Is lupus a serious disease? Yes. It has been known to medicine since ancient times, and used to be viewed with a shudder as one of the "great dreaded diseases." Often it was fatal. Today its mortality rate is down. Those who have it, and treat it, are distancing it from that "dreaded" old label, because of better treatment and more understanding. Yet there's still no cure for this chronic autoimmune disease.
Unlike AIDS, which results from the immune system being weakened, lupus is the result of an over-active immune system. Science doesn't yet know what causes lupus, though it may be triggered by genetic and environmental factors that interact. It attacks and inflames the skin, or (in its more systemic form) the joints, muscles, lungs, heart, kidneys and central nervous system. When lupus attacks and inflames the heart, it causes myocardia...which can result in heart failure.
Yet it would seem that Michael's lupus has prompted more of that rushing to judgment that we've seen directed at the singer's life. Many Americans were ready to brush aside his acquittal of criminal charges in 2005 so they could go on believing that he was a "proven pedophile." Others (including Bill O'Reilly) were ready to believe that he was bleaching his skin in order to deny his racial identity as an African American. Still others have evidently brushed off the mention of lupus, so they can look at Jackson as just another of those show-biz addicts who get hooked on prescription drugs.
But I'm thinking about the weighty word "lupus" and wondering how deeply this disease will alter his biography if it turns out to have been a major factor in his death.
My Friend Rose, and Her Lupus
I've had an interest in lupus since a Florida friend of mine, Rose Bass, was diagnosed with systemic lupus erythematosus in the 1970s. This was at a time when the disease was still little understood and often fatal. She had to give up a promising career as a CPA. Fortunately, her parents became lifelong caregivers as she became more disabled and shut-in. It took her around 25 years to die, and she experienced excruciating pain. Towards the end of her life, Rose got involved with other lupus activists who were trying to raise a most positive public consciousness about the disease. Her framed picture sits on my shelf as I write this.
Some time ago, I ran across some new research about lupus. According to a New England Journal of Medicine article in 2007, an international group has discovered a gene, NALP1, that possibly links lupus with another autoimmune condition that Jackson had, namely vitiligo, which attacks the pigment in skin and turns it white in patches.
Today lupus is viewed as controllable and treatable to some degree, depending on the form it takes and how severe it is. It can go into remission, then suddenly flare again. Its onset can be triggered by stress, infections, illness, trauma, certain medications, even exposure to sunlight.
Here is the Lupus Foundation of America's description of the form that Jackson may have had -- namely the one that attacks the skin, cutaneous lupus erythematosus:
"Although there are many types of rashes and lesions (sores) caused by cutaneous lupus, the most common rash is raised, scaly and red, but not itchy. It is commonly known as a discoid rash, because the areas of rash are shaped like disks, or circles. Another common example of cutaneous lupus is a rash over the cheeks and across the bridge of the nose, known as the butterfly rash. Other rashes or sores may appear on the face, neck, or scalp (areas of the skin that are exposed to sunlight or fluorescent light), or in the mouth, nose, or vagina. Hair loss and changes in the pigment, or color, of the skin are also symptoms of cutaneous lupus."
The LFA adds: " Approximately 10 percent of people who have cutaneous lupus will develop systemic lupus. However, it is likely that these people already had systemic lupus, with the skin rash as their main symptom."
From Stress to Stress
Arround 1986, when Jackson was 28, he was first diagnosed with lupus by Dr. Klein. At the same time, Klein diagnosed the singer's case of vitiligo.
In his King interview last night, Klein commented that lupus and vitiligo often occur together, and shared details on the treatment. He said that he and Jackson opted for use of chemical creams that gradually lightened the areas of normally pigmented skin. Their aim was to match the areas progressively whitened by the disease. The only other option was wearing dense makeup over the light areas, an approach that Klein said would have been unworkable -- too patently visible -- for the off-stage part of Jackson's life.
Since Jackson had already had a lot of plastic surgery by then, both on his scalp and his nose, pain and pain management was already an issue. Klein mentioned that Jackson was very sensitive to pain.
Some media sources assert that Jackson mentioned both diseases during his famous Oprah interview in 1993. However, in the interview footage I've found, he told Oprah that his medical issues were "private." He did mention that he had a "skin disorder" he "couldn't do anything about," because it "came from his father's side of the family." In his King interview, Dr. Klein confirmed that a male relative on Jackson's family had this disorder. It could have been vitiligo, or lupus, or both -- since they may be genetically linked. In other words, cutaneous lupus could be what Jackson had suffered all along -- ever since his teen years, when he had developed a bad case of what looked like acne, that his father and brothers teased him about.
In other words, cutaneous lupus could have been touched off by all the stress and emotional trauma of those teen years, when he was dealing with abuses by his father.
Some media sources state that Jackson's lupus went into remission. However, the medical literature tells us that lupus remissions can end with frightening suddenness. The 12 years between 1993 and 2005 were highly stressful. During that stressful period, autoimmune disease may have been gone active in his system again. There was the two episodes of being tried for child molestation, the 2005 trial and acquittal, his marriages and divorces, custody fights over children, plus the pile-up of his colossal debts, and the apparent collapse of his career.
After hiding out in Bahrein for a while, Jackson quietly returned to the U.S., and took up an isolated hidden life in Las Vegas, where even his family reportedly couldn't see him. According to information cited by CNN, the rare glimpses of Jackson showed him looking thin, disheveled and unwell.
Is it possible that, in his final years and months, as a result of all the sustained stress, Jackson became one of that 10 percent who progress into a more systemic form of lupus? Did he experience increasing joint and muscle pain because of it, prompting more desperation around painkillers?
Some media sources insist that, about this time, the Jackson family went to Las Vegas and tried to do an intervention on what was said to be his growing addiction to prescription drugs, but they were rebuffed by him. In 2007 his mother and most of his siblings issued a statement denying that they had done any such intervention.
Last night, on "Larry King Live," Dr. Klein's version of the story was that Jackson went quietly to Europe on his own personal intervention, and there he put himself into rehab for a while.
Whatever the truth about how Jackson dealt with his addiction, it does appear that recently he was pulling himself together, getting his life back on track and planning his "This Is It" comeback.
Klein said he saw Jackson days before his death, during the rehearsals at Staples Center. According to Klein, the singer looked fit and happy. "He was dancing for my patients," Klein said.
Asked about the needle tracks by King, Klein said he didn't see any, but added that he hadn't looked for them. He also couldn't account for the "emaciated" look of the body being alleged by the unnamed source, and pointed out that dancers always try hard to stay thin.
If in fact Jackson was developing a more systemic lupus, it may explain the chronic back pain that he complained about. It may explain his occasional appearances in a wheelchair. Lupus symptoms may also explain his loss of weight, and loss of all his hair. Not to mention that it could have affected his heart. In combination with the effects of powerful prescription drugs, lupus-induced myocardia might have contributed to the heart failure that killed him.
Questions for the Future
Sometime in the coming months, when the final autopsy report is in, and authorities have dug through the hidden facts of Jackson's medical condition to the very bottom -- and/or perhaps when someone finally writes a definitive biography of MJ -- we may finally learn more of the truth about this medical side of his life, and that secret battle to protect his looks and his livelihood.
Why did Jackson chose to hide the fact of his disease, and his treatment? Likely he didn't want his image associated with a "dreaded disease" that might make his fans say eoowwww. Hollywood in the 1980s was already consumed with hiding cases of AIDS among stars, producers, writers, directors. Jackson always described himself as a perfectionist, so surely his skin conditions were "imperfections" that were profoundly upsetting to him as a performance artist who was bent on creating a unique brand based on personal appearance. They put a whole new twist on his song "Man in the Mirror." He told Oprah that he didn't look at himself in the mirror very often. Apparently he didn't want his fans to look at him that way either.
Unfortunately, by hiding these medical facts (which was his right, after all), Jackson touched off three decades of wild and often unkind allegations that he was bleaching his skin because he "didn't want to be black." Even after his death, these allegations are still being made, notably by Bill O'Reilly, who ignores all the medical evidence and asserts that Jackson isn't a black icon because he lightened his skin. Fortunately most people in the black community understood that Jackson did have vitiligo...notably all the other black icons who turned out to celebrate him after his death.
In MSNBC and People interviews shortly after Jackson's death, Dr. Deepak Chopra (a therapist and friend of Jackson's for many years) was another witness who talked about Jackson's lupus and vitiligo. In his chat with Keith Olbermann on MSNBC, Chopra talked bluntly about his long-time concerns over Jackson's growing addition to painkillers and other prescription drugs. He blames Jackson's death on the out-of-control use of prescription drugs and is calling for an all-out investigation of these practices in the entertainment industry.
Law enforcement is now interviewing all of Jackson's doctors -- including, apparently, Dr. Klein. Whether or not any of them administered those drugs that killed him -- whether or not any of them broke the law, or whether they violated good medical practice when they treated him -- is another story.
If the autopsy report pinpoints that illegally administered prescription drugs were the cause of death, somebody will probably be going to prison.
But drug addiction doesn't answer all those questions about Jackson's life. If advancing lupus was part of that vast shadow that fell across his later life, then how did he manage to perform so brilliantly during that last 90-minute rehearsal at Staples Center? As he laughed and joked with the other dancers, there was his apparent ease of movement, his casual crispness with a lot of the old moves, his expression of enjoying himself. All that may have been made possible because he had enough painkillers in his system to numb an elephant.
But that 90-minute victory also tells us volumes about the power of his will to make his dancing feet obey -- to make a comeback against all odds -- to return to the stage that (as he told Oprah) was the only place on Earth where he felt "at home."
As for the 50 London performances that were lined up, we can only guess at how Jackson thought he would get through them, given the colossal amount of drugs he would have needed to deliver for his fans every single time.
One final question: since Jackson knew that his disease might be inherited, did he worry about passing it on to his offspring?
Today, with all the questions raging about who was the real biological father of his three children, is it possible that there's a medical reason for why this question might be asked? Did Jackson arrange for at least one anonymous sperm donor so his sons and daughter would never develop lupus -- so they would never live in the hell of pain that he had known?