I remember the day that Michael Jackson died vividly. For many in my generation it has become something of a JFK moment. I'll never forget where we were when we heard the news. We were on holiday with friends on a Greek island as we watched the story break on the BBC World News channel, having received a text which we thought was a joke from a friend in London. Our shock soon became sadness at the loss of someone so ludicrously talented - someone we'd grown up listening to on the radio, and done bad impressions of doing the moonwalk. I remember thinking how strange it would be that my son's generation would grow up never knowing MJ as a living person - a little bit like Elvis Presley was to me.
I wouldn't have said that I was a massive MJ fan, but as a huge music and Motown lover, I realised after his death that I had somehow managed to collect almost his entire catalogue over the last 30 years of music buying. I still have the original gatefold sleeve version of Thriller and remember catching him live in Paris on the Dangerous tour in 1992. He rocked.
As the story of his death unfolded after what seemed like weeks of global outpouring of grief, my medic friends and I became increasingly interested in the medical aspects of his care. Enter Dr Conrad Murray, a cardiologist from Las Vegas. Let me tell you that there is nothing pleasurable about watching a fellow medic being scrutinised and hauled over the coals in the media until a case has been to court, but this story was beyond unusual, making it bizarrely captivating. Even summarising it sounds ridiculous: a doctor had apparently given the King of Pop an intravenous anaesthetic in order to help him sleep of a night, after which he died.
My medical brain was curious on many levels. Pharmacologically, the whole thing was mind bending. How and why did Dr Murray end up giving MJ such powerful drugs in the first place? And if he was a cardiologist, how could he become a personal physician treating general medical conditions? And in terms of the doctor-patient relationship I wondered if the fact that Murray was hired with a huge fee in mind, pressured him into prescribing and administering drugs in a setting and for a reason where no other doctor seemingly would?
Certainly one could argue that the profit motive of private medicine could make a doctor want to give a patient what he or she wanted. And all Jackson wanted was to get a good night's sleep. Imagine it. You're the doctor responsible for the wellbeing of the most famous pop star in the world. Apparently Jackson had suffered with insomnia for years and, according to trial testimony, had asked several doctors to prescribe him propofol (an anesthetic agent which he referred to as 'milk' because of its white appearance). Murray obliged, and on the day of Jackson's death he had been given a cocktail of benzodiazepines - midazolam, lorazepam, diazepam as well as propofol.
There are so many causes for insomnia including stress, thyroid problems, depression, noise, light - in fact sleeping pills themselves can cause it. I do wonder whether Jackson had ever tried sleep hygiene, behavioural techniques, biofeedback or other measures as well as medication. What amazes me is that with all the money that Jackson had and the wealth of medical contacts Murray would have presumably had, that a sleep medicine specialist wasn't brought in to help. Had that happened maybe MJ would still be with us? Who knows. Sleep medicine as a discipline is really quite specialised, often with strict referral criteria here in the NHS, where it mainly focuses on the diagnosis and treatment of sleep apnoea and narcolepsy, but there are private clinics which deal with insomnia from other causes. Apart from the fact that this case is saddening from every angle with Murray facing up to four years in jail following the jury's verdict last night, it is a timely reminder that there isn't always a pill for every ill. Both doctors and patients ought to remember that.
As for The King of Pop, who chased sleep so much and will now sadly and ironically never wake up, he really was Gone Too Soon
This post has been modified from its original version.
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