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Thriller Killer

Posted by Dr No on 25 August 2009

jacko.jpgThe news that Michael Jackson’s physician, Dr Conrad Murray, is to be charged with manslaughter for allegedly killing Jacko with an anaesthetic called propofol raises many questions – not least of which is why was propofol being used in the first place?

Doctors tend to be a bit like drivers when asked about their abilities – most reckon they are better than average. This is hardly surprising – a doctor who goes around saying he or she is worse than average isn’t going to do much for their patients – or their professional income.

Unfortunately they can’t all be better than average. In fact, there is an awful lot of dodgy prescribing going on, and, often as not it is over-prescribing – be it too much of a necessary drug, or, even more commonly, using a drug when it is not needed in the first place.

Doctors are often ambivalent about prescribing. They may deplore the over-prescribing of others but have no problem with their own prescribing habits – even if they are prescribing the very same drugs as those they seek to criticise. Even the excellent (and seriously ancient if he remembers the introduction of benzos) Jobbing Doctor is not immune to this practice.

There are tremendous pressures on doctors to prescribe. Even governments over-prescribe. Non-doctors may think it is all down to Big Pharma, and certainly a lot of it is, but there are other important factors, and one of the most potent is patient pressure.

In the case of powerful, often addictive drugs, the best course is never to start a drug – unless it is absolutely necessary. Once the patient has slept in the arms of Morphia, it is a thousand-fold more difficult to dissuade them from further prescriptions than it is to dissuade them from starting in the first place.

But for patients who like taking drugs (and of course many do not) who team up with a high-prescribing doctor it is all too easy to slide down the slope of ever increasing prescriptions for ever more potent drugs.

Propofol is a potent intravenous anaesthetic. It is short acting with little hangover effect – but potentially fatal complications can be delayed – which is why patients need to be monitored after taking it. It is not, repeat not, indicated for insomnia.

There can be no doubt that Dr Murray’s prescription of propofol for Jacko’s insomnia was inappropriate. Whether it came about because Murray is a trigger happy prescriber, or whether it was Jacko’s pleas for relief from his insomnia, there can be no doubt that it was a striking example of bad medicine.


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