A Tragic Lesson
Could Heath Ledger's overdose have been prevented?
In the two weeks since Heath Ledger's body was discovered Jan. 22 in his downtown Manhattan apartment, rumors about the cause of his death have swirled. Was it suicide? Illegal drugs? Initial reports were inconclusive. But after conducting toxicological tests, the New York City medical examiner's office concluded Wednesday that the 28-year-old Australian-born actor and star of "Brokeback Mountain" died from an accidental but lethal combination of prescription medications used to treat anxiety, insomnia and pain. They include: oxycodone (the active ingredient in the prescription painkiller Oxycontin), hydrocodone (often combined with acetaminophen for pain relief in drugs like Vicodin), diazepam (an anti-anxiety medicine sold under the brand name Valium), alprazolam (another anti-anxiety drug sold under the commercial name Xanax), temazepam (or Restoril, which is commonly prescribed as a sleep aid) and doxylamine (an antihistamine that can be found in over-the-counter brands like Unisom, which is used for the short-term treatment of insomnia).
The report didn't note what concentration of each drug Ledger had in his body, but it raises unsettling questions. Why did the actor have so many prescription drugs in his possession? And was he properly informed of the potentially deadly result of combining the drugs or ingesting more than the prescribed amount at one time? NEWSWEEK's Jennifer Barrett posed those questions to Charles Barber, a lecturer in psychiatry at the Yale University School of Medicine whose new book, "Comfortably Numb: How Psychiatry is Medicating a Nation" (Pantheon), was published this week. Excerpts:
NEWSWEEK: The coroner's report found that Ledger died from a lethal combination of prescription drugs. Is it surprising that he had so many prescription drugs on hand?
Charles Barber: I don't want to comment on his case in particular, but I'd say that, in general, it's fairly easy to get prescription drugs from doctors, and people can go to multiple doctors--and the doctors don't necessarily talk to one another.
Why is that?
Psychiatric drugs used to be largely prescribed just by psychiatrists, and what's happened in the '90s and in this decade is that they are now prescribed by primary-care providers--in fact, the majority of antidepressants are being prescribed by primary-care providers [PCPs]. And there can be a real lack of follow-up after they are prescribed. Before the drugs became so widespread, people usually had a therapist involved in addition to drug treatment. Now it's far more common to have drug treatment alone and no therapy and, furthermore, to have a real lack of follow-up around the medications.
In your book, you argue that Americans are being overmedicated, at least for mental-health issues. Why?
The critical sea change came in the mid-'90s when prescription drugs were advertised on TV for first time. The TV commercials for drugs are banned everywhere in the world except the United States and New Zealand. The commercials really turned these drugs into household names, and they [became associated with] commodities like toothpaste or automobiles. But the fact is, they aren't just products. They are powerful agents. Yet studies have shown that in many instances doctors will prescribe drugs that their patients ask for after seeing them on TV, despite feeling ambivalent about the appropriateness of the drug.
Do you find that there is a lack of awareness among consumers about the risks of different medications--even some that seem benign?
That comes from this idea that they are on the TV with Colgate and Chevrolet and Diet Coke. It instills in consumers the idea that they are commodities like any other. The commoditization of drugs has created a sort of entitlement among patients, too. They think, if this drug is doing great things for people on TV, why shouldn't I have it?
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Posted By: docktorb@aol.com @ 04/21/2008 12:23:59 PM
Comment: Heath Ledger was both over and undermedicated. His last interview was almost certain evidence of a cyclothymic/bipolar problem. It's strange to me that the psychiatry professor didn't say anything about that.
That would go against his antimedicine theory. Yes,too many medicines are being given, but in Heath Ledger's case the right medicine, a mood stabilizer, was not prscribed. A primary care doctor should know to screen for that, but with the government and insurance companies push for assembly line medicine, it's not surprising that it was missed. As a primary care physician, I frequuently am reluctant to send a patient to a psychiatrist as the commentator suggests. In our area they tend to add a medicine at every visit instead of changing to an effective one. Children are often on five or six medicines when the do better when changed to one mood stabilizer and perhaps an anti depressant.
It is possible that Ledger refused a mood stabilizer, opting for the bandaid treatment with valium like drugs. These give immediate relief but don't treat the underlying condition. Things usually get worse over the long haul as in Ledger's case. It's easy to see a desperate in amanic insomnia taking more and more drugs to get to sleep. Finally it's enough to puy you in a permanent sleep. As many as one in thirty people has bipolar or it's milder cousin, cyclothymic disorder. This is extremely common in actors and other creative people. They tend to be the movers and shakers of the world. Think Alexander the Great, Teddy Roosevelt,Ted Turner, Van Gogh, Jim Bakker. They get things done but are at risk of getting carried away. It's only a little exageration to say these people either become millionaires, go to prison, or both. It must be controled to get the maximum benefit without the harmful results. This does involve counseling, education, and yes, mood stabilizers at the lowest effective dose. A knowledgible primary care physician is essential to manageing this condition through it's fluctuating stages.
Posted By: docktorb@aol.com @ 04/21/2008 12:22:55 PM
Comment: Heath Ledger was both over and undermedicated. His last interview was almost certain evidence of a cyclothymic/bipolar problem. It's strange to me that the psychiatry professor didn't say anything about that.
That would go against his antimedicine theory. Yes,too many medicines are being given, but in Heath Ledger's case the right medicine, a mood stabilizer, was not prscribed. A primary care doctor should know to screen for that, but with the government and insurance companies push for assembly line medicine, it's not surprising that it was missed. As a primary care physician, I frequuently am reluctant to send a patient to a psychiatrist as the commentator suggests. In our area they tend to add a medicine at every visit instead of changing to an effective one. Children are often on five or six medicines when the do better when changed to one mood stabilizer and perhaps an anti depressant.
It is possible that Ledger refused a mood stabilizer, opting for the bandaid treatment with valium like drugs. These give immediate relief but don't treat the underlying condition. Things usually get worse over the long haul as in Ledger's case. It's easy to see a desperate in amanic insomnia taking more and more drugs to get to sleep. Finally it's enough to puy you in a permanent sleep. As many as one in thirty people has bipolar or it's milder cousin, cyclothymic disorder. This is extremely common in actors and other creative people. They tend to be the movers and shakers of the world. Think Alexander the Great, Teddy Roosevelt,Ted Turner, Van Gogh, Jim Bakker. They get things done but are at risk of getting carried away. It's only a little exageration to say these people either become millionaires, go to prison, or both. It must be controled to get the maximum benefit without the harmful results. This does involve counseling, education, and yes, mood stabilizers at the lowest effective dose. A knowledgible primary care physician is essential to manageing this condition through it's fluctuating stages.
Posted By: the.cheshire @ 02/22/2008 3:42:09 AM
Comment: I doubt very much if poverty was 'the biggest cause' or even a factor in Heath Ledger's death. The use of the word "then" for "than" makes me doubt your professionalism, but I do agree that drugs make people "do strange and terrible things they would regret forever"--if they ever get off of them and get back to a mental state where they can regret them. I agree with this because that's exactly what happened to me.
I was prescribed Paxil and Xanax and Trazodone all at the same time. When I complained to my Dr. that I was getting worse instead of better, he increased the dosage. How was that supposed to help?
TV commercials for drugs clearly tell of side-effects and negative results, which the doctors should, but usually don't. When you fill a prescription, the drug store staples a sheet of paper with the side effects written on it, so that is no excuse for patients wanting the drugs anyway, unless they can't read (closed captioning) or hear--yet there were other side effects from the drugs I took that I experienced, that weren't anywhere on the papers or in the doctor's mouth, that I actually had to search the internet to find.
People already on drugs don't mind being put on more drugs. It's like using peroxide to pre-soften resistant hair so that it will "take" more peroxide hair color-- one drug conditions the patient to accept more with no concern for the side effects or damage they can cause.
Aren't doctors to drug companies what mechanics are to parts companies? It's sad the way things are and it's sad that Heath is dead. I think it boils down to one thing. When it comes to what happens to the people taking their prescriptions, the doctors and the drug companies simply do-- not-- care--.