Elvis Presley: Head Trauma, Autoimmunity, Pain, and Early Death
In the spring of 1981, I was working in my West Covina office when my secretary said an attorney wanted to talk with me about a case. "Dr. Tennant, I'm James Neal. I'm an attorney in Tennessee and I'm defending Dr. George Nichopoulos [Dr. Nick], Elvis Presley's doctor. Incidentally, if my name doesn't ring a bell, I'm the lawyer who prosecuted Richard Nixon in the Watergate Trial." The call itself wasn't all that unexpected; a few months earlier, I had appeared on behalf of the US government in the trial against the physician of Howard Hughes. In those years, I was one of the only physicians who was studying opioids for both pain and addiction, and I did a lot of forensic and legal testimony.1-3
I accepted Mr. Neal's offer to review Dr. Nick's case, and soon found myself embedded in a study of Elvis' drug addiction, pain, and medical problems. At the time, the public issue and controversy was centering on Elvis' drug use, and whether he died of a heart attack or drug overdose. There was little interest in his underlying medical problems, pain, or why he died at the relatively young age of 42. Dr. Nick was being criminally charged with murder because he had been the main physician prescribing medications to Elvis.
Mr. Neal and his law firm provided me with a trove of documents about Elvis' medical history including: Dr. Nick's medical records, hospitalization records, autopsy report, prescription records, and a confidential 161-page private investigation of Elvis' medical and drug history crafted by Mr. Neal and his law firm. I agreed to be a defense witness at Dr. Nick's Memphis, Tennessee, criminal trial in October 1981. The jury sided with me, and cleared Dr. Nick of criminal charges. They found that Dr. Nick was a fine physician who took care of Elvis for more than 10 years.
Although I accomplished my mission, the mystery of Elvis' myriad medical problems and early death has mystified me ever since. For starters, it appears that Elvis Presley was quite well until approximately the last 10 years of his life. In the last 3 years of his life, Elvis was so ill and disabled he required around-the-clock nursing care. After Dr. Nick's trial, I carefully stored all of my records knowing that someday science would pony-up enough information to permit an understanding of Elvis' medical and pain problems. I believe that day has come.
Progress in modern pain management finally has provided us with enough scientific knowledge about traumatic brain injury (TBI), autoimmune disease, and pain to unravel his medical history. After piecing the evidence together, it is quite clear to me that Elvis' major disabling medical problems stemmed from multiple head injuries that led to an autoimmune inflammatory disorder with subsequent central pain. His terminal event was cardiac arrhythmia, underpinned by drug abuse, genetic defects, and hastened along by an atrocious diet. This article will review how I have come up with this assessment.
Controversy Over Cause of Death
When Elvis Presley "unexpectedly" died on August 16, 1977, a great public controversy erupted. The pathologists—including the coroner of Shelby County, Tennessee—found that Elvis died of a heart attack. However, ABC's "20/20," anchored by Ted Koppel, believed Elvis had died of a drug overdose and stated there was a cover-up regarding his death. They questioned why criminal charges had not been filed against Dr. Nick by the Shelby County district attorney. The popularity and influence of this show had an impact. The Tennessee medical board investigated the matter and acquitted Dr. Nick of acting unethically, unprofessionally, or of gross malpractice,but they convicted him of improperly prescribing medications to 10 individual patients, including Elvis Presley and the singer Jerry Lee Lewis. Shortly thereafter, the district attorney general's office brought a criminal indictment against Dr. Nick alleging that he had willfully and feloniously prescribed controlled substances to the same 10 individuals for which the board found him guilty.
Elvis Presley's autopsy was the root cause of the public controversy. As many have read, Elvis was found dead, face down, on the bathroom floor by his live-in girlfriend, Ginger Alden. How long he had been dead is unknown, but attempts to revive him were unsuccessful. His autopsy was performed at Baptist Memorial Hospital in Memphis on the day he died. The head pathologist was Thomas McChesney, MD; the consultant to the case was Jerry T. Francisco, MD, county coroner of Shelby County. The final pathological diagnoses are listed in Table 1.
One major finding was the severity of Elvis Presley's heart and cardiovascular disease. Although he was under treatment for hypertension, Dr. Nick—as well as the other doctors who saw Elvis when he was hospitalized—were not aware that his heart was about double the normal size (520 g) and that he had significant atherosclerosis in his coronary vessels, aorta, and cerebral arteries.
It was also discovered that he had an antitrypsin deficiency, which is a rare genetic condition that causes emphysema. Microscopic examination of his lungs revealed "a rare interstitial lymphoid, inflammatory infiltrate, particularly beneath the epithelium of bronchi."4 The diagnoses listed in the table are verbatim from Elvis' autopsy report. Interestingly, the pathologists tested him for immune deficiencies, and found Elvis had hypogammaglobulinemia, a disorder of the body's immune system, as indicated by decreased levels of immunoglobulin A (IgA) and IgG. Rosette formation studies revealed decreased numbers of T cells and B cells (lymphocytes).
My retrospective review of his autopsy findings, when paired with his medical history of multi-organ abnormalities over a 10-year period, clearly reveals that Elvis was suffering from an autoimmune inflammatory disorder.5-13 To help support the presence of an autoimmune disease, I found that Dr. Nick's records revealed, prior to death, that Elvis had eosinophilia and elevated C-reactive protein (CRP).
Samples of Elvis' serum, urine, and tissues were taken at autopsy and sent to BioScience Laboratories in Van Nuys, California, which, at the time, was considered the most prestigious, accurate, and scientific toxicology laboratory in the United States. My autopsy copy lists 10 different drugs in his serum—including the metabolite of diazepam (Valium)—of which only two had been prescribed by Dr. Nick (Table 2). On October 17, 1977, Ronald Oremich, PhD, and Norman Weissman, PhD, of BioScience, opined:
"Diazepam, methaqualone, phenobarbital, ethchlorvynol, and ethinamate are below or within their respective ranges. Codeine was present at a level approximately 10 times those concentrations found therapeutically. In view of the polypharmacy aspects, this case must be looked at in terms of the cumulative pharmacological effect of the drugs identified by the report."
This report appeared to contradict the cardiac cause of death, so Baptist Memorial Hospital asked the noted toxicologist Irving Sunshine, PhD, professor of toxicology at Utah University, to review the toxicology findings put forth by BioScience. He put forth this written opinion on March 27, 1978: