Doctors to the Stars

Chapter 21 Doctors to the Stars And also under the (Obama) healthcare plan, pop stars will still be able to choose their own creepy personal physicians. So that’ll be good. – David Letterman People have always been fascinated with celebrities – and doctors have always been willing to line up to treat them. Going back to antiquity, kings and pharaohs had their personal physicians and today’s political elites are no different. The twentieth and twenty-first centuries have also seen the rise of a new generation of gods walk- ing among us, the “superstars.” These darlings of the paparazzi include professional athletes, musicians, artists, actors and actresses, religious icons, as well as some celebrities of dubious talent. Nowadays, celebrities routinely have their “court physicians.” These are the descendents of the doctors of yesteryear who “helped” their patients with leeches, bloodletting, enemas, and emetics; only now they use pills, syringes, and prescription pads to mollify their petulant clients. This Faustian doctor/patient relationship can make the physicians rich and famous – or leave them destitute, discredited or imprisoned. Dr. Feelgood Fame, money and influence, are often close companions of fate, prompting dangerous self indulgence. While it is true that alcohol abuse and drug addiction are running rampant in Western society at all socioeconomic levels, many people only seem to notice when one of the “beautiful people” are afflicted with these maladies. Celebrities are often surrounded by an entourage or “posse” of close friends who are only too willing to make sure that the gravy train is kept running. These freeloading valets perform a variety of duties for their bosses including thorough ego stroking, scoring drugs, ordering pizza, and dialing 911 in case of an overdose. However, there comes a time when even the best posse is ill-equipped to handle the complex needs of a celebrity addict. J.A. Perper and S.J. Cina, When Doctors Kill: Who, Why, and How, 201 DOI 10.1007/978-1-4419-1369-2_21, © Springer Science+Business Media, LLC 2010 202 21 Doctors to the Stars Enter the “Concierge Physician,” a newly labeled entity that has, in fact, been around for decades. These doctors are paid very well to provide customized, personal care to their well-to-do clients. While some of them do, in fact, provide prompt and high quality medical services, other “doctors to the stars” turn into pushers and dealers of prescription medications, violating the most basic professional and ethical standards. In some cases, in addition to serving as the celebrity’s primary caregiver, the retained doctor also becomes a close friend, intimate confidant, and even lover. Celebrities and Abuse of Prescription Drugs Many celebrities have died following overdoses of illicit drugs such as cocaine and heroin. Others luminaries have been extinguished in alcohol-related fatalities. By and large, these deaths have little to do with the actions of physicians and, as such, will not be further mentioned. Instead, we will take a look at several high profile fatalities spanning five decades involving prescription drug abuse and questionable medical care. After all, you are reading When Doctors Kill, not When Overindulgent Stars Get High and Wake Up Dead. We are working on that one-it’s going to be big! In recent decades, the United States has experienced a dramatic increase in the abuse of prescription medications (pain relievers, anesthetics, sleeping aids, tran- quilizers, stimulants and sedatives). According to government data, millions of Americans abuse prescription drugs. In 2006, 16.2 million Americans ages 12 and older had taken a prescription pain reliever, tranquilizer, stimulant, or sedative for nonmedical purposes at least once during the previous year. In fact, it is estimated that there are currently more prescription drug abusers than illicit drug abusers. Fatal overdoses from prescription painkillers alone have more than doubled from 3,994 in 2000 to 8,541 in 2005 (the last year for which complete data is available) – this doesn’t even address the problems associated with sedatives such as Valium and Xanax™. The Centers for Disease Control and Prevention (CDC) has predicted that prescription drug abuse related deaths will continue to increase at an alarming rate. We have certainly witnessed this trend in our forensic practice. While we still encounter deaths due to heroin or cocaine use, we see several cases a week involving prescription drug toxicity. The abuser routinely obtains these drugs through one of four main routes: stealing them, buying them illegally, accepting them as offerings from their friends (or disciples in the case of celebrities), or obtaining excessive prescriptions and medications from licensed physicians. As this book is focused on doctors who kill, we will focus on the latter means. In some situations, an honest doctor is duped by a deceptive patient who feigns an illness or symptom to obtain drugs. In fact, the Internet has created a cohort of very savvy patients who know just the right things to say to get what they want. With malpractice litigation running rampant, physicians are essentially forced to do something for most everyone Celebrities and Abuse of Prescription Drugs 203 who comes through their door for fear of being sued for “failure to treat.” In other cases, however, physicians running “pill mills”, shady pain clinics, and other high-profit, cash-only practices are eager to build a clientele who knows they can rely on the good doctor to cure what ails them. These unethical practitioners have cast a shadow on the many physicians who correctly and judiciously prescribe medications for pain, mental illness, or emotional stress. In fact, it is likely that some patients who truly need painkillers are being underprescribed badly needed medications because some doctors are afraid of being accused of creating and enabling addicts. The Rich and Famous have the financial means to rent a “personal physician” to address their urgent or ongoing care needs. Many celebrities would justify the need for round-the-clock medical attention by reminding us just how stressful their lives can be. To be fair, some world-class athletes and performing artists do have to put up with stressors that most of us do not have to endure including: – Long and strenuous performance hours interfering with the normal “biological clock” – Weeks to months of grueling rehearsals – Months of cross country and international travel – An ongoing battle against aging resulting in dependency on plastic surgery, toxins, hormones, or other remedies – Unrelenting scrutiny from the media and fans – A constant fear of tumbling down from stardom into obscurity – Probing interviews – Blackmail attempts or civil suits by employees, acquaintances, or strangers threatening disclosure of some real or imaginary scandal – Innate sensuality leading to sexual excesses and a propensity toward short-lived marriages often followed by acrimonious divorces and litigation – A sense of loneliness and isolation while in the midst of tumultuous gatherings of fans and “friends” – A nagging insecurity that anyone who claims to care for them actually loves their persona and not “the real me,” and – A total loss of privacy due to relentless pursuit by the paparazzi Couple these stressors with a tendency to party all night, eat very little, and embrace the philosophy of “it’s better to burn out than to fade away” and you have a recipe for a celebrity fatality waiting to happen. Whereas, remarkably, some celebrities are able to create a “normal life” for themselves and their families, others cannot cope with the unbearable stress that comes with success. The triad of insomnia, depression and resulting drug abuse/ addiction has been afflicting our brightest stars for decades if not centuries. We may call this psychopathological state the “SIDDA” syndrome (Stress, Insomnia, Depression, Drug Abuse). Obviously members of the general population may suffer from this condition, but members of the entertainment elite seem to be particu- larly prone to developing this condition. Wolfgang Amadeus Mozart, a former child prodigy turned pop star, may have been an early sufferer of this condition. 204 21 Doctors to the Stars SIDDA fatalities are likely closely related to another condition afflicting both celebrities and countless others who party themselves to death, DUMASS (Death Using Multiple Addictive Substance Syndrome). Doctors who choose to treat celebrities are seeking out an inherently high-risk patient population. It is no wonder that they are handsomely compensated for their efforts. Nonetheless, physicians are responsible for treating their patients in a manner consistent with the accepted standard of care regardless of who they are. It is the sworn duty of these concierge doctors to be providers of relief and appropriate therapy, not enablers of drug addiction or, worse still, creators of addicts. By virtue of their training doctors are more aware of the addictive potential of prescription medications than are their patients (rich or poor, famous or not). “Physicians to the stars” may create addicts by flippantly or indiscriminately prescribing and providing medications to their luminous clients just as doctors staffing “pill mills” may create addicts out of patients just like us who have legitimate medical conditions requiring potent prescription drugs. Once a patient has become hooked on a medication, a phenomenon called “tolerance” may ensue. Over time, in order to

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