Hoff Entertainment via Wikimedia Commons
Source: Hoff Entertainment via Wikimedia Commons

The list of names keeps growing: Prince, Michael Jackson, Joan Rivers. All dead before their time due in part to bad decisions by their celebrity doctors, the ones who should be looking out for their safety the most. 

Perhaps the public takes a certain perverse glee in rediscovering time and time again that those we glorify and idealize, the higher the better, are covering up deep chasms of despair. The fact is that the famous are still just human beings like you or I, prone to the same demons and same problems, but in much more exaggerated form. Because of their power and money, whatever underlying desires and wishes they have can be achieved quickly and completely, even if it is ultimately at their own expense.

What unnerves me about the so-called power of celebrity are those who profit on the sidelines from their grandiosity. In particular, several sudden celebrity deaths involve the use or misuse of prescription drugs. Anna Nicole Smith and Heath Ledger’s untimely demises will always be shrouded in some amount of mystery as to whether the overdoses were accidental, suicidal, homicidal. But one can’t help thinking why were they on so many damn pills? Where did they get them from? 

It’s hard to know if the doctors prescribing these medications were caving into the celebrity virus, wanting to share in the money and glamour by providing private arsenals of medications to their patients. Anna Nicole’s psychiatrist was arrested and charged with overprescribing controlled substances to her. Michael Jackson’s personal physician was arrested for administering Propofol to him without being monitored in an operating room with trained personnel, the only safe setting for that drug. Joan Rivers' surgeon was also sued for using inappropriate levels of monitoring for her level of sedation during an otherwise routine outpatient cosmetic procedure. Dr. Drew Pinsky, the media physician and addiction specialist, angrily noted on CNN that Prince likely should have been directly admitted from his hospital to an inpatient rehabilitation unit or program right after his first near-death overdose a few days before his fatal one, instead of being allowed to leave, waiting several days, and flying in a private addiction doctor, too little, too late.  

For doctors involved in the care of VIPs, negotiating the tension between a celebrity’s demands, privacy, and what is in their best interest is always a very tenuous and challenging situation. When a celebrity threatens to ruin a doctor’s career if the doctor doesn’t do what they want, that threat may very well be strong, given a celebrity's influence and money. On the other hand, some doctors may prey upon celebrities as well; these doctors may order excessive procedures and give questionable medications and pseudo-advice, under the guise of expert care while simply raking in the profits and “reputation” of having been a celebrity’s physician. (Case in point, check out Gwyneth Paltrow’s holistic med-babble straight from her doctor on her much maligned website, or the iffy claims of Dr. Oz on his talk show, pushing the merits of green coffee beans.)

It’s unclear also if the doctors who prescribed these pills were simply unaware of how many meds their patients were collecting either. Heath Ledger reportedly overdosed on many different types of benzos and opiates (and I assume to him, they easily could have come from other people also of course). As someone who once prescribed medications out of a hospital unit, I did not have clear and easy access to the amounts of medications patients already had at home or had received from other outpatient physicians. I may have had my suspicions based on a patient’s behavior or history, if they have a history of substance abuse or “doctor shopping” as some term it, but I did not have any concrete evidence or information at hand on a uniform basis.

Sometimes pharmacies can track medication utilization through their insurance companies; Medicaid will sometimes deny a patient’s refill request if they have already received a given month’s supply. But for the vast majority, pharmacies, like physicians, operate in the dark, and do not know if a patient has visited 10 different pharmacies with 10 xanax scripts from 10 different doctors. Controversies remain over whether some form of unified national database for medical and prescription information would be a boon to medical care, preventing this abuse of the current system, or an unwelcome invasion of privacy leading to future health insurance denials and premium hikes.

I would hope that all physicians would follow the Hippocratic oath to do no harm, but physicians are prone to human vices as well. Conrad Murray apparently got into financial trouble due to a lavish lifestyle and having to pay child support to many children by different women. But even given all the various pressures placed upon physicians in recent decades (rising malpractice awards and liability costs, rising medical school tuition, managed care oversight and insurance denials, decreased reimbursements and increased workloads, etc.) perhaps some physicians felt a certain amount of anger and entitlement. I myself feel my blood boil when after 8 years of arduous medical training (and trust me, it was really tough), I have my medical opinion overridden by a managed care evaluator who has never seen the patient. Sometimes that anger spills over into looking at the money we make. In the last couple decades, we saw trial lawyers and investment bankers raking in millions while we toiled away working overnight, splicing veins and doing rectal exams, all under threat of career-ending lawsuit. Who wouldn’t want a piece of the money pie swelling up around us? 

Accordingly, some prominent doctors marched alongside drug companies, giving basically lecture-style commercials for the drugs the companies paid them to shill, and publishing biased research funded by the companies. Others shifted to creating elaborate medical services geared towards full fee payments outside the oversight of insurance. Full body scanning, botox injections, personal 24-hour access lines and "concierge medicine" service are just the tip of the iceberg. Conrad Murray was the ultimate personal physician, but he was utterly reckless in allowing his patient to dictate their own care.  

It’s impossible to fully know which of the aforementioned issues might have been involved in the shady deaths of these celebrities, if any. But given the recent spotlight on ethics in other career fields, perhaps a harder light needs to be shone still on the ethics of doctors, who we implicitly trust as professionals that vow to help others and save lives. We are not immune to the dazzle of celebrity and wealth either, and this can be our downfall, as illustrated so well in Tender is the Night by F Scott Fitzgerald, or The Citadel by AJ Cronin. In the former, Dr. Dick Diver falls in love with his glamorous, wealthy, mentally ill patient, and marries her, with disastrous consequences to his reputation. In the Citadel, Dr. Andrew Manson watches his idealism erode away as he sees his senior colleagues profit-take from wealthy hypochondriacs. Both are eerily prescient in describing physician-patient dynamics at play today in this world of capitalist overdrive. 

So to the doctors who kept shaving Michael Jackson’s nose away even as little remained, to those who handed out Valium and Oxycontin like candy and implanted Octomom with extra embryos, and racked up millions on the side to endorse increased medications for “bipolar” children, please take a good hard look at yourselves. It’s not all about the cash money. You went into the wrong field then. 

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