As more is emerging about the death of Michael Jackson, the role of rampant drug abuse is becoming clear. In fact, it appears that Elvis Presley's drug use was modest compared to Michael Jackson's. The drugs being preliminarily reported by the media (thus far) include meperidine (Demerol), hydrocodone (Vicodin, LorTabs), oxycodone (Oxycontin), hydromorphone (Dilaudid), methadone, alprazolam (Xanax), hydroxyzine (Vistraril), as well as antidepressants and medication for gastrointestinal distress (probably related to the massive amounts of drugs he was taking). Today we learned that Michael had been requesting propofol (Diprivan) for sleep. How would he now what to ask for if he had never received it? Propofol is a potent short-acting hypnotic anesthetic agent we use to sleep people for short, painful procedures. Only in the last few years has propofol been used outside the operating room. Thus, doctors must have introduced Michael Jackson to propofol. Insomnia is not an indication for propofolol (Jackson's insomnia was probably due to all of the drugs he was taking--he could not get enough opiates in his system to sleep).
It seems, of late, that physicians have played a role in several celebrity deaths. The role of enabling physicians was well detailed following the death of Elvis. Recently, physicians appeared to have some complicity in the deaths of Danny Gans, Anna Nicole Smith, Heath Ledger and now Michael Jackson. The cases of Jackson and Smith appear to be the most egregious.
Physicians are not unique as humans and can be enamored by fame and famous people. Just like the "groupies" who will sleep with a famous person for the thrill of being close to celebrity, there are physicians willing to compromise medical ethics and the law to gain proximity to celebrities.
To me, it is amazing that people like Michael Jackson and Anna Nicole Smith could have been prescribed such massive doses of narcotics. It would seem that such prescriptions (either to the name of the person the medication was prescribed to or the pharmacy filling the script) would raise a red flag for authorities. In our emergency department, we can access a database and see what controlled substances a patient has received and who prescribed them. This issue of propofol is perplexing. It is an injectable agent not usually found in pharmacies. It would have to come from a physician or hospital. Propofol is not a controlled drug. But, you would have to be an idiot to use it anywhere outside a closely monitored hospital setting.
It is a sad day when professional ethics and physician common sense give way to the desire to be close to celebrities. Had Michael Jackson, Danny Gans, or Anna Nicole Smith been anybody else, many of these physicians would have refused to write these dangerous scripts. What happened to the most fundamental medical principle-- primum non nocere (first, do no harm)? Medicine, as a profession, has fallen far from the pedestal on which it once rested.