Michael Jackson: A Victim of

Conflict of Interest

The tools of an anesthesiologist rarely make headlines. We are one of the invisible
specialties, performing our best work while our patients are unconscious. But these
days a lot of people ask me if I'm planning to use that "Michael Jackson Drug" to put
them to sleep. I usually answer "yes," and then start explaining.

I make my living helping people safely sleep through painful events. Michael
Jackson's probable mode of death, propofol, is a drug I use everyday in the operating
room. In a full dose propofol induces general anesthesia in less than two minutes, and
when drizzled slowly through the veins it causes a lovely sedation famous for spinning
pleasant dreams with very few nasty after affects -- a big improvement over biting
bullets, whiskey, and every other drug that came before it. The most prized
characteristic of this milky white chemical is its quick action; in moderate doses
propofol is in and out of the system in about ten minutes. This roller coaster ride
through the body and brain means patients can stay soundly anesthetized for short
surgeries, but be awake and on their way home an hour after they leave the operating
room.

It's that same quick onset and disappearance, however, that makes propofol so
dangerous. The line between a light, pleasant nap and asphyxiation is perilously
narrow, and it takes training and experience to use it judiciously. Remarkably, the drug
isn't closely monitored by the Drug Enforcement Agency, though it is now under
discussion. Anyone with access to a procedural suite or operating room can walk out
with handfuls of the stuff and no one would be counting the lost vials. That wouldn't
be possible with tightly controlled drugs more famous for abuse, such as narcotics like
morphine, fentanyl or Demerol, whose long history of addiction dates back to opium
dens.

When I treat a patient with narcotics I am required to sign out each dose and
account for its use or disposal. It isn't a perfect system, even the best governmental
oversight won't stop a determined, troubled individual, particularly when they have
sufficient influence over a doctor with easy access. But in Michael Jackson's case
better regulation would have imposed one more layer of safety between his desires
and his doctor's irresponsible acquiescence. Unfortunately the only point of control lay
with the cardiologist on Jackson's personal payroll, who apparently forgot his Oath
when he cashed his check.

Jackson is only the most recent victim of medical judgment apparently blinded by
the bright lights of stardom. But a doctor's ethical imperative is to be paid for advice
and skill, not drugs or an ill-advised, patient-designed plan of care. Demerol, Adderall,
oxycontin and propofol aren't stocked on Rite Aid's shelves because the margin
between a therapeutic dose and a toxic overdose for these potent medications is not
financially negotiable. The cardiologist who treated Michael Jackson succumbed to a
blatant conflict of interest: dangerous practice in exchange for dollars. Such conflicts
bleed through many layers of healthcare today, from pharmaceuticals to scientific
studies to durable medical goods and, yes, even the protected realm of the doctor-
patient pact. It is a shadowy cost of healthcare -- in both lives and money -- that few
lobbyists are likely to decry, but a cost Congress needs to examine before finalizing
our next healthcare financing scheme.

I will continue to reassure my patients that propofol is an excellent drug, safe

when used in the controlled environment of an operating room or ICU. Like the vast
majority of doctors, I will promise to listen to my patients' requests and concerns, and
then make the most educated and objective decisions for their care -- regardless of
their ability to pay me.
I wasn't a huge Michael Jackson fan, but I still mourned for this talented man who
seemed so tortured by early fame and money. Maybe for that reason I found it even
more tragic to surmise that Jackson's death resulted from his own desperate search
for an artificial pathway to that most natural state of healing: sleep. Like millions, I
wish I could know what music we lost when his doctor helped him slip too deeply into
that dream.
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Question for Discussion

1. What is your impression of Michael?

2. What kind of music do you interested in?

3. How do you think about Pop music?

4. How do you think about the media over-consumption of Michael Jackson?

5. What do you think about Michael Jackson’s death.