Mejor que una interpretación personal de un prospectus de una medicina, yo, personalmente, en mi opinión, me fio más de un tal Dr. Schaffer:
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 http://www.csam-asam.org/pdf/misc/DS..._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. 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 http://www.csam-asam.org/pdf/misc/DS..._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: Durante el juicio, la defensa y varios medios de comunicación repetidamente llamaron “drogadicto” a Michael Jackson. En base a su conocimiento e investigación en este caso, ¿diría usted que Michael Jackson era "un drogadicto" o no?
Doctor Steve Shafer: "Adicción" es un término profano, no un término médico. El término médico correcto es dependencia a una sustancia. Usted encontrará una explicación exacta de esto en Wikipedia. Usted también puede encontrar una buena descripción en http: // www.csam-asam.org/pdf/misc/DS ..._diagnosis.doc.
Pienso que Michael Jackson probablemente tenía una dependencia a sedantes en el momento de su muerte, porque él recibía sedantes por vía intravenosa cada noche. Ese tipo de exposición con regularidad es casi seguro que cause dependencia.
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.
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: 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.
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: 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 (Fisher/Shafer NONMEM Workshop) 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.
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 (Fisher/Shafer NONMEM Workshop) 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: 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).
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: En base a todo lo que usted conoce, ¿qué piensa usted que pasó el 25 de junio de 2009?
Doctor Steve Shafer: Michael Jackson murió de una parada respiratoria (su respiración se paró) mientras estaba recibiendo propofol, exactamente como el forense puso en su informe. Había una contribución del lorazepam, tal y como también informó el forense. El forense acertó en esto.
MJJC: ¿Cuánto está usted de convencido que MJ estaba bajo un goteo esa noche?
Doctor Steve Shafer: Estoy completamente convencido. Murray admitió a la utilización de un goteo cada noche. Él dijo que él trataba de desenganchar a Michael Jackson. Yo no lo creo a él. Los niveles de propofol en la orina sugieren dosis masivas, más de 2000 mg, como expliqué en mi testimonio de refutación. Los niveles en sangre muestran las concentraciones del anestésico propofol. Todo esto cuadra con un goteo.
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.
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 Exclusive Q&A with Dr. Steve Shafer - Read his answers
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