MJJC Exclusive Q&A with Dr. Steve Shafer - Read his answers

[ivy]

Before I post Dr. Steve Shafer's answers to our questions, I think I must tell you what happened behind the scenes so that you can understand the generosity of Dr. Shafer better and realize what a wonderful human being he is.

When we approach people for Q&A's , we generally have a discussion about a reasonable number of questions that they are willing to answer. In the end the questions we send range between 15 to 25.

When I asked Dr. Shafer if he would do a Q&A with us and he replied as "Yes", we were all ecstatic. It was such a wonderful opportunity to ask questions about Michael's death that still bothered us. Surprisingly rather than giving me a maximum question number, Dr. Shafer asked me to send him the questions as they come. Soon enough I realized that he was planning on answering them all. To be honest I couldn't even believe that it was happening. It was beyond our expectations.

I omitted some questions that was either i)similar to questions asked before ii) too general iii)clearly out of Dr. Shafer's area of expertise and iv)too confusing. I sent him 86 questions and he answered them all.

In his conversations with Gaz, Dr. Alon Steinberg would describe Dr. Shafer as "bright and unselfish". Indeed, Dr. Shafer might be the most generous person I have ever seen. I thought that you all should know that not only Dr.Shafer agreed to our Q&A but answered all the questions we sent his way. Dr. Steve Shafer deserves all the credit.

Furthermore Dr. Shafer also told me that he would be happy to answer any follow up questions if needed. Well if that happens let's agree to send him a more reasonable number of questions this time.

Now as we have 86 questions, I will be posting Dr. Shafer's answers in 3 parts - so that we can discuss them better.

Part 1 will be posted today (December 19). It will have 28 questions covering Michael Jackson, Dr. Steve Shafer and Murray Trial in general.

Part 2 will be posted on December 21. It will have 33 questions covering Dr. White, Conrad Murray and Michael's death.

Part 3 will be posted on December 22. It will have 25 questions covering Propofol, Demerol, Lorazepam, Flumanezil, Insomnia etc..

So once again I want to thank Dr. Steve Shafer for his generosity for answering our high number of questions. And let's start discussing.

[ivy]

MJJC Exclusive Q&A with Dr. Steve Shafer Part 1

This is Part 1 of 3 of Dr. Steve Shafer's answers to MJJCommunity questions. In this first installment Dr. Shafer will be answering questions about Michael Jackson, himself (Dr. Shafer) and Conrad Murray trial in general.

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Questions about Michael Jackson in general

MJJC: Have you ever listened to Michael Jackson’s music and if yes, what song is your favorite?

Dr. Steve Shafer: I grew up listening to Michael Jackson’s music, just like the rest of the world. Thriller was the only album that I knew well, and “Beat it” is my favorite track from it. The message and the music both appealed to me.


MJJC: What was your opinion about Michael Jackson before this trial?

Dr. Steve Shafer: I knew very little about his personal life, other than the occasional sensational headlines. I intentionally read nothing about his life before the trial, because I did not want to introduce bias into my testimony. I’ve read a lot since the trial.


MJJC:Did your opinion about Michael Jackson change during and after this trial? Positively or negatively, and what is your current opinion about Michael Jackson?

Dr. Steve Shafer: Yes. During the trial I saw him as a patient, just like many patients I’ve cared for. During the trial I had no mental image of Michael Jackson as an icon or famous entertainer. He was a patient who died receiving medical care. It was important to keep focused on him as a patient.

Having said that, I was conscious that his interactions with Conrad Murray were, in part, a tragic side effect of his wealth. I spent 20 years on the faculty at Stanford University, and more recently at Columbia University. Patients who are very wealthy often choose a big-name medical center. Most wealthy patients are very kind and decent people. However, I occasionally encounter a wealthy patient who believes that because he or she is rich, he or she can simply tell me how to give anesthesia. That is what they are used to: giving orders and having people say “yes.” I believe that Michael Jackson fell into this trap: believing that he could tell doctors what to do and expect them say “yes.” This doesn’t excuse his doctors for saying “yes.” However, wealth and fame can be a curse.

My opinion of Michael Jackson is that he was an immensely gifted musician, entertainer, and genuinely compassionate individual. However, he was thrust into (well deserved) stardom as a youngster, and spent his entire life under the glare of public scrutiny. That does not seem like a blessing to me. To me it seems like a tragedy. He never lived a normal life.


MJJC: During the trial, the defense and various media outlets repeatedly called Michael Jackson a "drug addict". Based on your knowledge and research in this case, would you say that Michael Jackson was a "drug addict" or not?

Dr. Steve Shafer: “Addiction” is a lay term, not a medical term. The correct medical term is substance dependency. You will find an accurate explanation of this in Wikipedia. You can also find a good description at www.csam-asam.org/pdf/misc/DSM_criteria_for_diagnosis.doc.

I think Michael Jackson likely had a dependency on sedatives at the time of his death, because he was receiving intravenous sedatives every night. That type of regular exposure is almost certain to cause dependency.



MJJC: Can Dr. Shafer render an opinion on the chronic condition of Michael’s lungs (respiratory bronchiolitis, multifocal chronic interstitial pneumonitis, chronic inflammation)? Some TV doctor (Dr. Drew) alleged that it could be due to continuous/long term Propofol use. However MJ is known to have Pleurisy at 1977 and reported to say “he had a blister on his lungs” in later years. Could it be caused by the Propofol or could it be related to his Lupus?

Dr. Steve Shafer: Propofol is commonly used for infusions in intensive care units. I am not aware of any primary effect of propofol on the lungs. However, because Michael Jackson’s trachea (windpipe) was not protected while he was receiving propofol, he could have regularly inhaled small amounts of saliva or regurgitated stomach contents while anesthetized from propofol. That can damage the lungs and produce chronic inflammation.
 

Questions about Dr. Shafer in general

MJJC: Since your father passed away during the trial, was it hard to do the testimony? (and please accept our most sincere condolences for your loss)

Dr. Steve Shafer: I’ve shared with some members of the MJJCommunity my personal story about my father’s passing. I’ll spare you the details, other than to say that for me, the trial brought me an unexpected gift: the chance to be with my father when he died. Had it not been for the trial, I would have been in New Jersey. As it was, I was at his bedside, offering love and morphine. (I can only hope that one of my kids decides to take up a career in anesthesia.)

During my testimony, I felt that my father was beside me. It gave me confidence, particularly during cross examination. I knew that since my Dad was with me, I’d be OK.


MJJC: During testimony we learned that you drank Propofol. Did you drink it before you conducted the scientific research? What prompted you to drink it yourself?

Dr. Steve Shafer: I knew that the defense would reject animal studies as not applying to humans, just as Paul White did when asked about animal studies of propofol in urine. There is no way that I could conduct a human study in the US in three months, so I thought the best evidence I could get was to simply drink propofol and report if it had any effects. I knew the pharmacology well enough to be absolutely certain it was inert.

About a week later my colleague Pablo Sepulveda in Chile told me he would be able to conduct a clinical trial in volunteers. That made my drinking propofol completely irrelevant.

However, please remember that propofol is unique in the complete “first pass” metabolism. One should not try this with other drugs. Indeed, many drugs on the anesthesia cart would be fatal if consumed like that. This should not be attempted as a party trick!


MJJC: Any comments on Mr. Chernoff referring to you as a "cop"?

Dr. Steve Shafer: No, that’s his job. It didn’t bother me at all.


MJJC: During your cross examination Defense asked "Are you aware that everything you said here was your merely your opinion?" In your answer you concluded that this was an interesting question- where does 'personal opinion' end and where does "Dr. Shafer" begin? So did you, Dr. Shafer, come to any conclusion in this conundrum? Do you consider it wise or even desirable to split your mind in the Dr. figure- and Steven Shafer? Is it even possible to do so? What would the result most likely be? Could there be considerable "strength" in a personal, honest opinion?

Dr. Steve Shafer: I thought about that question quite a bit afterwards. I was not expecting it, probably because I am not an experienced expert witness. This was only the second time I have testified in court.

Mr. Chernoff was playing to my scientific training. Scientists are reluctant to state that something is a certain fact. There is evidence, and conclusions, but science is always open to new evidence and new conclusions. His asking me “wasn’t your testimony entirely your opinion” was an invitation to say “yes”, based on my interpreting “your opinion” as referring to my scientific opinion. If I had answered “yes,” it would have opened the door for him to say in his closing statement “Dr. Shafer himself admitted that his views were just his opinions.” That would play to the common use of “opinion” as mere speculation unsupported by data.

There were two aspects to my testimony: standard of care, and propofol pharmacology. I need to discuss fact vs. opinion for these separately.

Many aspects of the “standard of care” have been codified by organizations. For example, the American Society of Anesthesiologists has practice guidelines that very clearly spell out the standard of care during administration of anesthesia. My testimony was based largely on those guidelines. One could argue that it was merely my “opinion” to represent the published guidelines of the American Society of Anesthesiologists as fact. However, it is a fact that they have published guidelines on the standard of care, and those published guidelines were the basis of my “opinion.”

There are aspects of the standard of care are not covered by published guidelines because they are self-evident. I believe doctors should not lie. I believe Conrad Murray’s misrepresentation of the drugs that he gave to Michael Jackson was an unconscionable violation of the standard of care. Is it my opinion? Yes. However, I think every person on the planet shares my opinion that a doctor should not lie. Similarly, it is my opinion that doctors must place the interest of their patients ahead of their personal interests. That is my “opinion.” However, again I think it is an opinion that is universally shared. Can that be dismissed as “mere opinion?”

Regarding the scientific part of the testimony, my “opinion” is that of an expert in the field. The simulations I presented were mathematically accurate representations of the pharmacokinetics. Baring a mathematical error on my part, the simulations show exactly the blood and effect site propofol concentrations predicted by specific pharmacokinetic models for specific doses. The “expert” aspect is to decide what doses should be simulated, and whether these are likely scenarios. I did a lot of simulations, and even shared with the defense my spreadsheets so that they could do simulations as well. I chose some over others based on data. That is an “expert opinion.” However, it is more scientifically precise to say “conclusion, based on the data” that to call it “opinion”, since the latter implies uninformed speculation.


MJJC: Did it amuse you like it did many when Dr. White was called "Dr. Shafer" several times in court by Prosecution, Defense and even the Judge?

Dr. Steve Shafer: Yes. I think everyone was amused.


MJJC: Have you met any of the Jackson Family before, in between or after the trial? If so did they ever asked you any medical questions?

Dr. Steve Shafer: I spoke with them briefly several times walking to or from the courtroom. They were very kind, and offered condolences on the death of my father. I shared that we both had suffered loss, and offered condolences in return. I appreciated their kindness.


MJJC: Did your life change after this trial? If yes, positively or negatively?

Dr. Steve Shafer: I learned a huge amount from the trial, including:
• A lot about the pharmacology of propofol and lorazepam (I did a LOT of reading to educate myself on the issues, and to respond to claims made by the defense).
• Something about how the criminal justice system works. I was impressed by what I saw. In particular, the office of the District Attorney was absolutely honest and transparent. This was not a “game.” It was an attempt to determine the truth.
• Different approaches to discerning truth. In science, “truth” is determined by experiment, observation, peer review, and the ever-questioning nature of science. In science, the burden of proof is on the person making the claim. In criminal law, “truth” is determined by a jury that arrives knowing almost nothing, the exact opposite of peer reviewers. In criminal law, the burden of proof is on the prosecution. The defense can assert anything without evidence. I learned that both systems work.

I have received wonderful feedback from my professional colleagues. It won’t change me, but it has been rewarding.

I have had very kind letters from the Michael Jackson community. I did not expect these, but they have been appreciated.


MJJC: What do you think about Michael Jackson fans love and appreciation towards you? Do you know that many fans publicly express their love and gratitude to you, and use your pictures and quotes to express themselves? What do you think about that?

Dr. Steve Shafer: It didn’t expect it! However, I do understand that not knowing what happened to Michael Jackson has been a cause of considerable pain to his millions of fans. If my testimony was helpful, and perhaps brought a closure to his passing so they can again focus on his music and message, then I’m honored to have had the opportunity.

I have tried to answer many of the e-mails I have received. I am appreciative of the kind comments I have received from his fans all over the world.


MJJC: Now that the trial is over what’s next for Dr. Steve Shafer? Returning to practice? Teaching? Patient education and advocacy?

Dr. Steve Shafer: All of the above.

I did not watch the first two days of Paul White’s testimony, because I was back in the operating rooms at Columbia University giving anesthesia. I love clinical anesthesia. I love taking care of patients. We all need to define who we are. For me, it’s simple: I’m a doctor. I care for patients. If I ever stop caring for patients, I won’t know who I am. That’s what I do.

Having said that, my work as Editor-in-Chief of Anesthesia & Analgesia requires about 60 hours per week. Even during the trial I would go home and read a dozen new submissions every night, assign editors and reviewers, and process another dozen decision letters. I will be doing that every day until my term as Editor-in-Chief ends in 2016.

I continue to teach. You will get a laugh at the most recent lecture I have given at Columbia: the role of clinical pharmacology (e.g., pharmacokinetics) in the trial of Conrad Murray.

Anesthesia & Analgesia is the largest medical journal in the field of anesthesiology. I use Anesthesia & Analgesia as a platform to advocate for patient education, patient care, and patient safety (http://www.anesthesia-analgesia.org). Only rarely does that involve my own writing. The Journal advances patient care through editorial policies anchored in doing what is best for patients.

I continue to pursue my own research, primarily modeling the behavior of drugs used in anesthesia. Much of this is now in collaboration with my wife, Pamela Flood, who is the chief of Obstetrical Anesthesia at the University of California in San Francisco.

I am actively involved in developing new drugs to improve the safety of anesthesia and pain management. In 2003 I co-founded a biotech company to develop better drugs for anesthesia and pain management. You can find it at http://www.pharmacofore.com. Our work is progressing well, and this also consumes some of my attention.


MJJC: How the medical community has responded/reacted towards you since your testimony?

Dr. Steve Shafer: The response has been uniformly positive. There has been considerable appreciation that I spoke for the values that physicians hold, as well as for clearly explaining the medical and scientific issues involved. I didn’t testify to garner any attention or recognition, and it makes me a little uncomfortable. However, the validation of my testimony from my medical colleagues has been affirming that I did the right thing.


MJJC: Did media approach you for interviews? If yes, why didn’t we see you on TV?

Dr. Steve Shafer: Yes, I was approached, but I don’t think the interviews were aired. I think the reason is that they didn’t like my answers. I was asked about what I thought Conrad Murray’s sentence should be. I answered honestly that I didn’t have the background to judge that. I said that our lawmakers determine the appropriate sentences for criminal behavior, and judges then impose sentences based on the dictates of the law. I said that this was really a question for Judge Pastor, who IS an expert. I don’t think they liked that answer. They probably hoped for something much more vengeful from me.

I was asked how I felt about my role in convicting Conrad Murray. I honestly replied that I don’t think I had much of a role. Conrad Murray gave Michael Jackson propofol in a bedroom, with no training, no monitoring, no backup, no accountability, abandoned him to talk on the phone, and then lied about his action. His guilt was obvious when the facts emerged in 2009, and it just as obvious after my testimony.


MJJC: One of the most shocking parts of Dr. White’s testimony was when he admitted that he had not fully reviewed the current scientific literature on Propofol. Under cross-examination he also admitted that had not completely read the journal articles that were used to create the Propofol simulations that he presented as the basis of his court testimony. As a scientist I found this to be extremely irresponsible professional behavior. Can you please discuss how you prepared for your testimony in this trial?

Dr. Steve Shafer: I spent dozens, and perhaps hundreds, of hours in preparation. I read well over 100 papers. I analyzed the data numerous ways, and even made my spreadsheets available to the defense. I did the “heavy lifting” that is expected of an expert. This isn’t unique to this case – it’s how I approach everything I do.


MJJC: Judge Pastor picked out Murray's recording of MJ as the piece of evidence that affected him the most during the trial. Was there any one thing that affected Dr Shafer in all the evidence that he looked at?

Dr. Steve Shafer: Yes, the consistency Conrad Murray’s behavior. In the sentencing hearing Judge Pastor outlined in detail Conrad Murray’s pattern of repeated lying, self-serving actions, and reckless disregard for the wellbeing of his patient. That was what I saw also.


MJJC: How did you decide to choose your profession? What did it start with?

Dr. Steve Shafer: Many physicians choose a medical career very early in life. I knew from the time I was 9 years old that I wanted to be a physician. The inspiration was my pediatrician. He seemed to know absolutely everything, and I was amazed at the breath of his knowledge. Additionally, every year he spent several months on the “Ship Hope” practicing medicine in third world countries. I profoundly admired his sense of service to others. That was my role model


MJJC: Did any of your parents relate to medical sphere?

Dr. Steve Shafer: I am the first physician in my family. My father was a management consultant, and my mother was a housewife. Both of them took pride in having a son who went to medical school. I became the family resource for all medical questions.


MJJC: Did your father know about your intention to take a stand in Conrad Murray's trial? If yes, what were his thoughts about it, if any?

Dr. Steve Shafer: Yes. He liked it a lot. He told me it made him proud. He was also aware that I was visiting him every day because I was in Los Angeles for the trial.

He watched my testimony on Thursday morning, and died that evening.

 
Questions about trial in general

MJJC: What do you think about DA Walgren?

Dr. Steve Shafer: He is brilliant, dedicated, and absolutely honest. He worked incredibly hard. I think he got about 4 hours of sleep every night of the trial.

Part of my job was educating Mr. Walgren in the science. By the time of the trial, he was occasionally correcting my calculations! He was so effective when dealing with expert opinion in part because he truly understood the scientific principles.

As a taxpayer, it is amazing that attorneys like Mr. Walgren work for the State of California at a public servant’s salary. We are really getting our money’s worth!


MJJC: Did you see Judge Pastor give his sentencing statement? Any comments on that?

Dr. Steve Shafer: Yes, I watched it live. I smiled when Judge Pastor used specific words and ideas that I introduced in my testimony. Also, having read all of the documents numerous times, it was clear to me that Conrad Murray repeatedly lied. However, that was irrelevant to my testimony, and so I appropriately kept that opinion to myself. I appreciated hearing the judge, who is better able to judge Murray’s veracity than I am, lay out the pattern of self-serving lies by Conrad Murray.


MJJC: Do you think Murray just made a 'fatal mistake' or do you think it’s something more?

Dr. Steve Shafer: The fatal mistake was saying “Yes” to Michael Jackson’s request for a physician to administer propofol. That was followed by innumerable other fatal mistakes, but it all traces back to the initial lack of judgment.

MJJC: Do you believe Murray got the appropriate charge of Manslaughter or do you believe what he did was much more serious that it should have been something like Murder 2?

Dr. Steve Shafer: I’m not qualified to judge this, and am very glad I was not asked for an opinion on this during my testimony. I am glad he was found guilty. That was important: doctors are accountable for their actions. We are not above the law.

I only gave one television interview after the trial, because I had to teach a course (www.nonmemcourse.com) immediately after the trial. I was asked what I thought about the fact that the worse possible sentence was 4 years in jail. I answered that I wasn’t qualified to render an opinion. I think they wanted a much more bloodthirsty response, because they never ran the interview.


MJJC: What kind of punishment would be appropriate in your personal opinion?

Dr. Steve Shafer: Emphasizing that this is just my uninformed personal opinion, I believe that he must lose his license, never practice medicine again, and be accountable to the Jackson family. Please let me emphasize again that criminal punishment isn’t something I know about.


MJJC: In his closing argument Ed Chernoff stated once more that "lack of record keeping did not kill Michael Jackson". Would you find this a particularly irresponsible assumption- especially in light of your lengthy and detailed explanation of Pharmacokinetics and Pharmacodynamics? Would Ed Chernoff's closing argument be especially irresponsible and outrageous- considering that the assumed physician did not keep any records?

Dr. Steve Shafer: Mr. Chernoff’s statement is false. The lack of record keeping did contribute to Michael Jackson’s death. Without records Conrad Murray could not look for trends, such as seeing if larger doses were needed each day. Without records Conrad Murray could not look at past doses to determine what was a safe dose, and what was a dangerous dose.

Record keeping re-enforces vigilance. When you write down the vital signs every 5 minutes, it forces you to keep an eye on the patient. Record keeping would have forced Conrad Murray to stay close to Michael Jackson and continuously write down vital signs (at a minimum he had the pulse oximeter on the finger and could physically count the rate of breathing and heart rate). Record keeping would have forced Conrad Murray to monitor the intravenous infusion rate. Record keeping might have kept Michael Jackson alive. Thus, Mr. Chernoff’s statement is false.


MJJC: Lots of hyperbole has been made of the IV tubing/matching/non matching. Could you explain in detail once more (with no defense attorney interrupting) why this has no bearing on the statements made by you?

Dr. Steve Shafer: I initially believed that the IV tubing that Conrad Murray purchased in large quantities from Sea Coast Medical was non-vented, because I did not see the vent in the picture taken by the medical examiner, no vent is described in the product description from Sea Coast Medical, and I was unsuccessful in my initial effort to purchase the tubing from Sea Coast Medical. It turns out that it was vented, which I only realized after I physically examined the tubing in court.

However, the fact that the smaller infusion set was vented only increases the ease with which Conrad Murray set up the infusion, and the ease of concealing the tubing set on the day Michael Jackson died.

However, it still comes back to the big picture: Conrad Murray was giving Michael Jackson an anesthetic drug in his bedroom with inadequate training, inadequate monitoring, and no backup. That is why Michael Jackson died. None of these issues changes the big picture.


Note: Part 2 of 3 will be posted December 21st.

[ivy]

MJJC Exclusive Q&A with Dr. Steve Shafer Part 2

This is Part 2 of 3 of Dr. Steve Shafer's answers to MJJCommunity questions. In this second installment Dr. Shafer will be answering questions about Dr. Paul White, Conrad Murray and Michael Jackson's death.

Questions about Dr. White

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MJJC: While watching the trial it felt like there’s an animosity or fall out between you and Dr. White. Are we correct about this? If yes did this fall out stem from the events of the trial or is there a history to this?

Dr. Steve Shafer: Paul has been a friend for nearly three decades. The Paul White you saw on television was not the Paul White that I have known since medical school. He has made many contributions to our specialty. It is my hope that his contributions are his permanent legacy, not his defense of Conrad Murray.

Paul has been a cherished mentor since I was medical student. I was not his “student” as Chernoff stated, and I did not appreciate the implication that Paul taught me what I knew about propofol. However, Paul has given me counsel on everything from medical school to romance. I was expecting Chernoff to ask “Hasn’t Dr. White been a mentor to you?” I was ready to say “yes”.


MJJC: What did you think of Dr. White’s testimony and his behavior? Did anything he said change your opinion about your colleague? Were you surprised by the things he said and things he did (such as his comments to the media) or didn’t do (such as not doing his own charts, not overseeing the Beagle experiment)?

Dr. Steve Shafer: There were factual errors in Paul’s testimony. Paul is capable of outstanding scholarship. I don’t know the dynamics of his relationship to the defense team that led to him not doing the heavy lifting that he usually does when it comes to checking the literature. I wish he had contacted me in advance. I would have been happy to help him review the literature and explain the science.

The different approaches of science and law to discerning the truth failed Paul. If this had been an argument over a scientific manuscript, Paul and I would have spoken directly, without attorneys trying to discredit either one of us. We would have lined up papers, and arguments, and “duked it out” by e-mail, or perhaps over an extended lunch at one of our favorite Mexican restaurants. That would have worked and the science would be right (at least as “right” as we could get it). There would be no adverse consequences for either of us. As scientists collaborating to “get it right” we would have done well. The criminal justice system isn’t set up to allow scientists representing opposing sides to collaborate in an effort to find the truth.


MJJC: Are you still friends with Dr. White?

Dr. Steve Shafer: There may be some bruised feelings, but we will get past it. We have a lot of shared history.


MJJC: You worked with Dr. White and you are/were friend with him. So how it's possible to have 2 completely different opinions about what happened the night of 25 June 2009 from two close people?

Dr. Steve Shafer: Paul White admitted in court that he only considered self-injection scenarios. This severely limited the scenarios he considered.


MJJC: What do you think of your colleague Dr. White going out of his way to justify Conrad Murray's actions, from a medical point of view?

Dr. Steve Shafer: I don’t understand it at all.


 
Questions about Dr. Murray

MJJC: Did you purposely NOT refer to Conrad Murray as a doctor during your testimony? Have you heard the news reports about how furious it made him?

Dr. Steve Shafer: I was not aware of that. It would be very unlike me to refer to him as “Mr. Murray,” as my habit is to be respectful. I probably referred to him simply as “Conrad Murray”. If I never said “Dr. Conrad Murray”, then this is indeed a Freudian slip. I don’t see him as a doctor.


MJJC: Viewers at home could see Murray losing his temper when you started the IV demonstration, was that temper flare up noticeable to you from where you were positioned in the courtroom?

Dr. Steve Shafer: I read about it, but I didn’t personally observe it. I was focused on the jury.


MJJC: If so, were you fearful of what Murray may do (i.e. did you think there was a possibility that he would physically attack you)?

Dr. Steve Shafer: Not at all.


MJJC: What are your thoughts on Murray as a doctor?

Dr. Steve Shafer: I believe he violated the fundamental trust between doctors and patients, and that he did so not in an isolated incident under duress, but intentionally and repeatedly. That is not something a doctor would do.


MJJC: Did you hear about and/or watch the Conrad Murray documentary.

Dr. Steve Shafer: No, I just heard about it.


MJJC: If so what are your thoughts about it. Do you feel that his participation in this documentary further proves Murray's lack of professional ethics and an unsuitable candidate for the medical profession?

Dr. Steve Shafer: I can’t imagine why he would participate in a documentary that would be shown prior to sentencing. Evidently they filmed the attorneys swearing at each other, with Paul White and Conrad Murray on a couch in Flanagan’s home. It seems reckless for everyone involved.


 
Questions about the role of propofol in Michael Jackson’s death

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MJJC: Based on everything you know, what do you think happened on June 25, 2009?

Dr. Steve Shafer: Michael Jackson died from respiratory arrest (his breathing stopped) while receiving propofol, exactly as the coroner reported. There was a contribution of the lorazepam, also as reported by the coroner. The coroner got it right.


MJJC: How convinced are you that MJ was on a drip that night?

Dr. Steve Shafer: I’m completely convinced. Murray admitted to using a drip every night. He said he was trying to wean Michael Jackson. I don’t believe him. The urine propofol levels suggest massive doses, more than 2000 mg, as I explained in my rebuttal testimony. The blood levels show anesthetic concentrations of propofol. It all fits with an infusion (drip).


MJJC: If we disregard Murray's police interview, in your professional opinion, how long was MJ gone before Murray finally found him? Some experts are under the impression that the delay in calling 911 can only be explained by him knowing MJ was already dead.

Dr. Steve Shafer: I think he was already dead, but that is really speculative. I don’t believe anything Conrad Murray says, and there are no records. My guess that he was dead is based on the limited window between stopping breathing and death (10-20 minutes). Murray would have to observe him in that window to have a chance to revive him.


MJJC: There are some rumors that Michael actually ate a meal the night he died in Murray's so-called "care". Do you think Michael was fasting for the required time? Or was this yet one more deviation from the standard of care by Murray? What are your thoughts on this?

Dr. Steve Shafer: I’m not aware of any data suggesting Michael Jackson ever fasted. It doesn’t come up anywhere in the record. My guess is that he ate, because he would likely be hungry after a vigorous rehearsal.


MJJC: What do you think about June 19th (Kenny Ortega's email describing Michael- chills, seeming lost), and June 21st (hot and cold symptoms described by Cherylin Lee). What could those symptoms come from?

Dr. Steve Shafer: It is hard to know. The defense proposed that those might be withdrawal from Demerol, and that is correct. It might also be withdrawal from lorazepam. Propofol withdrawal hasn’t been described, because nobody other than Michael Jackson has ever received propofol night after night for insomnia. However, at least in theory it could be propofol withdrawal.

However, it could also be the usual sort of illness: the “stomach flu” or a bad cold. There is no way of knowing.


MJJC: Do you have an opinion about June 23rd and 24th, when Michael seemed to be feeling great? What could this improvement come from?

Dr. Steve Shafer: I don’t know. After the trial I watched “This is It.” There was obvious excitement and exuberance as rehearsals were nearing the end, and the tour was approaching. It could simply be excitement and exuberance in expectation of the tour.


MJJC: Does it surprise you MJ didn't die sooner than June 25th after finding out Murray was given MJ Propofol without proper equipment for 2 months (according to Murray) prior to MJs death?

Dr. Steve Shafer: Yes. I think that is quite surprising. We don’t know if there were prior close calls, because there are no records.



MJJC: May 2009 audio recording of Michael in which he was slurring his words attracted a lot of attention. In an interview Dr. Murray said Michael was under the influence of Propofol during that recording. However some people say Propofol does not cause slurred speech. What do you think about that recording? Any idea what drugs can cause that speech?

Dr. Steve Shafer: Sedatives cause slurred speech. This could have been caused by midazolam, lorazepam, or propofol.


MJJC: Do you think there was a chance for Michael to be in good health and to continue normal usual life after such long respiratory arrest even if paramedics could reanimate him?

Dr. Steve Shafer: Definitely, if they arrived in time.


MJJC: This is a hard question but we have to ask. When there is overdose of Propofol and it causes death, like it happened to Michael, does the person suffer? Do they feel pain? Or is it like dying in your sleep that you feel nothing?

Dr. Steve Shafer: It is an easy question to answer: there is no suffering with a propofol overdose. The person falls asleep quickly and comfortably. The brain is deeply depressed, and the brain never returns to consciousness.


MJJC: If Michael had been your patient and asked you for Propofol to help him sleep, how would you have responded? What would you suggest to him? Would you have recommended he see a sleep specialist?

Dr. Steve Shafer: Absolutely the right question to ask! I would have referred him to a sleep specialist. He had a very serious sleep disorder that was threatening his tour, his ability to perform, his ability to create music, and potentially his life. It needed urgent care from someone who knows what he or she is doing.



MJJC: Do you know what the long-term effects of using Propofol would be? Murray has indicated that MJ was using Propofol for 6 weeks, apparently for sleeping 8 hours or so a night. Have you ever read about case studies of patients doing this or, as it was put forward in the trial, was MJ an experiment?

Dr. Steve Shafer: This was an experiment. I don’t think any other patient in the world has ever received this. There may be long term effects – that is a question that can’t be answered without clinical research. I don’t know what effects to expect, but it seems likely that tolerance and dependence would develop.


MJJC: How about even longer terms such as months or even years taking of deep sedation of Propofol, could it affect human health and any organs? Is it possible to take Propofol for a long time and don’t have any associated negative side effect?

Dr. Steve Shafer: We don’t know – the studies have not been done.


MJJC: There might not be enough information to have a clear picture of what was going on, but we would like to know your opinion about what Murray was prescribing to Michael (from late 2006), the amounts of midazolam, lorazepam and flumazenil Murray was buying, and the possible consequences of such a treatment.

Dr. Steve Shafer: I am not sure what amounts you are referring to. I am aware of the drugs that Murray purchased in 2009, but I did not review his previous treatment of Michael Jackson, because it didn’t relate directly to the questions I was trying to answer at the trial.


MJJC: According to his police interview, it seems that Murray knew he shouldn't mix Lorazepam and Propofol, so we are confused about their use together. Why would Dr. Murray or anyone mix those together?

Dr. Steve Shafer: There is nothing wrong with giving lorazepam and propofol at more or less the same time. Anesthesiologists routinely give midazolam at the start of an anesthetic, and propofol a few minutes later. Midazolam and lorazepam are closely related. You just have to know that the effects are “synergistic”, meaning that you need to reduce the dose of propofol when you give a lot of midazolam or lorazepam.


MJJC: Do you have any idea about how much lorazepam had he been given and when?

Dr. Steve Shafer: Yes, he gave a lot. The lorazepam levels in the blood were high enough to contribute to the cause of death, as stated in the coroner’s report, and as emphasized by the defense. As accurately stated by the defense, the lorazepam concentration in his blood was enough to put most of us to sleep. There were 8.4 milligrams of lorazepam in his autopsy urine, and another 5.8 milligrams of lorazepam in the urine that was recovered at the scene, which presumably was from the same night. So Michael Jackson received a lot of lorazepam. However, because there are no records, and I don’t trust what Conrad Murray says, it is hard to be more precise.


MJJC: Dr Kamangar said that dependency would be faster if benzos were given IV. Now was this a "treatment" that would have made him highly dependent on benzodiazepines? If Michael had survived, would he have been able to recover from this?

Dr. Steve Shafer: Yes to both questions. Intravenous drug use typically results in faster dependence. Regardless of the degree of dependency, one can recover from it with appropriate treatment. The big problem for Michael Jackson would have been whether he would be willing to stay away from intravenous sedatives for the rest of his life. Without a change in life priorities it is often very hard to wean individuals who are dependent on drugs.


MJJC: After spending what must have been hours of going through Murray's police statement, then the evidence itself, did you feel shocked with the results you were coming up with - the amount of propofol that had to have been given by Murray to obtain the blood results found at autopsy, the botched attempt by Murray to create his own Tate Gallery of Modern Art drip, etc.?

Dr. Steve Shafer: Since Conrad Murray ordered staggering quantities of propofol to give to Michael Jackson, and Michael Jackson had an anesthetic concentration of propofol in his blood, I expected the simulations to confirm that he received anesthetic quantities of propofol. They did.


MJJC: During your testimony you have stated that MJ first had a respiratory arrest and then a cardiac arrest. Dr.Steinberg also testified similarly based on Murray’s own words (that there was heart beat/ blood pressure when he found Michael). We have seen the defense argue that it might have been a cardiac arrest rather than respiratory arrest first. Even in the Murray documentary they showed a scene between defense lawyers that they planned to ask you if direct cardiac arrest was possible but later decided to not ask that question as they were afraid of your possible answer. Can you elaborate on this a little?

Dr. Steve Shafer: I cannot find any evidence that the scenario outlined by the defense, instant cardiac arrest in 90 seconds, has ever occurred. I have spent hours looking for such evidence, including searching the medical literature and communicating with company officials who tracked propofol adverse events. To the best of my knowledge this has never been reported. Not even once.

I also do not believe any anesthesiologist has ever seen this. There is no mechanism by which lorazepam and propofol would act together to cause instant death. If the Judge had permitted it, I believe the trial could have been extended for several years while every anesthesiologist in the United States took the witness stand to testify that this scenario was complete bunk.

Consider the absurdity of claiming that 25 milligrams injected over 4 minutes was so safe that almost no monitoring was required, while the same dose injected over 1 minute was so toxic as to cause magical instant death! It makes no sense.

Of all the misrepresentations by the defense, the assertion of magical instant death from a small dose of propofol is the most harmful to patients. It is false. Asserting instant cardiac death from a very small dose of propofol can only be expected to increase the anxiety of patients requiring sedation and anesthesia.



MJJC: As far as we can understand from Defense line of questioning and Dr. White testimony defense theory of what happened on June 25, 2009 is as follows: Murray gave MJ Valium and then 2 doses of Lorazepam and 2 doses of Midazolam. As MJ was unable to sleep Murray gave him a bolus of 25mg Propofol. During the night/day (unclear when) MJ swallowed 8 pills of Lorazepam unknown to Dr. Murray. MJ was moving around the room even though he had an IV and a condom catheter on and with all these medications on board, he self injected an already filed and left on the night stand syringe that had 25mg of Propofol. What can you say about the Defense’s version of the events?

Dr. Steve Shafer: The primary point is that it doesn’t matter. Michael Jackson would be alive if Conrad Murray had not committed multiple egregious and unconscionable violations of the standard of care. He was administering a general anesthetic to Michael Jackson in his bedroom, with no training, monitoring, or backup. He abandoned his patient. When he returned, his patient was either dead or nearly so. It speaks for itself.

We know that Michael Jackson received a lot of lorazepam. Maybe he took pills. Maybe Conrad Murray gave him more intravenously than he admitted to. We do know is that there was not enough unmetabolized lorazepam in Michael Jackson’s stomach to suggest recent ingestion. We do know that there was evidence in the room of large doses of intravenous propofol administration. We do know that the amount of unchanged propofol in the urine suggests administration of well over 1000 mg (100 mls) of propofol. Thus, the defense scenario is not consistent with the physical or autopsy data for either lorazepam or propofol.


MJJC: Dr. Shafer, you said at the trial that probably at the time of death the drip was still on and that would explain why the propofol concentration on the femoral blood was so high. But Dr. White said that he would doubt the propofol could still be infused once the blood circulation has stopped. Could you expand on this, please?

Dr. Steve Shafer: I claimed that Michael Jackson died during the infusion, which is why the blood concentration was as high as it was. He didn’t have to die at the end of the infusion, and there is no reason to think that he did. He simply died during the infusion. The 100 ml propofol bottle was empty, I expect that he died before the bottle was empty, but that by the time Conrad Murray found him the bottle had run out as well.

I was surprised that the defense claimed that my simulations required that Michal Jackson die at the end of the infusion. There was no such requirement. I was disappointed that Paul White went along with this.


MJJC: In case there was cardiac arrest initially and not subsequently after respiratory arrest as Murray told the police, that cardiac arrest could have been caused by a sudden high/fast dose from the drip since there was no infusion pump to regulate the rate of the drip?

Dr. Steve Shafer: No. The heart is quite a reliable organ. It can stop suddenly, but not from anything propofol does. What makes the heart stop abruptly is: 1) an arrhythmia, typically from an acute heart attack, 2) something that completely blocks circulation, such as injection of a large dose of air, or a blood clot from the legs that suddenly blocks flow into the lungs, 3) administration of a large dose of intravenous potassium, which interferes with the electrical activity of the heart. Propofol will stop breathing, and it will drop the blood pressure. Neither of those will cause the heart to abruptly stop. As far as I can tell, nobody has ever seen a patient’s heart suddenly stop from any dose of propofol.


MJJC: According to Walgren's words during closing arguments "we don't know whether Michael awoke, yelled for help and choke while Conrad Murray wasn't in his bedroom, and we'll never know" and to Alberto Alvarez testimony that Michael's eyes and mouth were wide open, I want to ask you: could Michael suffered before death and could he really yelled for help and choke while dying? And if no, why his eyes /mouth were open if he died sleeping?

Dr. Steve Shafer: Michael Jackson did not suffer. He died because he stopped breathing. He was unconscious at the time. If he had been conscious, he would have been breathing.

It doesn’t mean anything if a patient’s eyes or mouth are open or closed after death. I witnessed my own father’s death during the time I was testifying. I was at his bedside. He was in and out of consciousness for about two hours before his death. My last communication from him, an “OK” sign with his hand, was about an hour before his death. After he died, I noted that his eyes and mouth were both open. I closed them.

Note: Part 3 of 3 will be posted on December 22, 2011.

[ivy]

MJJC Exclusive Q&A with Dr. Steve Shafer Part 3

This is Part 3 of 3 of Dr. Steve Shafer's answers to MJJCommunity questions. In this third and final installment Dr. Shafer will be answering questions about Propofol, Lorazepam, Flumanezil, Insomnia and related matters.

http://i43.tinypic.com/21l0klg.jpg

Questions about propofol in general

MJJC: Do you feel that your testimony helped alleviate patient concerns about Propofol or are things more or less the same?

Dr. Steve Shafer: It may have helped, but only a little. On the Friday that Paul White testified I was working at the “Allen Pavilion,” a regional hospital run by Columbia University that serves a low-income area of Manhattan and the Bronx. I was caring for an elderly man who asked what drug he would get. I told him “propofol.” As usually happens, he asked if that was the drug that killed Michael Jackson. I told him that propofol didn’t kill Michael Jackson, Conrad Murray killed Michael Jackson. I also said that propofol was very safe drug. He said “I heard that doctor say that at on television, but I don’t believe him.”

I told him I was the doctor he saw on television. He thought that was hilarious: the doctor in blue scrubs, wearing a surgical hat, with a stethoscope around his neck working in this clinic for poor patients might be the “famous” doctor he saw on television. “Yea, right” was his answer. He didn’t believe me for a second. However, he was reassured by my “joke” about being the doctor he saw on television, and everything went well.


MJJC: Can a person become dependent or addicted to propofol? If yes what kind of dependency is it physical or psychological?

Dr. Steve Shafer: There is not much data about this, because propofol must be given intravenously, and it really burns, which discourages abuse. However, there have been a number of deaths of anesthesiologists and other health care personal from propofol abuse. Based on this, I am reasonably confident that it is addictive.


MJJC: Why would someone even have the idea to use Propofol as a sleep aid? If it is only to be used for surgery then why would anyone suggest giving it someone to get some sleep?

Dr. Steve Shafer: The mechanism of action of propofol is the same as drugs like Ambien that are commonly used to induce sleep. This is a reasonable research question. However, it should never be put into practiced until it has been studied in a proper research setting. After that work has been done, it should only be used with appropriate documentation and precautions.



MJJC: Are the drug companies who make Propofol looking into testing Propofol for sleep? Do you think there will be more research studies about Propofol being used for sleep?

Dr. Steve Shafer: Yes to both questions.


MJJC: What are the known effects on the nervous system & the brain of long term Propofol use?

Dr. Steve Shafer: Not a lot, because it is rarely used for long term use. I have been able to find one report of a patient who received propofol in the intensive care unit for 51 days. This is from the conclusion of the article: “To our knowledge, this report represents the first documentation of propofol use for long-term sedation in a mechanically ventilated pregnant patient and the longest duration of continuous infusion propofol published in the medical literature. Propofol was used for 51 days with no documented maternal adverse events.” (Tajchman SK, Bruno JJ. Prolonged propofol use in a critically ill pregnant patient. Ann Pharmacother. 2010;44:2018-22)

This patient was weaned from propofol over several days without adverse consequences. So administration for 2 months appears to not have long term consequences, at least based on this example, and the fact that Michael Jackson continued to function at rehearsal. However, those are just two data points. More research needs to be done if one contemplates development of propofol for long term use.


MJJC: Does one get a "restful sleep" from Propofol? We have heard experts contradict each other on this.

Dr. Steve Shafer: The contradiction reflects the state of the science. I received propofol for anesthesia about a year ago, and I have given propofol to thousands of patients. There is often a feeling of having slept well after awakening from propofol.

However, studies suggest that propofol sleep it is quite different from normal sleep, and is not “restorative” the way that normal sleep is restorative. For example, dreams are important in brain function. Patients don’t dream on propofol, except at the time of awakening. My interpretation of the data is that propofol might be OK for getting a patient off to sleep, but that maintaining a patient on propofol for sleep (as we sometimes do in intensive care units) probably is denying patients restorative sleep.


MJJC: Do you agree that Propofol should be re-classified as a controlled substance?

Dr. Steve Shafer: No. I think this will hurt patients. In emergencies we need propofol immediately, and in large quantities. I am opposed to placing obstacles in the way of doctors caring for patients, unless there is clear benefit. Conrad Murray could have still obtained propofol for Michael Jackson, because doctors can order controlled substances. Since most propofol abuse is by doctors, making it controlled won’t limit the ability of doctors to abuse it. It will just impair their ability to care for emergency patients.

This has been the subject of an issue of Anesthesia & Analgesia. Here is the cover of that issue: http://www.aaeditor.org/HWP/Covers/0710.cover.jpg.


MJJC: Do you think now the anesthesiology community will be more careful in how they promote and teach one to use Propofol?

Dr. Steve Shafer: We already take this very seriously. We are very involved in teaching the safe use of sedatives to our medical colleagues. This will continue. Perhaps they will be more receptive to the importance of safe sedation. However, nothing we can do will reach a doctor who does not put patients first.


MJJC: Do you think the medical community has learned from Michael’s death in regards over prescribing to a powerful wealthy person and wrong doing by a doctor?

Dr. Steve Shafer: Absolutely. I mentioned this above. I am aware of this because I occasionally see this in my practice. Doctors serve patients by acting as doctors. That is a message for doctors and patients alike.


MJJC: Can you explain “Propofol lollipop” a little more?

Dr. Steve Shafer: Propofol absorbed from the stomach never reaches the brain, because it is all removed by the liver. However, the blood supply to the mouth and esophagus (above the diaphragm) does not return directly to the liver. Instead, it just goes to the heart, and from there goes everywhere including the brain. So a propofol lollipop would provide propofol to the venous blood, and from there to the brain. Paul White and I discussed this at one of the breaks prior to his testimony. It is a reasonable idea, provided the dose was adequately controlled.

Should this ever become available, then I would reconsider my position on classifying propofol as a controlled substance. My current view is highly influenced by the fact that it only works when given intravenously, and that really burns!


MJJC: What does Propofol taste like?

Dr. Steve Shafer: It has the consistency of skim milk, and tastes like a very medicinal salad dressing.


MJJC: Beagle Propofol experiment done by the Defense has made PETA and MJ fans angry. We don’t expect that you have any direct information about the Beagle experiment but as the humans weren’t affected by drinking Propofol, is it safe to assume that the Beagles were unharmed as well?

Dr. Steve Shafer: I think it is very unlikely that any harm came to the beagles. There should be no effect from drinking propofol. However, I am uncomfortable that neither the experimental protocol nor the results of the experiment were presented in court. I believe that when animals or humans participate in trials, there is an ethical obligation to write up and publish the research to add to the body of knowledge. It is the increased knowledge that morally justifies the research. I wrote our human study up for publication, asked Paul White to review it, and gave it to the defense. I believe they should have done the same with their beagle study.


MJJC: We heard the theory of some of the Benzos or/and Propofol that were given to MJ by Murray can be used for people with drug addiction to help them off their addiction to other drugs such as Demerol, Is this true? Can you comment on this?

Dr. Steve Shafer: There is a technique of rapid detoxification that involves placing patients under general anesthesia for a long period of time (hours to days) and pharmacologically reversing opioids with “opioid antagonists”, drugs that chemically block the effects of Demerol and similar drugs. This is controversial, but it probably works in some patients.


Questions about Demerol

MJJC: Was the amount of Demerol Dr. Klein give to Michael normal or was it too large a dose?

Dr. Steve Shafer: I can’t answer without knowing why Demerol was given. Dr. Klein did not testify at the trial. I’m uncomfortable offering any opinion without more information.


MJJC: Does your answer change if you consider MJ’s history (burn victim) with the drug? Do you think it was excessive?

Dr. Steve Shafer: Again, I apologize, but I don’t want to render an opinion without knowing why Dr. Klein was administering Demerol. This probably reflects my caution as an Editor-in-Chief of a medical journal. Medical editors are reluctant to render a public opinion unless they are confident they understand the facts.


MJJC: In your opinion, does Demerol aggravate insomnia as a side effect? Did it play any part in Michael's physical and mental health? What was the best treatment for Michael's insomnia?

Dr. Steve Shafer: There are three questions here. I’ll answer them in order:

Demerol’s chemical name in the United States is “meperidine.” In many countries it is known as “pethidine.” Meperidine has a metabolite, “normeperidine”, that is a nervous system stimulant. As a nervous stimulant, I would expect it to exacerbate insomnia.

The coroner examined both blood and urine for meperidine (Demerol) and normeperidine. Neither could be detected. Thus, meperidine did not play a direct role in Michael Jackson’s death on June 25th. However, you asked a more general question about “play any part in Michael’s physical and mental health.” It is a good question, and I will again need to apologize for not answering it. I have not read Dr. Klein’s medical records or heard a detailed explanation of Michael Jackson’s care. I am uncomfortable speculating without that information.

Sleep disorders are complex, and treating them is a specialized branch of medicine. It is my understanding that any drug that affects the level of consciousness can exacerbate sleep disorders. There is a nice description of sleep disorders, and the treatment of common sleep disorders, at http://www.sleepfoundation.org/article/sleep-related-problems/sleep-aids-and-insomnia.


Questions about lorazepam, flumazenil, and ephedrine

MJJC: Could the free lorazepam detected in the gastric liquid be explained by the stomach hemorrhage caused by CPR or even by accidental mixing of adjacent blood at the time of autopsy (as it was suggested by the Coroner, Dr. Rogers in the preliminary, though not mentioned again during the trial)?


Dr. Steve Shafer: Maybe. However, free lorazepam would be expected simply because molecules like lorazepam would be expected to cross from the blood into the stomach, just like they cross into all tissues. That is how the lidocaine and propofol got into the stomach. Lorazepam should behave just the same way.

Additionally, the enzyme beta glucuronidase is secreted by the wall of the stomach into the stomach fluid. Beta glucuronidase is the enzyme that would turn lorazepam glucuronide back into lorazepam. So blood could account for it, but most of it is likely the simple diffusion of lorazepam from the blood into the stomach.


MJJC: Is there any other reason for Flumazenil to be administered apart from reversing the effects of benzodiazepines (in this case Lorazepam)?

Dr. Steve Shafer: No.


MJJC: Does it even make sense to give a person Flumazenil who according to Dr. Murray only received 4 mg of Lorazepam to begin with?

Dr. Steve Shafer: The most critical part of any resuscitation is to move air in and out of the patient’s lungs. The problem with giving flumazenil is that it distracted Conrad Murray from the critical task of moving air in and out of Michael Jackson’s lungs. If there were several people were involved in the resuscitation, then giving flumazenil would have made sense. However, since Conrad Murray was alone, any interruption longer than a few seconds was too long.


MJJC: Can you explain your consideration of the Lorazepam levels, in more detail?

Dr. Steve Shafer: I’ll answer as well as I can, but I’m not sure exactly what you want to know. The lorazepam levels were high enough that you or I would have been very sleepy from them. However, patents become tolerant to lorazepam and related drugs (the “benzodiazepines”). Since Michael Jackson had a fairly high concentration, and according to Conrad Murray that was not enough drug to induce sleep, he must have been tolerant.

The defense wanted to attribute Michael Jackson’s death, in part, to oral lorazepam. The problem with this theory is that there was only a minute amount of lorazepam in Michael Jackson’s stomach. To explain this minute amount, the defense alleged that Michael Jackson swallowed lorazepam about 5 hours before the time of death. If that were true, then the lorazepam concentration would have peaked about the time Conrad Murray claims Michael Jackson was pleading for more drug to fall asleep. So that argument doesn’t make sense.


MJJC: According to autopsy report there was ephedrine found in Michael's body. It's a drug that aggravates insomnia. How ephedrine goes with benzos and propofol, could it subdue effect of these drugs?

Dr. Steve Shafer: There was a bottle of capsules composed of ephedrine, caffeine, and aspirin in the room. Ephedrine is sometimes used in resuscitation. Since there was ephedrine in Michael Jackson’s autopsy urine, as well as the urine that was found at the scene, I would assume that the ephedrine was from oral ingestion, and not from administration as part of the resuscitation.

Ephedrine can reduce the effects of propofol and benzodiazepines on blood pressure and heart rate. Chronic ephedrine might aggravate insomnia.

 
Question about medical research in general

MJJC: Judge Pastor referred to Murray as making Michael Jackson part of a “scientific experiment”. This could unfortunately dissuade patients from feeling comfortable participating in clinical trials and other types of beneficial scientific and medical research. Can you discuss the important intersection between the research of scientists and the clinical practice of physicians?

Dr. Steve Shafer: I’ve performed dozens of clinical trials. I don’t think this will adversely affect recruiting patients into clinical trials, because this “experiment” bears no resemblance to a scientific study. I think “experiment” is an accurate term, because it correctly implies that Conrad Murray had no idea what he would find day after day of propofol administration. So this was an experiment that he was conducting every day to see how Michael Jackson would respond. However, I don’t think anybody would confuse this experiment with a proper scientific experiment.

The larger question you ask is about the intersection between research and practice. This is an important question, and (fortunately) one that has been given very careful consideration. The answer goes back to the Nuremberg Code, which followed the trial of Nazi doctors guilty of atrocities at the end of World War II. You can find an excellent account on Wikipedia. This was updated by the Belmont Report, published in 1978. Again, there is an excellent account in Wikipedia. As explained in the Belmont Report, “research” differs from clinical practice in that research is a systemic investigation intended to create generalizable knowledge. “Systematic” means that the investigator intentionally gathers data to answer a question. Generalizable knowledge means that the investigator believes the information gathered is useful to others, and intends to “generalize” the knowledge, usually by publishing it. If you Google “Anesthesia & Analgesia policy in institutional review board approval and informed consent for research” you will find an editorial I wrote in March on the subject.


 
Questions about insomnia

MJJC: Decades of lies, slander, deceit, inhuman treatment from the media and public misconceptions had caused Michael immense hurt, pain and anguish resulting in insomnia. We know Propofol was not the answer, but what do you think he should have done (medically) to treat it?

Dr. Steve Shafer: He should have been in the care of a sleep medicine doctor. He had a terrible affliction, one that requires expert care.


MJJC: Do you think meditation that Murray was talking about in his police interview could really help Michael to sleep?

Dr. Steve Shafer: Maybe. Conrad Murray mentioned both propofol and lorazepam. These are both sedatives that act on the same receptor in the body, the “GABA” receptor. Most sleeping medications also act on GABA, the exceptions being antihistamines (e.g., benedryl) and melatonin. So I would expect these drugs to induce sleep. However, they should not be used to maintain sleep, because the drugs interfere with some of the brain function that is required for sleep to be “restorative”, meaning that it refreshes the brain.

 
Final comments

MJJC: Anything you want to say to the members of MJJCommunity and Michael Jackson fans in general.

Dr. Steve Shafer: Once your questions about Michael Jackson’s tragic death have been answered, I encourage you to set it aside. Conrad Murray has been convicted. We have a reasonable understanding of what happened. It’s time to return to the bonds that brought the MJJCommunity together in the first place: your celebration of Michael Jackson’s life, his message, and his music.

I appreciate the opportunity to address your questions, and hope that the answers are helpful to the MJJCommunity.

Sincerely,

Steve Shafer

[ivy]

Place holder to post our communications with Dr. Shafer

[ivy]

Place holder 1

[Pace,MioDolceCuore]

Oh, holy cow, thank you Dr. Shafer- and thank you Ivy for posting. Lovely to read his well thought out take on things. His answers are NOT run-of-the-mill copy and paste answers.

The appearance of physicians like Dr. Shafer help to restore a sense of "order" in my messed up universe since that fateful day and perhaps it is only well befitting that Michael's fans extend the love to a man who seems bottomlessly generous in answering the multitude of questions.

"Gratitude" isn't strong enough a word and neither is Dankeschoen!

[Diplomate]

Thanks Ivy ! And thanks to the Dr Shafer! I like when he says " Mr. Chernoff’s statement is false. The lack of record keeping did contribute to Michael Jackson’s death. " One more time we can see how stupid is Chernoff.

[Mirabella76]

JEEEZZZ!!!! It's a real huge interview! I can't believe we did it! God bless Steve Shafer, MJJC and Ivy! I really can't believe! I suspected he'd just answer briefly and that's it. Can't believe he's so kind.
It's a late night in my country and i'll read all tommorow. But i can see he answered two of my questions!
Love you Steve Shafer! :wub::wub::wub:

[mjmirror]

Dr Shafer has a heart of gold! So many questions and he answered them all..simply, wow.

[ivy]

and if you prefer I can post all the sections once rather than waiting a few days between them.

[Pace,MioDolceCuore]

^^^All of it, yes. Me greedy cookie monster! Thank you!

[The Brown Gangsta]

So he works around 60 hours a week for the medical journal, teaches, still works in the operating room and he still took the time to put in countless hours of research for the Conrad Murray trial...and pro bono too?? That's incredible! By my not so scientific calculations, I approximate that Dr. Shaffer probably sleeps a total of 10 minutes every 3 weeks....he deserves a vacation :)

[elusive moonwalker]

thanks ivy and thanks steve. hes one in a million. what can you say.taking time to answer everything and going into detail.

[ivy]

So he works around 60 hours a week for the medical journal, teaches, still works in the operating room and he still took the time to put in countless hours of research for the Conrad Murray trial...and pro bono too?? That's incredible! By my not so scientific calculations, I approximate that Dr. Shaffer probably sleeps a total of 10 minutes every 3 weeks....he deserves a vacation :)

and he also answered our 86 questions.

[Erikmjfan]

wow, he answeared all 86 questions! he is the kind of guy that just make u feel a bit more hopeful about the world and mankind.

[myosotis]

Thank you so much to Dr Shafer for answering so many questions with such thoroughness and care; you write with wonderful clarity and rare compassion, humility, honesty and insight. This must have been a tremendously emotionally painful time for you, but your scientific focus never wavered and your testimony cut through a very murky defence like a laser light. The University, your patients, and your research community are so lucky to have you (but I am sure they know that already!)

[Ashtanga]

I sent him 86 questions and he answered them all.

Wow! :o Happy that he devoted his time to answer questions.

[xthunderx2]

Thank you Ivy..I didn't know that it was ok to discuss in this thread,,but now I do. Thank you so much Dr.Shafer for taking the time to answer ALL those questions...you are just amazing,

[ivy]

yes please discuss his answers on this thread :)

[qbee]

I am so overwhelmed Dr. Shafer took the time out of his important busy schedule to answer each and everyone of our questions. I just cant explain how much respect, gratitude and yes even love I have for the MAN. Not only did he answer graciously but he took time and thoughtful care on each one. I imagine that is how he also cares for patients and everything he does with thoughtful care. Do you realise how much respect Dr. Shafer just gave us in doing that.
I feel so special :DI just cant put in words how much I love him for doing this for us. Both he and Mr Walgren are Honest hard working men with integrity and both a genius in their field.


Thank you Ivy and Gaz for arranging this for us :)

[ivy]

okay let's go over some stuff


Dr. Steve Shafer: I grew up listening to Michael Jackson’s music, just like the rest of the world. Thriller was the only album that I knew well, and “Beat it” is my favorite track from it. The message and the music both appealed to me.


I was like yes ! :) I also found out recently that Dr. Steinberg also likes Michael's music :)



My opinion of Michael Jackson is that he was an immensely gifted musician, entertainer, and genuinely compassionate individual.

so true.


However, he was thrust into (well deserved) stardom as a youngster, and spent his entire life under the glare of public scrutiny. That does not seem like a blessing to me. To me it seems like a tragedy. He never lived a normal life.

sad but true I guess. his fame has always been his curse as well.



Dr. Steve Shafer: I knew that the defense would reject animal studies as not applying to humans, just as Paul White did when asked about animal studies of propofol in urine. There is no way that I could conduct a human study in the US in three months, so I thought the best evidence I could get was to simply drink propofol and report if it had any effects. I knew the pharmacology well enough to be absolutely certain it was inert.

wow. Dr. Shafer is an unbelievable individual. How many other people would have done this? Drink Propofol when push come to shove?


MJJC: Did it amuse you like it did many when Dr. White was called "Dr. Shafer" several times in court by Prosecution, Defense and even the Judge?

Dr. Steve Shafer: Yes. I think everyone was amused.

So were we :)

http://media.tumblr.com/tumblr_lu3mvzFN4d1qmvf1s.gif

http://www.deviantart.com/download/128073864/Michael_Jackson_Laugh_by_NANAKiryu.gif


MJJC: What do you think about Michael Jackson fans love and appreciation towards you? Do you know that many fans publicly express their love and gratitude to you, and use your pictures and quotes to express themselves? What do you think about that?

Dr. Steve Shafer: It didn’t expect it! However, I do understand that not knowing what happened to Michael Jackson has been a cause of considerable pain to his millions of fans. If my testimony was helpful, and perhaps brought a closure to his passing so they can again focus on his music and message, then I’m honored to have had the opportunity.

I have tried to answer many of the e-mails I have received. I am appreciative of the kind comments I have received from his fans all over the world.

so let's insert this here. I actually emailed this to Dr. Shafer as well. :)

http://24.media.tumblr.com/tumblr_ltfxk780yB1qclx0oo1_500.jpg



For me, it’s simple: I’m a doctor. I care for patients. If I ever stop caring for patients, I won’t know who I am. That’s what I do.

he's a wonderful doctor.



Dr. Steve Shafer: I spent dozens, and perhaps hundreds, of hours in preparation. I read well over 100 papers. I analyzed the data numerous ways, and even made my spreadsheets available to the defense. I did the “heavy lifting” that is expected of an expert. This isn’t unique to this case – it’s how I approach everything I do.

can we get an applause for Dr. Shafer?

http://i453.photobucket.com/albums/qq253/rigmutton/orson-welles-clapping.gif



MJJC: Did your father know about your intention to take a stand in Conrad Murray's trial? If yes, what were his thoughts about it, if any?

Dr. Steve Shafer: Yes. He liked it a lot. He told me it made him proud. He was also aware that I was visiting him every day because I was in Los Angeles for the trial.

He watched my testimony on Thursday morning, and died that evening.

This is really sad. I once again wanted to say how sorry I am for his loss.
 

Questions about trial in general

MJJC: What do you think about DA Walgren?

Dr. Steve Shafer: He is brilliant, dedicated, and absolutely honest. He worked incredibly hard. I think he got about 4 hours of sleep every night of the trial.

Part of my job was educating Mr. Walgren in the science. By the time of the trial, he was occasionally correcting my calculations! He was so effective when dealing with expert opinion in part because he truly understood the scientific principles.

As a taxpayer, it is amazing that attorneys like Mr. Walgren work for the State of California at a public servant’s salary. We are really getting our money’s worth!

Do you remember? During the trial we were asking if Dr. Shafer was educating Walgren and it turned out he was. This made me all giddy inside. :P


Dr. Steve Shafer: Mr. Chernoff’s statement is false. The lack of record keeping did contribute to Michael Jackson’s death. Without records Conrad Murray could not look for trends, such as seeing if larger doses were needed each day. Without records Conrad Murray could not look at past doses to determine what was a safe dose, and what was a dangerous dose.

Record keeping re-enforces vigilance. When you write down the vital signs every 5 minutes, it forces you to keep an eye on the patient. Record keeping would have forced Conrad Murray to stay close to Michael Jackson and continuously write down vital signs (at a minimum he had the pulse oximeter on the finger and could physically count the rate of breathing and heart rate). Record keeping would have forced Conrad Murray to monitor the intravenous infusion rate. Record keeping might have kept Michael Jackson alive. Thus, Mr. Chernoff’s statement is false.

and there you go Chernoff. Dr. Shafer told you.

[Pace,MioDolceCuore]

^^^ That 'lack of record keeping did not kill him" bugged the $%^& out of me, I just wanted to hit a wall, or something. I understand that Chernoff is doing his job- but this entire 'pretending I did not understand" and willfully saying things you know to be wrong is just getting under my skin. AAAAAAAAAAAH. I wished he had a chance to get these things out on TV where the world would have to take note.

And oops, when that macro macroed itself- I had no idea Dr. Shafer's wife was the head of the Obstetrics anesthesia department- all giddy on the inside made me laugh today. I couldn't have made that up. :hysterical::hysterical:

[Rhilo]

Wow, I'm so impressed by Dr. Shafer and his answers. They are long, descriptive and informative. How kind of him to take time off his busy schedule to answer all the questions. I am just so impressed by his humbleness and generosity. Thank you Dr. Shafer!

[mlg2804]

Wow, I loved reading that. Thank you so much Dr Shafer. Just brilliant and what an interesting read.

[allieb]

Beautiful!!!! Thank you soooo much MJJC and Dr. Shafer. He is an angel! <3

[Bridgett_361]

Thank you doctor shafer, you are one of the few true gentleman around, lot of blessing to you and you family

[The Brown Gangsta]

okay let's go over some stuff

I was like yes ! :) I also found out recently that Dr. Steinberg also likes Michael's music :)

lol with Dr. Steinberg, I could already tell that he listened to Michael's music (he kind of gave that "one of us" vibe :)


okay actually emailed this to Dr. Shafer as well. :)

http://24.media.tumblr.com/tumblr_ltfxk780yB1qclx0oo1_500.jpg

lol lol lol!!! I really hope he found the humor (bonus points if he got the BOTDF reference) in that picture!

[Dialdancer]

As someone else said on another site: "Dr Shafer sounds like a very kind gentleman. Not a word we hear much any more."

MJJC is doing an incredible job on behalf of Michael.


Thank you.

[ivy]

lol lol lol!!! I really hope he found the humor (bonus points if he got the BOTDF reference) in that picture!

probably he didn't get the reference (as he said he's only knowledgeable about Thriller album) and thought that we are a bunch of crazies :P

[classic]

Thanks to all that brought this interview to us. Dr. Shafer is really kind to have done this; I don't think many people in his position would have done so to this extent. It seems as if he gets what is important in this case and why it is important for people to have as much answered as possible.

The thing that most stood out to me in part one was his comments about how the record keeping could have saved Michael's life. I remember how many people would gloss over that in discussions about this case. The way that he explained it does make you feel that such a routine thing could have saved Michael. It was like Michael wasn't even being treated like a real patient, in my opinion.

[Annie123]

Thank you ivy and Dr. Shafer. A true man of integrity.

[CaptainEoLove85]

What a wonderful guy. :D Not surprised the media didn't want to air his interview. :smilerolleyes: Thanks again. :)

[love is magical]

Very intelligent and insightful answers from a gracious man!

[Arklove]

I'm convinced Dr. Shafer is an angel :D

[Vinter]

The only question which is left after all:
How much time a day does he sleep and does he sleep sometimes at all..? :scratch:

[djbaby]

thanks to Dr Shafer and Ivy for this - amazing!

[bouee]

What a kind man ... It's amazing, I don't know what to say.. It's great to see there are still people like him.

[Angela_MJJ]

Wow I loved reading the first part he really took the time to answer the questions!


probably he didn't get the reference (as he said he's only knowledgeable about Thriller album) and thought that we are a bunch of crazies :P

Lol @ he thinks we are a bunch of crazies :rofl:

[The Brown Gangsta]

This part kind of disappointed me:

MJJC: Can Dr. Shafer render an opinion on the chronic condition of Michael’s lungs (respiratory bronchiolitis, multifocal chronic interstitial pneumonitis, chronic inflammation)? Some TV doctor (Dr. Drew) alleged that it could be due to continuous/long term Propofol use. However MJ is known to have Pleurisy at 1977 and reported to say “he had a blister on his lungs” in later years. Could it be caused by the Propofol or could it be related to his Lupus?

Dr. Steve Shafer: Propofol is commonly used for infusions in intensive care units. I am not aware of any primary effect of propofol on the lungs. However, because Michael Jackson’s trachea (windpipe) was not protected while he was receiving propofol, he could have regularly inhaled small amounts of saliva or regurgitated stomach contents while anesthetized from propofol. That can damage the lungs and produce chronic inflammation.

I was hoping to get an answer that we could slap Dr. Drew across the face with, I'm sick of him and all of his sensationalistic stories. As a man of science, I understand that Dr. Shafer has to keep his mind open to all possibilities but I would love to see someone as accomplished as he is call Drew Pinsky a quack (of course he's far too professional to do such a thing but I can still dream lol).

[twinklEE]

Dr. Shafer is an amazing human being and I can't put the gratitude I have for him into words. All I can say is that Dr. Shafer was one of the key factors in getting Murray's ass convicted, and for that alone I could bow down in front of him a million times, and it still wouldn't be enough.

[elusive moonwalker]

Id like to know if theres anywhere we can watch the talk he gave about the case that he mentiond in the q&a

[Ben]

I dont think this man even has the slightest idea how grateful we are and how much what they did means to us.

[Memefan]

i love him. I just love him.

Reading his answers at 6:30AM is just bliss. How I wish MJ had met Dr Schafer instead of Dr Death.

What a class act. I just adore the guy.

[RusFanatkaMJ]

IVY, thank you:) and huge thanks for everything to Dr. Steve Shafer!:)

[bubbyduck4MJ]

Thank you :)

[ivy]

This part kind of disappointed me:


I was hoping to get an answer that we could slap Dr. Drew across the face with, I'm sick of him and all of his sensationalistic stories. As a man of science, I understand that Dr. Shafer has to keep his mind open to all possibilities but I would love to see someone as accomplished as he is call Drew Pinsky a quack (of course he's far too professional to do such a thing but I can still dream lol).

well he can't create answers that would please us. Also as far as I understand even if it was due to propofol, it was due to improper giving of it.

[The Brown Gangsta]

well he can't create answers that would please us. Also as far as I understand even if it was due to propofol, it was due to improper giving of it.

Sorry, I didn't mean for it to come across as an attack on Dr. Shafer. I was just venting from my frustrations many of the unfounded claims that Dr. Drew has been selling as the absolute truth. If anything, the hostility in the post was meant for Drew not Dr. Shafer.

[ivy]

Some members offered to do translations of MJJC Q&A with Dr. Shafer, please see this thread if you want to translate it. There's no requirement that it needs to be translated, it's totally voluntary and your choice. http://www.mjjcommunity.com/forum/threads/120617-MJJC-Exclusive-Q-amp-A-with-Dr.-Shafer-Translations

[Daryll748]

WOW, Thanks to Gaz and Ivy for this PRO Q & A :clapping:
I just wanted to express my gratitude again to Dr Shafer :D
He brought me CLOSURE...
He showed me that GREAT Docs still exist and only a 'minority' are "quaks"...
He RESTORED my confidence in Docs...

I do WISH Michael had met Dr. Shafer FIRST instead of Murray... :beee:
I found it a pity that I don't live in the US as I would certainly TRUST you, Dr. Shafer, as my Doctor :angel:

I do have ONE more question :blush: ...
WHY did Michael NEED all those IV meds at night??? Maybe, for his lupus or his 'current' medical condition.... Something I always wonder about is...
WHY Propofol ????? I know what it does... its WONDERFUL for OP's but ARGH, NOT as a "sleep aid" hey...

I still WISH there was a way we could have SAVED Michael...
Gone much too soon and NO ONE 'protected' him...

[Justthefacts]

You know Michael had had issues with this lungs for years. So why do you even care about what Drew says ESP since you know already

[Ankita]

God bless Dr.Shafer! He truly is amazing!

I had sent to him a small note thanking him(on behalf of all of us) for all that he did so justice could be served. He was so kind to send a reply thanking me in return(what a man!) and I hope he won't mind my sharing that letter here.

here-

Dear Ankita:</SPAN>

It is very nice to hear from you. I appreciate your kind thoughts.</SPAN>

I was honored, and humbled, to have an opportunity to explain to a jury the fundamental principle of medicine: doctors put patients first. I believe the jury understood this message and reached the correct conclusion.</SPAN>

I am grateful to the many Michael Jackson fans who have contacted me since the trial. I think that not knowing what happened on June 25, 2009 has caused a lot of pain within the Michael Jackson community. It is my hope that by explaining what happened that day I have brought some closure to their loss.</SPAN>

I grew up listening to Michael Jackson’s music (who didn’t”). However, I knew little of Michael Jackson prior to the case, other than that he wrote great dance and party music. I’ve learned more about Michael Jackson, his life, his ideals, and his music since the trial. I understand how he has become such an important influence in the lives of millions of fans. With the end of the trial, and the conviction of Conrad Murray, it is my hope that his fans can return to the joy of his life, his music, and his legacy. </SPAN>

Again, thank you for the kind words.</SPAN>

Sincerely,</SPAN>

Steve Shafer

******

and another-</SPAN>Dear Ankita:</SPAN>

I have read the article, and it is very moving. Thank you for sharing it!</SPAN>

I will continue to read about the life of Michael Jackson, and learn about this remarkable, brilliant, talented, and complex man. I will also spend more time studying his music, and his lyrics. As mentioned, I knew little about Michael Jackson, and enjoyed but had not studied his music, at the time of the trial. I intentionally kept it that way, so that I could see him only as a patient.</SPAN>

Again, I appreciate your sharing this with me.</SPAN>

Sincerely,</SPAN>

Steve Shafer

I know he's a busy man, so I wrote to him only twice and he was so kind to reply, and now our 86 questions! Thank you Dr. Shafer!</SPAN>

[The Brown Gangsta]

Do you think Dr. Shafer would be comfortable with sharing his class notes/ppt from his lecture on "the role of clinical pharmacology in the trial of Conrad Murray"?

Some schools are sensitive about sharing course materials with people that aren't currently enrolled students but I think it would be an interesting read

[HumanNature2210]

Wow, I'm impressed!! All 86 questions and from what I can see, answering them in full, not half-hearted cut n paste type. This man is awesome! Thank you some much Dr Shaffer for taking your precious time to write back to us. I just want to say that I am sorry for your lost.

I am currently re-reading Frank Cascio's book, My Friend Michael when I came upon this thread, reading that Dr Shaffer is from New Jersey and he does not know much about Michael Jackson, probably other than what is offered by the media, this crazy image painted of Michael as the icon, King of Pop. I suddenly have this crazy idea - the Cascio's are also from New Jersey and perhaps it could help Dr Shaffer to understand Michael the man better if he gets to read the book. The book also put into context why Michael is using the drugs to cope with some difficult time in his life and how he also go thru with the help of another doctor from Florida to get rid of the drugs usage. The other good book will be "The man in the Music" by Joe Vogel. Since he is trying to read up and understand more of Michael, we should perhaps guide him to the right channel instead of ending up reading rubbish stuff like Halprin or Diane Diamond. What do you think Ivy?

[Vinter]

Daryll748 (http://www.mjjcommunity.com/forum/members/5499-Daryll748), your so kind and moving words made me cry... :cry:
Thank you for my tears..

[Daryll748]

Daryll748 (http://www.mjjcommunity.com/forum/members/5499-Daryll748), your so kind and moving words made me cry... :cry:
Thank you for my tears..

Oh Vinter :better: I didn't mean to make you :cry:
Just my :2cents:here...

Indeed, I have 'closure' because of Dr. Shafer, DA Mr Walgren and Judge Michael Pastor but that doesn't mean I'm fine... I still MISS Michael 'terribly' and I kinda 'blocked' all these stuff cause I need to 'live' and make Michael PROUD...
Anyway, Its ever so sweet of Dr. Shafer to HELP us UNDERSTAND what happened in these 'fatal' moments...

[Vinter]

MJJC: Since your father passed away during the trial, was it hard to do the testimony? (and please accept our most sincere condolences for your loss)

Dr. Steve Shafer: I’ve shared with some members of the MJJCommunity my personal story about my father’s passing.
Well, one of them was me but it's too personal story so I should not have posted it here in such details. It was just so similar with my grandmother's death..

[Vinter]

Oh Vinter :better: I didn't mean to make you :cry:
Just my :2cents:here...

Indeed, I have 'closure' because of Dr. Shafer, DA Mr Walgren and Judge Michael Pastor but that doesn't mean I'm fine... I still MISS Michael 'terribly' and I kinda 'blocked' all these stuff cause I need to 'live' and make Michael PROUD...
Anyway, Its ever so sweet of Dr. Shafer to HELP us UNDERSTAND what happened in these 'fatal' moments...
I know, you didn't.. they [words] just touched my heart very much so it was emotional.. and thank you for this!

Yeah, just quoting his brilliant words which he wrote to me in reply (I so agree with him):
"It is important when dealing with a tragic loss to understand how it happened.
Not knowing can be as painful as the loss itself".

[Ankita]

Wow, I'm impressed!! All 86 questions and from what I can see, answering them in full, not half-hearted cut n paste type. This man is awesome! Thank you some much Dr Shaffer for taking your precious time to write back to us. I just want to say that I am sorry for your lost.

I am currently re-reading Frank Cascio's book, My Friend Michael when I came upon this thread, reading that Dr Shaffer is from New Jersey and he does not know much about Michael Jackson, probably other than what is offered by the media, this crazy image painted of Michael as the icon, King of Pop. I suddenly have this crazy idea - the Cascio's are also from New Jersey and perhaps it could help Dr Shaffer to understand Michael the man better if he gets to read the book. The book also put into context why Michael is using the drugs to cope with some difficult time in his life and how he also go thru with the help of another doctor from Florida to get rid of the drugs usage. The other good book will be "The man in the Music" by Joe Vogel. Since he is trying to read up and understand more of Michael, we should perhaps guide him to the right channel instead of ending up reading rubbish stuff like Halprin or Diane Diamond. What do you think Ivy?

I'm very sure that with the wisdom, integrity and sense of innate justice Dr. Shafer has, never in a million years will he end up reading OR believing the absolute crap written about Michael by scums like DD or Halprin. He is beginning to learn about Michael from Michael himself-through his music, his videos, his words, his philanthropy and the absolute, unconditional love, respect, admiration we-his fans have for him and for his message. THIS is how he's learning to know who Michael really was and I know we have nothing to worry about because THIS is the BEST way!

[soulmum]

Thank you for this.

[Victory22]

Dr. Shafer is a true hero and I can never thank him enough for what he did for MJ, his children and the fans. He has restored my faith in the human race and our system of justice. I don’t have the words in my vocabulary to express just how much I love, respect and admire Dr. Steven Shafer. May God bless him always and his family. What an extraordinary special person he is. The depth of his grace, generosity and care for others reminds me of our Michael.

[Bonnie Blue]

Thank you to Dr shafer and to ivy and mjjc for the great q and a. Really interesting, and very kind of the doctor to take the time. Loved his reply to chernoff's statement that lack of record keeping didn't kill mj. Should be emailed to chernoff's lawfirm, and flannigans. You could tell in court that was something he felt really strongly about as he mentioned it in relation to his father.




However, he was thrust into (well deserved) stardom as a youngster, and spent his entire life under the glare of public scrutiny. That does not seem like a blessing to me. To me it seems like a tragedy. He never lived a normal life. [/COLOR]



Great to hear someone who recognises that fame at an early age is not such a great aspiration. It's a pity that not more people feel the same way.

[Sophielo]

Bless him he's so lovely. He must be ridiculously busy and for him to agree to this and answer every question goes beyond expectations. Thank you!

[Vinter]

The depth of his grace, generosity and care for others reminds me of our Michael.
That is so true!

[Ankita]

Dr. Shafer is a true hero and I can never thank him enough for what he did for MJ, his children and the fans. He has restored my faith in the human race and our system of justice. I don’t have the words in my vocabulary to express just how much I love, respect and admire Dr. Steven Shafer. May God bless him always and his family. What an extraordinary special person he is. The depth of his grace, generosity and care for others reminds me of our Michael.

Yes, so true..

[Louise.]

What a truly amazing man. :flowers:

[Milka]

probably he didn't get the reference (as he said he's only knowledgeable about Thriller album) and thought that we are a bunch of crazies :P

Then you have to explain it to him, ivy. ;)

[HumanNature2210]

Thanks Ankita! I was coming more from the angle of how we as fan can help if Dr Shaffer really wants to learn more about Michael. As we all know, Dr Shaffer is a very busy man, hence, does not have the time like us fans who read up tonnes and tonnes of material pertaining to Michael and sort out what is rubbish and what is gem. If we can guide him to the right direction, I don't know, perhaps insightful articles written by Rev Barbara Kauffman (sp), Joe Vogel's articles, etc.


I'm very sure that with the wisdom, integrity and sense of innate justice Dr. Shafer has, never in a million years will he end up reading OR believing the absolute crap written about Michael by scums like DD or Halprin. He is beginning to learn about Michael from Michael himself-through his music, his videos, his words, his philanthropy and the absolute, unconditional love, respect, admiration we-his fans have for him and for his message. THIS is how he's learning to know who Michael really was and I know we have nothing to worry about because THIS is the BEST way!

[ivy]

http://mjssfljunky.tumblr.com/post/14525847636/that-moment-when-dr-schafer-was-asked

by MJs SFL Junky


That Moment When Dr. Schafer Was Asked…


MJJC: Have you ever listened to Michael Jackson’s music and if yes, what song is your favorite?
Dr. Steve Shafer: I grew up listening to Michael Jackson’s music, just like the rest of the world. Thriller was the only album that I knew well, and “Beat it” is my favorite track from it. The message and the music both appealed to me.

Hells Yeahz…Beat It!

http://i511.photobucket.com/albums/s360/cwicemvp12/gifs/JackSaysYes.gif

Ya hear dat ConRAT…BEAT IT!

http://media.scout.com/media/forums/emoticons/168/crazycat.gif

http://images5.fanpop.com/image/photos/26700000/Beat-It-GIFS-michael-jackson-26727086-350-263.gif



MJJC: Did your opinion about Michael Jackson change during and after this trial? Positively or negatively, and what is your current opinion about Michael Jackson?
Dr. Steve Shafer: My opinion of Michael Jackson is that he was an immensely gifted musician, entertainer, and genuinely compassionate individual. However, he was thrust into (well deserved) stardom as a youngster, and spent his entire life under the glare of public scrutiny. That does not seem like a blessing to me. To me it seems like a tragedy. He never lived a normal life.

http://media.tumblr.com/tumblr_lwex61AbxI1qihqr8.gif


MJJC: Since your father passed away during the trial, was it hard to do the testimony? (and please accept our most sincere condolences for your loss)
Dr. Steve Shafer: I’ve shared with some members of the MJJCommunity my personal story about my father’s passing. I’ll spare you the details, other than to say that for me, the trial brought me an unexpected gift: the chance to be with my father when he die
Had it not been for the trial, I would have been in New Jersey. As it was, I was at his bedside, offering love and morphine.

Awwwww, Dr. Schafer, so sweet!

http://images2.fanpop.com/image/photos/9700000/I-wanna-a-hug-michael-jackson-9770533-400-300.gif


(I can only hope that one of my kids decides to take up a career in anesthesia.)

http://27.media.tumblr.com/tumblr_lk1i6zFvwA1qixleeo1_500.gif


During my testimony, I felt that my father was beside me. It gave me confidence, particularly during cross examination. I knew that since my Dad was with me, I’d be OK.

Awwww, now I feel all warm and tingly inside!

http://images5.fanpop.com/image/photos/25100000/MJJ-michael-jackson-25143639-500-374.gif


MJJC: During testimony we learned that you drank Propofol. Did you drink it before you conducted the scientific research? What prompted you to drink it yourself?
Dr. Steve Shafer: I knew that the defense would reject animal studies as not applying to humans, just as Paul White did when asked about animal studies of propofol in urine. There is no way that I could conduct a human study in the US in three months, so I thought the best evidence I could get was to simply drink propofol and report if it had any effects. I knew the pharmacology well enough to be absolutely certain it was inert.

Dr. Schafer da man!

http://i43.tinypic.com/rm88w0.jpg

http://www.japemonster.com/wp-content/uploads/2011/12/funny-gifs-love-that-jiggle.gif


About a week later my colleague Pablo Sepulveda in Chile told me he would be able to conduct a clinical trial in volunteers. That made my drinking propofol completely irrelevant.

You still a G, Dr. Schafer!

http://i107.photobucket.com/albums/m294/Niece5/24o4vmx.gif

You handled the damn bidniz!

http://i27.photobucket.com/albums/c169/mulika112/give-in-to-me-s.gif


However, please remember that propofol is unique in the complete “first pass” metabolism. One should not try this with other drugs. Indeed, many drugs on the anesthesia cart would be fatal if consumed like that. This should not be attempted as a party trick!

Welp, there go my entire plans for my New Year’s Party!

http://media.tumblr.com/tumblr_lvt1jt0tMw1qcsp5b.gif


MJJC: Any comments on Mr. Chernoff referring to you as a “cop”?
Dr. Steve Shafer: No, that’s his job. It didn’t bother me at all.

http://media.tumblr.com/tumblr_led171UfNI1qdlkgg.gif


MJJC: Did it amuse you like it did many when Dr. White was called “Dr. Shafer” several times in court by Prosecution, Defense and even the Judge?
Dr. Steve Shafer: Yes. I think everyone was amused.

http://media.tumblr.com/tumblr_ludh9h4icp1ql180m.gif

http://media.tumblr.com/tumblr_lvfanunoMf1qkz1ro.gif

http://gifs.gifbin.com/052009/1243271414_black_guy_laughing.gif



MJJC: Did media approach you for interviews? If yes, why didn’t we see you on TV?
Dr. Steve Shafer: Yes, I was approached, but I don’t think the interviews were aired. I think the reason is that they didn’t like my answers. I was asked about what I thought Conrad Murray’s sentence should be. I answered honestly that I didn’t have the background to judge that. I said that our lawmakers determine the appropriate sentences for criminal behavior, and judges then impose sentences based on the dictates of the law. I said that this was really a question for Judge Pastor, who IS an expert. I don’t think they liked that answer. They probably hoped for something much more vengeful from me.

Oh the media think they cute!

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The dirty bastards!

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I was asked how I felt about my role in convicting Conrad Murray. I honestly replied that I don’t think I had much of a role. Conrad Murray gave Michael Jackson propofol in a bedroom, with no training, no monitoring, no backup, no accountability, abandoned him to talk on the phone, and then lied about his action. His guilt was obvious when the facts emerged in 2009, and it just as obvious after my testimony.

Yaaassss!!!

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MJJC: Judge Pastor picked out Murray’s recording of MJ as the piece of evidence that affected him the most during the trial. Was there any one thing that affected Dr Shafer in all the evidence that he looked at?
Dr. Steve Shafer: Yes, the consistency Conrad Murray’s behavior. In the sentencing hearing Judge Pastor outlined in detail Conrad Murray’s pattern of repeated lying, self-serving actions, and reckless disregard for the wellbeing of his patient. That was what I saw also.


MJJC: How did you decide to choose your profession? What did it start with?
Dr. Steve Shafer: Many physicians choose a medical career very early in life. I knew from the time I was 9 years old that I wanted to be a physician. The inspiration was my pediatrician. He seemed to know absolutely everything, and I was amazed at the breath of his knowledge. Additionally, every year he spent several months on the “Ship Hope” practicing medicine in third world countries. I profoundly admired his sense of service to others. That was my role model

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MJJC: What do you think about DA Walgren?
Dr. Steve Shafer: He is brilliant, dedicated, and absolutely honest. He worked incredibly hard. I think he got about 4 hours of sleep every night of the trial.

Part of my job was educating Mr. Walgren in the science. By the time of the trial, he was occasionally correcting my calculations! He was so effective when dealing with expert opinion in part because he truly understood the scientific principles.

As a taxpayer, it is amazing that attorneys like Mr. Walgren work for the State of California at a public servant’s salary. We are really getting our money’s worth!

Somebody sounds like he has a guy crush, so sweet!

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MJJC: Did you see Judge Pastor give his sentencing statement? Any comments on that?
Dr. Steve Shafer: Yes, I watched it live. I smiled when Judge Pastor used specific words and ideas that I introduced in my testimony. Also, having read all of the documents numerous times, it was clear to me that Conrad Murray repeatedly lied. However, that was irrelevant to my testimony, and so I appropriately kept that opinion to myself. I appreciated hearing the judge, who is better able to judge Murray’s veracity than I am, lay out the pattern of self-serving lies by Conrad Murray.

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MJJC: Do you think Murray just made a ‘fatal mistake’ or do you think it’s something more?
Dr. Steve Shafer: The fatal mistake was saying “Yes” to Michael Jackson’s request for a physician to administer propofol. That was followed by innumerable other fatal mistakes, but it all traces back to the initial lack of judgment.

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MJJC: What kind of punishment would be appropriate in your personal opinion?
Dr. Steve Shafer: Emphasizing that this is just my uninformed personal opinion, I believe that he must lose his license, never practice medicine again, and be accountable to the Jackson family. Please let me emphasize again that criminal punishment isn’t something I know about.

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MJJC: In his closing argument Ed Chernoff stated once more that “lack of record keeping did not kill Michael Jackson”. Would you find this a particularly irresponsible assumption- especially in light of your lengthy and detailed explanation of Pharmacokinetics and Pharmacodynamics? Would Ed Chernoff’s closing argument be especially irresponsible and outrageous- considering that the assumed physician did not keep any records?
Dr. Steve Shafer: Mr. Chernoff’s statement is false. The lack of record keeping did contribute to Michael Jackson’s death. Without records Conrad Murray could not look for trends, such as seeing if larger doses were needed each day. Without records Conrad Murray could not look at past doses to determine what was a safe dose, and what was a dangerous dose.

Record keeping re-enforces vigilance. When you write down the vital signs every 5 minutes, it forces you to keep an eye on the patient. Record keeping would have forced Conrad Murray to stay close to Michael Jackson and continuously write down vital signs (at a minimum he had the pulse oximeter on the finger and could physically count the rate of breathing and heart rate). Record keeping would have forced Conrad Murray to monitor the intravenous infusion rate. Record keeping might have kept Michael Jackson alive. Thus, Mr. Chernoff’s statement is false.

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MJJC: Lots of hyperbole has been made of the IV tubing/matching/non matching. Could you explain in detail once more (with no defense attorney interrupting) why this has no bearing on the statements made by you?
Dr. Steve Shafer: I initially believed that the IV tubing that Conrad Murray purchased in large quantities from Sea Coast Medical was non-vented, because I did not see the vent in the picture taken by the medical examiner, no vent is described in the product description from Sea Coast Medical, and I was unsuccessful in my initial effort to purchase the tubing from Sea Coast Medical. It turns out that it was vented, which I only realized after I physically examined the tubing in court.

However, the fact that the smaller infusion set was vented only increases the ease with which Conrad Murray set up the infusion, and the ease of concealing the tubing set on the day Michael Jackson died.

However, it still comes back to the big picture: Conrad Murray was giving Michael Jackson an anesthetic drug in his bedroom with inadequate training, inadequate monitoring, and no backup. That is why Michael Jackson died. None of these issues changes the big picture.

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Read Part 1 of Dr. Schafer’s Q&A on MJJC:
MJJC Exclusive Q&A with Dr. Steve Shafer - Read his answers - Part 1

[qbee]

^^ :hysterical: thank you Ivy ... That was awesome

[shelly_webster]

I just wanted to say thank you to, all the people involved in that Q&A, it's very interesting.

[ivy]

Part 2 will be posted in an hour.

[xthunderx2]

Part 2 will be posted in an hour.

:clapping: thank you IVY,,,I cant wait to read more.

[shelly_webster]

I really want to read more.

[ivy]

I'll post part 2 in a separate thread so that it will be more visible. I'll merge the threads a few days later.

[ivy]

MJJC Exclusive Q&A with Dr. Steve Shafer Part 2

This is Part 2 of 3 of Dr. Steve Shafer's answers to MJJCommunity questions. In this second installment Dr. Shafer will be answering questions about Dr. Paul White, Conrad Murray and Michael Jackson's death.

Questions about Dr. White

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MJJC: While watching the trial it felt like there’s an animosity or fall out between you and Dr. White. Are we correct about this? If yes did this fall out stem from the events of the trial or is there a history to this?

Dr. Steve Shafer: Paul has been a friend for nearly three decades. The Paul White you saw on television was not the Paul White that I have known since medical school. He has made many contributions to our specialty. It is my hope that his contributions are his permanent legacy, not his defense of Conrad Murray.

Paul has been a cherished mentor since I was medical student. I was not his “student” as Chernoff stated, and I did not appreciate the implication that Paul taught me what I knew about propofol. However, Paul has given me counsel on everything from medical school to romance. I was expecting Chernoff to ask “Hasn’t Dr. White been a mentor to you?” I was ready to say “yes”.


MJJC: What did you think of Dr. White’s testimony and his behavior? Did anything he said change your opinion about your colleague? Were you surprised by the things he said and things he did (such as his comments to the media) or didn’t do (such as not doing his own charts, not overseeing the Beagle experiment)?

Dr. Steve Shafer: There were factual errors in Paul’s testimony. Paul is capable of outstanding scholarship. I don’t know the dynamics of his relationship to the defense team that led to him not doing the heavy lifting that he usually does when it comes to checking the literature. I wish he had contacted me in advance. I would have been happy to help him review the literature and explain the science.

The different approaches of science and law to discerning the truth failed Paul. If this had been an argument over a scientific manuscript, Paul and I would have spoken directly, without attorneys trying to discredit either one of us. We would have lined up papers, and arguments, and “duked it out” by e-mail, or perhaps over an extended lunch at one of our favorite Mexican restaurants. That would have worked and the science would be right (at least as “right” as we could get it). There would be no adverse consequences for either of us. As scientists collaborating to “get it right” we would have done well. The criminal justice system isn’t set up to allow scientists representing opposing sides to collaborate in an effort to find the truth.


MJJC: Are you still friends with Dr. White?

Dr. Steve Shafer: There may be some bruised feelings, but we will get past it. We have a lot of shared history.


MJJC: You worked with Dr. White and you are/were friend with him. So how it's possible to have 2 completely different opinions about what happened the night of 25 June 2009 from two close people?

Dr. Steve Shafer: Paul White admitted in court that he only considered self-injection scenarios. This severely limited the scenarios he considered.


MJJC: What do you think of your colleague Dr. White going out of his way to justify Conrad Murray's actions, from a medical point of view?

Dr. Steve Shafer: I don’t understand it at all.


 
Questions about Dr. Murray

MJJC: Did you purposely NOT refer to Conrad Murray as a doctor during your testimony? Have you heard the news reports about how furious it made him?

Dr. Steve Shafer: I was not aware of that. It would be very unlike me to refer to him as “Mr. Murray,” as my habit is to be respectful. I probably referred to him simply as “Conrad Murray”. If I never said “Dr. Conrad Murray”, then this is indeed a Freudian slip. I don’t see him as a doctor.


MJJC: Viewers at home could see Murray losing his temper when you started the IV demonstration, was that temper flare up noticeable to you from where you were positioned in the courtroom?

Dr. Steve Shafer: I read about it, but I didn’t personally observe it. I was focused on the jury.


MJJC: If so, were you fearful of what Murray may do (i.e. did you think there was a possibility that he would physically attack you)?

Dr. Steve Shafer: Not at all.


MJJC: What are your thoughts on Murray as a doctor?

Dr. Steve Shafer: I believe he violated the fundamental trust between doctors and patients, and that he did so not in an isolated incident under duress, but intentionally and repeatedly. That is not something a doctor would do.


MJJC: Did you hear about and/or watch the Conrad Murray documentary.

Dr. Steve Shafer: No, I just heard about it.


MJJC: If so what are your thoughts about it. Do you feel that his participation in this documentary further proves Murray's lack of professional ethics and an unsuitable candidate for the medical profession?

Dr. Steve Shafer: I can’t imagine why he would participate in a documentary that would be shown prior to sentencing. Evidently they filmed the attorneys swearing at each other, with Paul White and Conrad Murray on a couch in Flanagan’s home. It seems reckless for everyone involved.


 
Questions about the role of propofol in Michael Jackson’s death

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MJJC: Based on everything you know, what do you think happened on June 25, 2009?

Dr. Steve Shafer: Michael Jackson died from respiratory arrest (his breathing stopped) while receiving propofol, exactly as the coroner reported. There was a contribution of the lorazepam, also as reported by the coroner. The coroner got it right.


MJJC: How convinced are you that MJ was on a drip that night?

Dr. Steve Shafer: I’m completely convinced. Murray admitted to using a drip every night. He said he was trying to wean Michael Jackson. I don’t believe him. The urine propofol levels suggest massive doses, more than 2000 mg, as I explained in my rebuttal testimony. The blood levels show anesthetic concentrations of propofol. It all fits with an infusion (drip).


MJJC: If we disregard Murray's police interview, in your professional opinion, how long was MJ gone before Murray finally found him? Some experts are under the impression that the delay in calling 911 can only be explained by him knowing MJ was already dead.

Dr. Steve Shafer: I think he was already dead, but that is really speculative. I don’t believe anything Conrad Murray says, and there are no records. My guess that he was dead is based on the limited window between stopping breathing and death (10-20 minutes). Murray would have to observe him in that window to have a chance to revive him.


MJJC: There are some rumors that Michael actually ate a meal the night he died in Murray's so-called "care". Do you think Michael was fasting for the required time? Or was this yet one more deviation from the standard of care by Murray? What are your thoughts on this?

Dr. Steve Shafer: I’m not aware of any data suggesting Michael Jackson ever fasted. It doesn’t come up anywhere in the record. My guess is that he ate, because he would likely be hungry after a vigorous rehearsal.


MJJC: What do you think about June 19th (Kenny Ortega's email describing Michael- chills, seeming lost), and June 21st (hot and cold symptoms described by Cherylin Lee). What could those symptoms come from?

Dr. Steve Shafer: It is hard to know. The defense proposed that those might be withdrawal from Demerol, and that is correct. It might also be withdrawal from lorazepam. Propofol withdrawal hasn’t been described, because nobody other than Michael Jackson has ever received propofol night after night for insomnia. However, at least in theory it could be propofol withdrawal.

However, it could also be the usual sort of illness: the “stomach flu” or a bad cold. There is no way of knowing.


MJJC: Do you have an opinion about June 23rd and 24th, when Michael seemed to be feeling great? What could this improvement come from?

Dr. Steve Shafer: I don’t know. After the trial I watched “This is It.” There was obvious excitement and exuberance as rehearsals were nearing the end, and the tour was approaching. It could simply be excitement and exuberance in expectation of the tour.


MJJC: Does it surprise you MJ didn't die sooner than June 25th after finding out Murray was given MJ Propofol without proper equipment for 2 months (according to Murray) prior to MJs death?

Dr. Steve Shafer: Yes. I think that is quite surprising. We don’t know if there were prior close calls, because there are no records.



MJJC: May 2009 audio recording of Michael in which he was slurring his words attracted a lot of attention. In an interview Dr. Murray said Michael was under the influence of Propofol during that recording. However some people say Propofol does not cause slurred speech. What do you think about that recording? Any idea what drugs can cause that speech?

Dr. Steve Shafer: Sedatives cause slurred speech. This could have been caused by midazolam, lorazepam, or propofol.


MJJC: Do you think there was a chance for Michael to be in good health and to continue normal usual life after such long respiratory arrest even if paramedics could reanimate him?

Dr. Steve Shafer: Definitely, if they arrived in time.


MJJC: This is a hard question but we have to ask. When there is overdose of Propofol and it causes death, like it happened to Michael, does the person suffer? Do they feel pain? Or is it like dying in your sleep that you feel nothing?

Dr. Steve Shafer: It is an easy question to answer: there is no suffering with a propofol overdose. The person falls asleep quickly and comfortably. The brain is deeply depressed, and the brain never returns to consciousness.


MJJC: If Michael had been your patient and asked you for Propofol to help him sleep, how would you have responded? What would you suggest to him? Would you have recommended he see a sleep specialist?

Dr. Steve Shafer: Absolutely the right question to ask! I would have referred him to a sleep specialist. He had a very serious sleep disorder that was threatening his tour, his ability to perform, his ability to create music, and potentially his life. It needed urgent care from someone who knows what he or she is doing.



MJJC: Do you know what the long-term effects of using Propofol would be? Murray has indicated that MJ was using Propofol for 6 weeks, apparently for sleeping 8 hours or so a night. Have you ever read about case studies of patients doing this or, as it was put forward in the trial, was MJ an experiment?

Dr. Steve Shafer: This was an experiment. I don’t think any other patient in the world has ever received this. There may be long term effects – that is a question that can’t be answered without clinical research. I don’t know what effects to expect, but it seems likely that tolerance and dependence would develop.


MJJC: How about even longer terms such as months or even years taking of deep sedation of Propofol, could it affect human health and any organs? Is it possible to take Propofol for a long time and don’t have any associated negative side effect?

Dr. Steve Shafer: We don’t know – the studies have not been done.


MJJC: There might not be enough information to have a clear picture of what was going on, but we would like to know your opinion about what Murray was prescribing to Michael (from late 2006), the amounts of midazolam, lorazepam and flumazenil Murray was buying, and the possible consequences of such a treatment.

Dr. Steve Shafer: I am not sure what amounts you are referring to. I am aware of the drugs that Murray purchased in 2009, but I did not review his previous treatment of Michael Jackson, because it didn’t relate directly to the questions I was trying to answer at the trial.


MJJC: According to his police interview, it seems that Murray knew he shouldn't mix Lorazepam and Propofol, so we are confused about their use together. Why would Dr. Murray or anyone mix those together?

Dr. Steve Shafer: There is nothing wrong with giving lorazepam and propofol at more or less the same time. Anesthesiologists routinely give midazolam at the start of an anesthetic, and propofol a few minutes later. Midazolam and lorazepam are closely related. You just have to know that the effects are “synergistic”, meaning that you need to reduce the dose of propofol when you give a lot of midazolam or lorazepam.


MJJC: Do you have any idea about how much lorazepam had he been given and when?

Dr. Steve Shafer: Yes, he gave a lot. The lorazepam levels in the blood were high enough to contribute to the cause of death, as stated in the coroner’s report, and as emphasized by the defense. As accurately stated by the defense, the lorazepam concentration in his blood was enough to put most of us to sleep. There were 8.4 milligrams of lorazepam in his autopsy urine, and another 5.8 milligrams of lorazepam in the urine that was recovered at the scene, which presumably was from the same night. So Michael Jackson received a lot of lorazepam. However, because there are no records, and I don’t trust what Conrad Murray says, it is hard to be more precise.


MJJC: Dr Kamangar said that dependency would be faster if benzos were given IV. Now was this a "treatment" that would have made him highly dependent on benzodiazepines? If Michael had survived, would he have been able to recover from this?

Dr. Steve Shafer: Yes to both questions. Intravenous drug use typically results in faster dependence. Regardless of the degree of dependency, one can recover from it with appropriate treatment. The big problem for Michael Jackson would have been whether he would be willing to stay away from intravenous sedatives for the rest of his life. Without a change in life priorities it is often very hard to wean individuals who are dependent on drugs.


MJJC: After spending what must have been hours of going through Murray's police statement, then the evidence itself, did you feel shocked with the results you were coming up with - the amount of propofol that had to have been given by Murray to obtain the blood results found at autopsy, the botched attempt by Murray to create his own Tate Gallery of Modern Art drip, etc.?

Dr. Steve Shafer: Since Conrad Murray ordered staggering quantities of propofol to give to Michael Jackson, and Michael Jackson had an anesthetic concentration of propofol in his blood, I expected the simulations to confirm that he received anesthetic quantities of propofol. They did.


MJJC: During your testimony you have stated that MJ first had a respiratory arrest and then a cardiac arrest. Dr.Steinberg also testified similarly based on Murray’s own words (that there was heart beat/ blood pressure when he found Michael). We have seen the defense argue that it might have been a cardiac arrest rather than respiratory arrest first. Even in the Murray documentary they showed a scene between defense lawyers that they planned to ask you if direct cardiac arrest was possible but later decided to not ask that question as they were afraid of your possible answer. Can you elaborate on this a little?

Dr. Steve Shafer: I cannot find any evidence that the scenario outlined by the defense, instant cardiac arrest in 90 seconds, has ever occurred. I have spent hours looking for such evidence, including searching the medical literature and communicating with company officials who tracked propofol adverse events. To the best of my knowledge this has never been reported. Not even once.

I also do not believe any anesthesiologist has ever seen this. There is no mechanism by which lorazepam and propofol would act together to cause instant death. If the Judge had permitted it, I believe the trial could have been extended for several years while every anesthesiologist in the United States took the witness stand to testify that this scenario was complete bunk.

Consider the absurdity of claiming that 25 milligrams injected over 4 minutes was so safe that almost no monitoring was required, while the same dose injected over 1 minute was so toxic as to cause magical instant death! It makes no sense.

Of all the misrepresentations by the defense, the assertion of magical instant death from a small dose of propofol is the most harmful to patients. It is false. Asserting instant cardiac death from a very small dose of propofol can only be expected to increase the anxiety of patients requiring sedation and anesthesia.



MJJC: As far as we can understand from Defense line of questioning and Dr. White testimony defense theory of what happened on June 25, 2009 is as follows: Murray gave MJ Valium and then 2 doses of Lorazepam and 2 doses of Midazolam. As MJ was unable to sleep Murray gave him a bolus of 25mg Propofol. During the night/day (unclear when) MJ swallowed 8 pills of Lorazepam unknown to Dr. Murray. MJ was moving around the room even though he had an IV and a condom catheter on and with all these medications on board, he self injected an already filed and left on the night stand syringe that had 25mg of Propofol. What can you say about the Defense’s version of the events?

Dr. Steve Shafer: The primary point is that it doesn’t matter. Michael Jackson would be alive if Conrad Murray had not committed multiple egregious and unconscionable violations of the standard of care. He was administering a general anesthetic to Michael Jackson in his bedroom, with no training, monitoring, or backup. He abandoned his patient. When he returned, his patient was either dead or nearly so. It speaks for itself.

We know that Michael Jackson received a lot of lorazepam. Maybe he took pills. Maybe Conrad Murray gave him more intravenously than he admitted to. We do know is that there was not enough unmetabolized lorazepam in Michael Jackson’s stomach to suggest recent ingestion. We do know that there was evidence in the room of large doses of intravenous propofol administration. We do know that the amount of unchanged propofol in the urine suggests administration of well over 1000 mg (100 mls) of propofol. Thus, the defense scenario is not consistent with the physical or autopsy data for either lorazepam or propofol.


MJJC: Dr. Shafer, you said at the trial that probably at the time of death the drip was still on and that would explain why the propofol concentration on the femoral blood was so high. But Dr. White said that he would doubt the propofol could still be infused once the blood circulation has stopped. Could you expand on this, please?

Dr. Steve Shafer: I claimed that Michael Jackson died during the infusion, which is why the blood concentration was as high as it was. He didn’t have to die at the end of the infusion, and there is no reason to think that he did. He simply died during the infusion. The 100 ml propofol bottle was empty, I expect that he died before the bottle was empty, but that by the time Conrad Murray found him the bottle had run out as well.

I was surprised that the defense claimed that my simulations required that Michal Jackson die at the end of the infusion. There was no such requirement. I was disappointed that Paul White went along with this.


MJJC: In case there was cardiac arrest initially and not subsequently after respiratory arrest as Murray told the police, that cardiac arrest could have been caused by a sudden high/fast dose from the drip since there was no infusion pump to regulate the rate of the drip?

Dr. Steve Shafer: No. The heart is quite a reliable organ. It can stop suddenly, but not from anything propofol does. What makes the heart stop abruptly is: 1) an arrhythmia, typically from an acute heart attack, 2) something that completely blocks circulation, such as injection of a large dose of air, or a blood clot from the legs that suddenly blocks flow into the lungs, 3) administration of a large dose of intravenous potassium, which interferes with the electrical activity of the heart. Propofol will stop breathing, and it will drop the blood pressure. Neither of those will cause the heart to abruptly stop. As far as I can tell, nobody has ever seen a patient’s heart suddenly stop from any dose of propofol.


MJJC: According to Walgren's words during closing arguments "we don't know whether Michael awoke, yelled for help and choke while Conrad Murray wasn't in his bedroom, and we'll never know" and to Alberto Alvarez testimony that Michael's eyes and mouth were wide open, I want to ask you: could Michael suffered before death and could he really yelled for help and choke while dying? And if no, why his eyes /mouth were open if he died sleeping?

Dr. Steve Shafer: Michael Jackson did not suffer. He died because he stopped breathing. He was unconscious at the time. If he had been conscious, he would have been breathing.

It doesn’t mean anything if a patient’s eyes or mouth are open or closed after death. I witnessed my own father’s death during the time I was testifying. I was at his bedside. He was in and out of consciousness for about two hours before his death. My last communication from him, an “OK” sign with his hand, was about an hour before his death. After he died, I noted that his eyes and mouth were both open. I closed them.

Note: Part 3 of 3 will be posted 24 hours later - on December 22, 2011.

[ivy]

please feel free to post and discuss

[qbee]

Thank you Ivy. Here is the link to Part 2

MJJC Exclusive Q&A with Dr. Steve Shafer - Read his answers - Part 2
http://www.mjjcommunity.com/forum/threads/120626-MJJC-Exclusive-Q-amp-A-with-Dr.-Steve-Shafer-Read-his-answers-Part-2?p=3563362#post3563362

[Memefan]

THANK YOU DR SHAFER.

I will be forever grateful....these answers are bringing me a lot of unexpected peace.

Thank you Sir!!!

[xthunderx2]

I know Michael didn't suffer..I knew that he just fell into a peaceful sleep...but...even what Dr Shafer says doesn't make sense about Michael eyes and mouth being open. If he fell into a peaceful sleep...his eyes and mouth would remain closed. (I have witnessed this first hand so I know) I think that Murray opened them up himself...before Alberto came in the room.

[MsCassieMollie]

Dr. Shafer is so cool for doing this! :)

Thank you!

[qbee]

It was very comforting to me that Dr Shafer stated twice in his answers that Michael did Not suffer

[windy09]

Thank you Ivy and MJJC for this Q & A with Dr. Shafer. I have the utmost respect for Dr. Shafer. Please extend our sincerest gratitude to him for taking the time to answer all of the questions in addition to all that he does. He really is a wonderfully nice person. :angel:

[CaptainEoLove85]

Thanks again. Very informative.


MJJC: If Michael had been your patient and asked you for Propofol to help him sleep, how would you have responded? What would you suggest to him? Would you have recommended he see a sleep specialist?

Dr. Steve Shafer: Absolutely the right question to ask! I would have referred him to a sleep specialist. He had a very serious sleep disorder that was threatening his tour, his ability to perform, his ability to create music, and potentially his life. It needed urgent care from someone who knows what he or she is doing.

My question. Yeah, that's why I wish Michael could have seen Dr. Shafer or another doctor like him. :sigh: :(


Consider the absurdity of claiming that 25 milligrams injected over 4 minutes was so safe that almost no monitoring was required, while the same dose injected over 1 minute was so toxic as to cause magical instant death! It makes no sense.

Of all the misrepresentations by the defense, the assertion of magical instant death from a small dose of propofol is the most harmful to patients. It is false. Asserting instant cardiac death from a very small dose of propofol can only be expected to increase the anxiety of patients requiring sedation and anesthesia.

I take it Dr. Shafer didn't like this defense theory. :P

[windy09]

It was very comforting to me that Dr Shafer stated twice in his answers that Michael did Not suffer

Yes me too qbee. To hear that from someone who is an expert on propofol provided some comfort that Michael didn't suffer. Once again, I extend my sincere gratitude to Ivy, MJJC and Dr. Shafer. :angel:

[Ashtanga]

My question. Yeah, that's why I wish Michael could have seen Dr. Shafer or another doctor like him. :sigh: :(



Yes. :(

[Vici]

MJJC: Do you think there was a chance for Michael to be in good health and to continue normal usual life after such long respiratory arrest even if paramedics could reanimate him?

Dr. Steve Shafer: Definitely, if they arrived in time.




:( :( :(





MJJC: During your testimony you have stated that MJ first had a respiratory arrest and then a cardiac arrest. Dr.Steinberg also testified similarly based on Murray’s own words (that there was heart beat/ blood pressure when he found Michael). We have seen the defense argue that it might have been a cardiac arrest rather than respiratory arrest first. Even in the Murray documentary they showed a scene between defense lawyers that they planned to ask you if direct cardiac arrest was possible but later decided to not ask that question as they were afraid of your possible answer. Can you elaborate on this a little?

Dr. Steve Shafer: I cannot find any evidence that the scenario outlined by the defense, instant cardiac arrest in 90 seconds, has ever occurred. I have spent hours looking for such evidence, including searching the medical literature and communicating with company officials who tracked propofol adverse events. To the best of my knowledge this has never been reported. Not even once.

I also do not believe any anesthesiologist has ever seen this. There is no mechanism by which lorazepam and propofol would act together to cause instant death. If the Judge had permitted it, I believe the trial could have been extended for several years while every anesthesiologist in the United States took the witness stand to testify that this scenario was complete bunk.

Consider the absurdity of claiming that 25 milligrams injected over 4 minutes was so safe that almost no monitoring was required, while the same dose injected over 1 minute was so toxic as to cause magical instant death! It makes no sense.

Of all the misrepresentations by the defense, the assertion of magical instant death from a small dose of propofol is the most harmful to patients. It is false. Asserting instant cardiac death from a very small dose of propofol can only be expected to increase the anxiety of patients requiring sedation and anesthesia.





Love him!!

[Ashtanga]

God bless Dr.Shafer! He truly is amazing!

I had sent to him a small note thanking him(on behalf of all of us) for all that he did so justice could be served. He was so kind to send a reply thanking me in return(what a man!) and I hope he won't mind my sharing that letter here.

here-

Dear Ankita:

It is very nice to hear from you. I appreciate your kind thoughts.

I was honored, and humbled, to have an opportunity to explain to a jury the fundamental principle of medicine: doctors put patients first. I believe the jury understood this message and reached the correct conclusion.

I am grateful to the many Michael Jackson fans who have contacted me since the trial. I think that not knowing what happened on June 25, 2009 has caused a lot of pain within the Michael Jackson community. It is my hope that by explaining what happened that day I have brought some closure to their loss.

I grew up listening to Michael Jackson’s music (who didn’t”). However, I knew little of Michael Jackson prior to the case, other than that he wrote great dance and party music. I’ve learned more about Michael Jackson, his life, his ideals, and his music since the trial. I understand how he has become such an important influence in the lives of millions of fans. With the end of the trial, and the conviction of Conrad Murray, it is my hope that his fans can return to the joy of his life, his music, and his legacy.

Again, thank you for the kind words.

Sincerely,

Steve Shafer

******

and another-Dear Ankita:

I have read the article, and it is very moving. Thank you for sharing it!I will continue to read about the life of Michael Jackson, and learn about this remarkable, brilliant, talented, and complex man. I will also spend more time studying his music, and his lyrics. As mentioned, I knew little about Michael Jackson, and enjoyed but had not studied his music, at the time of the trial. I intentionally kept it that way, so that I could see him only as a patient.

Again, I appreciate your sharing this with me.

Sincerely,

Steve Shafer

I know he's a busy man, so I wrote to him only twice and he was so kind to reply, and now our 86 questions! Thank you Dr. Shafer!

Great man. :heart:








http://mjssfljunky.tumblr.com/post/14525847636/that-moment-when-dr-schafer-was-asked

by MJs SFL Junky


That Moment When Dr. Schafer Was Asked…



Hells Yeahz…Beat It!

http://i511.photobucket.com/albums/s360/cwicemvp12/gifs/JackSaysYes.gif

Ya hear dat ConRAT…BEAT IT!

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http://images5.fanpop.com/image/photos/26700000/Beat-It-GIFS-michael-jackson-26727086-350-263.gif



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Awwwww, Dr. Schafer, so sweet!

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Awwww, now I feel all warm and tingly inside!

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Dr. Schafer da man!

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You still a G, Dr. Schafer!

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You handled the damn bidniz!

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Welp, there go my entire plans for my New Year’s Party!

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Oh the media think they cute!

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The dirty bastards!

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Yaaassss!!!

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Somebody sounds like he has a guy crush, so sweet!

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Read Part 1 of Dr. Schafer’s Q&A on MJJC:
MJJC Exclusive Q&A with Dr. Steve Shafer - Read his answers - Part 1

The gifs.... http://www.hornedhalo.org/images/kermit.gif :lol: And Shirley Temple... :wub:

[ForeverKOP]

Can this please be included in our follow up response to Dr. Shafer's answers?



MJJC: During the trial, the defense and various media outlets repeatedly called Michael Jackson a "drug addict". Based on your knowledge and research in this case, would you say that Michael Jackson was a "drug addict" or not?

Dr. Steve Shafer: “Addiction” is a lay term, not a medical term. The correct medical term is substance dependency. You will find an accurate explanation of this in Wikipedia. You can also find a good description at www.csam-asam.org/pdf/misc/DSM_criteria_for_diagnosis.doc (http://www.csam-asam.org/pdf/misc/DSM_criteria_for_diagnosis.doc).

I think Michael Jackson likely had a dependency on sedatives at the time of his death, because he was receiving intravenous sedatives every night. That type of regular exposure is almost certain to cause dependency.



Dr. Shafer, thanks for your response and the included attachment. If I may ask again, could you provide a more clear/straightforward answer to my original question, as in "Yes he was" or "No he was not" in regards to the specific term "drug addict"? I understand that it is not classified as a medical term, but it is used quite often in the general public - or as you said, by "laymen". And because it is used so often, I would like to know if it is justified when people (as laymen) call Michael Jackson a "drug addict". I ask with specific regards to the term because it seems like there are just so many different variations of it - as in "drug abuser", "drug addict", "drug dependent", etc. - with fine lines separating all of them from one another (as you demonstrated in your response by calling Michael Jackson "dependent" instead) and because there has been a lot of debate concerning it's usage with Michael's name. For example, many list the fact that his autopsy report proved he was a healthy man for his age and that there were no damaged organs whatsoever along with other evidence to prove their point (that using the term is wrong). The other side simply points to what seemed like a massive amount of drug use (along with its noticeable side-effects) which took place during the last months of his life as shown during the trial. So again, I simply ask, based on your knowledge and research in this case, would you say that Michael Jackson was a "drug addict" or not? Thanks again!

[Victory22]

I am also comforted and very relieved Dr. Shafer confirmed that Michael did not suffer. I trust his medical opinion completely. MJ just fell into a deep, peaceful sleep and woke up in the loving arms of his creator.

[bluetopez]

WOW! Thank U Dr. Shaffer for taking the time to answer ALL questions.


By the way I do think Dr. Shafer debunks Dr. Drew statement about MJ lungs. Because Dr. Drew just thinks it was directly cause by long Propofol use which there is no proof of like Dr. Shafer said.

Now Dr. Shafer describes the lack of monitoring eqipment not being use as the more logical reason for MJs lungs being damage because he could have swallowed his own siliva down to his lungs or/and he vomitted and that went to his lungs. That's a big diffrence. Also just to point out many know about MJ having lung issues since he was a teen aswell something Dr. Drew fails to mention because he don't care or don't know.

Oh and damn the media for not airing Dr. Shafer's one and only TV interview. Geez They really don't like when they don't get their way, don't they! SMH

[Mirabella76]

MJJC: What do you think about June 19th (Kenny Ortega's email describing Michael- chills, seeming lost), and June 21st (hot and cold symptoms described by Cherylin Lee). What could those symptoms come from?

Dr. Steve Shafer: It is hard to know. The defense proposed that those might be withdrawal from Demerol, and that is correct. It might also be withdrawal from lorazepam. Propofol withdrawal hasn’t been described, because nobody other than Michael Jackson has ever received propofol night after night for insomnia. However, at least in theory it could be propofol withdrawal.

However, it could also be the usual sort of illness: the “stomach flu” or a bad cold. There is no way of knowing.


very interesting point.


MJJC: Do you think there was a chance for Michael to be in good health and to continue normal usual life after such long respiratory arrest even if paramedics could reanimate him?

Dr. Steve Shafer: Definitely, if they arrived in time.

The meaning of that question was IF MJ wasn't breathing for 10 or more minutes and IF paramedics would be able to reanimate him in this circumstances COULD he return to normal life? There are so many accidents when person is staying alive only until life supporting equipment helps him. He can't breath himself and his brain is dead.
Dr. Shafer allows MJ could return to normal life without any negative effect in such circumstances. It's surprising me.


MJJC: According to Walgren's words during closing arguments "we don't know whether Michael awoke, yelled for help and choke while Conrad Murray wasn't in his bedroom, and we'll never know" and to Alberto Alvarez testimony that Michael's eyes and mouth were wide open, I want to ask you: could Michael suffered before death and could he really yelled for help and choke while dying? And if no, why his eyes /mouth were open if he died sleeping?

Dr. Steve Shafer: Michael Jackson did not suffer. He died because he stopped breathing. He was unconscious at the time. If he had been conscious, he would have been breathing.

It doesn’t mean anything if a patient’s eyes or mouth are open or closed after death. I witnessed my own father’s death during the time I was testifying. I was at his bedside. He was in and out of consciousness for about two hours before his death. My last communication from him, an “OK” sign with his hand, was about an hour before his death. After he died, I noted that his eyes and mouth were both open. I closed them.

I needed to know that Michael didn't suffer at all. God blessed him and gave him gentle death......


The last words about Steven's father are very heartbreaking. Rest in peace....

[Louise.]

Dr. Shafer is an amazing guy. I have nothing but complete respect for him.

[elusive moonwalker]

Im abit confused by the question about murray telling the police mj had a C.A. murray said he found a pulse yet he adlo claimed a C.A?

[elusive moonwalker]

Never mind i think i just read the question wrong.one thing i wonder though is why in the pros case didnt they bring up the 200mg of dip in the urine. that is daming evidence as that amount can only come from a drip .yet it only came up in rebutal kinda like an oversight after the defence did their messed up graphs

[elusive moonwalker]

Can this please be included in our follow up response to Dr. Shafer's answers? Dr. Shafer, thanks for your response and the included attachment. If I may ask again, could you provide a more clear/straightforward answer to my original question, as in "Yes he was" or "No he was not" in regards to the specific term "drug addict"? I understand that it is not classified as a medical term, but it is used quite often in the general public - or as you said, by "laymen". And because it is used so often, I would like to know if it is justified when people (as laymen) call Michael Jackson a "drug addict". I ask with specific regards to the term because it seems like there are just so many different variations of it - as in "drug abuser", "drug addict", "drug dependent", etc. - with fine lines separating all of them from one another (as you demonstrated in your response by calling Michael Jackson "dependent" instead) and because there has been a lot of debate concerning it's usage with Michael's name. For example, many list the fact that his autopsy report proved he was a healthy man for his age and that there were no damaged organs whatsoever along with other evidence to prove their point (that using the term is wrong). The other side simply points to what seemed like a massive amount of drug use (along with its noticeable side-effects) which took place during the last months of his life as shown during the trial. So again, I simply ask, based on your knowledge and research in this case, would you say that Michael Jackson was a "drug addict" or not? Thanks again! i would say he answered your question in the second set of answers. he stated he believed there was a dependency on benzos because you cannot give that amount by iv and not create some sort of dependency. we can see that would be caused by murray as the bottles of pills of benzos prescribed and taken by mj had been under used..u seem to be concentrating to much on some tabloid term when it has been described as to the difference between addiction and dependency

[goldiee]

What a nice man to do this! And he answered so many! Too bad he couldn't been Michael's doctor.

[ivy]

I think he answered that as well. He won't call Michael an "addict" because it's not a medical term. Just based on long term (6 week) IV administration of benzos he would classify it as dependency.

[ivy]

The meaning of that question was IF MJ wasn't breathing for 10 or more minutes and IF paramedics would be able to reanimate him in this circumstances COULD he return to normal life? There are so many accidents when person is staying alive only until life supporting equipment helps him. He can't breath himself and his brain is dead.
Dr. Shafer allows MJ could return to normal life without any negative effect in such circumstances. It's surprising me.

As far as I can understand - yes the question is vague as well - he mentions "if they arrived on time"

Dr. Shafer says Michael had a respiratory arrest and it would take 10-20 minutes for his heart to stop (cardiac arrest) and die.

So my understanding is - if Murray saw Michael having respiratory arrest and if he called the paramedics right away and if they arrived in time - within that 10 - 20 minute period- they could have revived him with no negative after effects.

Paramedic Sennef also said a similar thing. But I think they were called too late and perhaps even after Michael was already dead and nothing would bring him back.


Im abit confused by the question about murray telling the police mj had a C.A. murray said he found a pulse yet he adlo claimed a C.A?

It's not Murray. It's his defense. They argued that Michael died from an instant cardiac arrest. Because if you remember Shafer's models he accounted for respiratory arrest and cardiac arrest 10 minutes later. That 10 minutes was removing propofol from the body and it required Michael to die when on drip - and continue to receive Propofol after he died.

As that 10 minute window wasn't allowing any defense theory to stick they came up with the instant cardiac arrest theory - therefore propofol wouldn't be removed from the body.


Never mindone thing i wonder though is why in the pros case didnt they bring up the 200mg of dip in the urine. that is daming evidence as that amount can only come from a drip .yet it only came up in rebutal kinda like an oversight after the defence did their messed up graphs

I think it's because the coroner's toxicology guy - was it Anderson?- classified urine as not a good determinant of what was given. remember his testimony? he said that they most use blood levels as urine might show several days? when defense used urine to make a point, they debunked it on rebuttal.

[Ramona122003]

I think he answered that as well. He won't call Michael an "addict" because it's not a medical term. Just based on long term (6 week) IV administration of benzos he would classify it as dependency.

Wonder if you could ask Shafer if he thinks Murray gave all those benzos per IV on purpose to create a dependency to assure Michael would never fire him. In part 2, he clearly said there was allot of Lopz in Michael's system to put even a tolerate person to sleep and Murray was given propofol on top of that. He also gave Lopz through an IV which creates dependency even faster instead of the pills he actually prescription for Michael.

I also wonder if he could give an opinion to why Murray was given Lopz and the other sleep medication, forgot its name, if they were both chemically the same except for the half-life. You think after six-week he would know by now what works and not just mix drugs the way he did.

[Ankita]

Can this please be included in our follow up response to Dr. Shafer's answers?



Dr. Shafer, thanks for your response and the included attachment. If I may ask again, could you provide a more clear/straightforward answer to my original question, as in "Yes he was" or "No he was not" in regards to the specific term "drug addict"? I understand that it is not classified as a medical term, but it is used quite often in the general public - or as you said, by "laymen". And because it is used so often, I would like to know if it is justified when people (as laymen) call Michael Jackson a "drug addict". I ask with specific regards to the term because it seems like there are just so many different variations of it - as in "drug abuser", "drug addict", "drug dependent", etc. - with fine lines separating all of them from one another (as you demonstrated in your response by calling Michael Jackson "dependent" instead) and because there has been a lot of debate concerning it's usage with Michael's name. For example, many list the fact that his autopsy report proved he was a healthy man for his age and that there were no damaged organs whatsoever along with other evidence to prove their point (that using the term is wrong). The other side simply points to what seemed like a massive amount of drug use (along with its noticeable side-effects) which took place during the last months of his life as shown during the trial. So again, I simply ask, based on your knowledge and research in this case, would you say that Michael Jackson was a "drug addict" or not? Thanks again!

No. Going by Dr. Shafer's answers, its VERY clear that Michael should NOT be called a drug ADDICT/ABUSER because he was not one.

[Morphine7]

It's weird to say that, but yes I'm happy that Michael didn't suffer when he dies. And I wished he had people like Dr Shafer around him when he was dealing with all his physical problems.

[Mirabella76]

As far as I can understand - yes the question is vague as well - he mentions "if they arrived on time"

Dr. Shafer says Michael had a respiratory arrest and it would take 10-20 minutes for his heart to stop (cardiac arrest) and die.

So my understanding is - if Murray saw Michael having respiratory arrest and if he called the paramedics right away and if they arrived in time - within that 10 - 20 minute period- they could have revived him with no negative after effects.

Paramedic Sennef also said a similar thing. But I think they were called too late and perhaps even after Michael was already dead and nothing would bring him back.

I see this situation this way: Michael fell into clinical death (if i understand that term correct). To my knowledge it takes 5 or 7 min for brain to start dying after respiratory and cardical arrest because of hypoxia. You can save someone's life (i mean reanimate him) but you can't guarantee normal life 'cuz brain could be damaged or even dead.


The brain, however, appears to accumulate ischemic injury faster than any other organ. Without special treatment after circulation is restarted, full recovery of the brain after more than 3 minutes of clinical death at normal body temperature is rare.[6] (http://en.wikipedia.org/wiki/Clinical_death#cite_note-5)[7] (http://en.wikipedia.org/wiki/Clinical_death#cite_note-6) Usually brain damage or later brain death results after longer intervals of clinical death even if the heart is restarted and blood circulation is successfully restored. Brain injury is therefore the limiting factor for recovery from clinical death.

http://en.wikipedia.org/wiki/Clinical_death

It's bitter to say but Murray gave Michael no chance at all. Even if they came a bit earlier we don't know could they save him or not. Or maybe they could restart his heart but could't return him to normal life. I can't stop thinking of it.

[suzynyc]

What a nice man Dr. Shafer is, not to mention humble, intelligent (without being pompous), generous with his time to answer all our questions and open minded about Michael and his music. Too bad he couldn't be Michael's doctor (or mine for that matter).

How interesting that this trial enabled Dr. Shafer to be close to his father as he passed. Makes you wonder if higher powers were involved...

[virginia_woolf]

I'm just glad that Michael didn't suffer.

[ivy]

I see this situation this way: Michael fell into clinical death (if i understand that term correct). To my knowledge it takes 5 or 7 min for brain to start dying after respiratory and cardical arrest because of hypoxia. You can save someone's life (i mean reanimate him) but you can't guarantee normal life 'cuz brain could be damaged or even dead.

I think clinical death is when both breathing and heart stop.

However in Michael's case his breathing stopped first (respiratory arrest) however his heart was beating - even harder to distribute the remaining oxygen. They said that the heart stopping (cardiac arrest) would happen around 10 minutes. that would be clinical death and if brain damage happened in 5-7 minutes after that, you'll see that it would have give 15-17 minutes time frame from when he first stopped breathing to brain death to reanimate him.

that's how I understood it but I'm no expert in medical stuff.

[FlyAway]

A big thank you to DR Shafer!!! :heart: And to everyone for asking such great questions! :flowers:

[ilmjj]

It's weird to say that, but yes I'm happy that Michael didn't suffer when he dies. And I wished he had people like Dr Shafer around him when he was dealing with all his physical problems.
I wish Michael had met all three of the wonderful doctors that testified for the prosecution while he was alive. They are men of integrity and I know Michael would have respected that

[willbe]

I know Michael didn't suffer..I knew that he just fell into a peaceful sleep...but...even what Dr Shafer says doesn't make sense about Michael eyes and mouth being open. If he fell into a peaceful sleep...his eyes and mouth would remain closed. (I have witnessed this first hand so I know) I think that Murray opened them up himself...before Alberto came in the room.





People die peacefully with their eyes and mouth opened, just as some people sleep with their mouth and eyes opened.

[ivy]

MJJC Exclusive Q&A with Dr. Steve Shafer Part 3

This is Part 3 of 3 of Dr. Steve Shafer's answers to MJJCommunity questions. In this third and final installment Dr. Shafer will be answering questions about Propofol, Lorazepam, Flumanezil, Insomnia and related matters.

http://i43.tinypic.com/21l0klg.jpg

Questions about propofol in general

MJJC: Do you feel that your testimony helped alleviate patient concerns about Propofol or are things more or less the same?

Dr. Steve Shafer: It may have helped, but only a little. On the Friday that Paul White testified I was working at the “Allen Pavilion,” a regional hospital run by Columbia University that serves a low-income area of Manhattan and the Bronx. I was caring for an elderly man who asked what drug he would get. I told him “propofol.” As usually happens, he asked if that was the drug that killed Michael Jackson. I told him that propofol didn’t kill Michael Jackson, Conrad Murray killed Michael Jackson. I also said that propofol was very safe drug. He said “I heard that doctor say that at on television, but I don’t believe him.”

I told him I was the doctor he saw on television. He thought that was hilarious: the doctor in blue scrubs, wearing a surgical hat, with a stethoscope around his neck working in this clinic for poor patients might be the “famous” doctor he saw on television. “Yea, right” was his answer. He didn’t believe me for a second. However, he was reassured by my “joke” about being the doctor he saw on television, and everything went well.


MJJC: Can a person become dependent or addicted to propofol? If yes what kind of dependency is it physical or psychological?

Dr. Steve Shafer: There is not much data about this, because propofol must be given intravenously, and it really burns, which discourages abuse. However, there have been a number of deaths of anesthesiologists and other health care personal from propofol abuse. Based on this, I am reasonably confident that it is addictive.


MJJC: Why would someone even have the idea to use Propofol as a sleep aid? If it is only to be used for surgery then why would anyone suggest giving it someone to get some sleep?

Dr. Steve Shafer: The mechanism of action of propofol is the same as drugs like Ambien that are commonly used to induce sleep. This is a reasonable research question. However, it should never be put into practiced until it has been studied in a proper research setting. After that work has been done, it should only be used with appropriate documentation and precautions.



MJJC: Are the drug companies who make Propofol looking into testing Propofol for sleep? Do you think there will be more research studies about Propofol being used for sleep?

Dr. Steve Shafer: Yes to both questions.


MJJC: What are the known effects on the nervous system & the brain of long term Propofol use?

Dr. Steve Shafer: Not a lot, because it is rarely used for long term use. I have been able to find one report of a patient who received propofol in the intensive care unit for 51 days. This is from the conclusion of the article: “To our knowledge, this report represents the first documentation of propofol use for long-term sedation in a mechanically ventilated pregnant patient and the longest duration of continuous infusion propofol published in the medical literature. Propofol was used for 51 days with no documented maternal adverse events.” (Tajchman SK, Bruno JJ. Prolonged propofol use in a critically ill pregnant patient. Ann Pharmacother. 2010;44:2018-22)

This patient was weaned from propofol over several days without adverse consequences. So administration for 2 months appears to not have long term consequences, at least based on this example, and the fact that Michael Jackson continued to function at rehearsal. However, those are just two data points. More research needs to be done if one contemplates development of propofol for long term use.


MJJC: Does one get a "restful sleep" from Propofol? We have heard experts contradict each other on this.

Dr. Steve Shafer: The contradiction reflects the state of the science. I received propofol for anesthesia about a year ago, and I have given propofol to thousands of patients. There is often a feeling of having slept well after awakening from propofol.

However, studies suggest that propofol sleep it is quite different from normal sleep, and is not “restorative” the way that normal sleep is restorative. For example, dreams are important in brain function. Patients don’t dream on propofol, except at the time of awakening. My interpretation of the data is that propofol might be OK for getting a patient off to sleep, but that maintaining a patient on propofol for sleep (as we sometimes do in intensive care units) probably is denying patients restorative sleep.


MJJC: Do you agree that Propofol should be re-classified as a controlled substance?

Dr. Steve Shafer: No. I think this will hurt patients. In emergencies we need propofol immediately, and in large quantities. I am opposed to placing obstacles in the way of doctors caring for patients, unless there is clear benefit. Conrad Murray could have still obtained propofol for Michael Jackson, because doctors can order controlled substances. Since most propofol abuse is by doctors, making it controlled won’t limit the ability of doctors to abuse it. It will just impair their ability to care for emergency patients.

This has been the subject of an issue of Anesthesia & Analgesia. Here is the cover of that issue: http://www.aaeditor.org/HWP/Covers/0710.cover.jpg.


MJJC: Do you think now the anesthesiology community will be more careful in how they promote and teach one to use Propofol?

Dr. Steve Shafer: We already take this very seriously. We are very involved in teaching the safe use of sedatives to our medical colleagues. This will continue. Perhaps they will be more receptive to the importance of safe sedation. However, nothing we can do will reach a doctor who does not put patients first.


MJJC: Do you think the medical community has learned from Michael’s death in regards over prescribing to a powerful wealthy person and wrong doing by a doctor?

Dr. Steve Shafer: Absolutely. I mentioned this above. I am aware of this because I occasionally see this in my practice. Doctors serve patients by acting as doctors. That is a message for doctors and patients alike.


MJJC: Can you explain “Propofol lollipop” a little more?

Dr. Steve Shafer: Propofol absorbed from the stomach never reaches the brain, because it is all removed by the liver. However, the blood supply to the mouth and esophagus (above the diaphragm) does not return directly to the liver. Instead, it just goes to the heart, and from there goes everywhere including the brain. So a propofol lollipop would provide propofol to the venous blood, and from there to the brain. Paul White and I discussed this at one of the breaks prior to his testimony. It is a reasonable idea, provided the dose was adequately controlled.

Should this ever become available, then I would reconsider my position on classifying propofol as a controlled substance. My current view is highly influenced by the fact that it only works when given intravenously, and that really burns!


MJJC: What does Propofol taste like?

Dr. Steve Shafer: It has the consistency of skim milk, and tastes like a very medicinal salad dressing.


MJJC: Beagle Propofol experiment done by the Defense has made PETA and MJ fans angry. We don’t expect that you have any direct information about the Beagle experiment but as the humans weren’t affected by drinking Propofol, is it safe to assume that the Beagles were unharmed as well?

Dr. Steve Shafer: I think it is very unlikely that any harm came to the beagles. There should be no effect from drinking propofol. However, I am uncomfortable that neither the experimental protocol nor the results of the experiment were presented in court. I believe that when animals or humans participate in trials, there is an ethical obligation to write up and publish the research to add to the body of knowledge. It is the increased knowledge that morally justifies the research. I wrote our human study up for publication, asked Paul White to review it, and gave it to the defense. I believe they should have done the same with their beagle study.


MJJC: We heard the theory of some of the Benzos or/and Propofol that were given to MJ by Murray can be used for people with drug addiction to help them off their addiction to other drugs such as Demerol, Is this true? Can you comment on this?

Dr. Steve Shafer: There is a technique of rapid detoxification that involves placing patients under general anesthesia for a long period of time (hours to days) and pharmacologically reversing opioids with “opioid antagonists”, drugs that chemically block the effects of Demerol and similar drugs. This is controversial, but it probably works in some patients.


Questions about Demerol

MJJC: Was the amount of Demerol Dr. Klein give to Michael normal or was it too large a dose?

Dr. Steve Shafer: I can’t answer without knowing why Demerol was given. Dr. Klein did not testify at the trial. I’m uncomfortable offering any opinion without more information.


MJJC: Does your answer change if you consider MJ’s history (burn victim) with the drug? Do you think it was excessive?

Dr. Steve Shafer: Again, I apologize, but I don’t want to render an opinion without knowing why Dr. Klein was administering Demerol. This probably reflects my caution as an Editor-in-Chief of a medical journal. Medical editors are reluctant to render a public opinion unless they are confident they understand the facts.


MJJC: In your opinion, does Demerol aggravate insomnia as a side effect? Did it play any part in Michael's physical and mental health? What was the best treatment for Michael's insomnia?

Dr. Steve Shafer: There are three questions here. I’ll answer them in order:

Demerol’s chemical name in the United States is “meperidine.” In many countries it is known as “pethidine.” Meperidine has a metabolite, “normeperidine”, that is a nervous system stimulant. As a nervous stimulant, I would expect it to exacerbate insomnia.

The coroner examined both blood and urine for meperidine (Demerol) and normeperidine. Neither could be detected. Thus, meperidine did not play a direct role in Michael Jackson’s death on June 25th. However, you asked a more general question about “play any part in Michael’s physical and mental health.” It is a good question, and I will again need to apologize for not answering it. I have not read Dr. Klein’s medical records or heard a detailed explanation of Michael Jackson’s care. I am uncomfortable speculating without that information.

Sleep disorders are complex, and treating them is a specialized branch of medicine. It is my understanding that any drug that affects the level of consciousness can exacerbate sleep disorders. There is a nice description of sleep disorders, and the treatment of common sleep disorders, at http://www.sleepfoundation.org/article/sleep-related-problems/sleep-aids-and-insomnia.


Questions about lorazepam, flumazenil, and ephedrine

MJJC: Could the free lorazepam detected in the gastric liquid be explained by the stomach hemorrhage caused by CPR or even by accidental mixing of adjacent blood at the time of autopsy (as it was suggested by the Coroner, Dr. Rogers in the preliminary, though not mentioned again during the trial)?


Dr. Steve Shafer: Maybe. However, free lorazepam would be expected simply because molecules like lorazepam would be expected to cross from the blood into the stomach, just like they cross into all tissues. That is how the lidocaine and propofol got into the stomach. Lorazepam should behave just the same way.

Additionally, the enzyme beta glucuronidase is secreted by the wall of the stomach into the stomach fluid. Beta glucuronidase is the enzyme that would turn lorazepam glucuronide back into lorazepam. So blood could account for it, but most of it is likely the simple diffusion of lorazepam from the blood into the stomach.


MJJC: Is there any other reason for Flumazenil to be administered apart from reversing the effects of benzodiazepines (in this case Lorazepam)?

Dr. Steve Shafer: No.


MJJC: Does it even make sense to give a person Flumazenil who according to Dr. Murray only received 4 mg of Lorazepam to begin with?

Dr. Steve Shafer: The most critical part of any resuscitation is to move air in and out of the patient’s lungs. The problem with giving flumazenil is that it distracted Conrad Murray from the critical task of moving air in and out of Michael Jackson’s lungs. If there were several people were involved in the resuscitation, then giving flumazenil would have made sense. However, since Conrad Murray was alone, any interruption longer than a few seconds was too long.


MJJC: Can you explain your consideration of the Lorazepam levels, in more detail?

Dr. Steve Shafer: I’ll answer as well as I can, but I’m not sure exactly what you want to know. The lorazepam levels were high enough that you or I would have been very sleepy from them. However, patents become tolerant to lorazepam and related drugs (the “benzodiazepines”). Since Michael Jackson had a fairly high concentration, and according to Conrad Murray that was not enough drug to induce sleep, he must have been tolerant.

The defense wanted to attribute Michael Jackson’s death, in part, to oral lorazepam. The problem with this theory is that there was only a minute amount of lorazepam in Michael Jackson’s stomach. To explain this minute amount, the defense alleged that Michael Jackson swallowed lorazepam about 5 hours before the time of death. If that were true, then the lorazepam concentration would have peaked about the time Conrad Murray claims Michael Jackson was pleading for more drug to fall asleep. So that argument doesn’t make sense.


MJJC: According to autopsy report there was ephedrine found in Michael's body. It's a drug that aggravates insomnia. How ephedrine goes with benzos and propofol, could it subdue effect of these drugs?

Dr. Steve Shafer: There was a bottle of capsules composed of ephedrine, caffeine, and aspirin in the room. Ephedrine is sometimes used in resuscitation. Since there was ephedrine in Michael Jackson’s autopsy urine, as well as the urine that was found at the scene, I would assume that the ephedrine was from oral ingestion, and not from administration as part of the resuscitation.

Ephedrine can reduce the effects of propofol and benzodiazepines on blood pressure and heart rate. Chronic ephedrine might aggravate insomnia.

 
Question about medical research in general

MJJC: Judge Pastor referred to Murray as making Michael Jackson part of a “scientific experiment”. This could unfortunately dissuade patients from feeling comfortable participating in clinical trials and other types of beneficial scientific and medical research. Can you discuss the important intersection between the research of scientists and the clinical practice of physicians?

Dr. Steve Shafer: I’ve performed dozens of clinical trials. I don’t think this will adversely affect recruiting patients into clinical trials, because this “experiment” bears no resemblance to a scientific study. I think “experiment” is an accurate term, because it correctly implies that Conrad Murray had no idea what he would find day after day of propofol administration. So this was an experiment that he was conducting every day to see how Michael Jackson would respond. However, I don’t think anybody would confuse this experiment with a proper scientific experiment.

The larger question you ask is about the intersection between research and practice. This is an important question, and (fortunately) one that has been given very careful consideration. The answer goes back to the Nuremberg Code, which followed the trial of Nazi doctors guilty of atrocities at the end of World War II. You can find an excellent account on Wikipedia. This was updated by the Belmont Report, published in 1978. Again, there is an excellent account in Wikipedia. As explained in the Belmont Report, “research” differs from clinical practice in that research is a systemic investigation intended to create generalizable knowledge. “Systematic” means that the investigator intentionally gathers data to answer a question. Generalizable knowledge means that the investigator believes the information gathered is useful to others, and intends to “generalize” the knowledge, usually by publishing it. If you Google “Anesthesia & Analgesia policy in institutional review board approval and informed consent for research” you will find an editorial I wrote in March on the subject.


 
Questions about insomnia

MJJC: Decades of lies, slander, deceit, inhuman treatment from the media and public misconceptions had caused Michael immense hurt, pain and anguish resulting in insomnia. We know Propofol was not the answer, but what do you think he should have done (medically) to treat it?

Dr. Steve Shafer: He should have been in the care of a sleep medicine doctor. He had a terrible affliction, one that requires expert care.


MJJC: Do you think meditation that Murray was talking about in his police interview could really help Michael to sleep?

Dr. Steve Shafer: Maybe. Conrad Murray mentioned both propofol and lorazepam. These are both sedatives that act on the same receptor in the body, the “GABA” receptor. Most sleeping medications also act on GABA, the exceptions being antihistamines (e.g., benedryl) and melatonin. So I would expect these drugs to induce sleep. However, they should not be used to maintain sleep, because the drugs interfere with some of the brain function that is required for sleep to be “restorative”, meaning that it refreshes the brain.

 
Final comments

MJJC: Anything you want to say to the members of MJJCommunity and Michael Jackson fans in general.

Dr. Steve Shafer: Once your questions about Michael Jackson’s tragic death have been answered, I encourage you to set it aside. Conrad Murray has been convicted. We have a reasonable understanding of what happened. It’s time to return to the bonds that brought the MJJCommunity together in the first place: your celebration of Michael Jackson’s life, his message, and his music.

I appreciate the opportunity to address your questions, and hope that the answers are helpful to the MJJCommunity.

Sincerely,

Steve Shafer

[Vici]

Final comments

MJJC: Anything you want to say to the members of MJJCommunity and Michael Jackson fans in general.

Dr. Steve Shafer: Once your questions about Michael Jackson’s tragic death have been answered, I encourage you to set it aside. Conrad Murray has been convicted. We have a reasonable understanding of what happened. It’s time to return to the bonds that brought the MJJCommunity together in the first place: your celebration of Michael Jackson’s life, his message, and his music.

I appreciate the opportunity to address your questions, and hope that the answers are helpful to the MJJCommunity.

Sincerely,

Steve Shafer

Such a sweet man,.... only if it were all so simple.. :(

[elusive moonwalker]

Thanks ivy

[xthunderx2]

again Ivy Thank you sooo much for taking the time to do this...and Thank you Dr Shafer for answering all of these questions...you have been an absolute blessing,

[ivy]

Such a sweet man,.... only if it were all so simple.. :(

he wants us to heal, that's what I understood and it seems like that's why he takes his time to answer our questions. He wants to bring MJ fans closure so that we can move on.

[ivy]

also if you want to write any thank you messages to Dr.Shafer please do so. I'll copy them with your nicknames and send it to him. If you already posted "thank you" messages you don't have to write it again. I'll go through this 3 threads and copy already written messages.

[Yana Jackson]

Thank you, Ivy and Dr. Shafer.

[Yana Jackson]

he wants us to heal, that's what I understood and it seems like that's why he takes his time to answer our questions. He wants to bring MJ fans closure so that we can move on.

Agreed. This is very important and we should take heed as best as we can.

[Hicci]

Thank you Dr Shafer and Ivy.

[CaptainEoLove85]

Thanks. Love him. :wub:

[Snow White 1937]

What a nice man Dr. Shafer is, not to mention humble, intelligent (without being pompous), generous with his time to answer all our questions and open minded about Michael and his music. Too bad he couldn't be Michael's doctor (or mine for that matter).

How interesting that this trial enabled Dr. Shafer to be close to his father as he passed. Makes you wonder if higher powers were involved...
I was thinking exactly the same!!!

Dr Shafer, thank you for everything you have done. We (fans, patients, students, colleagues) are lucky to have you. Thank you for being a kind, insightful, humble, poised and gracious gentleman. *standing ovations* God bless you and your family.

[GiselaMJJ]

First of all, I truly grateful to Dr. Shafer for his kindness in answering our questions.

Although I researched some things, or do I have personal experiences with others, His explanations were really helpful to me.


I can never thank enough to Dr. Shafer, his expert testimony was the basis for Murray was convicted.


So Thank you for everything Dr. Shafer! In Mexico you also have people (like me) who feel a deep appreciation and affection for you. Thank you!


****

By the way: I can not see also to Murray as a doctor, I always address him as "pseudo doctor"

****

And thank you very much to Ivy and Gaz you for organizing this session of questions and answers. :)

****

Dr. Shafer is absolutely right when he says "It's time to return to the bonds MJJCommunity That Brought together in the first place the: your celebration of Michael Jackson's life, His message, and His Music." :( I did mourn, these words prompted tears once again welled up in my eyes ...because it still hurts ... But he is quite right: It's time.

[Speechless09]

Dr. Steve Shafer: Once your questions about Michael Jackson’s tragic death have been answered, I encourage you to set it aside. Conrad Murray has been convicted. We have a reasonable understanding of what happened. It’s time to return to the bonds that brought the MJJCommunity together in the first place: your celebration of Michael Jackson’s life, his message, and his music.

I appreciate the opportunity to address your questions, and hope that the answers are helpful to the MJJCommunity.

Sincerely,

Steve Shafer



he wants us to heal, that's what I understood and it seems like that's why he takes his time to answer our questions. He wants to bring MJ fans closure so that we can move on.


My head says it is time to move on but for my heart it is not so simple and it takes more time. :(

Thank you so much Dr. Shafer. Your answers gives me finally some answers and peace. I am sad that there was no doctor like you in MJ's life.

@ Ivy and Gaz: thank you for taking the time for doing this.:)

[Mirabella76]

I have so much to say but i'm afraid my knowledge of english is not enough to express all i'd like to say. But I try.

First of all i want to thank this forum for great opportunity to follow the trial news, keep in touch with people like me who loves Michael, wants to know the truth and who's aware of importance of this trial. You helped to go through this and i'm very grateful from my heart. I want to thank Ivy for your work and care about our wishes and concerns.

I want to thank Dr. Shafer for his courage, honest point of view, his works, care, his seeking the truth, his respect to Michael and politeness to MJ fans.
Your attentive attitude to us, people who you even haven't met in your life, to our feelings, fears, concerns and our pain touched me very deeply. Your actions and words reminded me Michael himself and sometimes put a smile on my face, sometimes draw to tears. Things that you've done matter a lot for us.
I wish you and your family well. Please be happy and healthy and God bless you.

[Rhilo]

Again, thank you Dr. Shafer!

[Victory22]

Dr. Shafer’s message to the fans touched my heart and made me cry. I miss MJ more than words can express but Dr. Shafer’s sincere love concern and care toward the fans brings healing to my soul. From the depth of my heart thank you Dr. Steven Shafer. You are a brilliant and lovely man.

[Daryll748]

PHEW:cry: that was a tough read but THANKS again to IVY, GAZ, the wonderful fans indeed for asking such 'daring' and 'heartbreaking' questions... I mean you get nowhere if you only comment 'we'll never get to the bottom of this' hey :doh:

This is my :2cents:

Dr. Steve Shafer: The primary point is that it doesn’t matter. Michael Jackson would be alive if Conrad Murray had not committed multiple
egregious and unconscionable violations of the standard of care. He was administering a general anesthetic to Michael Jackson in his bedroom,
with no training, monitoring, or backup. He abandoned his patient. When he returned, his patient was either dead or nearly so. It speaks for
itself.

In my humble opinion... That's why its MURDER for me... Murray just 'left him to die' :mat:

Dr. Steve Shafer : I claimed that Michael Jackson died during the infusion, which is why the blood concentration was as high as it was.
He didn’t have to die at the end of the infusion, and there is no reason to think that he did. He simply died during the infusion.
The 100 ml propofol bottle was empty, I expect that he died before the bottle was empty, but that by the time Conrad Murray found him the bottle
had run out as well.

SO did the bottle run out in the 2 minutes???? I don't think so...
My humble opinion says again that when Murray found Michael...
He KNEW all to well that Michael was gone and he even 'tried' to cover up his own a$$ and blame Michael...

Dr. Steve Shafer: Michael Jackson did not suffer. He died because he stopped breathing. He was unconscious at the time. If he had been conscious,
he would have been breathing.

Thank you, Dr Shafer for the closure... :flowers:

[Louise.]

Dr. Shafer, thank you so, so much for taking the time to answer all of the questions! It's obvious you are busy with lots of other things, so the idea that you spent time doing this for us is amazing. I honestly cannot thank you enough, we are all so grateful!

Oh, and Ivy and Gaz, thank you as well! :flowers:

[Daryll748]

Dr. Steve Shafer: It may have helped, but only a little. On the Friday that Paul White testified I was working at the “Allen Pavilion,” a regional hospital run by Columbia University that serves a low-income area of Manhattan and the Bronx. I was caring for an elderly man who asked what drug he would get. I told him “propofol.” As usually happens, he asked if that was the drug that killed Michael Jackson. I told him that propofol didn’t kill Michael Jackson, Conrad Murray killed Michael Jackson. I also said that propofol was very safe drug. He said “I heard that doctor say that at on television, but I don’t believe him.”
I told him I was the doctor he saw on television. He thought that was hilarious: the doctor in blue scrubs, wearing a surgical hat, with a stethoscope around his neck working in this clinic for poor patients might be the “famous” doctor he saw on television. “Yea, right” was his answer. He didn’t believe me for a second. However, he was reassured by my “joke” about being the doctor he saw on television, and everything went well.

WOW, a Doc that even helps the poor... Even more RESPECT for you, Dr. Shafer... Indeed Murray killed Michael :(

Dr. Steve Shafer: The contradiction reflects the state of the science. I received propofol for anesthesia about a year ago, and I have given propofol to thousands of patients. There is often a feeling of having slept well after awakening from propofol.
However, studies suggest that propofol sleep it is quite different from normal sleep, and is not “restorative” the way that normal sleep is restorative. For example, dreams are important in brain function. Patients don’t dream on propofol, except at the time of awakening. My interpretation of the data is that propofol might be OK for getting a patient off to sleep, but that maintaining a patient on propofol for sleep (as we sometimes do in intensive care units) probably is denying patients restorative sleep.

Yep, in my own experience... I did sleep quite well and long... They even had to 'wake' me... Although, its true... its NOT a 'healing' sleep as you are aware of NOTHING... No dreams, no nightmares but also no awareness, no consiousness... So, that makes you real 'vulnerable'...Though, it leaves you calm and rested for a few days... The nursing staff was on edge why I wasn't nagging or demanding like other patients.
I was too quiet and calm in their opinion... I guess, the effect of the 'drug' has totally left me as I've been a BOMB the last months...

Dr. Steve Shafer: We already take this very seriously. We are very involved in teaching the safe use of sedatives to our medical colleagues. This will continue. Perhaps they will be more receptive to the importance of safe sedation. However, nothing we can do will reach a doctor who does not put patients first.

That gives me also a sense of closure... to know MIchael didn't die in 'vain'... They are taking lessons out of it...

Dr. Steve Shafer: Propofol absorbed from the stomach never reaches the brain, because it is all removed by the liver. However, the blood supply to the mouth and esophagus (above the diaphragm) does not return directly to the liver. Instead, it just goes to the heart, and from there goes everywhere including the brain. So a propofol lollipop would provide propofol to the venous blood, and from there to the brain. Paul White and I discussed this at one of the breaks prior to his testimony. It is a reasonable idea, provided the dose was adequately controlled.Should this ever become available, then I would reconsider my position on classifying propofol as a controlled substance. My current view is highly influenced by the fact that it only works when given intravenously, and that really burns!

That was really 'learnful' see, how smart we're getting hey ;)
Anyway, indeed Propofol really burns...
Usually, they first inject another sedative so you won't feel it but in my case, I'm 'allergic' to the other stuff and so they gave it 'pure'to me... Though, you only feel it for about 10 seconds and you're out...

Dr. Steve Shafer: There are three questions here. I’ll answer them in order:
Demerol’s chemical name in the United States is “meperidine.” In many countries it is known as “pethidine.” Meperidine has a metabolite, “normeperidine”, that is a nervous system stimulant. As a nervous stimulant, I would expect it to exacerbate insomnia. The coroner examined both blood and urine for meperidine (Demerol) and normeperidine. Neither could be detected. Thus, meperidine did not play a direct role in Michael Jackson’s death on June 25th. However, you asked a more general question about “play any part in Michael’s physical and mental health.” It is a good question, and I will again need to apologize for not answering it. I have not read Dr. Klein’s medical records or heard a detailed explanation of Michael Jackson’s care. I am uncomfortable speculating without that information. Sleep disorders are complex, and treating them is a specialized branch of medicine. It is my understanding that any drug that affects the level of consciousness can exacerbate sleep disorders. There is a nice description of sleep disorders, and the treatment of common sleep disorders, at http://www.sleepfoundation.org/artic...s-and-insomnia.Man,

The more I read the more I gasp... WOW, what an awesome Professional... NOT one answer is 'babbling' but all right to the tee and even with 'references' ... Thanks Dr. Shafer.

The defense wanted to attribute Michael Jackson’s death, in part, to oral lorazepam. The problem with this theory is that there was only a minute amount of lorazepam in Michael Jackson’s stomach. To explain this minute amount, the defense alleged that Michael Jackson swallowed lorazepam about 5 hours before the time of death. If that were true, then the lorazepam concentration would have peaked about the time Conrad Murray claims Michael Jackson was pleading for more drug to fall asleep. So that argument doesn’t make sense.

Indeed, it doesn't and that makes Murray a 'headless' chicken just bumping his head on every wall... WHERE has Murray got his license???

Dr. Steve Shafer: Once your questions about Michael Jackson’s tragic death have been answered, I encourage you to set it aside. Conrad Murray has been convicted. We have a reasonable understanding of what happened. It’s time to return to the bonds that brought the MJJCommunity together in the first place: your celebration of Michael Jackson’s life, his message, and his music.
I appreciate the opportunity to address your questions, and hope that the answers are helpful to the MJJCommunity.
Sincerely,
Steve Shafer

THANK YOU SO MUCH Dr. Shafer:punk: as you made us STRONGER, SMARTER and for me you brought CLOSURE to this 'horrible' adventure...

[christy]

Thank You Dr Steve Shafer for taking time off your busy schedule to help us fans find closure.
Maybe some of us fans have already moved on.
You have no idea how timely your encouragement comes just now only to reinforce that.
Thank you for reminding us preserving Michael Jackson's legacy is the way to go forward.
And Major props go to Ivy and Gaz for putting this together.

[Ankita]

I asked two questions, both have been answered. Thankyou Ivy and Dr.Shafer.

[ilmjj]

Thank you Dr. Shafer. It makes me happy that you know how much Michael Jackson means to us. His message lives on. If you ever get the chance I hope you go see the Cirque du Soleil Immortal World Tour. Michael is there...:wub:
Love, Susan

[love is magical]

Dr. Steve Shafer: Once your questions about Michael Jackson’s tragic death have been answered, I encourage you to set it aside. Conrad Murray has been convicted. We have a reasonable understanding of what happened. It’s time to return to the bonds that brought the MJJCommunity together in the first place: your celebration of Michael Jackson’s life, his message, and his music.



Wise words from a very wise man!

Dr. Shafer, thank you from the bottom of my heart!

[MJ4MJ]

Dr Shafer, Words cannot describe how grateful I am that you were prepared to testify at the trial and stand up for what is right and true. You are obviously a man of integrity and have a great passion for your work. Thank you so much for taking the time to answer our questions and as usual presenting your answers in a way we can all understand. It is appreciated more than you will ever know.

Thanks to Ivy and the team at MJJC

[Ben]

In his life, Michael met a lot of people, and most of them, at one point or another, used him, lied to him, back stabbed him, dragged his name through the mud, stole from him. An even greater number of people, who never met Michael, spent a lot of time, and sometimes a whole career, spreading terrible lies and accusations about him. They isolated and crushed him.
We saw him suffer and witnessed the excruciating pain he was inflicted. He stood up again and again. He still had the courage and ability to give love, to find the mere will to give love.
In a sadly ironic turn of events, a few amazing individuals stood up for him at last, to defend him one last time, when he was already gone.
Dear doctor Shafer, you did much more than protecting the name of decent medecine in your country. You protected the truth, you showed honesty, respect, decency, which are values we were not used to see anymore about Michael. For that only, you'll be remembered with a gratitude you can't even imagine. As MJ fans, you see, we dont have too many heroes. We spend a lot of time defending Michael against hateful or greedy people. You will have a special place in our heart, with the likes of Tom Mesereau.
Thank you for the compassion, understanding and respect you showed for us too. We're not used to it either.
You're a rare individual, you give me hope in humanity. I think I share the thought of many when I say I wish Michael had met you.
Thank you for being who you are.

[elusive moonwalker]

Beautiful words ben

[ForeverKOP]

Can it still be included in our follow up response? Please?

[Speechlessgirl27]

I enjoyed reading this. I have to admire Dr Shafer for the all the time he put in preparing for the trial while working so many hours. That shows deidcation.Its wonderful for a child at 9 to know what their career will be and to actually achieve their dream. He sure does have a heart of gold. I often wish Michael went to him for insomnia treatment.

[Victory22]

Thank you very much Ivy and MJJC.

[Vinter]

How interesting that this trial enabled Dr. Shafer to be close to his father as he passed. Makes you wonder if higher powers were involved...
I was thinking exactly the same!!!
Me too. I do not believe in such coincidences.




If he fell into a peaceful sleep...his eyes and mouth would remain closed. (I have witnessed this first hand so I know) I think that Murray opened them up himself...before Alberto came in the room.
People die peacefully with their eyes and mouth opened, just as some people sleep with their mouth and eyes opened.
I do think so too. I think the muscles may relax that way, that's why they were open.
For what reason should Murray open them..? To simulate a sudden recent eccident?


So my understanding is - if Murray saw Michael having respiratory arrest and if he called the paramedics right away and if they arrived in time - within that 10 - 20 minute period- they could have revived him with no negative after effects. Paramedic Sennef also said a similar thing.
Yeah, that only proves that Murray was not in the room for at least 15 mins or even more.


It's bitter to say but Murray gave Michael no chance at all. Even if they [paramedics] came a bit earlier we don't know could they save him or not. Or maybe they could restart his heart but could't return him to normal life. I can't stop thinking of it.
I can't stop thinking of it too. He really didn't! And for a second I thought "should we now 'thank' him for that??" cuz Michael would not want to live like a 'vegatable' (I'm sorry for this comparison).. but of course nothing can excuse Murray for what he did or didn't do.



But I think they [paramedics] were called too late and perhaps even after Michael was already dead and nothing would bring him back.

My humble opinion says again that when Murray found Michael... He KNEW all to well that Michael was gone and he even 'tried' to cover up his own a$$ and blame Michael...
That's exactly what I'm almost sure of.

I do want believe that Michael didn't suffer and Dr.Shafer's answer just brought comfort to me.

[Vinter]

@Ben, you put me into tears... so touching and heartbeaking..
Hug you...

[Arklove]

In his life, Michael met a lot of people, and most of them, at one point or another, used him, lied to him, back stabbed him, dragged his name through the mud, stole from him. An even greater number of people, who never met Michael, spent a lot of time, and sometimes a whole career, spreading terrible lies and accusations about him. They isolated and crushed him.
We saw him suffer and witnessed the excruciating pain he was inflicted. He stood up again and again. He still had the courage and ability to give love, to find the mere will to give love.
In a sadly ironic turn of events, a few amazing individuals stood up for him at last, to defend him one last time, when he was already gone.
Dear doctor Shafer, you did much more than protecting the name of decent medecine in your country. You protected the truth, you showed honesty, respect, decency, which are values we were not used to see anymore about Michael. For that only, you'll be remembered with a gratitude you can't even imagine. As MJ fans, you see, we dont have too many heroes. We spend a lot of time defending Michael against hateful or greedy people. You will have a special place in our heart, with the likes of Tom Mesereau.
Thank you for the compassion, understanding and respect you showed for us too. We're not used to it either.
You're a rare individual, you give me hope in humanity. I think I share the thought of many when I say I wish Michael had met you.
Thank you for being who you are.

Amazing words....Thank you for saying that....

I love the bolded part....Oh how different things would have been :cry:

[ivy]

Pamela and I extend our best wishes to you and the MJJCommunity for a wonderful holiday season, and for a new year filled with peace, joy, celebration, and great music.

Sincerely,

Steve

[shelly_webster]

He really seems to be a very nice guy. Thanks to all of you.

[Ashtanga]

Pamela and I extend our best wishes to you and the MJJCommunity for a wonderful holiday season, and for a new year filled with peace, joy, celebration, and great music.

Sincerely,

Steve

:heart:


He is so adorable. :girl_sigh:

[elusive moonwalker]

Isnt he lovely

[bubbyduck4MJ]

Thank you. x

[mijaons]

Ben, that's every word I wanted to say. The ill effects of Michael's isolation were horrendous. He never met a class of people different from cons from 1999-2009. Often I think about how much damage Bashir did. Truly ironic that for a better class of people to be associated with Michael, he had to be gone.

[Vinter]

Pamela and I extend our best wishes to you and the MJJCommunity for a wonderful holiday season, and for a new year filled with peace, joy, celebration, and great music.

Sincerely,

Steve
Thank you so much for sharing!
Love him..

[windy09]

Pamela and I extend our best wishes to you and the MJJCommunity for a wonderful holiday season, and for a new year filled with peace, joy, celebration, and great music.

Sincerely,

Steve


Thank you Ivy.

[windy09]

MJJC Exclusive Q&A with Dr. Steve Shafer Part 3

This is Part 3 of 3 of Dr. Steve Shafer's answers to MJJCommunity questions. In this third and final installment Dr. Shafer will be answering questions about Propofol, Lorazepam, Flumanezil, Insomnia and related matters.

http://i43.tinypic.com/21l0klg.jpg

Questions about propofol in general

MJJC: Do you feel that your testimony helped alleviate patient concerns about Propofol or are things more or less the same?

Dr. Steve Shafer: It may have helped, but only a little. On the Friday that Paul White testified I was working at the “Allen Pavilion,” a regional hospital run by Columbia University that serves a low-income area of Manhattan and the Bronx. I was caring for an elderly man who asked what drug he would get. I told him “propofol.” As usually happens, he asked if that was the drug that killed Michael Jackson. I told him that propofol didn’t kill Michael Jackson, Conrad Murray killed Michael Jackson. I also said that propofol was very safe drug. He said “I heard that doctor say that at on television, but I don’t believe him.”

I told him I was the doctor he saw on television. He thought that was hilarious: the doctor in blue scrubs, wearing a surgical hat, with a stethoscope around his neck working in this clinic for poor patients might be the “famous” doctor he saw on television. “Yea, right” was his answer. He didn’t believe me for a second. However, he was reassured by my “joke” about being the doctor he saw on television, and everything went well.


MJJC: Can a person become dependent or addicted to propofol? If yes what kind of dependency is it physical or psychological?

Dr. Steve Shafer: There is not much data about this, because propofol must be given intravenously, and it really burns, which discourages abuse. However, there have been a number of deaths of anesthesiologists and other health care personal from propofol abuse. Based on this, I am reasonably confident that it is addictive.


MJJC: Why would someone even have the idea to use Propofol as a sleep aid? If it is only to be used for surgery then why would anyone suggest giving it someone to get some sleep?

Dr. Steve Shafer: The mechanism of action of propofol is the same as drugs like Ambien that are commonly used to induce sleep. This is a reasonable research question. However, it should never be put into practiced until it has been studied in a proper research setting. After that work has been done, it should only be used with appropriate documentation and precautions.



MJJC: Are the drug companies who make Propofol looking into testing Propofol for sleep? Do you think there will be more research studies about Propofol being used for sleep?

Dr. Steve Shafer: Yes to both questions.


MJJC: What are the known effects on the nervous system & the brain of long term Propofol use?

Dr. Steve Shafer: Not a lot, because it is rarely used for long term use. I have been able to find one report of a patient who received propofol in the intensive care unit for 51 days. This is from the conclusion of the article: “To our knowledge, this report represents the first documentation of propofol use for long-term sedation in a mechanically ventilated pregnant patient and the longest duration of continuous infusion propofol published in the medical literature. Propofol was used for 51 days with no documented maternal adverse events.” (Tajchman SK, Bruno JJ. Prolonged propofol use in a critically ill pregnant patient. Ann Pharmacother. 2010;44:2018-22)

This patient was weaned from propofol over several days without adverse consequences. So administration for 2 months appears to not have long term consequences, at least based on this example, and the fact that Michael Jackson continued to function at rehearsal. However, those are just two data points. More research needs to be done if one contemplates development of propofol for long term use.


MJJC: Does one get a "restful sleep" from Propofol? We have heard experts contradict each other on this.

Dr. Steve Shafer: The contradiction reflects the state of the science. I received propofol for anesthesia about a year ago, and I have given propofol to thousands of patients. There is often a feeling of having slept well after awakening from propofol.

However, studies suggest that propofol sleep it is quite different from normal sleep, and is not “restorative” the way that normal sleep is restorative. For example, dreams are important in brain function. Patients don’t dream on propofol, except at the time of awakening. My interpretation of the data is that propofol might be OK for getting a patient off to sleep, but that maintaining a patient on propofol for sleep (as we sometimes do in intensive care units) probably is denying patients restorative sleep.


MJJC: Do you agree that Propofol should be re-classified as a controlled substance?

Dr. Steve Shafer: No. I think this will hurt patients. In emergencies we need propofol immediately, and in large quantities. I am opposed to placing obstacles in the way of doctors caring for patients, unless there is clear benefit. Conrad Murray could have still obtained propofol for Michael Jackson, because doctors can order controlled substances. Since most propofol abuse is by doctors, making it controlled won’t limit the ability of doctors to abuse it. It will just impair their ability to care for emergency patients.

This has been the subject of an issue of Anesthesia & Analgesia. Here is the cover of that issue: http://www.aaeditor.org/HWP/Covers/0710.cover.jpg.


MJJC: Do you think now the anesthesiology community will be more careful in how they promote and teach one to use Propofol?

Dr. Steve Shafer: We already take this very seriously. We are very involved in teaching the safe use of sedatives to our medical colleagues. This will continue. Perhaps they will be more receptive to the importance of safe sedation. However, nothing we can do will reach a doctor who does not put patients first.


MJJC: Do you think the medical community has learned from Michael’s death in regards over prescribing to a powerful wealthy person and wrong doing by a doctor?

Dr. Steve Shafer: Absolutely. I mentioned this above. I am aware of this because I occasionally see this in my practice. Doctors serve patients by acting as doctors. That is a message for doctors and patients alike.


MJJC: Can you explain “Propofol lollipop” a little more?

Dr. Steve Shafer: Propofol absorbed from the stomach never reaches the brain, because it is all removed by the liver. However, the blood supply to the mouth and esophagus (above the diaphragm) does not return directly to the liver. Instead, it just goes to the heart, and from there goes everywhere including the brain. So a propofol lollipop would provide propofol to the venous blood, and from there to the brain. Paul White and I discussed this at one of the breaks prior to his testimony. It is a reasonable idea, provided the dose was adequately controlled.

Should this ever become available, then I would reconsider my position on classifying propofol as a controlled substance. My current view is highly influenced by the fact that it only works when given intravenously, and that really burns!


MJJC: What does Propofol taste like?

Dr. Steve Shafer: It has the consistency of skim milk, and tastes like a very medicinal salad dressing.


MJJC: Beagle Propofol experiment done by the Defense has made PETA and MJ fans angry. We don’t expect that you have any direct information about the Beagle experiment but as the humans weren’t affected by drinking Propofol, is it safe to assume that the Beagles were unharmed as well?

Dr. Steve Shafer: I think it is very unlikely that any harm came to the beagles. There should be no effect from drinking propofol. However, I am uncomfortable that neither the experimental protocol nor the results of the experiment were presented in court. I believe that when animals or humans participate in trials, there is an ethical obligation to write up and publish the research to add to the body of knowledge. It is the increased knowledge that morally justifies the research. I wrote our human study up for publication, asked Paul White to review it, and gave it to the defense. I believe they should have done the same with their beagle study.


MJJC: We heard the theory of some of the Benzos or/and Propofol that were given to MJ by Murray can be used for people with drug addiction to help them off their addiction to other drugs such as Demerol, Is this true? Can you comment on this?

Dr. Steve Shafer: There is a technique of rapid detoxification that involves placing patients under general anesthesia for a long period of time (hours to days) and pharmacologically reversing opioids with “opioid antagonists”, drugs that chemically block the effects of Demerol and similar drugs. This is controversial, but it probably works in some patients.


Questions about Demerol

MJJC: Was the amount of Demerol Dr. Klein give to Michael normal or was it too large a dose?

Dr. Steve Shafer: I can’t answer without knowing why Demerol was given. Dr. Klein did not testify at the trial. I’m uncomfortable offering any opinion without more information.


MJJC: Does your answer change if you consider MJ’s history (burn victim) with the drug? Do you think it was excessive?

Dr. Steve Shafer: Again, I apologize, but I don’t want to render an opinion without knowing why Dr. Klein was administering Demerol. This probably reflects my caution as an Editor-in-Chief of a medical journal. Medical editors are reluctant to render a public opinion unless they are confident they understand the facts.


MJJC: In your opinion, does Demerol aggravate insomnia as a side effect? Did it play any part in Michael's physical and mental health? What was the best treatment for Michael's insomnia?

Dr. Steve Shafer: There are three questions here. I’ll answer them in order:

Demerol’s chemical name in the United States is “meperidine.” In many countries it is known as “pethidine.” Meperidine has a metabolite, “normeperidine”, that is a nervous system stimulant. As a nervous stimulant, I would expect it to exacerbate insomnia.

The coroner examined both blood and urine for meperidine (Demerol) and normeperidine. Neither could be detected. Thus, meperidine did not play a direct role in Michael Jackson’s death on June 25th. However, you asked a more general question about “play any part in Michael’s physical and mental health.” It is a good question, and I will again need to apologize for not answering it. I have not read Dr. Klein’s medical records or heard a detailed explanation of Michael Jackson’s care. I am uncomfortable speculating without that information.

Sleep disorders are complex, and treating them is a specialized branch of medicine. It is my understanding that any drug that affects the level of consciousness can exacerbate sleep disorders. There is a nice description of sleep disorders, and the treatment of common sleep disorders, at http://www.sleepfoundation.org/article/sleep-related-problems/sleep-aids-and-insomnia.


Questions about lorazepam, flumazenil, and ephedrine

MJJC: Could the free lorazepam detected in the gastric liquid be explained by the stomach hemorrhage caused by CPR or even by accidental mixing of adjacent blood at the time of autopsy (as it was suggested by the Coroner, Dr. Rogers in the preliminary, though not mentioned again during the trial)?


Dr. Steve Shafer: Maybe. However, free lorazepam would be expected simply because molecules like lorazepam would be expected to cross from the blood into the stomach, just like they cross into all tissues. That is how the lidocaine and propofol got into the stomach. Lorazepam should behave just the same way.

Additionally, the enzyme beta glucuronidase is secreted by the wall of the stomach into the stomach fluid. Beta glucuronidase is the enzyme that would turn lorazepam glucuronide back into lorazepam. So blood could account for it, but most of it is likely the simple diffusion of lorazepam from the blood into the stomach.


MJJC: Is there any other reason for Flumazenil to be administered apart from reversing the effects of benzodiazepines (in this case Lorazepam)?

Dr. Steve Shafer: No.


MJJC: Does it even make sense to give a person Flumazenil who according to Dr. Murray only received 4 mg of Lorazepam to begin with?

Dr. Steve Shafer: The most critical part of any resuscitation is to move air in and out of the patient’s lungs. The problem with giving flumazenil is that it distracted Conrad Murray from the critical task of moving air in and out of Michael Jackson’s lungs. If there were several people were involved in the resuscitation, then giving flumazenil would have made sense. However, since Conrad Murray was alone, any interruption longer than a few seconds was too long.


MJJC: Can you explain your consideration of the Lorazepam levels, in more detail?

Dr. Steve Shafer: I’ll answer as well as I can, but I’m not sure exactly what you want to know. The lorazepam levels were high enough that you or I would have been very sleepy from them. However, patents become tolerant to lorazepam and related drugs (the “benzodiazepines”). Since Michael Jackson had a fairly high concentration, and according to Conrad Murray that was not enough drug to induce sleep, he must have been tolerant.

The defense wanted to attribute Michael Jackson’s death, in part, to oral lorazepam. The problem with this theory is that there was only a minute amount of lorazepam in Michael Jackson’s stomach. To explain this minute amount, the defense alleged that Michael Jackson swallowed lorazepam about 5 hours before the time of death. If that were true, then the lorazepam concentration would have peaked about the time Conrad Murray claims Michael Jackson was pleading for more drug to fall asleep. So that argument doesn’t make sense.


MJJC: According to autopsy report there was ephedrine found in Michael's body. It's a drug that aggravates insomnia. How ephedrine goes with benzos and propofol, could it subdue effect of these drugs?

Dr. Steve Shafer: There was a bottle of capsules composed of ephedrine, caffeine, and aspirin in the room. Ephedrine is sometimes used in resuscitation. Since there was ephedrine in Michael Jackson’s autopsy urine, as well as the urine that was found at the scene, I would assume that the ephedrine was from oral ingestion, and not from administration as part of the resuscitation.

Ephedrine can reduce the effects of propofol and benzodiazepines on blood pressure and heart rate. Chronic ephedrine might aggravate insomnia.

 
Question about medical research in general

MJJC: Judge Pastor referred to Murray as making Michael Jackson part of a “scientific experiment”. This could unfortunately dissuade patients from feeling comfortable participating in clinical trials and other types of beneficial scientific and medical research. Can you discuss the important intersection between the research of scientists and the clinical practice of physicians?

Dr. Steve Shafer: I’ve performed dozens of clinical trials. I don’t think this will adversely affect recruiting patients into clinical trials, because this “experiment” bears no resemblance to a scientific study. I think “experiment” is an accurate term, because it correctly implies that Conrad Murray had no idea what he would find day after day of propofol administration. So this was an experiment that he was conducting every day to see how Michael Jackson would respond. However, I don’t think anybody would confuse this experiment with a proper scientific experiment.

The larger question you ask is about the intersection between research and practice. This is an important question, and (fortunately) one that has been given very careful consideration. The answer goes back to the Nuremberg Code, which followed the trial of Nazi doctors guilty of atrocities at the end of World War II. You can find an excellent account on Wikipedia. This was updated by the Belmont Report, published in 1978. Again, there is an excellent account in Wikipedia. As explained in the Belmont Report, “research” differs from clinical practice in that research is a systemic investigation intended to create generalizable knowledge. “Systematic” means that the investigator intentionally gathers data to answer a question. Generalizable knowledge means that the investigator believes the information gathered is useful to others, and intends to “generalize” the knowledge, usually by publishing it. If you Google “Anesthesia & Analgesia policy in institutional review board approval and informed consent for research” you will find an editorial I wrote in March on the subject.


 
Questions about insomnia

MJJC: Decades of lies, slander, deceit, inhuman treatment from the media and public misconceptions had caused Michael immense hurt, pain and anguish resulting in insomnia. We know Propofol was not the answer, but what do you think he should have done (medically) to treat it?

Dr. Steve Shafer: He should have been in the care of a sleep medicine doctor. He had a terrible affliction, one that requires expert care.


MJJC: Do you think meditation that Murray was talking about in his police interview could really help Michael to sleep?

Dr. Steve Shafer: Maybe. Conrad Murray mentioned both propofol and lorazepam. These are both sedatives that act on the same receptor in the body, the “GABA” receptor. Most sleeping medications also act on GABA, the exceptions being antihistamines (e.g., benedryl) and melatonin. So I would expect these drugs to induce sleep. However, they should not be used to maintain sleep, because the drugs interfere with some of the brain function that is required for sleep to be “restorative”, meaning that it refreshes the brain.

 
Final comments

MJJC: Anything you want to say to the members of MJJCommunity and Michael Jackson fans in general.

Dr. Steve Shafer: Once your questions about Michael Jackson’s tragic death have been answered, I encourage you to set it aside. Conrad Murray has been convicted. We have a reasonable understanding of what happened. It’s time to return to the bonds that brought the MJJCommunity together in the first place: your celebration of Michael Jackson’s life, his message, and his music.

I appreciate the opportunity to address your questions, and hope that the answers are helpful to the MJJCommunity.

Sincerely,

Steve Shafer


Thank you Ivy. Please extend my sincerest gratitude to Dr. Shafer. He is obviously a man of principle, compassion and integrity. Also, do you know if he is accepting any additional questions? I have a friend who has medical background and has a couple more questions which I don't think were answered. If not, perhaps there is an address for Dr. Shafer, which we can direct our questions independently? Please advise. Thank you.

[ivy]

He will answer follow up questions. So if you have any, you can write them on this thread.

[missred07]

Thank you Ivy, MJJC and all the other people who organize this Q&A. Really amazing work. Really organized Q&A.
I also wanted to thank Dr. Shafer to spend his time in his busy schedule to answering all 86 questions in so details.
Took me quite some time to read them all. He is really an amazing doctor and I admired him very much.

[windy09]

He will answer follow up questions. So if you have any, you can write them on this thread.

Thank you Ivy, I will get the question and will post.

[Victory22]

Ivy can we put together a MJ love package of music, books, stats about his humanitarian activity’s and accomplishments to send to Dr. Shafer? It would serve the dual purpose of educating the doctor about the phenomenal artist, musician, and dancer, composer MJ was and also serve as a thank you gift. What do you think? I would be willing to send money toward the goal.

[windy09]

Ivy can we put together a MJ love package of music, books, stats about his humanitarian activity’s and accomplishments to send to Dr. Shafer? It would serve the dual purpose of educating the doctor about the phenomenal artist, musician, and dancer, composer MJ was and also serve as a thank you gift. What do you think? I would be willing to send money toward the goal.

I think this is a good idea. We can't forget all the wonderful books (as you stated) about Michael's work and art such as the book by Joe Vogel. Also, what about referencing the Voices Education Project "Words and Violence" curriculum that was inspired by Michael. Just a thought?

[windy09]

He will answer follow up questions. So if you have any, you can write them on this thread.

Hi Ivy. Below are some additional questions that I asked you about for Dr. Shafer. Thank you.

Michael Jackson, by all accounts from those who knew him, was a very sensitive individual. I believe he was a true empath. When faced with human suffering he would burst into tears and was inconsolable. It is reportedly his compassion that drove his humanitarian and philanthropic pursuits on behalf of children and the disenfranchised. He was inaccurately portrayed and vilified in the media and was extorted as well as the target of racism in law enforcement. (All this is well documented if one does research.)

Michael’s brother reports that the light went out of Michael's eyes during the trauma of his 2005 trial and he became dispirited enough to leave the country.

This question is not asking your opinion about Michael Jackson's morals, behavior or treatment at the hands of others, but about PTSD (Post Traumatic Stress Disorder.) I know you cannot diagnose without seeing the patient, but given all that happened to Mr. Jackson, it is possible that his insomnia was related to PTSD and that his sleeplessness was trauma and stress related and a symptom of PTSD? His upcoming concert would be likely his last opportunity to redeem himself and I’m sure it caused him great anxiety in addition to the trauma.

Dr Murray, being a cardiologist, should have known of the off label use of Inderal or Propanolol as a treatment for PTSD and stress. Why on earth wouldn't he use that medication instead of benzodiazepines for stress and trauma?

I know he should have referred Michael for a sleep study and a specialist. But wouldn’t Inderal’s off label use for PTSD have alleviated some of his symptoms? It might have helped with sleep also. The use of heavy sedatives, anesthetic and benzodiazepines along with not referring him is further evidence of Murray’s incompetence. I believe he should have been referred for PTSD treatment.

I also believe that the first physician who used Propofol for sleep with Michael Jackson is guilty of malpractice.

Are you comfortable speaking to the issues raised here?

Thank you in advance and as a fellow medical professional, I thank you for being a role model and restoring my faith in the compassionate practice of medicine by a physician.

Rev.B. Kaufmann

[Ramona122003]

Repost of a question:


Wonder if you could ask Shafer if he thinks Murray gave all those benzos per IV on purpose to create a dependency to assure Michael would never fire him. In part 2, he clearly said there was allot of Lopz in Michael's system to put even a tolerate person to sleep and Murray was given propofol on top of that. He also gave Lopz through an IV which creates dependency even faster instead of the pills he actually prescription for Michael.

I also wonder if he could give an opinion to why Murray was given Lopz and the other sleep medication, forgot its name, if they were both chemically the same except for the half-life. You think after six-week he would know by now what works and not just mix drugs the way he did.

[HumanNature2210]

Wow Ben! You put it very nicely. I couldn't help tearing up.

Thank you Dr Shaffer from the bottom of my heart for taking your precious time to answer our questions. We fans cannot express how grateful we are for what you have done for Michael although he is no longer with us.



In his life, Michael met a lot of people, and most of them, at one point or another, used him, lied to him, back stabbed him, dragged his name through the mud, stole from him. An even greater number of people, who never met Michael, spent a lot of time, and sometimes a whole career, spreading terrible lies and accusations about him. They isolated and crushed him.
We saw him suffer and witnessed the excruciating pain he was inflicted. He stood up again and again. He still had the courage and ability to give love, to find the mere will to give love.
In a sadly ironic turn of events, a few amazing individuals stood up for him at last, to defend him one last time, when he was already gone.
Dear doctor Shafer, you did much more than protecting the name of decent medecine in your country. You protected the truth, you showed honesty, respect, decency, which are values we were not used to see anymore about Michael. For that only, you'll be remembered with a gratitude you can't even imagine. As MJ fans, you see, we dont have too many heroes. We spend a lot of time defending Michael against hateful or greedy people. You will have a special place in our heart, with the likes of Tom Mesereau.
Thank you for the compassion, understanding and respect you showed for us too. We're not used to it either.
You're a rare individual, you give me hope in humanity. I think I share the thought of many when I say I wish Michael had met you.
Thank you for being who you are.

[ivy]

As I mentioned I sent your comments to Dr. Shafer, this is what he wrote back


Wow, that is quite amazing! I’m really honored by the many kind comments from the MJJCommunity. I’m also honored to see my answers translated into foreign languages. That reflects an enormous dedication by you and your colleagues in the MJJCommunity. Please share with your community my appreciation for their kind comments and diligent translations.

[Diplomate]

In his life, Michael met a lot of people, and most of them, at one point or another, used him, lied to him, back stabbed him, dragged his name through the mud, stole from him. An even greater number of people, who never met Michael, spent a lot of time, and sometimes a whole career, spreading terrible lies and accusations about him. They isolated and crushed him.
We saw him suffer and witnessed the excruciating pain he was inflicted. He stood up again and again. He still had the courage and ability to give love, to find the mere will to give love.
In a sadly ironic turn of events, a few amazing individuals stood up for him at last, to defend him one last time, when he was already gone.
Dear doctor Shafer, you did much more than protecting the name of decent medecine in your country. You protected the truth, you showed honesty, respect, decency, which are values we were not used to see anymore about Michael. For that only, you'll be remembered with a gratitude you can't even imagine. As MJ fans, you see, we dont have too many heroes. We spend a lot of time defending Michael against hateful or greedy people. You will have a special place in our heart, with the likes of Tom Mesereau.
Thank you for the compassion, understanding and respect you showed for us too. We're not used to it either.
You're a rare individual, you give me hope in humanity. I think I share the thought of many when I say I wish Michael had met you.
Thank you for being who you are.

Speechless....

Thanks for that Ben, you said it all.

[Ashtanga]

As I mentioned I sent your comments to Dr. Shafer, this is what he wrote back


Wow, that is quite amazing! I’m really honored by the many kind comments from the MJJCommunity. I’m also honored to see my answers translated into foreign languages. That reflects an enormous dedication by you and your colleagues in the MJJCommunity. Please share with your community my appreciation for their kind comments and diligent translations.

Great man!!!! :wild:

[windy09]

As I mentioned I sent your comments to Dr. Shafer, this is what he wrote back


Wow, that is quite amazing! I’m really honored by the many kind comments from the MJJCommunity. I’m also honored to see my answers translated into foreign languages. That reflects an enormous dedication by you and your colleagues in the MJJCommunity. Please share with your community my appreciation for their kind comments and diligent translations.

Thank you.

[Ben]

As I mentioned I sent your comments to Dr. Shafer, this is what he wrote back


Wow, that is quite amazing! I’m really honored by the many kind comments from the MJJCommunity. I’m also honored to see my answers translated into foreign languages. That reflects an enormous dedication by you and your colleagues in the MJJCommunity. Please share with your community my appreciation for their kind comments and diligent translations.

Ah, sweet sweet man... If you had any idea... Only Ivy knows the struggle it has been for me. :hysterical:

I was honored to spread the words of such a man as you.

[Victory22]

Dr. Shafer is amazing! I love this man.

[Maria MJ]

I'm speechless at this man's integrity--it really restores a great deal of my lost faith to medical practice..
Hugely grateful to Ivy and the entire MJJC team who made this possible.

[Daryll748]

As I mentioned I sent your comments to Dr. Shafer, this is what he wrote back


Wow, that is quite amazing! I’m really honored by the many kind comments from the MJJCommunity. I’m also honored to see my answers translated into foreign languages. That reflects an enormous dedication by you and your colleagues in the MJJCommunity. Please share with your community my appreciation for their kind comments and diligent translations.

I can't THANK this man enough really... It seems 'corny' or 'over the top' but ... THANK YOU Dr. Shafer :wub:
You have INSPIRED me and NURTURED my feelings and DRIVE to help people again... You've build up my FAITH again in Docs... I'll be forever grateful for your kind and uplifting words...
YOU :punk:

[Severus Snape]

This man is officially my hero. http://fc03.deviantart.net/fs42/f/2009/112/2/1/An_Emoticon_From_Years_Gone_By_by_sereneworx.gif

Fascinating read. Too bad I was late to the party.

[Naturelle]

Ben, that's every word I wanted to say. The ill effects of Michael's isolation were horrendous. He never met a class of people different from cons from 1999-2009. Often I think about how much damage Bashir did. Truly ironic that for a better class of people to be associated with Michael, he had to be gone.

It started a lot sooner than 1999 :( Michael would have loved Dr. Shafer as his doctor, I know I would too. Thank you Dr. Shafer you are brillant! :wub:

[Naturelle]

In his life, Michael met a lot of people, and most of them, at one point or another, used him, lied to him, back stabbed him, dragged his name through the mud, stole from him. An even greater number of people, who never met Michael, spent a lot of time, and sometimes a whole career, spreading terrible lies and accusations about him. They isolated and crushed him.
We saw him suffer and witnessed the excruciating pain he was inflicted. He stood up again and again. He still had the courage and ability to give love, to find the mere will to give love.
In a sadly ironic turn of events, a few amazing individuals stood up for him at last, to defend him one last time, when he was already gone.
Dear doctor Shafer, you did much more than protecting the name of decent medecine in your country. You protected the truth, you showed honesty, respect, decency, which are values we were not used to see anymore about Michael. For that only, you'll be remembered with a gratitude you can't even imagine. As MJ fans, you see, we dont have too many heroes. We spend a lot of time defending Michael against hateful or greedy people. You will have a special place in our heart, with the likes of Tom Mesereau.
Thank you for the compassion, understanding and respect you showed for us too. We're not used to it either.
You're a rare individual, you give me hope in humanity. I think I share the thought of many when I say I wish Michael had met you.
Thank you for being who you are.

So very true. A BIG thank you to Gaz and Ivy for this wonderful idea of Q&A and bringging it to fruitation. :flowers:

[Victory22]

Please like Dr. Shafer's FB page and thank him.
https://www.facebook.com/bramev#!/pages/Dr-Steven-Shafer-Michael-Jackson-Trial/305748062775206

[qbee]

Please like Dr. Shafer's FB page and thank him.
https://www.facebook.com/bramev#!/pages/Dr-Steven-Shafer-Michael-Jackson-Trial/305748062775206

It not Dr Shafer's FB page. It was created by a fan. I think they should clarify that out of respect for Dr. Shafer.

[Victory22]

Good point. Thanks. I have no idea who created it.