House - Episode 6 (Season 4): “Whatever It Takes”
Two patients this week, so twice the fun. Foreman and the team treat a drag racer with neurological symptoms while House is summoned by the CIA to examine a sick agent. It was a fun episode, with a couple of nice surprises at the end, but the medicine itself was fairly haphazard and shallow.
Spoilers below, so don’t say I didn’t warn you!
Casey Alfonso is a young female drag racer. Shortly after winning a race, she starts to experience blurred vision and distorted hearing. She has a seizure and collapses. House takes the case not because he finds it interesting medically, but because he is impressed by Casey’s car. About this time, an agent from the CIA arrives to talk with him. There is a sick agent in Virginia and they’d like him to take a look.
Foreman notes that Casey’s labs show dehydration and suspects heat stroke. Challenged by House, the team comes up with several more possible diagnoses including a hereditary brain disorder, transient ischemia (a “mini-stroke”), and paraneoplastic syndrome. House adds calcium deficiency and Cushing’s Disease(the body makes too much of the steroid hormone cortisol because of a tumor in the pituitary gland) to the list on his way out the door. He orders the team to get a new patient history, perform a full neurological exam, and check a brain MRI. The history reveals nothing new except that Casey’s father experienced some nausea before the race. Foreman adds food poisoning to the list of possible diagnoses. The exam appears to shows decreased lower extremity reflexes, but Foreman and Frat Guy quibble over this.
With the decreased reflexes, Miller-Fisher becomes a possibility. Casey suffers another seizure and shows vertical nystagmus, seeming to confirm Miller Fisher Syndrome. Foreman wants to start her on plasmapheresis (removal, filtering, and return of her plasma), but she refuses, not trusting his diagnosis. When he returns to talk to her a second time, she has developed a fever and delirium. The differential now includes multiple sclerosis, meningitis, amyloidosis, and lupus. A spinal tap shows no evidence of meningitis, but seems to suggest multiple sclerosis. The blood work is weakly positive for lupus. Foreman favors the multiple sclerosis diagnosis and starts Casey on interferon. Behind his back, Cuthroat Bitch and Plastic Surgeon start her on steroids for lupus. Her fever improves, but she now develops numbness and paralysis in her legs. Foreman now suspects Botulism but Frat Guy suspects Polio. Foreman starts her on treatment for botulism when Frat Guy returns with labs showing that Casey does indeed have Polio. There is no treatment for polio, but Frat Guy wants to start her on high dose Vitamin C, a therapy that allegedly showed promise in the ’60s. She improves on the treatment and regains feeling and use of her legs. When House returns, the team tells him about their diagnosis and successful treatment of polio. Foreman walks into the room, pointing out inconsistencies in her labs: Casey’s blood was negative for polio when she entered the hospital. He suspects she may have porphyria. House shoots down that idea, but quickly points out the Frat Guy faked the polio diagnosis — Casey never had it. He gave her thallium to mimic the symptoms, faked her labs, then stopped the thallium so it looked like the Vitamin C therapy worked. Frat Guy tries to defend himself to the team, but they all look away. House tells him that he needs to quit, then after he leaves, tells Foreman to call the police. He also reveals that Foreman was right all along: heat stroke.
At a military hospital, House and Dr. Curtis, an immunologist from the Mayo Clinic, have been consulted on a patient the CIA suspects was a target of assassination. They will give no details of where “John” has been or what he was doing, but ultimately Dr. Terzi, the doctor in charge, informs them that he’s spent the better part of a year in Bolivia. She also tells them that multiple toxin screens have been negative, as have tests for heavy metal poisoning. The patient himself cannot add much more — he is cachectic (sickly thin) with peeling skin on his face and deformed fingernails. Reading in his chart that John eats a lot of chestnuts, Dr. Curtis suggests Horse Chestnut poisoning, but House discounts that. House favors alcohol-induced pancreatitis, but Curtis thinks John is a victim of radiation poisoning. He starts him on iodine and antibiotics to treat the radiation poisoning. John’s vitals stabilize and Dr. Curtis feels triumphant until House informs him that he stopped the iodine, but left the antibiotics going and stopped giving the patient food to treat his pancreatitis. House is feeling pleased with himself until they notice that John is not responsive and nearly comatose.
House now suspects Waldenström Macroglobulinemia, a rare cancer, while Dr. Curtis suspects an infection. John is started on plasmapheresis and chemotherapy for the Waldenström. Shortly after starting the chemo, John’s hair begins falling out. This is too soon to be related to the chemotherapy, and suggests that Dr. Curtis was right in his suspicion of radiation poisoning. The patient is restarted on the iodine along with some Chinese herbs that have shown success in limited trials. No one believes that John has long to live. As House is sitting by his bedside, John opens up a little to him. Listening to his story, House realizes that John was not in Bolivia, but instead Brazil. He does not have radiation poisoning, but instead selenium poisoning from eating too many Brazil nuts (which are called “chestnuts” in Brazil and are high in selenium). He is started on chelation therapy to treat the selenium toxicity and is expected to recover. House offers Dr. Terzi a place on his staff and is surprised when she shows up later at the hospital to take him up on the offer.
The medicine was all over the place this week, broad but not very thorough. Diagnoses were suggested and then forgotten with abandon. Simple things were missed and an unusual continuity error showed up. First, for heat stroke, a temperature is extremely important — you can’t diagnose heat stroke without it. It would have decreased by the time House’s team took over, but any competent EMT or ER doctor would have checked it.
Casey’s symptoms didn’t really match any of the diagnoses well. For instance, Miller Fisher can cause nystagmus, but it is a horizontal nystagmus. Vertical nystagmus is unlikely given that paralysis of the vertical gaze is common in Miller Fisher. The time course of her symptoms don’t fit well with most of the suggestions either.
A “weak positive” ANA is not uncommon in healthy non-Lupus patients, but I wonder why her ESR (sed rate) was so high.
Chase needs to put his mask on before he scrubs his hands, or he’ll contaminate his hands by putting it on afterwards.
Continuity: An MRI was ordered, then referred to as a CT (an entirely different test), and then called an MRI again. This is an error I haven’t seen on House before.
As for House and the CIA, pancreatitis is an easy diagnosis with simple blood tests (lipase and amylase). Antibiotics are not a treatment for pancreatitis (but he’s right that withholding food is). It seems weird that House would object to Curtis placing John on antibiotics for a possible infection when he has just been on them for the suspected radiation poisoning and pancreatitis.
The ultimate solutions were fitting, though more should have been done to diagnose heat stroke. It seems that all of Casey’s symptoms subsequent to admission can be blamed on the thallium. John must have really liked Brazil Nuts, but they are the food highest in Selenium, and chronic selenium toxicity (”Alkali Disease”) fits his symptoms well.
The medical mysteries were mixed. The CIA agent was interesting, but Casey’s case — initially at least — was humdrum. Together, they earn a B. The medicine was just average — lots of ideas but no follow through, particularly on Casey, so gets just a C. The solutions were good — simple for Foreman’s patient, and obscure for House’s — and earn an A-. The soap opera was only so-so, as their wasn’t much House interaction with Foreman, Wilson, Cuddy, or the team, which are usually the highlights of the episode. It was nice to see him spar with Dr. Curtis, but he didn’t have the history the other characters do. Foreman clearly needs to get the team to respect him, and the bantering with Dr. Terzi was intriguing. Overall, the soap opera earns a C+.
The previous House review
A list of all prior House reviews
November 7th, 2007 at 12:08 am
Woo hoo! Waiting for this all night. Thanks!!! :)
November 7th, 2007 at 12:14 am
I don’t envy you adding up your points for scoring this week. With two popular diagnoses: Lupus and MS. :)
However, no Polio, Heat stroke, or Selenium Poisoning. Maybe my EEE will show up next week.
November 7th, 2007 at 12:19 am
Hey, Scott, thanks for writing these up.
November 7th, 2007 at 12:26 am
Scott: Always a pleasure.
Speaking of pleasure: I’d have no complaint of having to work the extra clinic hours having Dr. CIA on-board, but I do wonder how that’s going to effect the dynamics of things. Lose one doc for another - are we ever going to have a coherent team, or is this the season of discontinuity?
And on another note: anyone know if House will be affected by the writers’ strike?
November 7th, 2007 at 12:46 am
HOUSE is never long on reality, but even so, didn’t the team take the supposed diagnosis of polio rather lightly? Polio has been eradicated in the Americas. A new case, especially in someone who hasn’t traveled to one of the few places in the world where it is still endemic, would be a very big deal indeed. Shouldn’t they have called the CDC? I know the show plays fast and loose with protocol, but omitting even a mention of the public health implications of a potential polio outbreak in the United States seems like a missed opportunity for more drama, not to mention being totally out of touch with the real world.
Also, Frat Guy’s outrage that polio, being a disease of the poor in remote areas, is neglected is just factually wrong. Has he missed the whole vaccination campaign that has almost eradicated the disease? It’s not like nobody’s been paying attention while millions die or are disabled.
Next week on HOUSE: A case of smallpox is greeted with yawns and then cured with leeches. The team congratulates itself until it turns out the patient actually had a bad case of acne.
November 7th, 2007 at 12:59 am
I’m surprised you didn’t mention the phone call with Wilson at all. That was one of the better moments.
Dr. Supermodel is going to be t-r-o-u-b-l-e if she is actually hired. With all the sex jokes she took in this episode I really can’t imagine her tolerating that forever.
Lots of minor things that could be added besides what you mentioned, in particular a lot of CIA-related things, but nothing really show-stopping.
Cuddy didn’t know about a black helicopter showing up without notice on highest priority on her hospital’s only(?) helipad? Really? Perhaps she should check her own logs (unless the CIA had them scrubbed, but even then there would be tons of witnesses, and I’m sure that if they saw an honest-to-god black helicopter like that it would be the talk of the whole staff for days).
November 7th, 2007 at 1:01 am
@Jonathan: According to what I’ve heard, FOX has several episodes already in the can, at least through the end of the year. They should also have the big Super Bowl episode done as well, but if the strike goes on for more than six weeks then there will be an unplanned hiatus for the show until it is resolved.
November 7th, 2007 at 1:13 am
The CT/MRI thing bugged me as well.
I was also confused how the CIA’s test for all heavy metals didn’t turn up selenium?
Frat Guy’s speech seemed forced and Polio is probably the worst example of a poor person disease they could have picked. If it weren’t for political issues and 3rd world despots, not to mention anti-western rumors (In various islamistans the polio vaccine is supposedly being used to sterilize the population) Polio would have joined Smallpox as only living on as exotic lab samples.
November 7th, 2007 at 1:17 am
Same thing as Mongo - if they did testing for every form of heavy metal poisoning, Selenium would have been tested for.
November 7th, 2007 at 1:23 am
Official Comment
I always thought Selenium was a heavy metal, but several of my resources didn’t include it in a list of heavy metals (most listed it separately as a “mineral”), so I decided the give the writers the benefit of the doubt.
November 7th, 2007 at 1:28 am
Re: the writers’ strike, there are enough episodes of prime time shows written/filmed/produced in advance to last probably through 2007 and a bit into 2008. There’s probably not much chance the strike will last that long, but I wish them the best of luck.
It’s getting harder and harder each week to avoid looking up which actors got hired for the long haul and, by extension, who ends up on House’s team. It seems Dr. CIA is going to be one, unless she finds a reason to leave next week. I hate Cutthroat Bitch and so was expecting 13 to be the token female, but if Dr. CIA stays on, 13 and Cutthroat Bitch could both go. I’d peg Kumar as most likely of the males to stay, with second place going to Plastic Surgeon; Big Love just seems flat and uninteresting. I can’t imagine Cutthroat Bitch being a part of the final team; there’s no more room for her to claw her way up, and undercutting the other applicants is her only gimmick (and it’s already tired).
Of course, this is all just wild mass guessing on my part.
November 7th, 2007 at 1:35 am
I picked thallium poisoning specifically for this episode, but I actually picked it for the CIA guy (back when the capsule released by Fox had nothing more than “CIA guy”). Imagine my surprise when it showed up in the drag racer.
I only get 5 for the thallium?!?! :)
November 7th, 2007 at 1:43 am
Selenium is not a clear-cut metal. It has some metallic properties, but then, so does silicon, which is also not considered a metal. I’m not certain what implications this has for a distinction between selenium poisoning and the various heavy metal poisonings, but it is definitely reasonable to consider selenium a non-metal (or possibly a semi-metal).
November 7th, 2007 at 2:48 am
I’m really enjoying the new season so far, but definitely not for the medical accuracy… Maybe when we have the classic team of 3 again, it will settle down a bit. I think having too many doctors really messes up the diagnostic process. They seem to spend more time sniping one another than coming to a consensus. What scares me is how likely it is that this is rather accurate to real life…
I have to say, though, that when they were saying “We cured polio with vitamin C!” I was thinking “Oh man, the polite dissent guy is going to go spare!” Naturally they stopped short and revealed it as a ruse. Still, I was really liking Grumpy/Frat Guy, he was really projecting an aura of quiet competence this episode, the best of any of the new crew so far. Now I’m wondering if he took the job for his own political purposes…
November 7th, 2007 at 3:11 am
Like Brian, I was also expecting Thallium for the CIA agent (I saw The Young Poisoner’s Handbook several years ago and it left quite the impression on me!), and was a bit surprised that it turned out to be the diagnosis for the drag racer. I wonder just how many Brazil nuts CIA dude must have eaten.
Interesting to see what’ll happen with ex-CIA doctor on the team now.
Also, is Frat Guy the appropriate name for him? I don’t recall House ever calling him that and I think of him as Third World Doctor Guy. Where did he get the thallium, anyway? It’s not something you can just buy at the corner store…
November 7th, 2007 at 4:18 am
The definition of a heavy metal is not entirely clear cut. In chemistry it would be restricted to certain metals of high atomic mass, but in medicine it might be more broadly applied to any poisonous metal.
Selenium doesn’t really fit either case. In biology it is more commonly considered a micro nutrient than a poison. In chemistry it is usually grouped with the non-metals and does not have a particularly high atomic mass. Since selenium overdose is apparently quite unusual, I could understand it not being tested for automatically.
November 7th, 2007 at 6:45 am
When the CIA guy started being worse again and losing his hair, I thought that the other doctor was secretly exposing him to radiation to prove his diagnosis. So I was on the right track with that, just the wrong patient. :)
November 7th, 2007 at 8:28 am
I was surprised at the doom and gloom about the polio diagnosis - “there’s no cure - she’s going to die…” Plenty of people including my uncle survived polio. The NIH website says “Mortality: 1%-4% chance in children. 10% chance in adults with bulbar and respiratory involvement” http://www.ncbi.nlm.nih.gov/books/bv.fcgi?&rid=physmedrehab.table.8357
Also, as was already pointed out, polio is a category 1 reportable disease to be reported immediately even on strong suspicion. And if somebody had cured a proven polio case with vitamin c, that would be a huge deal with scholarly articles for years to come.
But in the writers’ defense, it’s not that unrealistic to see it pop up in “first-world” countries, because of travel and also immigration, especially when it comes to illegal immigrants who won’t be lining up to get immunized.
November 7th, 2007 at 8:29 am
I didn’t think much of this episode…everything was so overwrought…I thought the Mayo clinic doctor was the most sympathetic character, and he was just a throw-away straight-man for House, who once again shows no human characteristics besides lust. Even Sherlock Holmes occasionally showed some fondness for Dr. Watson…House has become emotionally one-dimensional.
If House keeps wandering around and offering one of his three fellowships to people on a whim, won’t that piss off the other ‘reality show’ applicants? On the good side, he didn’t seem so pleased that supermodel-doctor showed up to call his bluff. Maybe she’ll be a big thorn in his side in the coming episodes. Will he make her take her place among the other rubes? (Maybe she’s a CIA spy!)
As for the ‘medicine’, I’ve really stopped paying attention. Most of it makes no sense to me, and it’s completely secondary to the plot.
November 7th, 2007 at 10:06 am
Bolivia is actually the number one exporter of Brazil nuts (yes, more than Brazil), so the “twist” of the CIA agent being in a different country wasn’t even necessary.
Actually, did you know that the country of Brazil was named after the nut, not the other way around?
I know nothing of medicine or science, so this will be my sole contribution to this particular post.
November 7th, 2007 at 10:08 am
Selenium is technically a non-metal, located to the right of the metalloid line on the periodic table, but could fall under one of the numerous definitions of heavy metals.
November 7th, 2007 at 10:08 am
I knew I recognized Casey’s father, he played “Biff” in the “Back to the Future” movies. I also am much pleased that lupus saved me from being shut out.
November 7th, 2007 at 10:09 am
I understand the need for some to see the actor’s faces. That’s why Spiderman can’t keep his mask on, for example. But I have to ask if it is now uncommon for a surgeon to have his mask placed on his face for him instead of fitting his own mask?
November 7th, 2007 at 10:27 am
After last week, this weeks episode was SUCH a twist, and so great! It was good to see Foreman with a challenge OTHER than House, and having seven of them was a great touch. And House’s banter was Dr. CIA was fabulous and hilarious…
Speaking of, I suspect she’ll be a permanent installment! I was surprised to see Michael Michele in the episode, but considering she’s “hired,” I think there’s a distinct possibility she’ll stick around. Thirteen may have a run for her money!
Frat Boy floored me with the poisoning thing. I never would have guess he had the balls for that. Wow. I never counted on him staying, but I never counted on him LEAVING like that, either.
And Plastic Guy obviously doesn’t watch his own show. It’s never lupus!
November 7th, 2007 at 10:34 am
Scott (feels weird calling you that considering you should really be addressed as Dr. (Your Surname)), I love your medical reviews and have been reading here religiously for quite a while now. While the actual medicine in this show may have been mostly accurate (I missed the continuity error) can I present the theory that House hasn’t just jumped the shark it has actually picked it out of the water, dressed it in sequins and spandex and is currently touring it in Des Moines as part of its highly successful Holiday on Ice review.
As I so drastically point out in my sarcastic post over at the tv-dot-com House forums (shameless plug) we are one step away from 24 meets Heroes here with almost any semblance of medical drama having left the building sometime early in season 3.
House’s cases have always been off-the-wall but at least the crux of the show was based around a sherlock holmesian detective story playing on every human beings natural hypochondria nervosa. As a side dish we were served with truly gritty drama about a man having to deal with a gigantic hole in his leg and his soul and battling personal pain all the way to the bottom of his vicodin bottle.
All of this is gone thanks to the kind executives over at Fox Kids who were called in for a consult to help the show “lighten up”.
Being a true die-hard fan who has Seasons One and Two on a loop whenever House is off the air I am sad to say I am abandoning hope that we will ever get back to the halcyon days of ascerbic wit, grit and just enough smart 3D generated imagery to make the goosebumps rise on the linings of my ventricles.
Rant over, very sorry for the off-topic, please keep up the good work, should I give up I will still come back to read here and see if things are getting back to normal
November 7th, 2007 at 10:38 am
This question is from out in left field but I do wonder, when I watch House, how helpful medical diagnostic software is in practice. Do doctors enter in a series of symptoms into a form and see a list of known ailments that fit?
November 7th, 2007 at 10:51 am
ugh. will michael michele end up ruining two perfectly good television programs? “homicide - life on the street” — she was that show’s shark, and her acting hasnt improved much over the last decade. there is a reason she was out of work.
the censors must have been getting coffee during house’s explicit sexual harrassment comments. that was some of the most unapologetically explicit dialog i’ve heard during prime time. mostly because of the context, but, still.
foreman is turning into a one-dimensional character, i think. that stinks.
November 7th, 2007 at 11:35 am
Very good review. Thanks for explaining what plasmaphosphoresis is. I give the show an A.
Was that Vanessa Williams as the new attractive medical doctor?
The humour was - as it often is - laugh out loud brilliant.
What a great flirt Gregory House is.
November 7th, 2007 at 11:35 am
I still can’t believe Dr. Terzi just showed up at the end of the episode. Is it really that easy to leave the CIA? I also wondered how she could give notice and show up for work on Monday. It’s funny, I have no trouble suspending disbelief for the medical issues but the logistics of the quitting CIA doctor bugs me.
November 7th, 2007 at 11:36 am
Daniel, that was Michael Michele. She used to play a doctor on ER.
November 7th, 2007 at 11:38 am
Kaelstorm, I haven’t read your other comments, but I agree with what you have said here. House has turned into a character who’s self-consciously rude. I feel the character almost preening with pleasure at being randomly nasty to, for example, the Dr. Curtis character.
There used to be a context and a reason for his ungoverned rudeness or even harshness, and the people around him cared about it and had reasons for putting up with it. Now, he’s a smug loose cannon whose presentation screams, “I can be rude because I’m oh so brilliant!”
They couldn’t go on forever working solely on the theme of his injury and pain, but there has to be a better thematic development than this.
November 7th, 2007 at 11:43 am
By coincidence, I flipped through MASH before House came on, and it struck me that House has a lot in common with Alan Alda’s character, Pierce: both are the best at what they do, both are irreverent and buck the system, both are comedic, and both are womanizers. Of course, there are differences, House, for example, is not nearly as compassionate, his sense of humor is generally offensive, and he appears to be less successful with the ladies than Pierce was (though not for lack of trying). Maybe its just coincidence; maybe they’re both just products of Hollywood’s character “template” for leading doctors; or maybe, in some writer’s mind, House IS Pierce twenty-some years older and a lot more cynical.
November 7th, 2007 at 11:59 am
Sigh….still no clinic patient. 6 episodes already, no clinic funnies :(
Thought this episode was pretty boring aside from the once in a while funny lines, but the storyline was quite boring to watch.
November 7th, 2007 at 12:21 pm
I agree with the above comments about the change in House’s character. I thought the dialogue in this episode was dreadful. As Kaelstrom says, what we liked about House is the way he voices what we’re all thinking but unwilling to say. And the curious way that something about his pain allows him to do that. But now they’ve just made him into a character saying not-that-funny one-liners in a totally unrealistic way that doesn’t really speak the “truth” but is just acerbic for shock value. And maybe it’s just me, but I hate the way they have everyone drooling over House. I’m sorry–sexual harassment like that just isn’t funny or sexy or whatever, and it’s irritating to see such a beautiful woman take it. Why doesn’t somebody tell House off? Why do the writers present him like he’s so perfect? Don’t they know that audiences like imperfect characters much more than perfect ones?
On another note, Scott or whoever else: I’m curious–even if the disease was polio, do polio symptoms progress that quickly? Or is that one of the things (like the doctors performing their own tests) that you’ve just given up pointing out?
November 7th, 2007 at 1:39 pm
It seems that the writers/producers on House don’t seem to think much about Doctors without Borders. They are 2/2 for being semi-crazed zealots, first there was Ron Livingston - willing to die from Malaria and then Grumpy doc poisons a patient to get people to test the whole Vitamin C beats Polio?
Plus it seems like Grumpy doc (who tried to quit once already) went through a whole hell of a lot of trouble to do what he did.
And I was thinking maybe Chase was expecting Cameron to put his mask on for him, until he pissed her off. It was nice to see old team actually get some face time for a change, though they still seem rather purposeless so far this season.
November 7th, 2007 at 1:49 pm
I too wondered how easy it is for someone to just up and quit their CIA job.
Anybody else notice House didn’t pop his Vicodin this episode? Did I just miss it, or was he so intrigued at being at CIA HQ that he focused on that instead of his pain? Would the CIA have confiscated his pills?
Was he being deliberately rude/provocative to Dr. CIA, the way he had to Dr. Thirteen when he first talked to her, as a test? I too thought he looked a little taken aback when she showed up at PPTH to accept the job. His expression when for a few moments he thought she wanted to “get physical” with him was great.
Will the remaining job candidates resent Dr. CIA being brought in at the last minute as more competition? Is she in the competition, or is the job a “done deal”? If she’s competing, and loses out, I would think she’d regret her decision to leave the CIA job.
I thought Cameron looked more mature in this episode. Jennifer Morrison’s decision to go back to her natural blonde hair color was a good choice - she said in an interview that she had colored it brown to be taken more seriously, but I think now she can look professional with it being blonde.
Thanks, Scott, for your great reviews as always.
November 7th, 2007 at 2:09 pm
mike: It was a question of language, not of nut-origin. They’re called one things in Portugese (spoken in Brazil) and another in Spanish (spoken in Bolivia).
November 7th, 2007 at 2:22 pm
First of all Scott, thank you so much for these reviews. I really enjoy reading them. Like many others, I am not happy with what is being done to the House characters and show. In fact, this season I am finding that the show has now become a parody of seasons 1 and 2 of the series. It seems to me that the show was originally a drama with comic moments and now has become a comedy with some dramatic moments. House, rather than being a character driven by physical pain and mental angst has become a juvenile joke — simply pushing the boundaries of rudeness. And don’t get me started on what they have done to Cameron’s character. Sometimes the series feels as if new writers have come in and have not absorbed or been briefed on ‘the Bible’ of all that had gone on before. I love Hugh Laurie, he is a brilliant actor, but I’m sure not enjoying ‘House lite’ the way I enjoyed the original House.
November 7th, 2007 at 3:00 pm
I agree with the growing trend of opinion above. The show is losing what made it great. Can somebody share more about the idea (see #25 Kaelstorm above) that consultants were brought in to alter the content of the show?
November 7th, 2007 at 3:06 pm
“Actually, did you know that the country of Brazil was named after the nut, not the other way around?”
mike:
no, it didn’t.
the country was named after brazilwood(Caesalpinia echinata), not after brazil nut(Bertholletia excelsa)
November 7th, 2007 at 3:26 pm
Mike : The country (Brazil) was named after a tree known as “pau-brasil” that means “red wood” and not “castanha-do-pará” or “brazilian nuts”.
November 7th, 2007 at 3:37 pm
I’m still holding out for the episode where the teenager is sick because they tried to get high from massive nutmeg ingestion.
November 7th, 2007 at 3:37 pm
Just wanted to comment on some HUGE inaccuracies from last nights show and that I have also seen in past episodes. I have MS and first thing to note is that it is not diagnosed that easily, nor does the characters symptoms fit the disease. Secondly interferons and steriods are both used to treat MS. Interferons do not cure MS or relieve any symptoms. Interferons act to slow the progression of the disease and hopefully limit the amount of relapses that occur. Steroids however are used to treat and relieve the symptoms (relapses) of MS. If you have MS you can and inevitable will at some point(s), take both medications at the same time and will not have the “side effects” that the show portrayed. Most likely you won’t have any side effects at all. Maybe hunger, a little weight gain and insomnia.
I love this show but I have to say it’s very irritating when you see something misportrayed as badly as this. Especially if you have been newly diagnosed and your main source of information is what you’ve seen or heard. Please! If you’re going to have a show such as this and portray actual diseases and such, do the homework and get your facts straigt. A short stint on WebMd gives you more accurate information than what I’ve seen.
November 7th, 2007 at 4:23 pm
To kimberly42 - House hasn’t been using his Vicodin much at all this season (because the writers want to tame the show?) so I was actually surprised to see him with it on the plane.
Disappointing episode in a string of disappointing episodes. House seems to have lost its edge for good.
November 7th, 2007 at 4:36 pm
Adding out to my fellow countrymen who already have spoken, Brazil was named after a tree called Brazilwood (”Pau-brasil” in portuguese - Caesalpinia echinata). Other than that, our carnival does not last forty days, and Brazil Nut can be largely found in Bolivia. The solution to this medical mistery was pretty wea… =/
November 7th, 2007 at 4:36 pm
wea=weak
November 7th, 2007 at 5:31 pm
RHill:
Good point about MS. I think it took more than a year for the doctors to diagnose my sister with MS. They went from one diagnosis to another, dwelled on transverse myelitis for a while before definitively diagnosing MS.
November 7th, 2007 at 5:39 pm
“If you have MS you can and inevitable will at some point(s), take both medications at the same time and will not have the “side effects” that the show portrayed. Most likely you won’t have any side effects at all.”
Ah, yeah. That’s because the patient didn’t actually have MS. Thus the side-effects you saw were not inaccurate.
November 7th, 2007 at 5:54 pm
Just want to add my voice to the chorus of folks complaining about this season. From House shocking himself to “death,” to having the newkids dig up a coffin, my willing-suspension-of-disbelief dial is being pushed into the red zone. And, yes, it seems the writers are just trying to jam House’s mouth with as many acid on-liners as they can. Some of the old shows, which were plenty funny, left me emotionally moved by the time the credits rolled. This season it’s like some sort of sloppy, empty “Everybody Hates Gregory” hour-long sitcom. With occasional mentions of Lupus and cheesecake shots of Lisa Edelstein walking away in an undersized skirt.
November 7th, 2007 at 6:27 pm
Scott, thanks for your efforts on this site to clarify the medicals, it’s getting to be as entertaining as the show. I agree with much that has been said about the change in the charecter of House and although I’m a great Hugh Laurie fan, (the roots of Houses acidic character I’m sure can be found in Blackadder III with Laurie and Rowan Atkinson), the sexual harrassment really step over the mark. Ummm … not good.
But my question is far more trivial. Cutthroat Bitch .. when she phoned House ….. first sighting of an iPhone in prime time TV drama?? Can anyone who recorded it confirm the sighting?
Does Steve Jobs know who’s touting his product? I mean, what would she do to that poor fat PC Guy if she ever got hold of his file???
Keep up the great work!
November 7th, 2007 at 11:11 pm
On the one hand, I can see the plotline justifications for this:
Cool off the craziness of the competition: it’s still a hospital and the point is the treat people.
Make Foreman not look like a punching bag less capable version of House.
On the other hand, the fact that those justifications are so transparent is not a great sign for the direction of the show.
Speaking of the writing, anyone know how much of the season they can produce at this point?
November 7th, 2007 at 11:59 pm
First not enough Wilson or House/Wilson although I enjoyed their phone exchange and House stealing Wilson’s lunch once again. The fact that it was in tupperware is interesting.
I liked the scenes between House and CIA doctor, especially the last one because it showed just how gullible House is. First, you don’t just leave the CIA. She has to be debriefed and I’m sure that would take more than 48 hours. Second, the CIA would have to agree to release her, which it seems to me would also take awhile (it’s a federal agency). Third, there is no way she’s going to make more as a House fellow than she does at the CIA, which I’m sure she already knows. MM is in one more episode - Ugly (407). I think she’s still working for the CIA and may be coming to PTTH to recruit one of House’s fellows in waiting.
Did anyone notice that House told CIA doc he lived just a couple of miles from PPTH, while in Meaning he said he ran the 8 miles between his place and PTTH.
November 8th, 2007 at 9:19 am
I really hate the diagnosis for MS they’ve used in this and I think one or two other episodes. “Start him/her on interferon. If he/she gets better, that’s what it is.”
My mom as MS and you don’t magically get better or even start to get better with a few injections of interferon. You have to take a shot every other day for the rest of your life. You will get flu like symptoms and the point of the drug is to keep you from getting worse, it doesn’t make you better. My mom hasn’t gotten any better and we can only guess that without the drug, she’d be much worse now, but there’s no way to really know. We can’t clone her and have a control mom and a testing mom.
November 8th, 2007 at 9:21 am
Debbie, please, no SPOILERS.
November 8th, 2007 at 11:16 am
> Can somebody share more about the idea (see #25 Kaelstorm above) that consultants were brought in to alter the content of the show?
It’s difficult for me to answer this accurately as I only worked in TV for about 6 months as a voice-over artist and it was European TV which has different rules.
Here goes: I used to write my own text and write text for the anchorman of the youth show I worked at. When it came time to record my voice overs I had a production assistant monitoring me in the voice booth. She would “tune” my dialog in about 5 minutes before I recorded (while I would spend upwards of 8 hours writing it) and then make further adjustments as I spoke. Her main focus was on clear vocalization but also on what she thought was “market-acceptable”. As our budget was low that was it.
The presenters and especially the anchorman was constantly monitored during filming by 2 producers and a network representative. They worked off flash focus testing = surveys of 10 - 50 “idealized viewers” and would dumb down almost everything. Cutting-edge pop-culture references were nuked out and we were forced to add explanations for even the most basic things.
The reason the network could even do that is that most of our budget came from the network (RTL in Germany) and the network people are only interested in one thing. Getting as broad an audience as possible to maximize ad revenues. That meant always working to the absolute lowest common denominator aka “the super redneck”. They assumed that a large part of their audience had an IQ between 70 and 90 and no high school level education.
In the early Seasons of House the original Exec. Prods. would have had almost total control over the direction of the show and the production company would have put up a large part of the budget so the artistic control would have been firmly centered with the core team of writers.
As the network puts up more and more cash it demands more and more control over the writing. This will often mean sending in network people for the writing and production meetings, usually with very strong veto rights. This works well for the production company as they don’t have the budget to cover the increased expense of higher salaries for actors etc. and more costs for extra set-building and props (think the CIA helicopter, probably a 5000 - 10000 dollar expense).
It happens more and more to shows as they become popular and budgets explode. Some examples: ER, CSI, 24. Funnily enough many shows that have run for 4 - 10 seasons and kept their quality only do so because they escape this vicious circle with anemically small budgets. The Stargate franchise, BSG and a lot of Joss Whedons stuff are a good example of low cost = creative freedom.
If you want a more in-depth look at some of the processes look for Ron Moore’s Battlestar Galactica podcasts, they offer some of the deepest insights into the subject matter. Also read up on Carlton Cuse’s battle to keep Lost moving in his direction. It cost him a good time-slot initially and now it has cost him the chance to make full seasons to close out the show. Again, apologies for the long, non-medical post.
November 8th, 2007 at 11:57 am
Kaelstorm,
Thanks for that. VERY interesting for those of us not versed in the business.
November 8th, 2007 at 12:37 pm
I’m Brazilian, and I can assure that everyone here eats lots of Castanhas-do-Pará (No one here know “Brazilian Nuts”, the name of the nuts is the name of the state where is originally from - Pará). I have naver seen some “poison case” like that.
By the way, the name of my country - “Brasil” was given by the portuguese (unfortunately) who have colonized here at first, and it derives from “pau-brasil” (some kind of tree). This name has been officially declared in 1824. At least the show hasn’t mistaken Buenos Aires as our political capital.
November 8th, 2007 at 3:11 pm
Kaelstrom, thanks. The idea makes sense. I guess I was asking more if we know in particular that consultants are in fact the reason for the changes in content/tone/roster of this season of House?
November 8th, 2007 at 4:07 pm
I liked CIA angle: nobody believed House’s consulting for them when he was telling the truth, and Cuddy believed only when House has lied. House deciding to take 8 hours of clinic duty only to put Wilson on 16 hours was nice touch too.
And I think the episode has showed a new part of Foreman - losing temper, jumping on diagnoses, having authority problem.
The CIA patient - I was sure it will be about Litvinenko case (polon-210 poisoning).
The best House moment - when in no time, given basic facts, he’s debunking Frat Guy’s trick.
November 8th, 2007 at 5:03 pm
“But my question is far more trivial. Cutthroat Bitch .. when she phoned House ….. first sighting of an iPhone in prime time TV drama?? Can anyone who recorded it confirm the sighting?”
Andy, this isn’t the first time for an iPhone appearance. NBC’s Journeyman has the main character with an iPhone, and he frequently pulls it out to look up stuff on a Google parody called “Finder-Spyder.”
Just thought I’d mention it since you asked.
Anyways, first post here, and I’d like to say that these House episodes have been pretty weak in terms of medicine, and don’t seem to have that same bite as they first did in seasons 1 and 2. Sucks for me since I missed the boat on the first two and picked up on the show late in the third season (my first episode was with the suicidal karate girl, which ended up having horrible medicine and an even more ridiculous solution; not a great way to start off, eh?).
November 8th, 2007 at 5:53 pm
I suck. :)
November 8th, 2007 at 6:24 pm
Can someone really eat enough Brazil nuts to get that sick? If so, roughly how many pounds would he need to eat (within how short a time)?
Back when polio was common, a stiff neck was often an early symptom. When a child got sick, a parent would say, “Touch your chin to your chest.” I don’t recall a similar test for the race car driver. (Also, as someone said, polio is a reportable disease.)
[non-medical] When the first CIA guy showed his CIA ID, did anyone besides me expect House to quip about the Culinary Institute of America, and Wilson’s lunch?
November 8th, 2007 at 7:49 pm
My favorite part of the entire episode HAS to be the way he pronounced “Castanhas Do Para” XD (I’m Brazilian, BTW.)
November 8th, 2007 at 9:06 pm
Matt, until Fox calls me in to consult I can’t say. Not even the executive producers would probably ever publicly confirm that ;) So I take my best guess and ask “Is there any other likely reason?”
November 9th, 2007 at 12:03 am
Best line, in my opinion:
House: “I know how to kill a man with my thumb!”
Cuddy: “Who doesn’t?”
The thing that bothered me most about this episode was Dr. Hot-CIA suddenly deciding to quit her job to go work for someone who clearly just wanted to sexually harass her.
November 9th, 2007 at 7:56 am
The funny thing is Brasil nuts are also high in Radium.
http://www.washingtonpost.com/ac2/wp-dyn/A37112-2003Dec28?language=printer
November 9th, 2007 at 4:33 pm
Why was there any debate at all about the CIA agent’s radiation poisoning? Wouldn’t radiation have been diagnosed merely by pointing a Geiger counter at him? If I recall correctly, the Russian emigre who was poisoned in London left radiation signs wherever he touched objects, such as the table where he had lunch, his office, his vehicle, his apartment, etc.
November 9th, 2007 at 4:49 pm
Official Comment
SteveE,
It depends how long ago the poisoning was and what radioactive element was used. The later stages of radioactive poisoning can occur long after the exposure.
November 9th, 2007 at 7:56 pm
I never see, in my entire life, someone poisoned by castanhas do pará. I’m eat lots of there, in chrismas :c)
“literaly: Castanhas-do-pará” has get in wikipedia??? hahaha
November 9th, 2007 at 7:59 pm
The poisoner was leaving radiation behind him. It took some time before they diagnosed Litvinenko. For a long time doctors were thinking about Thalium poisoning. I believe only after his dead they found out about Polonium. The use of Polonium as a poison has never been documented before, and this was probably the first time a person has been tested for the presence of 210Po in his or her body.
November 9th, 2007 at 8:55 pm
Regarding House dialogue this season:
The complex plots have necessarily limited all interactions. Hence we get unsweetened condensed House. Not the non-fat House that we’ve gotten used to.
Eventually, I suppose they’ll slow down the break-neck pace the individual episodes have been on….
Also, regarding the disappearance of the old young guns–it’s possible that they wanted less involvement in what is an incredibly grueling shooting schedule. Heck, Hugh Laurie may have wanted a break too.
November 9th, 2007 at 10:18 pm
***SPOILER WARNING***
In fall 2007, Penn joined the cast of the FOX medical drama House as one of Dr. House’s new fellowship applicants.[5] According to E!, Penn has signed on as a regular on the show along with Olivia Wilde and Peter Jacobson.
I really hope supermodel chick stays on as a regular. but according to the above…Indian guy (Kal Penn), Plastic Surgeon Guy, and Superhot Red Head “have signed on as regulars” leading me to to believe they’ll be the ones to stay. Hrmm…2 men/ 2 woman team??
November 10th, 2007 at 4:42 pm
I appreciated the reverse on the polio thing at the end - for once it’s not some ridiculously rare condition no one could have predicted.
November 10th, 2007 at 8:37 pm
Great work!
November 11th, 2007 at 12:26 pm
And of course……..it’s NEVER Lupus!
November 13th, 2007 at 12:10 pm
Im just waiting for an episode where it is actually Lupus!
That will completely throw everyone off!
November 14th, 2007 at 9:36 am
Regarding the possibility of radiation poisoning:
It would be extremely difficult to immediately identify that radiation poisoning had occured by purely nuclear measurements. A standard counter would not register alpha emitters (Po-210) or even pure beta emitters (Strontium-90). Only a poison that had significant gamma emission could be detected and those would make poor poisons. Alpha particles are like cluster bombing in a local cell. Beta particles are akin to a plane crash and gammas are more like a drunk driving a big truck at night.
Because of the unique seeking nature of some of these elements you could pick up radioactivity in the sweat and blood work immediately if it was Po-210 and most of the other elements that would make acceptable poisons. Sr-90 has a biological half life of less than a day if I recall and so without question a stool or urine sample could be proven to not have emissions. However, alpha particles travel thousandths of millimeters before stopping (they’re big) and the Sr-90 wouldn’t come out strongly in sweat if I recall correctly. In all cases the samples would have to be given a more robust measurement but it could be done immediately (and in any lab that houses nuclear material).
This idea should have been immediately discounted. The reason for the failure to identify Litvienko’s case was that no one expected to be poisoned with radiation. The Soviets (and UK, US, etc) had developed significantly better and faster poisons and so in Litvienko’s case was a Russian attack there is no reason to do that. Radiation poisoning is a slow death.
Additonally: There is no reason to believe Dr. CIA couldn’t just stop working. While she likely has some clearance it’s obvious that she even if she has Need-to-Know that the Agency will lie to her. This is pretty indicative that she does not have enough information that CIA would require her to stick around for a while.
November 16th, 2007 at 6:00 am
The timing on the Thalliumpoisening was a bit off. As far as I know, it takes a few days till the symptoms show. And with high doses the hair would fall off (something that wouldnt happen with polio, i suppose). It might work if he immeidatly poisened her when she was emitted, but that wouldnt make any sense - its implied that he started the poisening when Foreman threw him out of the case
November 16th, 2007 at 6:04 am
Oh, and Selenium is a Non-Metal, so it wouldnt be in the chart of heavy metals…
(Yes, Ive studied chemistry)
November 16th, 2007 at 5:02 pm
Thank you RHill and Sumit, I’m very glad to see someone else annoyed at the complete lack of understanding this show is afflited by, regarding how interferons work for MS. I noticed the same thing in episode 24 (season 3) where Foreman suggested the exact same thing. Noone replied when I posted back then, but the post can be seen here http://politedissent.com/archives/1665
November 19th, 2007 at 12:17 am
I think the writers were sort of hinting at dioxin poisoning, which allegedly happened to Yushchenko. It caused pockmarks, and was originally thought by some to be acute pancreatitis.
November 19th, 2007 at 9:54 am
Mike:’Actually, did you know that the country of Brazil was named after the nut, not the other way around?’
Mike, this is plainly wrong.
Brazil is called so because of a red wood the portuguese found in the new discovered country (1500 AD). It is called Pau-Brasil (literally Ember wood), because of its strong red color that resembles the red color of the red-hot coal or ember (brasa in portuguese). It was one of the main products the portuguese took from Brasil and used for obtaining a red pigment or for decorative uses.
I just saw other brazilians also took the offense and rectified the trivia. Just added my bit of trivia to it.
December 29th, 2007 at 1:26 pm
Another Brazilian rolling eyes here. Seriously, 40 days of carnival? Carnival is held 40 days before Easter, but it only lasts a few days (maybe a week in some regions).
I’m also curious about how many castanhas-do-Para’ this guy had to eat to get that sick. O_o
February 28th, 2008 at 5:57 pm
As a Brazilian who’s nuts for nuts, I can say: NO WAY IN HECK would someone eat enough nuts to be poisoned. Remember, boys and girls, those little gems are really, really greasy. I can easily do 30 or 40 nuts, but after 15 I need to be VERY close to an empty bathroom, if you know what I mean.
Nature’s Xenical, as I like to call them.
April 11th, 2008 at 6:40 am
I’m surprised no one caught the Jeeves and Wooster reference. House tells Dr. Terzi that he was contacting his valet; in the Jeeves and Wooster series, Hugh Laurie is Bertie Wooster, a gentleman-about-town, and Stephen Fry plays Jeeves, his smart, articulate valet.
April 17th, 2008 at 9:05 pm
@ TheNukeE: I’ve got to be a nerd here and correct some of the stuff you said: All nuclear reaction (either alpha, beta or fision-reactions) also emit gamma-radiation. Whereas alpha- or beta-particles might not leave the body, gamma-radiation will do so and could therefore be detected outside the body. I’m also pretty sure that you could do this with a modern germanium-detectors (most sensitive detectors available). With this kind of detector you could even find out exactly which kind of isotope it is, since you would get a gamma-spectrum. This only works, of course, only if the radioactive agent is still in the body in a high enough concentration. With Sr90, I agree, that would not work.
April 25th, 2008 at 3:33 am
Of course there he would pronounce it in the correct English way, val’ett rather than val’ay.
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