Elizabeth Landau
CNN.com Health Writer/Producer

The general anesthetic Diprivan (propofol) has been making headlines as questions about Michael Jackson’s death abound. A nurse who had worked for the singer told CNN that Jackson requested the drug because he had trouble sleeping, and The Associated Press reported that it had been found in his home. Diprivan is not approved as a sleep aid by the Food and Drug Administration. Read more about propofol.

It turns out that propofol, used routinely for surgeries and procedures such as colonoscopies, has been a point of concern among some anesthesiologists because of the potential for abuse by health care workers. A 2007 study published by the International Anesthesia Research Society found that about 18 percent of the 126 academic anesthesia programs in the United States had at least one reported instance of propofol abuse within the previous 10 years.

Researchers also found that six out of 16 residents (about 38 percent) who abused propofol died from it. While these are small numbers, lead author Dr. Paul Wischmeyer, professor of anesthesiology at the University of Colorado, believes this is indicative of a larger problem.

Keep reading…

Patients undergoing surgery may receive Diprivan to keep them sedated during the procedure.

Elizabeth Landau
CNN

Diprivan is a powerful I.V. anesthetic drug used for patients undergoing certain surgeries and diagnostic procedures.

The drug is making headlines with the claim from a nurse who worked for pop icon Michael Jackson that the singer, who died June 25, had repeatedly asked her about the drug. Nurse Cherilyn Lee told CNN that Jackson had brought up Diprivan about three months ago, saying he needed it for insomnia and that his doctor said it was safe.

“He said, ‘I am so sleepy. I cannot sleep. I want to have at least eight hours of sleep,’” Lee told CNN’s Anderson Cooper.

The medication, whose generic name is propofol, renders the patient unconscious for as long as doctors deem necessary. The patient wakes up almost immediately after the infusion is stopped, experts say.

But treating sleep disorders is not an approved use of the drug. The U.S. Food and Drug Administration says Diprivan should be given only by people trained in the administration of general anesthesia and who are not involved in the conduct of the surgery or diagnostic procedure.

Keep reading…

Program Note: Join us tonight on AC360º at 10 P.M. ET to hear Dr. Sanjay Gupta speak more on Michael Jackson’s on-going medical examination.

For toxicology screenings, blood samples are drawn from the leg and heart, as drugs can circulate around the body.

Madison Park
CNN

Unlike television crime shows in which machines can instantly spit out results, toxicology testing to determine what drugs are in a person’s body can be a long and painstaking process.

The Los Angeles County coroner’s office estimates that toxicology tests on the body of Michael Jackson could take six to eight weeks. The results are needed to determine the singer’s cause of death, a spokesman for the coroner said. The singer’s autopsy last week was inconclusive, although officials said there were no indications of external trauma or foul play.

Identifying drugs in the human body requires a lengthy sequence of tests and confirmations that can take weeks and even months, forensic experts said.

Questions about the possible role of prescription medications in Jackson’s death have swirled since Thursday, when the singer was found unconscious. Edward Chernoff, attorney for Dr. Conrad Murray, who tried to revive Jackson at the singer’s rented home, said the doctor was not aware of any prescription drug abuse by Jackson.

Keep reading…

Actress Farrah Fawcett had been battling anal cancer on and off for three years.

Program Note: For more on actress Farrah Fawcett and her battle with anal cancer, tune in tonight,  AC360° at 10 p.m. ET 

American Cancer Society &
National Cancer Institute

Anal cancer is fairly rare — much less common than cancer of the colon or rectum. The American Cancer Society estimates that in 2009 about 5,290 new cases of anal cancer will be diagnosed in the United States. The number of new anal cancer cases has been on the rise for many years.

Lifetime Risk
Based on rates from 2004-2006, 0.16% of men and women born today will be diagnosed with cancer of the anus, anal canal, and anorectum at some time during their lifetime. This number can also be expressed as 1 in 624 men and women will be diagnosed with cancer of the anus, anal canal, and anorectum during their lifetime. These statistics are called the lifetime risk. See Fast Stats for more detailed statistics, and Probability of Developing and Dying of Cancer for methodology.

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Program Note: Tune in tonight to for our special coverage of the debate around the legalization of marijuana, ‘America’s High: The case for and against pot,‘ on AC360° at 10 p.m. ET.

Allison Margolin
Criminal Defense Attorney

Charles Lynch, a dispensary operator from Morro Bay, California, who was indicted and convicted in federal court for activities related to selling marijuana to medical patients, received a sentence last Thursday of a year and a day.

John Littrell, Lynch’s attorney, indicated that Lynch received what is known as the “safety valve.” This is a federal statute that allows for a defendant who is otherwise subject to mandatory minimum sentences to have a reprieve and be sentenced outside of them. In order to qualify for the so-called ’safety valve,’ the defendant cannot be the “leader” of the organization. Littrell indicated the judge would issue a written order amidst objection by the U.S. Attorney to the safety valve in part on that basis.

He also indicated that Lynch was sentenced to 366 days in order to qualify for good time credits that would reduce Lynch’s sentence to around 10 months.

It is refreshing and fabulous that Judge Wu has liberally interpreted the safety valve to help reduce the prison exposure of a defendant who would have a medical defense in state court. Although the attorneys were precluded from mentioning the medical defense during Lynch’s jury trial, it is clear that his medical defense, though not technically available, motivated the court to sentence the defendant far below the 10-year-mandatory minimum that would otherwise apply to his convictions.

I believe that defense attorneys should use this case as well as USA v. Landa, 281 F. Supp. 2d 1139 (2003) , in which the district court contemplated compliance with state law as a basis for a downward departure in the guidelines (although that case lacked evidence of state law compliance), to argue that state law has a place in contemplating punishment when the state and federal law differ and the state gives more rights than the federal government.

I drafted a motion like this for Stephanie Landa on her appeal. For anyone interested, the argument is that the 10th Amendment is violated by the federal enforcement of marijuana’s Schedule I status in the medical states.

A few weeks ago, the New York Times Magazine published an article, “Obama’s Judicial Philosophy Analyzed,” by Charlie Savage, about what the author perceived to be Obama’s judicial philosophy and the one he believed Supreme Court justices appointed by Obama would follow.

The article suggested that Obama is interested in a court who articulates rights that many states (maybe a super-minority) have recognized, and pushes the other states along. That is why the recent legalization of medical marijuana in Rhode Island should be celebrated as a victory and replicated in more states.

Then we can use federal marijuana cases as a vehicle to go back to the U.S. Supreme Court and ask that the use of marijuana for medical purposes be recognized as a right that is held superior to the ban of the conduct by the Controlled Substances Act, the statute that regulates controlled substances and places marijuana in a category that has no medical use, Schedule I.

Editor’s Note: Harvard-educated Lawyer Allison B. Margolin is now a practicing criminal defense attorney in Los Angeles. She is often referred to as ‘L.A.’s ‘dopest’ attorney.

Jeffrey A. Miron
Special to CNN

Government spending on health care is growing at an alarming rate.

If recent trends continue, the two main government programs, Medicaid and Medicare, will increase from 6 percent of the nation’s Gross Domestic Product now to about 15 percent by 2040.

This means that, without policy changes, the United States faces enormous budget deficits, substantially higher taxes, or huge cuts in non-health spending.

No one wants higher deficits or taxes, and there is no consensus about cutting other spending. The only way to avoid some combination of these outcomes, however, is to reduce the growth rate of what we spend on health. The question, of course, is how?

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Properties near ground zero of the December 22 Tennessee spill are covered in sludge.

Stephanie Smith
CNN Medical Producer

Before December 22nd, except for people living near coal-burning plants, the phrase “coal fly ash” was not a part of the lexicon.

These days, coal, and specifically the waste produced when it is burned – called coal fly ash – are frequently topics of conversation, at least in Congress.

The conversation began after the largest industrial disaster in U.S. history – a spill ten times worse than Exxon Valdez.

It happened three days before Christmas, on a cold morning before dawn. A dam holding back more than one billion gallons of coal fly ash sludge trembled and finally broke, blanketing 300 acres in Kingston, Tennessee, and nearby Harriman, Tennessee. The coal ash, which was stored at the Tennessee Valley Authority’s Kingston plant for more than 50 years before the breach, could not be safely disposed. It was mixed with water and pumped into giant holding ponds.

There are no Federal guidelines or oversight over the more than 1300 ponds like the TVA’s in the U.S. According the Environmental Protection Agency, coal ash is subject to the same regulations as household garbage.

At a press conference in Washington, Senator Barbara Boxer announced that the Environmental Protection Agency has identified 44 more sites like TVA’s which pose a “high hazard” to nearby communities, but that the EPA in consultation with the Army Corps of Engineers, and the Department of Homeland Security, will not disclose the list of sites publicly.

In a letter addressed to those agencies, Senator Boxer indicated that if a breach were to occur at any of these sites, it would “pose a threat to the lives of people nearby.” Boxer also emphasized the public’s right to know where the hazardous sites are located, saying that the knowledge could empower it to press local authorities to make the sites safer.

Testing revealed that coal fly ash at the TVA site was laden with toxic elements like arsenic, lead and selenium, and radioactive waste. A slew of independent studies, including a recent Duke University study, indicate that the environment, the water, and the air near the TVA plant have been contaminated, and fish pulled from the Tennessee, Clinch and Emory rivers are testing at dangerously high levels for selenium and other heavy metals.

The environment is destroyed.

Six months after the spill, families living near the TVA plant are still reeling. Their chronic health concerns include upper respiratory problems, asthma, ear infections, headaches, and nausea. Organizations monitoring the situation on the ground are reporting those, and more, health problems in people living as far as 10 miles away from Kingston: bleeding from the ears, vomiting, skin rashes, blisters, and polyps in the nose.

Many in the area fear that every day they’re breathing in cancer-causing toxins. Many in the area are frightened about the future.

Now, it seems, 44 more communities like the ones in eastern Tennessee also hang in the balance.

Craig Jaggers
World Vision U.S.
Policy adviser for global health

The World Health Organization has made it official. The United Nations’ health agency raised its alert to the highest level for the new H1N1 “swine flu” pandemic yesterday, citing its spread and unknown potential for greater harm, while top health officials highlighted troubling questions for the world’s poor compared with wealthier nations:

“It is prudent to anticipate a bleaker picture as the virus spreads to areas with limited resources, poor health care, and a high prevalence of underlying medical problems,” WHO Director-General Margaret Chan said in the announcement.

Pandemics are not new to the billions of people in impoverished countries where AIDS, malaria and other diseases are already taking millions of lives each year. The onslaught of a new health threat in many of these places looms like the next massive wave on a stormy beach, threatening another body-slam against large populations already struggling for footing.

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AC360°

Is there a case for medical marijuana?

Tune in next week for an AC360° special, America’s High: The Case For and Against Pot.

We’ll break down the debate over marijuana in the United States – from the cases for and against legalization, to whether it’s helped medical patients and why — or why not.

So what do you think? Is there a case for medical marijuana?

Anderson will talk with Melissa Etheridge, who says medical marijuana helped tremendously during her battle with cancer.

Do you have questions for her? What would you like Anderson to ask?

Let us know and Anderson may bring it up in the interview.