Over the weekend, the nationwide media in the US were overtaken by a firestorm of speculation that Michael Jackson’s premature and sudden death, at the age of 50, was the result of a deadly cocktail of powerful painkillers and anti-depressants. Family and friends have complained of a close entourage of “enablers”, helping to intensify a long-running addiction and lead the pop star to his demise. One is tempted to ask, however: where were the doctors?
A growing movement of people inside and outside the medical profession is voicing concern that medicine in the US has morphed into a drug-delivery system, the functional logic of which is to expand the reach and ubiquity of powerful pharmaceutical medications, often without giving enough attention to the real effects on long-term patient health.
A culture of quick fixes and mechanical processing of health issues, coupled with a dysfunctional insurance system that incentivizes doctors to prescribe costly treatments and medicate to avoid personal financial fallout, has led to an American medical system in which the best science in the world is available but is also often ignored in pursuit of practices pushed by pharmaceutical conglomerates.
There are more and more doctors who resist this trend and who openly chastise fellow doctors for irresponsible medication prescription. The issue of peer pressure as related to antibiotics is especially severe: patients often don’t understand that antibiotics cannot cure viruses, are only effective against certain types of bacteria, and that implementing their use always enhances the likelihood of a stronger, evolved, more resistant strain.
They also tend not to understand the genetic turnover from generation to generation in a bacterial colony can be so rapid that this enhanced resistance could materialize in the same patient, before the infection is cured, thus harming the patient. Antibiotics need to be prescribed with care, and in the cases where they are most medically appropriate. Multi-resistant TB and MRSA are two bacterial strains that are now so evolved they have to be treated in all cases with a “cocktail” of carefully phased in and overlapping antibiotic treatments — a risky process that aims to wipe out all individual bacteria at once, but heightens the risk of a super-resistant bug for which no effective treatment has yet been developed.
Painkillers are also an evolutionary problem. Patients develop a “tolerance” to their effects. Cancer patients suffering with constant excruciating pain in all the bones in their body can be prescribed morphine, which has an initial palliative effect. But the dosage has to be constantly increased as the body becomes dependent. A patient taking the drug for months, with a persistent deterioration in bone and nerve health, can end up receiving 10 or 20 or even 30 times the dose that would be instantly lethal for a normal person.
If Michael Jackson, with his immense wealth and vast entourage, and a private lifestyle some have compared to the rarefied privileges of royalty —including the fear of those around him to deny his requests—, were developing an addiction to painkillers, it is conceivable that the habit would actually lead to a crippling lifestyle in which he would feel intense physical pain and discomfort from simply not upping the dose regularly.
A doctor should have seen this and prescribed a cure. The drugs should have been difficult to obtain, even given his wealth. But a medical culture that is oriented toward the delivery of medication, where prescription drugs cost considerably more —even many times more— than in any other industrialized nation, facilitates the flow of dangerous medications to individuals who should not be taking them.
What is clear, should any of the rumors that are circulating regarding Jackson’s medication regime be true, is that proper medical supervision of those treatments was not exercised. His personal doctor may not have been the source of the prescriptions, may or may not have known about it, and was probably lied to, if this was a real addiction. But the system could work better for patients’ health, with less focus on expanding the reach of prescription pharmaceuticals.