Monday, May 24, 2010
Brittany Murphy's Death - Learnings About Consumer Driven Healthcare and Pneumonia
Actress Brittany Murphy, age 32, died unexpectedly in December 2009 as a result of pneumonia. An autopsy report noted elevated levels of medications, like Vicoprofen, which contains the narcotic hydrocodone and other medications, the anti-histamine chlorpheniramine and L-methamphetamine which is found in decongestants. The hydrocodone in Vicoprofen can cause sedation and was used by the actress to treat menstrual cramps. The other medications are often used for symptom relief from respiratory infections.
Her husband noted that Murphy "was on an antibiotic and was taking cough medicine." Yet it is unclear if she was actually under the care of a doctor at the time of death. Other reports noted that the "star had been feeling ill prior to her death and had scheduled a doctor’s appointment on a Wednesday or Thursday — days before her Sunday death."
Her husband had been ill a week before and recovered so it was certainly reasonable for the actress to care for herself at home.
So what can we learn from this tragic and untimely death?
First, even in the 21st century pneumonia can kill despite our advanced antibiotics and medical technology. Among adults in 2000, there were about 135,000 hospitalizations due to pneumonia, and 60,000 cases of invasive disease, which included 3,300 cases of meningitis. Of those patients with the aggressive invasive disease, 14 percent were fatal.
Bacteria is becoming more resistant to medications as antibiotics are overused in treating viral infections, like colds and sinusitis, as well overuse in food production and livestock.
Patients at risk of pneumonia, elderly, young children, those with compromised respiratory systems (emphysema, asthma) and immune systems (diabetes) should ask their doctors about the pneumonia vaccine. Prior to the development of a vaccine that protected against Streptococcus pneumoniae, the bacteria annually caused over 700 cases of meningitis, 13,000 cases of blood infections, over 5,000,000 ear infections, and 200 deaths in children under five from invasive disease.
The type of vaccine administered varies depending on the age of the patient. For children, the vaccine is a series of shots given between the age of two to twenty-three months and is known as the pneumococcal conjugate vaccine (PCV). Other children may also get this vaccine at a later age if they have certain medical conditions. The pneumococcal polysaccharide vaccine (PPV) is recommended for adults sixty-five and older or who have other medical conditions. PPV is also given to children over the age of two with chronic illnesses.
It's unlikely Murphy would have needed a pneumococcal vaccine based on her medical history, which was otherwise healthy except for anemia, which is not unusual among women who are menstruating. However, according to the autopsy report the coroner noted a history of diabetes which alone would have been a reason for vaccination.
Second, it is unclear what dosages Murphy was taking of each of the listed medications. Certainly taking too much of any medication can be problematic particularly with hydrocodone and the chlorpheniramine. Both can cause sedation. The former drug can cause respiratory depression and decrease the drive the breathe, which can be fatal when taken in high doses.
Again it is unclear if she was under the care of a doctor at the time of her illness. Her husband notes that she was taking an antibiotic for a flu like illness. Yet, antibiotics are not appropriate for viral illnesses like the flu. Based on information from the coroner's report, the antibiotic clarithromycin which is used for pneumonia, was prescribed to her on November 17th, 2009, a month before the actress died. Was she ill before her December illness?
Finally, the assistant chief coroner noted that her death was "preventable".
Could Murphy have known how sick she was and how urgently she needed to seek medical care? It would been perfectly natural for her to have assumed that since her husband was recently ill and subsequently recovered that she would have done so as well. Isn't that what many of us do?
With increasing healthcare costs, many healthcare advisors are touting consumer driven healthcare as a way to slow medical expenditures. The theory goes that by having patients shoulder more financial responsibility on when to seek medical care and when they can safely skip advocates believe as a result people will make smarter choices and lower healthcare costs.
This is quite concerning.
Murphy, who arguably didn't have a financial barrier to seek care yet was quite ill, didn't get timely medical care. One wonders if individuals facing $50 to $100 office visits who might be equally as sick would simply stay home as well. At best, they might delay care and then subsequently end up in the emergency room or hospital not only requiring a lot more care but also a significant amount of out of pocket costs in the hundreds to thousands of dollars. At worst, they could die and have a death that was preventable.
Consumer driven healthcare, which is coming soon to you, requires that patients educate themselves in a way unprecedented than the past. Perhaps if Murphy had reviewed the symptom checker at the American Academy of Family Physicians she would have demanded an earlier appointment. (According to the coroner's report, Murphy was complaining of shortness of breath).
Instead of winging it, patients in these health insurance plans must educate themselves otherwise they are truly taking their lives into their own hands.
And the ignorance could be deadly.
(Sadly, her husband, Simon Monjack, age 39 was found dead today at home. Preliminary reports indicate he died of natural causes. Certainly he could have died from a broken heart).