Q: What are the drugs that have been mentioned in connection with Jackson’s death and how do they work?
A: Propofol (Diprovan): A powerful intravenous sedative — not a DEA controlled substance — was found on the premises. It is used by anesthesiologists to put a patient to sleep before general anesthesia and surgery, or alone in a surgical suite for an elective procedure such as a colonoscopy or biopsy. Only small doses are necessary to be effective, and it can easily be misused by an untrained health professional leading to a respiratory arrest.

Narcotics: Demoral, Percocet, Vicodan — there are varied reports of prescriptions for these being found. All can lead a patient to stop breathing or sustain a cardiac arrhythmia and cardiac arrest if overdosed — especially if used in combination. These are controlled substances and prescriptions are subject to DEA review. Misuse can lead to loss of license or criminal prosecution.

Sedatives: A prescription for Xanax was reportedly found. This can also lead to supressed breathing.

Q: What are the questions about substandard care that surrounded Jackson’s death?
A: Excess prescriptions of narcotics and sedatives. When he stopped breathing, no opiate antagonist (narcan) was given to reverse the effects of narcotics. The doctor in residence did not coordinate the 911 call. CPR was done on the bed without a backboard, rather than on the floor where more force could be administered to the heart. No defibrillator was available, and no mouth-to-mouth breathing was reportedly given.

Q: Why is there a delay in getting the autopsy results?
A: The initial autopsy apparently showed no structural damage to the heart to explain his death. There is speculation that prescription drugs contributed to or caused Jackson’s sudden death, and initial toxicology reports may soon be ready. More extensive reports take longer because they look at blood and hair to quantify the exact amounts and combinations that could have led to his death. This will include a microscopic examination of the brain itself, which could show the effects of drugs and help determine the exact cause of death.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.” Read more at www.doctorsiegel.com

There has been a firestorm of medical coverage, my own included, on Michael Jackson’s untimely death last week. There is much we still don’t know, including the final toxicology report which may help us to determine the combination of chemicals that appear to have led to his demise.

Here is what we do know:

1 – The initial autopsy appears to have shown no structural heart disease, in other words, no heart attack or heart failure. This increases the likelihood that prescription drugs were involved as a cause, leading to either a respiratory arrest (most likely), or an irregular heart rhythm which led to the heart stopping.

2 – The behavior of the medical team, especially Jackson’s personal physician, is very questionable, at least by my standards. I am a practicing internist, and I worked in the Bellevue Hospital Emergency Room for 8 years, and here are some of the points I and others have raised. Why wasn’t narcan, which rapidly reverses the effects of narcotics, administered? Why wasn’t he brought to the hospital if he wasn’t feeling well? Why did his personal physician allow or facilitate this concoction of pills that Jackson was supposedly taking. It isn’t simply a matter of writing or not writing a prescription; as a primary care doc I feel responsible for knowing and overseeing ALL medications my patients are taking. Why was CPR done on the bed instead of the floor, when the amount of force necessary to provide 30% cardiac output (the goal in CPR) requires full force that can be wasted on a bouncy mattress. Was Mouth to Mouth resuscitation used? Why didn’t the doctor direct the 911 call – why did he leave it to a security guard?

3 – The latest news involves a drug known as propofol or Diprivan. There are reports that Jackson may have been demanding, and possibly receiving this intravenous drug, which could certainly have led him to stop breathing. This is a drug that anesthesiologists ONLY use to induce anesthesia either as a stand alone treatment in elective procedures such as colonoscopies, endoscopies, small plastic surgeries, etc., or as a pre-anesthetic to put patients to sleep followed by general anesthesia and intubation. As a stand alone for colonoscopy, it is generally accompanied by a mask, though it is given intravenously. The dose must be very carefully regulated by an anesthesiologist, and in the doses used, generally only lasts for a half hour or hour. It is never used outside of a hospital or surgical suite.

4 – We have an epidemic of pill popping in our society. Narcotics are vastly overused, in combination with sedatives. These are dangerous combinations, especially when you consider that people become tolerant, requiring more and more to achieve the effect they want, and can easily slip into a toxic, life-threatening range.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.” Read more at www.doctorsiegel.com