Anesthesia represents: The Conrad Murray case

[Gern Blansten]

---

Members do not see this ad.

We've put people to sleep for drug addiction withdrawal. We put females to sleep for completely elective plastic surgery. Do you wag your judgement finger at these scenerios as well?

I agree with Jet on this one, as I alluded to before. What is determined to be acceptable practice, at times, appears arbitrary. Think back one hundred years ago. Do you think that a physician sitting in judgment of another physician would testify that putting someone under general anesthesia for a completely elective surgery to insert saline filled bags into the chest wall to help her self esteem would be looked upon favorably? Same with a drug addict undergoing rapid detox or liberal use of medicinal marijuana. At some point, our society decided that it was acceptable. We currently feel that giving someone propofol at home is criminal. Who is to say that 50 years from now, something similar won't be commonplace.

A lot of decisions in medicine and life are based on some strange things. Consider people who refuse blood transfusions for religious beliefs. Then research the bible verse this is based on, the number of people who have died related to to it (including countless children), and the number of doctrine changes that have occurred within the church over the past 75 years. Is it acceptable to knowingly not save a mother's life and doom her children to be raised without a mother, all based on religious doctrine that has changed dramatically over the past 75 years? I have honored this request before, but not without a lot of misgivings (thankfully, the outcome was good).

Beliefs change and usually for completely arbitrary reasons. Some things that one would never have believed 100 years ago are now commonplace. Other things are scoffed at. Who decides what becomes acceptable. One person said that there is a certification board that endorses one activity, so it is different. I suspect that this did not occur overnight. People are willing to pay for ways to change their appearance, therefore, there is money to be made, therefore, people train to be able to provide that service, therefore, the need for a certification board is needed. It does not just arise out of nowhere. There were people providing this service before a board was there to legitimize it.

I am playing the devil's advocate to try and get people to think about this a little bit differently. One hundred years from now, anesthesiologists may be delivering propofol (or it's equivalent) in clinics for sleep therapy. We just don't know what will be accepted as norm in the future. The odds that propofol infusions will ever be accepted is now pretty slim, given the rocky beginning and the criminal findings. But what if MJ's experience had been much different and in a different setting and he had come out as a proponent of propofol for sleep disorders in the media. Even though the FDA had not approved it for that and their was no scientific evidence to support it, I guarantee that if MJ had proclaimed how great it was and how it had helped him, the public requests for it would have been there. Heck, there are orthopedic surgeons breaking perfectly good legs of short people who want to be taller. The couple of these leg lengthening surgeries I have heard about were disastrous, but the physicians aren't being tried criminally for it.

I still say, it all depends on what is determined by society to be acceptable. Some pretty crazy stuff is deemed acceptable (much of plastic surgery, orthopedic leg lengthening, ECT's, ketamine infusions for migraines{supposedly effective}, celebrity rapid detox, leeches, botox, liberal use of medicinal marijuana etc). Many are effective treatments, but some crazy person and their physician had to try it first.

Granted, Conrad Murray made a poor choice. I am not arguing that and I am not condoning what he did. Just arguing that we do some weird stuff in the field of medicine; some accepted now as norm and others shunned as too far outside the norm. Is the first physician that ventures into new territory and has a bad outcome a criminal, or just a physician that makes really bad decisions?

 

[WholeLottaGame7]

I'd guess almost certainly not ...



I can't for the life of me find the reference I was thinking of there, which I think actually predated the last decade's rise in meth and rx drug abuse, so my statement may not even be accurate any more. I recall thinking the data there was skewed because most US illicit drug users are pot smokers, and a huge % of them are casual recreational users that certainly don't exhibit the behavior of addicts.

I guess I ought to retract my "Most recreational drug users aren't addicts" statement, since I can't cite any actual evidence. I believe it to be true though.

Seeing as how most of us have imbibed an alcoholic beverage or two (or ten) in our lifetimes, and seeing as how most of us are (hopefully) not alcoholics, I would say that your statement is more than likely correct.

 

[jetproppilot]

I hadn't thought about it, but maybe I am finger wagging.
Your expertise is in providing a safe anesthetic and providing pain relief in the peri-operative period.
NOT sleep medicine, addiction medicine, and maybe psychiatry, all of which Michael Jackson apparently needed.
I'm agnostic so I don't think it would be "a sin" to seek financial gain in this situation. I do believe in greed (and potentially negligence), which offering your "expertise" would, in my opinion, equate to here. "Cottage industry"? Give me a break bro.
Your examples of providing an anesthetic for elective surgery or withdrawal symptoms (which we know isn't completely supported by the evidence) do fall under your area of expertise, so the comparison is false.

Your antagonism persists. For what reason, I dunno dudette. Or dude. Or whatever you are.

Sooooo...

you said my expertise for providing an anesthetic for withdrawal symptoms falls within my level of expertise.

I'm not an addiction specialist. I'm a consultant to an addiction specialist.

You lambasted me for suggesting propofol for insomnia since I'm not a sleep specialist.

Uhhhhhh, THAT DOESN'T MATTER. I'm more qualified than anyone on planet earth to try a trial of propofol for insomnia treatment.

If and when there's

EVER A CORRELATION

between insomnia treatment and propofol, which there very well may be despite your

CLOSED MINDED, NURSE-STUPIDVISOR-esque thinking (protocol always protocol never think outside the box always think current day always accept the norm

the dude that figures it out will be

AN ANESTHESIOLOGIST

since "Sleep doctors"

can't use the s h it, and even if they could they couldn't

intervene in an emergency which would make them as guilty as...

Kinda surprising you list your title as

ATTENDING.

The title DOCTOR infers

forward thinkers that don't stifle new ideas.

Btw your sarcastic comeback to my suggestion of a cottage industry....you said

"Gimme a break bro."

That's what they told

Steve Jobs.

 

[Pooh & Annie]

We have very, very different opinions on this one.
I didn't initially mean to be antagonistic. Anyone who knows me would say I'm about as laid back as a person can get, sometimes to a fault. The laissez-faire attitude toward experimenting on patients for the right money just makes me a little ill.
I remember your argument about wearing the white coat to remind colleagues that anesthesiologists are doctors, and I agree. You know what would be even more effective? Be a doctor.
The idea that "I'd give MJ some propofol to get him some sleep, for the right price" is NOT being a doctor. You're an anesthesiologist and you think pushing propofol is "thinking outside the box"? I can't think of anything more inside the f*cking box. If I were a non-anesthesiologist medical colleague, I would probably read that and think "this is why anesthesiologists aren't doctors".
Michael Jackson's problem was the number of yes-men surrounding him, he didn't need one more. Instead of pushing propofol, how about telling him a) You're not the messiah. B) Drop the 300-whatever rehearsals/concerts in a year. Change your schedule and lifestyle or you will die. C) Kick the habit. Go to inpatient rehab now. D) See a psychiatrist. You're a f*cked up guy, and you need intense help. D) Sleep ain't your problem. Anyone who tells you it is is a quack. If you get your problems taken care of and you still have insomnia, a sleep specialist should get involved.
If you couldn't tell him what he needed to hear, then don't get involved. He had a nurse who he asked to push propofol and she was smart enough to get the hell out.
I'm way-the-hell far from perfect, and have never been on a high-horse in my life. But I like to think I wouldn't do the absolute wrong thing for my patient for the right price.
Steve Jobs?! Yeah. You're exactly like Steve Jobs dude.

 

[Pooh & Annie]

There is some preliminary evidence that propofol may provide restorative sleep, and no where have I said there's no future in its use as an agent for treatment of insomnia, although I'd be surprised if that happened. I'm not arguing about its potential novel uses. I'm arguing specifically that providing it to Michael Jackson, either by an anesthesiologist or otherwise, was wildly inappropriate and in this case, criminal.
Physicians should try to do the right thing for their patients. Experimental efforts might be reasonable only if appropriate, evidence-based methods have failed.

 

[jetproppilot]

We have very, very different opinions on this one.
I didn’t initially mean to be antagonistic. Anyone who knows me would say I’m about as laid back as a person can get, sometimes to a fault. The laissez-faire attitude toward experimenting on patients for the right money just makes me a little ill.
I remember your argument about wearing the white coat to remind colleagues that anesthesiologists are doctors, and I agree. You know what would be even more effective? Be a doctor.
The idea that “I’d give MJ some propofol to get him some sleep, for the right price” is NOT being a doctor. You’re an anesthesiologist and you think pushing propofol is “thinking outside the box”? I can’t think of anything more inside the f*cking box. If I were a non-anesthesiologist medical colleague, I would probably read that and think “this is why anesthesiologists aren’t doctors”.
Michael Jackson’s problem was the number of yes-men surrounding him, he didn’t need one more. Instead of pushing propofol, how about telling him a) You’re not the messiah. B) Drop the 300-whatever rehearsals/concerts in a year. Change your schedule and lifestyle or you will die. C) Kick the habit. Go to inpatient rehab now. D) See a psychiatrist. You’re a f*cked up guy, and you need intense help. D) Sleep ain’t your problem. Anyone who tells you it is is a quack. If you get your problems taken care of and you still have insomnia, a sleep specialist should get involved.
If you couldn’t tell him what he needed to hear, then don’t get involved. He had a nurse who he asked to push propofol and she was smart enough to get the hell out.
I’m way-the-hell far from perfect, and have never been on a high-horse in my life. But I like to think I wouldn’t do the absolute wrong thing for my patient for the right price.
Steve Jobs?! Yeah. You're exactly like Steve Jobs dude.

Whatever man.

You've missed my points and inferences.

Think outside the box.

 

[matt30]

Contrary to Dr. White's testimony, 25mg of propfol is enough to kill someone. I had someone in my group give a 90 year old 25mg of propfol for a TEE. About 10 minutes later I was called when the patient was arresting. Now, I don't know the stae Michael Jackson's heart was in. I remember seeing him in a wheel chair, so he was not the healthiest person on this planet.

Here's my question. Lets say Dr. Murray managed to bring Michael back. Someone comes by and reports Dr. Murray for this. Would there be criminal activity for using propofol outside of an approved medical setting or use? Kind of like how we use botox for wrinckles.

Even if 25mg could not have killed MJ, it is questionable behavior to leave the drug in the room for the purpose of self-administration. That in itself (if it is a significant deviation from the standard practice of a resonable prudent physician) would satisfy the gross negligence requirement.

If Dr. Murray was able to bring MJ back, it would not be manslaughter (obviously). The authorities could charge him with assault, but consent (almost universally across the united states) is a defense. The answer could be different if Murray somehow mislead MJ about the true nature and effects of the drug; even then prosecutors tend to leave these kinds of matters to the civil justice system.

 

[matt30]

An attorney actually interested in facts and applying "the law"? Those are few and far between. You haven't learned this yet?

The biggest problem with the profession is the ABA doesn't regulate with the same force as the AMA. There are about 200 law schools in the US; 100 more than are really needed IMHO. The few bad apples that get through tend to 1) get the most noteriety and 2) mess up in the most fantastic of ways.

 

[matt30]

I agree with Jet on this one, as I alluded to before. What is determined to be acceptable practice, at times, appears arbitrary. Think back one hundred years ago. Do you think that a physician sitting in judgment of another physician would testify that putting someone under general anesthesia for a completely elective surgery to insert saline filled bags into the chest wall to help her self esteem would be looked upon favorably?

I'm not sure what exactly the profession's standard for acceptable practice is but the law is fairly clear.

As the burden of taking necessary precautions becomes cheaper the law will allow more adventurous medical treatments. With the state of the law today home administration of propofol could be perfectly legal. Given the additional risks of doing it outside a proper medical setting, however, he should have had the works: an ambu-bag, ekg, defibrillator, a trained assistant to monitor the patient, ect.

 

[Gern Blansten]

I'm not sure what exactly the professions standard for acceptable practice is but the law is fairly clear.

As the burden of taking necessary precautions becomes cheaper, the law will allow more adventurous medical treatments. With the state of the law today, home administration of propofol could be perfectly legal. But given the additional risks of doing it outside a proper medical setting he should have had the works: an ambu-bag, ekg, defibrillator, a trained assistant to monitor the patient, ect.

No argument there. And just to reiterate, I in no way think what Murray did was acceptable. I just believe that we tolerate a lot of odd practices in medicine and deem them acceptable. This one is deemed criminal. Probably because MJ was famous. If not, CM would have gotten his license yanked and never practiced again, but probably would not serve time in prison.

 

[jetproppilot]

I just believe that we tolerate a lot of odd practices in medicine and deem them acceptable.

What's the definition of "odd practice?"

I completely agree with you btw but

breast implants are no longer odd, nor is putting a heroin addict under general anesthesia in an attempt to ameliorate his withdrawal symptoms....which is

precisely your point.

You're right....procedures done now would've been thought insane not too long ago.

Poo and Annie can't grasp that somebody

some ONE dude/dudette

started the breast augmentation revolution with an

idea.

Then tried it.

Somebody

some one dude

thought maybe drug addiction withdrawal could be made more palatable if it occurred under general anesthesia.

Then tried it.

I, like every other board certified anesthesiologist

has an intimate knowledge of propofol.

I think propofol can play a role in improving sleep cycles of insomniacs.

I'm not sure of that of course but I could provide a safe environment for a raging insomniac to try it out to see if it helps them back to normal sleep cycles.

Critics will lambast this assertion....as they

lambasted Steve Jobs

I'm sure the entire audience gets the correlation except for Poo and Ante.

No Poo, I don't think I'm Steve Jobs.

I think...no... I

KNOW

he was laughed at for some of his forward visions.

I'm an anesthesiologist.

I think propofol may be able to be utilized in some fashion

to

TREAT INSOMNIA.

There may be a cottage industry created (which you sarcastically commented on as well, POO).

Anesthesiologists providing safe care for insomniacs receiving powerful sedative hypnotics in an effort to restore their sleep patterns.

Your previous posts essentially called me crazy.

What are your credentials,

Poo?

I'm quite interested why you deem yourself

ARROGANTLY WORTHY

to scoff at my idea.

 

[Pooh & Annie]

I would've gladly administered MJ propofol at his home. My price for 24-7 care would've been higher.

He'd still be alive today though.

I didn't mean to sound like a d*ck. Nothing worse than a douche primping his feathers on an anonymous internet forum.

As I mentioned above, I never argued against any "ideas". I'm a pain physician and leave just about all options open for dying patients. My argument was with your statement above. Nothing else.

 

[jetproppilot]

I didn't mean to sound like a d*ck. Nothing worse than a douche primping his feathers on an anonymous internet forum.

Dude,

REALLY? DO YOU REALLY BELIEVE THIS REPLY YOU WROTE?

Review your posts man.

I believe

WHY YES!

YES,

YOU

INTENDED

TO SOUND LIKE A

DICK.

I put all four letters together for your viewing pleasure.

Your intent still eludes me.

As does your inability to put together

thoughts and inferences.

Thought you were beyond

concrete thinking.

 

[Pooh & Annie]

I'm willing to hear your outside-the-box consult idea.

As a consultant to Michael Jackson, my recommendations would have been:
1) Significant lifestyle modification with counseling about realistic working conditions (ie no 300+ rehearsals/concerts per year); evaluate for appropriateness of support (his managers and staff seem to only give/tell him what he wanted, not what he needed)
2) Inpatient rehabilitation for multiple medication addictions
3) Psychiatric evaluation
4) Nutrition assesment for failure to thrive (he was skin and bones)
In short, I think he needed multi-disciplinary assistance in order to survive and be healthy. Obviously I doubt he would have had any interest in listening, but I can only offer my advice as a physician.

These aren't exciting or innovative suggestions, but I'm not trying to be a "rokstar". I'm trying to offer advice that I think will help my patient in the short and long term.

From your post you intimate that you could help Michael Jackson with propofol. I would like to hear your plan. I think it's important for med students and residents to hear different options as offered by different physicians.

 

[Gern Blansten]

Not sure that propofol would play a role in treating insomnia, but I am not so bold as to say it could never be considered and that something similar might be accepted practice in 50 years.

 

[pgg]

So, Jet, would you be OK with an anesthesiologist administering sufentanil infusions to outpatients because he had an "outside-the-box theory" that it would

• help them rest, or
• make them happy, or
• prolong the lives of addicts because they'd have a safe source of drugs, or
• reduce an addict's risk of death by overdose because a board certified anesthesiologist was monitoring them, or
• reduce the risk of HIV and other diseases (clean needles!)

I bet you could make a lot of money doing that. And as an anesthesiologist, in the proper setting, with appropriate monitoring, you could surely do it safely. Aside from sufentanil being a Schedule II drug, is this any different than giving addicts propofol infusions?


Your (and Gern's) points about how a society's views of elective treatments or procedures change over time are well taken. I have a lot of respect for the entrepreneurial spirit.

But I'm having difficulty with an open-ended offer to supply an addict with drugs, regardless of whether it's a free service or extremely lucrative, while deliberately NOT offering to treat (or refer to someone else to treat) their medical and psychological problems in accordance with widely accepted standards.

 

[Gern Blansten]

So, Jet, would you be OK with an anesthesiologist administering sufentanil infusions to outpatients because he had an "outside-the-box theory" that it would

• help them rest, or
• make them happy, or
• prolong the lives of addicts because they'd have a safe source of drugs, or
• reduce an addict's risk of death by overdose because a board certified anesthesiologist was monitoring them, or
• reduce the risk of HIV and other diseases (clean needles!)

I bet you could make a lot of money doing that. And as an anesthesiologist, in the proper setting, with appropriate monitoring, you could surely do it safely. Aside from sufentanil being a Schedule II drug, is this any different than giving addicts propofol infusions?


Your (and Gern's) points about how a society's views of elective treatments or procedures change over time are well taken. I have a lot of respect for the entrepreneurial spirit.

But I'm having difficulty with an open-ended offer to supply an addict with drugs, regardless of whether it's a free service or extremely lucrative, while deliberately NOT offering to treat (or refer to someone else to treat) their medical and psychological problems in accordance with widely accepted standards.

I doubt that Jet is seriously advocating for providing this service. I think that he is just making the point that it may not be as far fetched as it might seem currently. The thought is clouded because of the tragic outcome of a physician who was ill prepared, in the wrong setting, and who made tragically poor decisions.
What if the first guy to do an epidural blood patch had their patient get an infection and die? And what if they were a celebrity who had given full consent to try out this new treatment?
My only point is that we do a lot of things in medicine that are accepted and commonplace that often make me think, "I would have liked to have been there the very first time this was done...what were they thinking? I can't believe someone really tried this."

 

[Pooh & Annie]

Not sure that propofol would play a role in treating insomnia, but I am not so bold as to say it could never be considered and that something similar might be accepted practice in 50 years.

Nobody here has been so bold as to say that. It's not even really an issue. There certainly could be a possibility that propofol may provide restorative sleep in some circumstances, which could potentially be safe and beneficial.

We also aren't discussion treating Michael Jackson in 50 years. We're discussing treating him in June of 2009. You said you agree with Jet, that propofol could benefit Michael Jackson in his current (then) condition. Well, I guess he really just said he would give it for more money, not that it would help him. I'll give him the benefit of the doubt and assume he offered that treatment because he thinks it is the best course of treatment for Michael Jackson, not because he wants to be MJ's doctor and make a lot of money.
I just want to hear the thought process involved in how this would be the best option for Michael Jackson in June, 2009.

 

[Pooh & Annie]

I doubt that Jet is seriously advocating for providing this service. I think that he is just making the point that it may not be as far fetched as it might seem currently.

Did you read Jet's post? If you're right, then there is no disagreement among any of us. We all agree that we have no idea where medicine will go. Id like to be among the forefront of medical technology in the future.
From your post I guess that you would be equally surprised if he advocated giving Michael Jackson propofol. He has nowhere indicated that that was schtick. I'm interested in how he would have provided Michael Jacksaon treatment with propofol.

 

[Gern Blansten]

You said you agree with Jet, that propofol could benefit Michael Jackson in his current (then) condition.

I said I agree with Jet that we provide a lot of services to patients that would have been scoffed at decades ago. I did not say I agreed that I think treating him with propofol would somehow benefit him. I also said that I do not know for certain that it would not have some benefit. The study has not been done as far as I know. For all I know, a study could be done in the future that did show some benefit.
The treatment plan you outlined above is certainly a far better treatment plan and is well established in evidence based medicine.
The ONLY point I have made is that certain practices in medicine are strange, and with a simple twist of fate, some are accepted as norm and some are rejected.
Removing fat and injecting it into someone's behind because they want a JLo butt is okay, even though lipo in office based settings was shut down in Florida due to multiple patient deaths.
Conrad Murray was way out there in his treatment of MJ, but is he really the only one who is doing strange stuff?
I feel like I have said this over and over, yet my message is consistently misconstrued.
Also, I know we are not talking about treating MJ in 50 years. I know this mainly because he is dead.🙂

 

[Pooh & Annie]

I said I agree with Jet that we provide a lot of services to patients that would have been scoffed at decades ago. I did not say I agreed that I think treating him with propofol would somehow benefit him. I also said that I do not know for certain that it would not have some benefit. The study has not been done as far as I know. For all I know, a study could be done in the future that did show some benefit.
The treatment plan you outlined above is certainly a far better treatment plan and is well established in evidence based medicine.
The ONLY point I have made is that certain practices in medicine are strange, and with a simple twist of fate, some are accepted as norm and some are rejected.
Removing fat and injecting it into someone's behind because they want a JLo butt is okay, even though lipo in office based settings was shut down in Florida due to multiple patient deaths.
Conrad Murray was way out there in his treatment of MJ, but is he really the only one who is doing strange stuff?
I feel like I have said this over and over, yet my message is consistently misconstrued.
Also, I know we are not talking about treating MJ in 50 years. I know this mainly because he is dead.🙂

You and I are in 100% agreement. You don't have to repeat your message.
The difference here: Doing experimental things that are out of the box, when your intent is to provide the best treatment course that you're aware of, is defensible. Providing unconventional/experimental options that are counterproductive to a patients health, when proven treatments exist is a violation of the Hippocratic oath and straight up greedy if done for profit.

 

[Gern Blansten]

You and I are in 100% agreement. You don't have to repeat your message.
The difference here: Doing experimental things that are out of the box, when your intent is to provide the best treatment course that you're aware of, is defensible. Providing unconventional/experimental options that are counterproductive to a patients health, when proven treatments exist is a violation of the Hippocratic oath and straight up greedy if done for profit.

Agree, though I still have trouble reconciling that with some practices that occur regularly across the US, thankfully, not where I work.

 

[Gern Blansten]

As for Jet, pretty sure he uses hyperbole for effect.
I am pretty sure he doesn't wanna be startin' something. He just wants to show that everything is not as black and white as it seems or as simple as A, B, C. Sometimes he's off the wall, but you need to just ease on down the road and enjoy yourself. The way you make me feel is bad, but now that Dr Murray has been found to be a smooth criminal, he just needs to look at the man in the mirror and know that what he did was dangerous. He should remember the time when he took the hippocratic oath, and realize he has left blood on the dancefloor. This thread has been a thriller, but now I need to beat it.

 

[Arch Guillotti]

All this silly arguing has got me workin day and night.

 

[Per4mer8]

All this silly arguing has got me workin day and night.

As a current applicant to this field I thoroughly enjoy this dialogue, I think some conversation/argument is great and this is one of those cases. I think hearing only from the established "standard" side is boring and not as thought provoking.

Now obviously I don't have anywhere near the knowledge of propofol as any of you, and I don't think I would ever be comfortable providing it's use as it was with MJ (even with all monitors/precautions) but I do want to hear Jets answers/plans. I hope he answers pgg's post.

I think evidence based medicine is great and def the future BUT I also think being so chained to it that no physician (who is supposed to be able to think for themselves and make decisions for individual patients) can TRY something not currently standard is against the very idea of medicine PRACTICE. if we go that way why not just have a nurse plug in sxs into Watson for it to spout out an answer like "87% of patients with these sxs responded favorably to xyz treatment" after which it prints out the script or referral to a surgeon with orders for one specific surgery procedure.

In that future world how do we get new treatments/drugs used in non-FDA approved ways? Obviously a study can compare a new med vs the gold standard but what about off-label use? It still is interesting to me that Demerol is used like candy for post-op shivering.

Just my rookie .02

 

[doctor712]

As for Jet, pretty sure he uses hyperbole for effect.
I am pretty sure he doesn't wanna be startin' something. He just wants to show that everything is not as black and white as it seems or as simple as A, B, C. Sometimes he's off the wall, but you need to just ease on down the road and enjoy yourself. The way you make me feel is bad, but now that Dr Murray has been found to be a smooth criminal, he just needs to look at the man in the mirror and know that what he did was dangerous. He should remember the time when he took the hippocratic oath, and realize he has left blood on the dancefloor. This thread has been a thriller, but now I need to beat it.

Well done GERN! 😀

 

[RT2MD]

As for Jet, pretty sure he uses hyperbole for effect.
I am pretty sure he doesn't wanna be startin' something. He just wants to show that everything is not as black and white as it seems or as simple as A, B, C. Sometimes he's off the wall, but you need to just ease on down the road and enjoy yourself. The way you make me feel is bad, but now that Dr Murray has been found to be a smooth criminal, he just needs to look at the man in the mirror and know that what he did was dangerous. He should remember the time when he took the hippocratic oath, and realize he has left blood on the dancefloor. This thread has been a thriller, but now I need to beat it.

Well played, sir... well played.

That last bit might have been a bit too much information though...

 

[Gern Blansten]

Well played, sir... well played.

That last bit might have been a bit too much information though...

Just a figure of speech my good sir...as I am sure MJ intended it to be interpreted.

 

[Ericokle]

Conrad Murray defends his actions in a TV interview:

http://www.cbc.ca/news/arts/story/2011/11/10/conrad-murray-today.html

 

[RT2MD]

Just a figure of speech my good sir...as I am sure MJ intended it to be interpreted.

Well, at least I was able to satisfy my Jr. High level sense of humor. 😎

 

[jetproppilot]

As for Jet, pretty sure he uses hyperbole for effect.
I am pretty sure he doesn't wanna be startin' something. He just wants to show that everything is not as black and white as it seems or as simple as A, B, C. Sometimes he's off the wall, but you need to just ease on down the road and enjoy yourself. The way you make me feel is bad, but now that Dr Murray has been found to be a smooth criminal, he just needs to look at the man in the mirror and know that what he did was dangerous. He should remember the time when he took the hippocratic oath, and realize he has left blood on the dancefloor. This thread has been a thriller, but now I need to beat it.

Hahahahahahahahahhahahahahahah!!!!!

Nicely done.

And Pooh,

RHYTHM NATION

can happen.

(ok it's his sister but Gern ate up all the good stuff...that's all I got)

Remarkable how great stuff comes from challenge and conflict.

I'll post more tomorrow.

 

[ssmallz]

This would have a been a much more interesting case if Dr Murray had been a) a physician skilled in airway management, b) monitoring the pt correctly, and c) acting in accordance with standards of care once things went wrong. This would be a totally different case and one with significant ethical and moral grey areas about the practice of medicine and off label uses of propofol.

 

[michigangirl]

Agree with ssmallz. There were so many things wrong with what Murray did that it was hard to focus on any one.

 

[Substance]

Jet, I think you have some pretty Off the Wall thinking there.

 

[jetproppilot]

You and I are in 100% agreement. You don't have to repeat your message.
The difference here: Doing experimental things that are out of the box, when your intent is to provide the best treatment course that you're aware of, is defensible. Providing unconventional/experimental options that are counterproductive to a patients health, when proven treatments exist is a violation of the Hippocratic oath and straight up greedy if done for profit.

Propofol administration

by an anesthesiologist

in MJ's setting would

NOT HAVE BEEN

"counterproductive to a patient's health".

Which would've made it

Not a violation of The Oath, Slim.

AS FAR AS YOUR COMMENTS ABOUT

GREED

Michael Jackson would be alive today had I been the

PROPOFOL GIVING DOCTOR.


HOW MUCH IS THAT WORTH?

And yeah, I'll confirm I would've

taken the gig. Readily.

All you JUDGEMENT DUDES out there....putting females to sleep for their BREAST AUGS.....

LIPO....

REALLY?

You dudes think risking a general anesthetic for

PUTTING BALLOONS IN A

WOMANS CHEST TO MAKE HER

BOOBS BIGGER IS

"OK"

yet when I

Suggest

Propofol may potentially help restore sleep patterns and

I'm ridiculed?

HAHAHAHAHAHAHAHAHAHAHAHAHAHA!!!!!!!!

[/B]

 

[pgg]

How about sufentanil, Jet?

 

[jetproppilot]

How about sufentanil, Jet?

Nahhh man.

Can't support it.

Sufentanil is a

great f u king drug man.

I endorse it

READILY

if you're talking about

BIG

anesthesia cases..


Using SUFENTA

in the areas where you are

GOING

with your post,

NO.

I'm not interested in feeding someone with an opioid addiction a new opioid.

So SUFENTA is out.

Wouldn't ENABLE

that line of thinking.

SOOOOOO......

where are you going with this?

 

[WholeLottaGame7]

Nahhh man.

Can't support it.

Sufentanil is a

great f u king drug man.

I endorse it

READILY

if you're talking about

BIG

anesthesia cases..


Using SUFENTA

in the areas where you are

GOING

with your post,

NO.

I'm not interested in feeding someone with an opioid addiction a new opioid.

So SUFENTA is out.

Wouldn't ENABLE

that line of thinking.

SOOOOOO......

where are you going with this?

I think the point is that "helping a patient get some sleep," "feeding an addict's habit," and "doing something counterproductive to a patient's health" are not separate scenarios, they are all sides of the same scenario. How do you distinguish one from another? Can you?

 

[pgg]

I'm not interested in feeding someone with an opioid addiction a new opioid.

It's interesting you say that, because feeding someone with a opioid addiction a new opioid (eg, methadone) is widely practiced and accepted as part of a treatment program ... in some cases, weaning isn't even an objective.

The first person to prescribe methadone to help opioid addicts was thinking outside the box. He boldly created a new cottage industry. Oooh, the naysayers must've been pissed!

Why is sufentanil too far outside the box for you?

So SUFENTA is out. Wouldn't ENABLE that line of thinking.

So you wouldn't ENABLE an opioid addict by supplying sufentanil. Check. We can agree on that.

But you'll ENABLE a propofol/benzo addict by supplying propofol?


There doesn't seem to be any logic or consistency to your stance here.

 

[Per4mer8]

Has propofol been proven addictive? I know there are talks about making it scheduled (not completely up on the politics/reasoning for this other than Fospropofol is getting the scheduled designation). Is it mainly due to the MJ case or does it have proven addiction/abuse potential?

If it is addictive then I see the similarities between giving it for benzo addiction and methadone for opioid addiction.

Good post pgg.

 

[Arch Guillotti]

Has propofol been proven addictive?

yes

Propofol Abuse Growing Problem for Anesthesiologists

 

[Gern Blansten]

yes

Propofol Abuse Growing Problem for Anesthesiologists

Your link highlights a part of the Murray trial that always troubled me. They acted as if MJ administering the drug to himself was out of the realm of possibilities. When in reality, it is highly possible and all of the dead propofol addicts who died alone in a room are a testimony to that.
Consider for a moment that if you had a syringe of propofol attached to a flowing IV. Do you think you could administer yourself a lethal dose though the IV before the effects of the propofol set in? If you answered yes, you are correct.
MJ had been watching someone do this every night for 1-2 years?? Pretty sure he now how to empty a syringe into an IV. Did he really do that? We will never know the truth, but to dismiss it as impossible is not being honest. There are many dead anesthesia providers who are proof.
This does not mean Murray did nothing wrong, it just might mean he was telling more truth than people give him credit for.

 

[Per4mer8]

yes

Propofol Abuse Growing Problem for Anesthesiologists

Read the article. Interesting but doesn't really discuss the actual scientific aspect of addiction/dependence. Point taken regardless. I still have no idea the draw of injecting something that burns and puts you to sleep (potentially for the last time) in seconds.

But....this abstract puts propofol addiction/dependence potential in more concrete terms. http://www.ncbi.nlm.nih.gov/m/pubmed/21809257/

 

[Arch Guillotti]

Read the article. Interesting but doesn't really discuss the actual scientific aspect of addiction/dependence. Point taken regardless. I still have no idea the draw of injecting something that burns and puts you to sleep (potentially for the last time) in seconds.

I did read it. If it isn't addiction, what is it?

 

[Per4mer8]

I did read it. If it isn't addiction, what is it?

Lol. "Read" as in I read the article, not you should read the article. I was simply saying I read the article but was looking for more than ya it's abused and ya people die from it.

 

[Arch Guillotti]

Lol. "Read" as in I read the article, not you should read the article. I was simply saying I read the article but was looking for more than ya it's abused and ya people die from it.

heh😛

It is clear that propofol has the potential for abuse and can hook you fast.

MJ was an addict.
Propofol is addictive.
Feeding an addicts habit sure sounds like bad medicine to me. I don't care how bad he wanted to sleep.

 

[jetproppilot]

It's interesting you say that, because feeding someone with a opioid addiction a new opioid (eg, methadone) is widely practiced and accepted as part of a treatment program ... in some cases, weaning isn't even an objective.

The first person to prescribe methadone to help opioid addicts was thinking outside the box. He boldly created a new cottage industry. Oooh, the naysayers must've been pissed!

Why is sufentanil too far outside the box for you?




So you wouldn't ENABLE an opioid addict by supplying sufentanil. Check. We can agree on that.

But you'll ENABLE a propofol/benzo addict by supplying propofol?


There doesn't seem to be any logic or consistency to your stance here.

It appears you are arguing for the

sake of arguing.

Dude, wtf?

What possible efficacy could come from giving Sufenta, or any other opioid for that matter, for sleep deprivation?

Ohhhh.... I remember...

None.

2-6-di isopropyl phenol is a powerful sedative hypnotic which I believe may ameliorate sleep problems.

Your point about methadone for opioid addicts is accurate but superfluous to this conversation.

Yes, Michael Jackson needed to purge himself of polypharmacy.

Had I been his MD I would've insisted that happen.

I think he could've made that happen with the right physician in his corner.

That being accomplished, if he still suffered from insomnia and desired propofol to assist with sleep I would've

GLADLY PROVIDED.

And like I've previously stated,

he'd still be alive today, moonwalking across your 60"

FLAT SCREEN.

Those of you out there who have been

JUDGMENTAL

about my opinion,

think about your judgement the next time you elect to

take a completely healthy 27 year old female to the operating room where you ENDORSE her risking SEVERAL potential complications

so

SOME DUDE CAN

1)Put a cuppla balloons in her chest to make her boobs bigger

2)Insert some big rod into her "saddle bags" (one of the most BRUTAL procedures I see btw) to suck fat out

3) completely FILET her face open with aspirations of higher cheek bones, a more prominent chin and a smaller nose

You judgmental people

CRACK ME UP

with your hypocrisy.

 

[pgg]

It appears you are arguing for the

sake of arguing.

Dude, wtf?

I'm sorry, I thought that's what you wanted when you reappeared and stirred the pot with your You Guys Suck thread. 😀 Drama, excitement, argument.

Actually, in truth, I'm arguing with you because you've made some very dangerous and ethically inappropriate declarations. Since you're a longtime respected member of the forum, I feel obligated to point out exactly how WRONG you are, lest tender impressionable young minds 🙂 or visiting laypeople get the idea that anesthesiologists have any legit business pushing drugs on addicts.

What possible efficacy could come from giving Sufenta, or any other opioid for that matter, for sleep deprivation?

None! That's the point!


Propofol might have some application in helping people get restorative sleep. Maybe.

MJ's problem wasn't insomnia though! He was a drug addict, and you said you'd supply his drugs! (But only if he paid you $millions.)

It's that simple.


All your blabber about new cottage industries and thinking outside the box are just pointless distractors to the real issue: Murray was supplying drugs to a drug addict waaaaaaay outside of ANY kind of addiction treatment, and you were not only OK with it, you said you'd have done it too, but for more money.

Yes, Michael Jackson needed to purge himself of polypharmacy.

Had I been his MD I would've insisted that happen.

Whoa whoa whoa, let's hear some safety beeping as that truck backs up.


That's great. It's also 180 degrees from everything else you've posted in this thread so far. You initially said you'd have given MJ his propofol, but you'd have charged more than $150K/month.

I'd like to think you've seen the error of your ways, and are changing your story now because you realize how ridiculously indefensible Murray's actions were.

Those of you out there who have been

JUDGMENTAL

about my opinion,

You're goddamn right I've been judgmental about your opinion - at least, when your opinion was that it would be OK to supply drugs to a drug addict as long as there was a 7-figure salary involved.

Now that your opinion has morphed and receded to "I'd treat his addiction, then maybe consider propofol ..." I'm somewhat less judgmental.

think about your judgement the next time you elect to take a completely healthy 27 year old female to the operating room where you ENDORSE her risking SEVERAL potential complications so SOME DUDE CAN

1)Put a cuppla balloons in her chest to make her boobs bigger

[...]

This is a very interesting area of medical ethics. There are some gray areas. That "completely healthy 27 year old female" may be physically completely healthy, but have psychiatric problems. Reasonable people can debate whether a psychiatric self-image problem is better treated with counseling or surgical alteration.

There are MANY areas of medicine with ethical gray areas. Elective aesthetic surgery. End of life care. Treating minors with crazy parents who get in the way. The level of health care all human beings are "entitled" to receive. The fact that ethical gray areas exist in medicine does not mean that your willingness to supply drugs to a drug addict if the paycheck is big enough is defensible, and I'm not obligated to pretend to respect or accept your position in that area.

I'm sorry if this hurts your feelings.

 

[jetproppilot]

Propofol might have some application in helping people get restorative sleep. Maybe.



Yeah, well, I read your incessantly

VERBOSE

POST,

man.

Look up above to your post, at YOUR QUOTE.

You are trying to argue something that is INARGUABLE.

Which is,

UHHHHHHHHHH,

my point.

Your sparring style leaves alot to be desired.

NO CONTEST.

I.E. : PROPOFOL MAY RESTORE SLEEP PATTERNS.

That's MY STANCE, SLIM.

WANNA SPAR, you

one hundred eighty pound, average

STICK?

I'm bored.

 

[jetproppilot]

I'm sorry, I thought that's what you wanted when you reappeared and stirred the pot with your You Guys Suck thread. 😀 Drama, excitement, argument.

Actually, in truth, I'm arguing with you because you've made some very dangerous and ethically inappropriate declarations. Since you're a longtime respected member of the forum, I feel obligated to point out exactly how WRONG you are, lest tender impressionable young minds 🙂 or visiting laypeople get the idea that anesthesiologists have any legit business pushing drugs on addicts.




None! That's the point!


Propofol might have some application in helping people get restorative sleep. Maybe.

MJ's problem wasn't insomnia though! He was a drug addict, and you said you'd supply his drugs! (But only if he paid you $millions.)

It's that simple.


All your blabber about new cottage industries and thinking outside the box are just pointless distractors to the real issue: Murray was supplying drugs to a drug addict waaaaaaay outside of ANY kind of addiction treatment, and you were not only OK with it, you said you'd have done it too, but for more money.




Whoa whoa whoa, let's hear some safety beeping as that truck backs up.


That's great. It's also 180 degrees from everything else you've posted in this thread so far. You initially said you'd have given MJ his propofol, but you'd have charged more than $150K/month.

I'd like to think you've seen the error of your ways, and are changing your story now because you realize how ridiculously indefensible Murray's actions were.




You're goddamn right I've been judgmental about your opinion - at least, when your opinion was that it would be OK to supply drugs to a drug addict as long as there was a 7-figure salary involved.

Now that your opinion has morphed and receded to "I'd treat his addiction, then maybe consider propofol ..." I'm somewhat less judgmental.




This is a very interesting area of medical ethics. There are some gray areas. That "completely healthy 27 year old female" may be physically completely healthy, but have psychiatric problems. Reasonable people can debate whether a psychiatric self-image problem is better treated with counseling or surgical alteration.

There are MANY areas of medicine with ethical gray areas. Elective aesthetic surgery. End of life care. Treating minors with crazy parents who get in the way. The level of health care all human beings are "entitled" to receive. The fact that ethical gray areas exist in medicine does not mean that your willingness to supply drugs to a drug addict if the paycheck is big enough is defensible, and I'm not obligated to pretend to respect or accept your position in that area.

I'm sorry if this hurts your feelings.

pgg,

for future reference if you ever find yourself in a predicament trying to justify your

PRODUCT

i left it ambiguous for a reason...dude if you think you can hurt my feelings you need to RESTART watching Queer Eye For The Straight Guy...

There's alotta Grey,

SLIM,

like you've noticed.

Here's the difference:

I AM NOT MURRAY.

MY DECISIONS WOULD'VE BEEN

COMPLETELY DIFFERENT

than that

MO FO.

My feelings relieved, that doesnt take away from the fact that

YOU ARE TOO STUPID

to see the difference.

Your fault,

SLIMSTER.

Not mine.