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

Re: MJJC Exclusive Q&A with Dr. Steve Shafer - Read his answers - Part 3

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!


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

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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.
 
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
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ivy;3563924 said:
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.
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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.:)
 
Re: MJJC Exclusive Q&A with Dr. Steve Shafer - Read his answers - Part 3

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.
 
Re: MJJC Exclusive Q&A with Dr. Steve Shafer - Read his answers - Part 3

Again, thank you Dr. Shafer!
 
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.
 
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:
 
Re: MJJC Exclusive Q&A with Dr. Steve Shafer - Read his answers - Part 3

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:
 
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...
 
Re: MJJC Exclusive Q&A with Dr. Steve Shafer - Read his answers - Part 3

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.
 
Re: MJJC Exclusive Q&A with Dr. Steve Shafer - Read his answers - Part 3

I asked two questions, both have been answered. Thankyou Ivy and Dr.Shafer.
 
Re: MJJC Exclusive Q&A with Dr. Steve Shafer - Read his answers - Part 3

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
 
Dr. Steve Shafer:
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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.
Click to expand...

Wise words from a very wise man!

Dr. Shafer, thank you from the bottom of my heart!
 
Re: MJJC Exclusive Q&A with Dr. Steve Shafer - Read his answers - Part 3

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
 
Re: MJJC Exclusive Q&A with Dr. Steve Shafer - Read his answers - Part 3

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.
 
Re: MJJC Exclusive Q&A with Dr. Steve Shafer - Read his answers - Part 3

Beautiful words ben
 
Re: MJJC Exclusive Q&A with Dr. Steve Shafer - Read his answers - Part 1

Can it still be included in our follow up response? Please?
 
Re: MJJC Exclusive Q&A with Dr. Steve Shafer - Read his answers - Part 1

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.
 
Re: MJJC Exclusive Q&A with Dr. Steve Shafer - Read his answers - Part 2

Snow White 1937 said:
suzynyc said:
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...
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I was thinking exactly the same!!!
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Me too. I do not believe in such coincidences.

willbe said:
xthunderx2 said:
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.
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People die peacefully with their eyes and mouth opened, just as some people sleep with their mouth and eyes opened.
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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?

ivy said:
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.
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Yeah, that only proves that Murray was not in the room for at least 15 mins or even more.

Mirabella76 said:
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.
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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.


ivy said:
But I think they [paramedics] were called too late and perhaps even after Michael was already dead and nothing would bring him back.
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Daryll748 said:
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...
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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.
 
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Re: MJJC Exclusive Q&A with Dr. Steve Shafer - Read his answers - Part 3

@Ben, you put me into tears... so touching and heartbeaking..
Hug you...
 
Re: MJJC Exclusive Q&A with Dr. Steve Shafer - Read his answers - Part 3

Ben said:
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.
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Amazing words....Thank you for saying that....

I love the bolded part....Oh how different things would have been :cry:
 
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
 
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.
 
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ivy said:
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
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Thank you so much for sharing!
Love him..
 
ivy;3563884 said:
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.

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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
Click to expand...


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.
 
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