When Dr. Conrad Murray was charged last week in Los Angeles with involuntary manslaughter in connection with the death of Michael Jackson, it once again put the focus on the complicated relationships some celebrities strike up with physicians on their payroll.
According to a Los Angeles County Coroner's report released earlier that morning, Jackson died of "acute propofol intoxication." It said the standard of care for administering the drug, which typically includes equipment for patient monitoring, precision dosing and resuscitation, was "not present." Propofol, an anesthetic normally used in hospital settings for surgical procedures, was allegedly given to the pop icon at his home by Murray to treat insomnia in the hours leading up to his death on June 25. If convicted, the Houston-based cardiologist may face up to four years in state prison. Murray pleaded not guilty and was released on $75,000 bail. He is due back in court on April 5. (He was ordered to quit prescribing heavy sedatives, including propofol, to his patients.)
But will the seriousness of the homicide charge facing Murray do anything to discourage a practice seemingly as old as Hollywood itself celebrity clients with substance-abuse problems, or with other real or imagined illnesses, finding doctors to give them the medicines and care they crave, even if it goes against proper medical practice? Or are the temptations whether the generous pay or the ego gratification of being patronized by a famous person simply too great to resist?
"The whole thing is going to send a chill," says Dr. Drew Pinsky, a substance-abuse expert and television personality who treats many celebrities, "but it's a highly complicated and nuanced problem that many people just don't understand. You know, there's a young celebrity dying of addiction every day now. And they're all dying from pharmaceutical death. So where are they getting them? They're getting them from my peers."
Dr. David Sack, CEO of Promises Treatment Centers, an alcohol-abuse rehabilitation program in Malibu and West Los Angeles that has many celebrity clients, says that at the very least the case will serve as a cautionary tale. "In many instances where there's been a fatality and there has been an investigation, the doctors have been reprimanded by the board, licenses have been suspended or revoked, but every one of these instances reminds the public and physicians of the risks," says Sack. "Will that be enough? For some it will, and for some it won't."
Sack points out an often fatal misconception. "What I would hope, first of all," he says, "is that people would realize that just because a drug is prescribed doesn't mean it's safe. It's only safe in a context, and once you change that context and you start to mix it with other pills and alcohol, it's not going to be safe. The public needs education, and I think physicians, when they realize the risks, are much less likely to be pressured into prescribing them when they're inappropriate or, more importantly, prescribing things without adequate supervision."
Part of the problem is that many times, when a doctor is treating a famous individual, the traditional relationship is reversed and boundaries are blurred, with the celebrity dictating what drugs or care they want and using their allure, threat of banishment and lucrative pay as means to get their way.
"I found it was very easy to get sucked into that population," says Dr. Victoria McEvoy, medical director and chief of pediatrics at Mass General West Medical Group, who has treated and written about the pitfalls of taking on high-profile clients. "One, because they're interesting people. But they're also very narcissistic in general, and needy, and as a result, if you want to be part of their care, often you can find yourself going beyond normal boundaries and going above and beyond what you would do for other patients." She adds, "It's very easy to slip over the line of giving good, objective care and maybe overtreating at times. You may feel pressure, like this physician apparently felt pressure by Michael Jackson to give him propofol and all these other things. It's very hard to say no to these people unless you keep a very strict sense of boundaries in their head."
Sack says the charge against Murray should give physicians pause before overtreating patients or administering to problems outside their areas of expertise. "It's going to make it much more likely that if I'm a cardiologist or general practitioner and I have an affluent or celebrity client who has a problem with drugs or alcohol, or it has turned into a drug or alcohol problem, then I'd be much more likely to refer them than to manage them in my office. It's going to make people much more cautious about the potential risks, and that's a good thing. People shouldn't get worse care just because they're famous. That's clearly the concern here. By virtue of his incredible wealth and celebrity, [Jackson] actually got worse treatment."
Far from the stereotypical image of Dr. Feelgoods acting with total disregard for their patients' health, Pinsky says, most doctors who get into trouble with celebrity clients mean well but are in over their heads. "It's not as simple as it seems, and it needs to change. If you want to distill it down to one thing, it's doctors really don't understand addiction, and that's how they get themselves into trouble. And then they also don't understand their relationship with celebrity and their own personality figuring into that relationship."
Even if Murray is acquitted, the trial's impact on other doctors won't be diminished, Pinsky says. "Doctors are very sensitive to their professional status being questioned. They would rather go to prison than to be publicly humiliated like this, with their ability as a doctor being questioned."
However, Arthur Caplan, Ph.D., director of the Center for Bioethics at the University of Pennsylvania, doesn't think the trial will have much consequence for the questionable doctors who are enlisted by celebrities when they can't get aboveboard practitioners to pander to their needs. "Even with those tough charges, the combination of extraordinary wealth, lavish lifestyle and doctors who operate on the fringes of their profession almost guarantees a replay at some point down the road," he says. "Medicine hasn't figured out how to weed out the fringe operators, and celebrities haven't figured out that it isn't good for their health to have a doctor who simply caters to their whims."