In Depth

Diagnoses of the Rich and Famous

Celebrity-Related Medical Stories Can Be Teaching Moments

Whether it is the recent revelation that actor Patrick Swayze is battling pancreatic cancer, the bipolar diagnosis of singer Britney Spears or the sudden deaths of Heath Ledger and
Kanye West’s mother, Donda, celebrity- related medical stories focus intensely—and some say irresponsibly—on the health issues involved. But experts agree the coverage can impart valuable information to the public.

When the 28-year-old Mr. Ledger was found dead in a Soho loft in New York on Jan. 22, there was immediate speculation on the cause of death. It was initially reported that sleeping pills and other prescription drugs were found in the apartment, along with a rolled-up $20 bill that appeared to contain drug residue. Within hours, the New York Police Department said the currency was clean and contained no evidence of drugs.

The media frenzy was on, but the facts were few and far between as the story was written in real time in a 24/7 news cycle.

“It was a circus with speculation that was inappropriate about a suicide or drug overdose,” said Dr. Paul Dougherty, a Los Angeles ophthalmologic surgeon who serves on the editorial board of the Journal of Refractive Surgery. “It was more about getting ratings than informing what happened. They didn’t have all the information. I think it was very hurtful to his family before the true circumstances came out. I was disappointed that there was a lot of hearsay and conjecture.”

But the questions remained and the speculation continued for weeks. What had caused the shocking death of the young, seemingly healthy actor?

While an autopsy report came back inconclusively, toxicology test results released more than two weeks after his death ended the conjecture.

“Mr. Heath Ledger died as the result of acute intoxication by the combined effects of oxycodone, hydrocodone, diazepam, temazepam, alprazolam and doxylamine. We have concluded that the manner of death is accident, resulting from the abuse of prescription medications,” said New York’s chief medical examiner.

The news spawned an additional round of stories, including reports on the dangers of mixing prescription drugs—useful information that affects untold numbers of people taking multiple medications.

“The issue is journalists need to be careful that their audience gets accurate information when something happens to a celebrity,” said Andrew Holtz, veteran health journalist and author of “The Medical Science of ‘House, M.D.’” “It’s the perfect opportunity to do stories on ongoing medical topics with a news hook. One of the problems is a lot of reporters who are entertainment or general assignment reporters have no background in health/medicine and don’t know when they are about to make a major gaffe. I don’t think they need to be experts, but editors have a responsibility [to see] that reporters have the appropriate background information.”

For MSNBC.com senior health editor Julia Sommerfeld, the cause of Mr. Ledger’s death formed the basis of new questions on which to report, or, as she called them, “teaching moments.”

“It was ruled an accidental OD, but how could taking all those pills at once be accidental?” Ms. Sommerfeld asked. “We started calling doctors and found out it happens quite often, such as in the cases of returning soldiers, who are in intense pain emotionally or physically. They keep taking pills to numb the pain—and it could seem like a suicide.”

“The takeaway message was that drugs can interact and have bad consequences, and your doctor needs to know everything you are taking,” said Trudy Lieberman, director of the Health & Medicine Reporting Program at City University of New York. “There’s no coordination, and it points up a big flaw in our health care system: the lack of a medical record that goes with you and lists all this. The media connected the dots, and that prompted people to say that unless someone is coordinating your care, the onus is on the individual.”

The death of rap singer Kanye West’s mother, Donda West, also created a media firestorm in November. The 58-year-old Ms. West died a day after undergoing several cosmetic surgeries—including a tummy tuck and a breast reduction—performed by Los Angeles plastic surgeon Dr. Jan Adams. The doctor had become something of a celebrity, appearing as an expert guest on “Oprah,” “The Other Half,” “Entertainment Tonight,” E!, ABC, CNN, NBC and “Extra.” He also had his own show on Discovery Health.

The initial coverage focused the blame on Dr. Adams, and it was revealed that he was not board-certified, that the California state medical board was investigating whether to revoke or suspend his license over alcohol-related arrests, that he had been the target of malpractice lawsuits and that he had paid out nearly $500,000 in civil settlements.

“A lot of the coverage was sensationalistic,” said Beverly Hills plastic surgeon Marc Mani, who has been featured on Discovery Health’s “Plastic Surgery: Before and After” and on “Extra.” “All of the physicians who knew about it knew it was a medical complication and not a ‘surgical misadventure.’ Indeed, in the autopsy, that’s what was found. There was nothing technically done wrong during the surgery. It’s a situation where a lot of conclusions were being drawn. Some of those things being said were rash statements.”

The L.A. County Coroner’s Office initially said Ms. West died from surgical complications, but after toxicology reports came in two months later, it said the cause of death was “coronary artery disease and multiple post-operative factors due to or as a consequence of liposuction and mammoplasty.” The report said the 5-foot-2 Ms. West weighed 188 pounds and developed bronchopneumonia in one lung after surgery.

“The final results of the autopsy didn’t bear out what was being said about that physician,” said Dr. Mani, who also pointed out that board certification is not legally required for any physician to perform surgery in the state of California, although he recommends that patients seek out surgeons who are board-certified.

“There is a tendency to point fingers, and not wait until all the facts come out,” said Dr. Mani. “The most responsible thing is to report the facts in a non-sensational way and then, when the actual results come out, report that. There’s a tendency to get the scoop as soon as you can. Obviously that affected that surgeon’s practice in a very negative way. With high-profile patients we deal with in my practice, the priority is safety and confidentiality. We definitely have had situations where we get media interest and we have to be on guard.”

The media initially portrayed Mr. Ledger’s death as a mystery and treated Ms. West’s death almost like a murder, Dr. Mani said, but he noted both cases eventually provided learning opportunities for the public. In Ms. West’s case, it was about the dangers of ignoring existing health conditions before surgery, and the risks of having multiple surgeries at once.

“The second wave of coverage was uniformly helpful and ultimately performed a service,” said Dr. Bruce Hensel, a Los Angeles-area emergency medical specialist and medical editor for KNBC-TV. “What we do know is she may not have spent enough time in the facility, and she had a great many procedures, which is a risk. People consider having five procedures, or believe ridiculous ads that you can take 50 pounds off in an hour. We are so driven to instant, complete cures; if we’d just back off, we’d be safer.”

Dr. Hensel reported after the Donda West case on choosing a doctor, preparing for surgery and protecting yourself afterward. Last month, he aired a special segment during the newscast on the dangers of plastic surgery. The piece took a skeptical look at misleading advertising claims and examined the risks of having multiple procedures performed at one time. It gave viewers suggestions on choosing a surgeon, preparing for surgery and post-surgical care.

Media coverage of celebrity medical treatments can have a big impact on practices, and can create confusion. When Nancy Reagan announced she was undergoing a radical mastectomy for breast cancer, there was controversy because most experts agreed less radical treatment would have been as effective.

Katie Couric’s on-camera colonoscopy raised questions because the procedure was not recommended for people under age 50 without a family history of colon cancer, and she did not fall into that category.

“By using her pulpit on the ‘Today’ show, she changed the practice for a period of time. Medical studies documented ‘the Katie Couric effect,’” said Mr. Holtz.

“What a celebrity does and says has an impact for a while, then fades,” he said. “You can make a judgment—good or bad—that may include information not well-supported by evidence at the time. It’s always done with good intentions. Both Katie and Nancy had medical experts backing them up, but those were personal opinions not held by others in the field. The weight of coverage tended to favor one opinion when evidence would give you a different view of the issue.”

Other celebrities use the media to advocate certain medications or treatments while not necessarily disclosing that they are paid promoters of the products. As is the case with just about every story, it’s incumbent upon journalists to ask the right questions.