August 9, 2020

Pop Science: Dr. Gregory House

Medical television enjoyed a surge of popularity in the early 2000s, and has developed a fanatic and loyal following, but not without criticism. Many practicing in medical fields have had a bone to pick with the level and manner of dramatization that make some of these television shows so riveting. 

Dr. House is played by famous actor Hugh Laurie.

In the pilot episode of House, a drama that follows Gregory House, the head of diagnostic medicine at a prestigious hospital, we’re introduced to 29-year-old Rebecca Adler who’s suffering from sudden on-set seizures and intermediate loss of cognitive and speech functions.

The first episode sets a precedent that is closely followed in all subsequent episodes: the patients whose files glean the attention of House suffer from such peculiar illnesses that make them medical anomalies in the extreme.

After seeking medical tests and treatments elsewhere for about a month, Rebecca winds up under the care of House and his team of young prodigies. A previous MRI revealed a legion in her brain. As a result, the patient was put on a radiation treatment in an effort to shrink the worrisome legion. In their own pursuit of answers, House orders that his own team begins by conducting a contrast MRI. 

Rebecca being one of the estimated .04-.3 percent of the population (according to radiopaedia.org) to have a serious allergy to gadolinium (the contrast agent), she has a serious anaphylactic reaction that results in a complete collapse of her airways. Therefore, the audience must assume that the original imaging lacked the contrast element that was involved in the MRI administered by House’s team.

Herein lies the first potential hiccup. Evrad.com provided a brief list of potential reasons a contrast MRI would be advantageous over an MRI that lacks a contrast agent. This list includes “enhancing the visibility of tumors, inflammation … etc.” 

Although I wasn’t able to gather definitive evidence to support this, I suspect that it would be highly unlikely that a patient would be submitted to a treatment as harsh as radiation therapy without enhanced imaging of the legion that the radiation treatment was designed to address. Therefore, I find it unlikely that Rebecca’s severe allergy to gadolinium was not discovered sooner.  

Nevertheless, ruling out the ability to perform a successful contrast MRI, House’s team brainstorms other ideas for how to treat the unknown cause of Rebecca’s life-threatening symptoms.

One method they employ is to give her high amounts of steroids. Her initial reaction to the treatment was promising, but devolved quickly. After the short-lived success, she developed total blindness in both eyes, which was soon followed by another seizure. 

As Rebecca’s experimental treatments continue to provide her with only frustration, House directs one member of his team to break into the patient’s apartment to unearth a potential explanation that Rebecca herself is either unwilling or unable to provide on her own. 

The search of the house uncovers nothing useful, except a package of sliced ham. House considers the implications of another rare connection between this package of lunch meat and the symptoms: neurocysticercosis.

Neurocysticercosis is defined by the CDC as “parasitic infection caused by larval cysts of the pork tapeworm.”

Although this is an infection that is present throughout the world, it is extremely rare in urban and suburban areas of the United States.

Granted, none of these ailments are entirely impossible or at all made up, but the combination of rare health problems is unlikely in the extreme, which just makes for good TV. 

One thing they did get right was the potential treatment for neurocysticercosis, for which they prescribed albendazole. She’s instructed to take two pills with food for the duration of her prescription, but Medicineplus.gov indicates that patients are traditionally instructed to take one pill twice a day, which is a minor discrepancy.

Alternatively, according to my research, another potential treatment are certain types of steroids. However, one the members of House’s inner circle asserted that steroids would ultimately make Rebecca’s condition worse. I’m no medical professional, but this seems like this statement could be a contradiction. 

All this aside, there are a few more glaring inaccuracies that can be identified in the show. In a quote from Dr. Nikki Stamp featured in the article Most Realistic Medical TV Shows on Surgimate.com, Stamp points out that a real doctor wouldn’t be the one to actually perform any of the tests that were conducted on Rebecca.

Considering that these tests were a focal point of the plot, in my opinion, that puts a notable ding in the accuracy score of House.

Overall, the unlikely but still feasible medical explanations are what gives House its appeal. Next week, we’ll examine how (if at all) the show has evolved and what other inconsistencies and accuracies appear in successive shows and episodes.

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