Michael Jackson and Medical Paternalism

Since Michael Jackson’s death, there has been a push to use the long arm of the law to ransack pharmacy shelves and pluck out a killer. Law enforcement and the public seem thirsty for the arrest of one or more of Jackson’s doctors on charges of homicide, or more specifically manslaughter. A physician can be legally responsible if he is found negligent or reckless in the death of a patient.

Dr. Conrad Murray was present during Jackson’s last moments, and if he physically administered a lethal drug, it would, of course, place him directly in the firing line. But what about the dozens of physicians who have written prescriptions for the singer over the years and who are now being tracked down and investigated? The indirect act of prescribing medications can legally expose an MD, but should it? Should the law be changed to shift a greater degree of responsibility to the patient?

Medical paternalism is interference in a person’s health by a doctor, the FDA or another “authority” because the “authority” is assumed to know what is best for that person. It is imposed against a patient’s will, results in a limitation of autonomy and can spiral into a “you can’t handle the truth” philosophy in which pertinent information is withheld from the sick.

Michael Jackson used aliases and “doctor shopped,” which means he went from one physician to another until he acquired the medications he desired or needed; and a tremendous amount of evidence suggests he required drugs to function. Debilitating insomnia had plagued him for years, just as it did Elvis Presley and Heath Ledger, both of whom also died from prescription drug overdoses.

Michael Jackson’s nurse, Cherilyn Lee, says the singer begged for a powerful sedative, even though he knew it could be deadly, because he was desperate to sleep; and publicist Rob Goldstein says Jackson would dance for eight hours straight in his hotel room hoping it would make him tired. Two months prior to his death, Heath Ledger revealed his agony in getting only two hours of sleep per night; and Elvis Presley’s doctor, George Nichopoulos--whose medical license was suspended when the singer died—says Presley got no more than three hours of sleep at a time. Presley was caught in demanding cycle of needing energy at showtime, then seeking sleep so he could feel refreshed the next day. Perhaps medication was the only solution if he wanted to remain an international star rather than an infirm recluse. Jackson had just left a more secluded life to jump into a grueling rehearsal and concert schedule when he overdosed.

It is all too easy for those who are free from pain and from crippling insomnia to mount their moral high horse and preach about willpower and alternative remedies. Most insomniacs have tried everything, still suffer and turn to heavier and heavier medications. Check the Internet blogs and sleep disorder forums; talk of suicide is as routine as brushing ones teeth.

“I’ve had insomnia for 14 years,” one person writes. “What is the value in a life with chronic unrelenting insomnia night after night?” Someone replies, “I am at 13 years, contemplating suicide.”

A lawyer comments, “If I get off meds, I can’t do my job,” and a teacher says, “I’m literally fighting to stay awake as soon as the day begins. I feel like death. I am only 25, and I look like I am 35-40.”

An unemployed woman writes, “My $200 per hour doctor is no help. He won’t prescribe sleeping pills because he is worried I will deliberately overdose. But life is not worth living. All I do is cry.”

Is this how Michael Jackson, Heath Ledger and Elvis Presley felt? If so, one can understand their desire to try hardcore medications, even at the risk of addiction, injury or death. Plus, life in show biz is demanding: a person must be at his best regularly and at exact times, a Herculean feat for someone with chronic insomnia.

Michael Jackson’s doctors have been described as greedy, selfish enablers with “blood on their hands,” but isn’t it just as likely they are caring individuals who are willing to risk personal liability to help the suffering? Dr. William Hurwitz has been described as such a person. He was a Virginia pain management physician, but now sits in jail for prescribing drugs that some of his patients abused. His property was seized by authorities, and after his practice closed, two patients reportedly killed themselves because of untreated pain.

Mentalist Uri Geller and one of Michael Jackson’s bodyguards claim they confiscated anesthesia injection equipment from the singer and screamed at him to get off drugs, but he ignored their warnings. Jackson was clearly willing to assume the risk, so why can’t his fans and family respect his decision? He would certainly want to be held personally responsible for his health-related choices rather than witness what could be described as a modern-day witch hunt against physicians who were arguably just trying to help.

Personal responsibility is unfortunately out-of-style. Today’s society is like a game of dodge ball: there is a tendency to skirt responsibility, shoving a scapegoat out in front to be struck and blaming the team’s loss on him. History teaches us that sins are symbolically washed away when a scapegoat is punished; it’s a ritual that seems to provide psychological satisfaction for a mourning nation that needs an answer to failure and loss. I believe this explains why doctors are routinely and overzealously pursued when a celebrity dies of a prescription overdose and why there is public outrage towards the doctors in Michael Jackson’s life.

Perhaps my libertarian tan lines are showing, but I think doctors, the FDA and other “authorities” should be advisors rather than powerful patriarchs who can shove their mighty pen in their pocket, depriving patients of medications which may be their only hope for a pain-free life. Centralized prescription databases—which are being launched throughout the nation--are risky, “big brother” enterprises that should be discontinued until such time as patients are given greater control over their own health.

In general, people assume a passive role in their medical lives, mindlessly trusting doctors. Instead they should be legally entitled to take greater responsibility for their own wellbeing and encouraged to research the pros and cons of their medications, in addition to pondering—rather than robotically accepting--the advice offered by health professionals. It is simple to log onto Internet forums and read about drug side effects and benefits, as well as clinical studies.

To assure patients are properly advised of side effects, signed disclosures could be required along with impartially produced Internet videos outlining the disadvantages and advantages of a particular drug. The goal would be threefold: proper disclosure, input from a doctor and tools that help individuals make decisions that are right for them.

Regulating medicine through criminal law enforcement is misguided and counterproductive, and could lead to fewer physicians, especially in the chronic pain management field. According to the Association of American Medical Colleges, there is already likely to be a shortage of 124,400 doctors by 2025. There are medical professionals today who specialize in “self-defense,” by putting their own desire to stay out of criminal court above the interest of the patient. Some flat-out refuse to treat those with chronic pain due to the ever-present oppression and intimidation by law enforcement. The Hippocratic Oath should not be at war with the Drug Enforcement Administration.

Individualism and self-determination are fundamental values that most of us cherish; however, in medicine, they rest on the pharmacy’s dusty back shelf. Medical paternalism is outdated and not a panacea.

America needs a new prescription; and frankly, I think Michael Jackson would agree.

Clueless at City Hall: Foreclosures and Tenants

You may have noticed the cascade of articles about foreclosure-related evictions that have streamed through mainstream media and the blogosphere with the common theme that tenants are drowning and need a legislative life vest. But you may not know that the Los Angeles City Council, in an ill-advised and shortsighted move, voted to give them more than that vest; it handed them an ocean liner, sinking everyone around them.

I am talking about the ordinance 180441 or Article 14.1 of Chapter IV of the Los Angeles Municipal Code, known as the “Eviction of Tenants from Foreclosed Residential Rental Properties.” It essentially bars evictions from foreclosed properties and places foreclosed single-family residences under the rent stabilization ordinance (RSO). Listed as an emergency measure, the ordinance barreled scrutiny-free through city hall in 12 days, leaving the public and neighborhood councils little time to respond.

This ordinance states a tenant cannot be evicted from a foreclosed house, condominium or post-1978 apartment building—all which would normally be exempt from the RSO--unless one of two conditions are met: 1) the tenant fails to pay the rent or breaches the lease in a significant way (residing in the country illegally or getting roommates in violation of the contract do not qualify as eviction-worthy offenses), or 2) the landlord plans to occupy the property or demolish the premises, which triggers payment of pricey relocation fees. In other words, a renter must be allowed to live in a foreclosed home until the new buyer takes possession, gives proper notice for him to move, and pays him thousands.

The ordinance was established to safeguard tenants from getting a mere 60-day notice, as state law provided, when they had fully complied with their lease. Although some tenant protections are sensible, this ordinance goes radically overboard, proving disastrous for buyers, financially strapped homeowners, property maintenance crews, real estate agents, banks, neighbors and the community as a whole.

The ordinance encourages fraud. According to local Realtors, it is common these days for a property owner, who is losing his home in foreclosure, to sign a bogus lease agreement with a friend or relative (pretending to be a “tenant”) at a below-market value. The owner can then continue to live in the property for pennies on the dollar, and can, upon eviction, collect $7300 - $18,300 in relocation fees. Real estate agents say they frequently find utility bills listed in the name of the property owner rather than the “tenant,” indicating a scam rather than a valid lease. Sometimes two property owners facing foreclosure will switch houses and sign bogus lease agreements for each other. A new cottage industry has emerged: owners facing foreclosure are contacted and told that for a fee they can stay in their homes. The above scheme is explained.

When foreclosing on houses, banks do not have rental schedules in their files like they do with large apartment buildings; this makes it easy to pretend a low lease amount is fair market value. High-end properties—which may have a view, a large lot or elaborate upgrades--are ideal for this purpose. A “tenant” can convincingly argue that $2000 per month is all that can be collected for a house that would really bring in $5000 due to amenities.

The new ordinance also hurts buyers, especially those who have slender bank accounts and lack experience in the real estate market. Let’s assume a first-time buyer wants to purchase a tenant-occupied foreclosure. First, he must get a loan on the property. The bank may charge him a higher interest rate and the insurance company may charge him an excessive premium due to the fact that the property cannot be owner-occupied at the close of escrow.

Even though the buyer plans to reside in the home, he cannot ask the tenant to leave until 60-days after the close of escrow, at which time the buyer will be responsible for thousands of dollars in relocation fees. If the renter refuses to vacate, the buyer will have to hire an attorney and go through costly and time-consuming eviction process. In the meantime, the tenant could stop paying rent, destroy the house and steal appliances. Unless the insurance company chips in, repairs and replacements will come out of the buyer’s pocket as will the unsubsidized mortgage payments.

Why would anyone purchase a tenant-occupied foreclosure? Apart from a naïve buyer who is unaware of the ramifications, these properties sell to savvy investors who require deep price discounts in order to accept the tenant-related risks. Realtors tell me that they must regularly mark down these properties by 20-40% in order to get them sold, thereby devastating neighborhood values. Nearby homeowners may not be able to refinance or sell their homes for their true worth. When property values tumble, tax revenues decrease, and the overall economy suffers.

The ordinance means an increase in foreclosures as tenants learn it is in their interest to undermine short sales. A short sale occurs when a homeowner, who wants to avoid foreclosure and has a property worth less than the mortgage, asks the bank to take a reduction on the note so he can sell. The bank agrees.

However, when a tenant learns about the ordinance, he is usually unwilling to cooperate with a short sale. He knows that if he refuses to leave, he can force the property into foreclosure, and can probably avoid paying rent for a number of months, stay in the home until 60 days after it is sold and receive thousands in relocation fees. It is a windfall for the tenant, but quite painful for the property owner, who was hoping to maintain a semblance of creditworthiness and sell for the highest price so as not to be damaged by exorbitant taxes. Neighbors prefer short sales because they sell for more than foreclosures and usually mean a smoother transfer of ownership. Short sales are also better for a bank’s bottom line, thus making wiser use of taxpayer “bailout” funds.

LA Council President Eric Garcetti says the new ordinance saves communities from “the nuisances that can accompany empty, boarded-up homes.” It is true that some vacant foreclosures are an eye-sore, but hanging onto a tenant is not the answer. Tenant-occupied properties tend to look worse than vacant foreclosures, especially on the interior, and they are a much tougher sell. It would be preferable to mandate banks to keep the exterior of foreclosure properties tidy, watered and free from vagrants.

Real estate agents usually recommend evicting tenants prior to putting a home on the market. Tenants who do not want to leave often intentionally sabotage sales; they may whisper to potential buyers that the house is falling apart or that the neighborhood is undesirable. They rarely allow a lockbox for easy access and even though they agree to appointments (as required by law), they may repeatedly “stand up” buyers, agents, repairmen and maintenance crews, wasting everyone’s time. They may refuse to let the pool man and gardener into the backyard; these low paid workers are rarely compensated for lost hours. A tenant-occupied property, on average, sells for less than a vacant home, again impairing neighborhood values.

LA’s ordinance is wholly unnecessary now that President Obama and Congress have passed a measure called “Protecting Tenants at Foreclosure Act of 2009,” which provides a 90-day eviction notice for month-to-month renters and gives those with a bona fide lease the ability to remain in a property until the end of the agreed-upon term. “Bona fide” means the contract is the result of an arm’s length transaction and the rent is not substantially under fair market value. This law is unlikely to fall prey to scams and does not provide for outrageous tenant paydays.

Although the federal law puts banks in the landlord business, it provides the necessary protections for renters and communities. It is a vast improvement over the local ordinance, which currently trumps federal law.

When society has floated too far to the east, there is a tendency for politicians to make a wide and radical swing to the west rather than guide the sail to a sane middle-ground. This is what the LA City Council has done. Tell them to revoke the local ordinance so the waters can be calm again.

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Note: The Greater Valley Glen Council recently passed a motion, which was forwarded to the LA City Council, suggesting the new ordinance be revoked entirely, or revised to apply only to (five units or greater) apartment buildings, since these properties tend to be sold with renters intact.

Hold the MSG: It’s Not Risk-Free

I always assumed monosodium glutamate was like a snowstorm in Los Angeles: easy to avoid. I simply needed to sidestep Chinese restaurants and eyeball product labels for those conspicuous three letters: MSG.

At the same time I asked myself, why even go to the trouble? What’s the harm in ingesting this salty filler? If it were a culinary “evil doer” surely Food and Drug Administration (FDA) would pierce it with its mighty sword or at least put it in the stockades for all see and taunt. Since the FDA had no ban and no serious disclosure requirement, I figured all was fine in kitchenville, grocerville and restaurantville. I was wrong.

I suffered from migraines before I was old enough to say the word, “eye ache,” my childhood name for the excruciating pain that pulverized one side of my face eight days out of every month. While my school friends enjoyed recess between classes, I’d lie in my usual spot: on the cot in the nurse’s office.

While my classmates whizzed through standardized tests, I held a cold pack to my forehead and struggled to discern the fuzzy print. While my buddies hoofed it up at the prom, I lay in a hatchback of pain in the parking lot in my date’s Saab. This was my life until 2003 when things took a turn for the worse.

I started getting migraines every day, and the one prescription medicine that had decreased the pain on occasion, no longer worked. I pushed through weeks, months and years, experimenting with allopathic medicines as well as alternative remedies, such as acupuncture, homeopathy, massage and hypnosis. Nothing helped.

Thursday’s child may have far to go, but on a Thursday in December 2008, I got closer to relief when my husband said, “Maybe your migraines will go away if you stop eating monosodium glutamate.”

“What are you talking about? I hardly ever eat anything with MSG.”

Turns out I was wrong. This substance, which was discovered in 1908 by Tokyo University professor Kikunae Ikeda, is now as ubiquitous as blue jeans.

After more than 40 years of misery, I have learned the truth about MSG. I have learned it is 15 times more prevalent in food than it was in 1969 and that some people, like myself, are super sensitive to it, despite the fact that the FDA says it is safe at normal levels for most people. I have discovered it is a secret saboteur of health; the food industry tricks consumers into buying products with free glutamic acid (or MSG) by listing it under any one of 43 innocent-sounding names, such as natural flavoring, seasonings, yeast extract, spices, pectin or citric acid. A pesticide company called Emerald BioAgriculture uses an MSG type of “growth enhancer” which they have been spraying onto selected vegetables and nuts since 1999; the company is currently looking to get government permission to use the substance on organic produce.

Meats, seafood and poultry can be rinsed or injected with MSG before reaching your plate, and restaurant salad bars can get an MSG spritz, giving lettuce that perky look. This toxic additive can be found in vitamins, soaps, cosmetics, chewing gum and intravenous hospital fluids. It can be found in children’s medications, and it might lurk inside your migraine prescription.

In short, MSG acts as cheap filler, a flavor enhancer and a cosmetic surgeon, fooling unsuspecting consumers into thinking aged, withered foods are fresh. It can hide unpleasant tastes. It has an addictive component much like nicotine, and recent studies in Spain have conclusively linked it with obesity. MSG means profits for the food industry and its powerful Washington lobbyists; and it is no surprise that proper labeling legislation remains elusive.

If any additive containing the essential active ingredient of MSG, glutamic acid or free glutamate, is an amount that is less than 78%, the government does not require it to be labeled MSG. This is deceptive because MSG itself contains over 78% free glutamates. Some products will even say “No MSG” when they have glutamic acid in another form.

There are epidemiological studies, such as those brought to light by Dr. Adrienne Samuels, suggesting that up to 40% of the US population suffer from adverse reactions to MSG with drowsiness, numbness, chest pains, nausea, facial pressure, difficulty in breathing or headaches. The FDA claims only 2% of the population experience a bad reaction, but even if this is right, it amounts to whopping 6 million Americans, more than the 3 million who are allergic to peanuts.

It has been six months since I decided to eat, drink and be MSG free. I consume carefully scrutinized items from a health food store because Dr. Russell Blaylock--author of a book about the toxicity of MSG called Excitotoxins: the Taste that Kills--claims 75% - 90% of the foods sold at traditional grocers are laced with the unhealthy additive. I try to avoid restaurants and “brown bag it” to dinner parties. Miraculously the daily migraines have disappeared.

I am not goof-proof and have had seven consumption mishaps. Three resulted in four-day migraines which appeared exactly 18 hours after I ate the questionable foods. Only three migraines in six months or 12 days of sickness is better than Christmas when you are accustomed to a life as an invalid.

If migraines are your curse, limit yourself to healthy food. Eat only organic fruits, vegetables, nuts and whole grains. Read every package. Ask every question. Petition every politician for better labeling laws.

President Obama has described current procedures for regulating food safety as a “hazard to human health” and plans to overhaul the system for the first time in more than 70 years. Yet, the toxicity of monosodium glutamate is not on his radar. Tell him it should be.

Tell him MSG is not risk-free.

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The Greater Valley Glen Council recently passed a motion which states, “For any new product or recipe change, food manufacturers must measure for free glutamic acid and disclose it as MSG on the label with levels present in milligrams.” The motion has been forwarded to the Los Angeles City Council and to Sacramento Legislators for further consideration.