Anna Nicole’s Doctors Couldn’t Have Made Worse Decisions If They Tried

I guess the death of Anna Nicole Smith has become old news.  All I found in the daily newspaper was a short item saying that the trial was going on in Los Angeles.

After more than one internet search, the only mention I found of what is going on online is this one, in what seems to be a Seattle tabloid.

I strongly suspect that this is a road that has been travelled more than I know.  After all, I am not exactly a celebrity watcher. Nevertheless, from what we already know about folks like Michael Jackson, and from what Dr. Nathalie Maullin seems to have said under oath, I think we have a pretty good idea of what it is like to be a drug-seeking celebrity.

First, I think it worth noting that Dr. Maullin was on staff at Cedars-Sinai at the time. Now putting aside the PR of the latter (it is allegedly the best in L.A.; they have ads and some top notch publicity firm–) Cedars Sinai is a hospital.  I can testify that to be on staff at any clinic or hospital, they do a background check. 

I am squeakly clean to the point of nausea — 30 years with no complaints, no challenges to my status, no malpractice suits.  Arguably, that is at least as much from my charm as from my unbridled hyper-competency (I work hard to keep it) but this is someone whom we can say has been pretty much free from serious medicolegal problems to get where she is or was.  Besides, I agree with a lot of her opinions, as far as this info goes.  I guess this is one place I am pretty mainstream.  See, I want my patients to stay alive, and I think she did, too.

Here is the road:

1. Celebrity patient has pain and requests drugs.  With benign back pain, assuming she did not have cancer in a bone or something horrific we do not know about, most (qualified and reasonable) doctors would have dived for the ibuprofen, maybe something to protect the stomach (since ten thousand people a year die from non steroidal inflammatories, of which ibuprofen is one; it causes stomach ulcers, can hit a blood vessel and make someone bleed out). This is not wildly effective, but a lot of people (especially those in county clinics) live with this and exercise, like swimming, and make do.

 2. A celebrity seems to want more, demanding freedom from pain, asking for something that does more.  Now a “normal” doctor can’t usually be bothered with this.  Most cases of back pain have no vertebral bone with cancer in it, or anything else that could conceivably be called a “lesion.”  Anyone who read literature would know the best chance for help with back pain would include psychotherapy or even medications or a way to address underlying stresses. These things work.  Although I’m a former back surgeon, I’ve “cured” many back pains with non-drug and non-surgery methods.  Some people like the results of physical therapy; many, like John Sarno, MD of NYU think it useless; whatever.  People get better without drugs  if they are willing to try, to participate in the therapy.

3. Although reasonable attempts may have been made, no celebrity known to me (again, I am no celebrity expert) except Anne Bancroft — who was Sarno’s most famous patient — has ever followed this kind of therapy.  Even relatively wealthy and powerful people with whom I have worked have said “just give me the pills” in pain situations, even if I warn seriously how dangerous and rotten the pills are.  Celebrities do not like to “participate in…treatment.”  Dr. Maullin noticed this problem with Anna Nicole Smith during her hospitalization. Celebrities have money and believe themselves to be important. Presumably, so do their completion bond guarantors and God knows who else. Addiction can be asymptomatic before people get messed up.

Celebrities would be expected to ask for higher and higher doses of addictive drugs and they get them.  Besides the cases reported in the media, there are LOTS of gossipy anecdotes that you hear about in the L.A. area.  Many doctors accept money and get in trouble.  Clearly the temptations are great.  The proximity to the famous.  The cash rewards from the rich.  Although I do wonder a bit when I hear people condemn all of us, I would be the first to admit that there are plenty of doctors out there who are enough to make me ashamed to be a medical doctor.

4. The patient gets in trouble.  Big trouble; life threatening or death.  Thanks to Dr. Maullin’s testimony, we have a clear description of at least one of Ms.Smith’s troubles. Nobody who actually knows what they are doing would ever, ever, take someone on both methadone and Xanax off both during pregnancy; a horrific decision which Ms. Smith made on her own, as she recounted to Dr. Maullin.  Doses and medical details are omitted here for obvious reasons, and this is the only reason I could disagree with Dr. Maullin. Sudden stopping of Xanax could cause seizure and maybe even lead to death. If someone is convulsing, this can seriously disrupt the circulation of the placenta/embryo/fetus depending on how far along the baby is.  We are talking dying dead. Was Ms. Smith not told?  Would she not listen?  Was she already so compromised she could not give an adequate informed consent?  Again, God knows; not the doctors. Incidentally, Dr. Maullin said that addiction problems could only be treated in a facility. Detox, maybe, but there are concierge practices and other alternatives available — especially to the wealthy. Problems are made for treatment; or better yet, prevention. There are lots of ways to do this.

There were more troubles.  We are grateful to whatever people believe in that she brought the baby through somehow, for she left the hospital and went home and had home visits from the same doctors who had been giving these things through pregnancy. Many docs, including me, will not prescribe these things without birth control in place.

5.  The doctors attempt to justify themselves. They could not manage a case where the patient seemed to be doing the managing. They say the use of pain medication was needed because of the enormity of the pain. If they were not complicitous in the death, any physicians involved were certainly guilty, especially if the doses were on the high side, of prescribing to a known addict.  Nothing good could have happened here.  The celebrity was in control and the doctors were collecting money.

I do not have another step here, except there is lots of tabloid press coverage, and secrecy that reveals what I say above to have been pretty much true.

Not all doctors are drug pushers, not all of them treat the patient like a cash cow, not all physicians try to take the easy way out at the expense of the health — or life — of their patients.

But if even one of them does so and makes international headlines, it injures the entire profession.