention into such matters of their personal behavior. Many others do not. The result is all too often a duplicitous charade where a (private, private non-profit, or public) Theraputic State where the citizenry is the least served, and intelligent adults are required to act like naughty children begging paternalistic authorities in order to attempt to obtain the privilege of receiving cost effective and efficacious treatment for their physical or mental sufferings by pharmacological agents known to be less physiologically harmful than the vast majority of medications in the PDR.

    Thus, such a war over the perceived mental hygiene of adult’s minds (as opposed to over their physical health) may ultimately prove to be “war without end” that serves to primarily benefit the interests of the State and industries which profit from supervision of the citizenry.

    Willfully choosing to stand in the role of subservient arbitrator between State and citizens has many edges that do not necessarily best serve either patients or physicians. A situation (potentially) rather “Orwellian” itself (hoping that you might appreciate the resonances I hear), where no plebeian would expect the pharmacological privileges that a Marilyn, Elvis, JFK, Rush Limbaugh, or Michael Jackson are afforded arising out of the “theater of wealth and power”, preferring to dutifully engage in mass public post-mortem rhetorical colonoscopies rife with zealous headshaking and uninformed judgement, while often privately wishing that they themselves could enjoy such liberties of autonomy and pleasure themselves.
    Such “newspeak” accomplishes little in the end, other than the dependence of the ruled upon the high priests of the Theraputic State, costing ordinary people lots of money, in addition to requiring that they leave their free will at the door, to be duly supervised by those who know better for them, and known best how they should live.

    Who can say whether the above cited public figures (sans Limbaugh … ) could have, should have, or would have become who they evolved to be (in part) with or without the use of the drugs that they consumed?

    The question is one of *who* decides in a free society – and *not* whether you (personally) are a well intentioned and competent physician acting under many non-ideal limitations (from both “above” as well as “below”). Your conscience and competence are meaningful virtues!

    I simply wonder sometimes in how many cases such a “crystal clarity” springs forth “in-vivo” (and not just in a “post-mortem” retrospective). I don’t think that society should criminalize doctoring any more than I think that society should criminalize (or overly supervise) human nature. As well, adult individuals must bear responsibility for their own personal actions (whether they are intoxicated by virtue of psychotropic agents, or by theist, statist, or academic zealotry) when such acts harm others.

    The only beneficiaries of such wars without end are the gendarmes who serve at the pleasure of the powerful and priviliged (and not those on whose behalf such dependencies on protection against themselves are allegedly mandatory for their socially acceptable development as adult human beings).

    Let us not as a people accept any societal structure or industry which seeks to persuade competent adults that:

    “War is Peace;
    Freedom is Slavery;
    Ignorance is Strength”
    because (as our friend George again quipped):
    “The great enemy of clear language is insincerity.”

    Thus, an intelligent person (including MJ) is both highly encouraged (as well as expected) to approach the medical community with an appropriate “ignorance” about the pharmacopia at the disposal of the physician, “slavishly” beg for the privilege of receiving effective pain/anxiety medications that have been tabooed for their psychotropic effects, while feigning support for a societal “war” upon ourselves and human nature waged ostensibly for our own good (for all but, of course, *themselves*). Any expressed viewpoint otherwise, would (I would be willing to bet), send *your* prescription pad deep into your pocket where it would stay in a few nanoseconds time …

    One wonders if MJ would have resorted to begging for measures as severe as dangerous propofol simply in order to sleep had he in actuality been granted the maintenance doses of opioids required to stabilize his use.

    A case could possibly be made that, in reality, it was a cadre of experts on “self-misuse”, and the fears that we are instructed to favor, who may have contributed to such a downfall engendered by MJ’s possible bouncing in and out of narcotic withdrawal, and its ravaging effects.

    Could MJ have been more a victim of the War on Drugs than a victim of the opioids themselves? What would have constituted “doing no harm” seems murky and non-concrete when considered from such a perspective.

    But I suspect that you must know what is best, Doctor -
    and we both appreciate that were you to see some wisdom in such a “maintenance” approach, you yourself
    are “criminalized” (in the case of opioids) by the State.

    Such mandatory scriptures (upon physician as well as patient) bring to mind the following cautionary warnings:

    “The war is not meant to be won, it is meant to be continuous.” … “The war is waged by the ruling group against its own subjects” … “to keep the very structure of society intact.”
    -George Orwell

    “The price of eternal vigilance is indifference.”
    -Marshall McLuhan

    Thus, as we both peer into the same societal crystal, I simply find less singular clarity as you appear to express perceiving. It is noted that our buddy George quipped:

    “I sometimes think that the price of liberty is not so much eternal vigilance as eternal dirt.”

    so our sometime disagreements enhance diversity of thought and discourse in a culture where (one might hope) a competent adult would be granted ownership (not only) of their own body, but even of their own minds … ;)

    Dr. Rocktor
    .

  • Doctor Rocktor

    (If) propofol use was, indeed, an actual factor involved:

    It is further noted that one of propofol’s pharmacological mechanisms of action involves GABA receptors in ways that may induce effects similar to the benzodiazepines.

    Thus, (if true), MJ’s (alleged) affinity for its effects upon his CNS may have in part evolved out of possible benzodiazepine use (as well as possible opioid use). Such things are less than straightforward to determine (even among the living), and not factually determinable.

    However, I believe that physicians are *not* turned into criminals by federal law (as they clearly are in the case of opioids) by providing maintenance dosing of benzodiazepines.

    Therefore, I do not see this additional GABA-receptor angle of speculation modifying or negating the ethical arguments heretofore set forth.

    As a practical matter, it is recognized that use of lagre amounts of benzodiazepines and/or opioids are not necessarily conducive to rehearsing (a reputed 6-10 hours) daily, or in the performance of the (absurd) number of 50 concert dates as was reportedly scheduled.

    Such realities (could) have motivated MJ to seek the short-acting relief that he allegedly found in propofol. It seems that (if such a scenario did in fact ensue), MJ may have died in a valiant attempt at avoidance of the very tabooed molecules that so many are bemoaning as his wrongdoing.

    It seems a fellow (as intelligent as MJ was reported by many to be) would likely (along with his doctors) be aware of the requisite dangers involved surrounding routine propofol administration. Thus, portraying him as a victim of the medical profession may not make common sense.

    The legal fact that propofil is not presently even a legally (“Schedule”) controlled substance seems to be relevant. Would a physician be in violation of Law for administering propofol to an informed and competent adult patient who was aware of, as well as willing to take, the risks involved in its use?

    That MJ may have (in essence) died in the all-american pursuit of *money* would not seem to likely even garner a footnote in the pages of the morass of self-appointed “life-coaches” who have come forth in attack of his personal pharmacological habits chosen throughout his life.

    Our society (largely) refrains from berating individuals for their accumulation and disposition of monetary wealth. We hold that right of property/debt most dear where it comes to monetary wealth. In fact, we verily worship those among us who both accumulate as well as lose money.

    If MJ “died over dollars”, who would cast the first stone? Why should he not be elevated to the status of hero under the mores of our culture’s (optional) “cathedral of wealth”?

    Yet, where it comes to controlled substances, our bodies, (and even) our minds, we relinquish our property rights on the premise that medical professionals necessarily know best for us how our lives should proceed as well as end.

    Participation in this (mandatory) “cathedral of supervision” is avoided only by committing the sin of “self-medication”. The resultant inquisitions are not kind (even in death) to those who would exercise autonomy regarding that which (we rightly should) consider even more sacrosanct than material wealth – our very own bodies and minds.

    A somewhat “Orwellian” culture we have evolved – where money and guns are (relatively) unfettered badges of power and influence, yet an individual’s peaceful exercise of free will in matters of psychotropic endeavor represent a lifelong societal stigma that trivializes and dehumanizes its detainees, relegating them to a presumption of mental illness requiring intensive supervision by the criminal justice, rehabilitation, and medical communities for life.

    When life becomes a prison (whether by one’s own hands, and/or with the assistance Theraputic State), death may be the only lasting exercise of autonomy (a sad state of affairs if avoidable by any other means). We should ask ourselves exactly whose best interests are being truly served by such industries of supervision – and ensure that they are, indeed, those of the citizens allegedly being protected, and ostensibly being served.
    .

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  • http://www.myspace.com/ Jerry Hawkins

    In regards to Michael Jackson and the alledged use of Propofol to help him get some sleep…..
    I’m not a Doctor Ok? But in life’s experiences, there are so many lesser potent medications for help with sleep loss or problems falling asleep, that I just cannot get with a Doctor administering Diprivan to Michael Jackson to help him get some sleep. There are much much safer “Hypnotics” available for this problem. Usually tho a Physchiatrist prescribes such meds….not a Doctor in the capacity of Michaels in my view.
    If one were to read all the medical reviews of this drug Propofol…..one Doctor sums it up by saying: “Using Propofol for sleep disorders is like using a Shotgun to kill and Ant”.
    Further, after so much has been disclosed to the general public about Michael and his health issues…..it would seem that a private therapist could have helped Michael much more so in a much healthier manner than this Doctor who prescribed so many powerful drugs for Michael.
    Issues Michael may have had that were emotionally upsetting brought to a closeure and peace.
    The one thing in regards to the child molestation charges must have really damaged Michael alot.
    Public humilation and embarrasement for Michael on so many levels. Duteronomy in the Bible points out how ….Just because a man is accused of a wrong doing….does not make him necessarily guilty….
    It’s a bit too late to help Michael….I am more than surprised however, how not enough of the Right People were made awares of Michaels delimas or at the right time.
    Personally, I really enjoyed MIchael’s Music and Performances over the years. Found him to be an exceptioanlly talented you man.

  • Wilson Van Sant

    Dr. Big Johnson and Jim Rocktor, P.I.,
    guys, get a room!
    there are obviously no lawyers here. regarding privacy, HIPAA, like so much legal makeup in our society, is meaningless and it is amazing how gullible people are. one subpoena takes care of that, and those are easy enough to trump up. happens all the time. and the medical information bureau contains ur entire medical history since birth. so, it just takes one.
    common sense rule of thumb; anyone who asks for information from you, like ur social, name, dob, etc. is asking it for a reason and its usually NOT in ur better interests. don’t give it until they’ve fully justified it.
    As for the doctor’s debate, i’d put a legal twist to it. I think the degree of “supervision” that is appropriate is really one of competence: wherever the general public would not reasonably be expected to be competent, in that matter the professional (the doctor) is accountable for ill-advisement. Period. Otherwise, why not just fire all the “professionals” and do everything ourselves? If it is ill-advised for this doctor to give MJ diprivan in his home and MJ can not be reasonably expected to know that, then the doctor is fully culpable. MJ would have done just as well without the doctor by treating himself, in that case.
    Honestly, i can’t see myself accepting diprivan at home for insomnia and it would scare the hell out of me if a doctor advised it, but maybe i know more than MJ did? i mean, anything used to knock u out for surgery – where u absolutely, positively can’t wake up – is probably a bit of a “stiff” fix for insomnia. so, the question is, is that common sense or not?
    Please limit ur reply to 3 pages or less. thank u