House – Episode 13 (Season 2): “Skin Deep”
A Monday episode of House brings us a young model and an interesting diagnosis. By the way, this medical review contains a few spoilers, so don’t say I didn’t warn you…
Alex, a 15 year old super-model, complains of feeling nauseous and is profusely sweating. Her father gives her a Valium and a drink of his champagne to calm her down. She heads on down the catwalk but stumbles. She experiences double vision and punches another model who tries to help. Finally, she collapses on the runway.
Alex is admitted to the hospital for evaluation of her collapse (though she describes it as more of a cataplectic attack). She admits to feeling sweaty and nauseous for a while. A history also reveals that she has yet to start menstruating. Lab tests are drawn and all are normal except for drug screen which comes back positive for “Valium” and “heroin.” The Valium can be explained by the pill her father gave her, but the heroin suggests to the team that she is suffering heroin withdrawal (I should point out that these tests are not that specific, so would have come up “benzodiazepine positive” and “opiate positive”, without identifying the specific drugs. For all we know, Alex could have been taking Xanax on her own in addition to the Valium her father gave her…)
The differential diagnosis includes heroin withdrawal, juvenile multiple sclerosis, and Parkinson’s syndrome. House suspects most of her symptoms are due to the withdrawal, but he wants her completely free from heroin so he can ensure that just the withdrawal was causing her problems. He decides to pursue a rapid detox. Basically, Alex is placed in a medically-induced coma and fed naltrexone. Naltrexone blocks the opioid receptors and sends the patient into a complete and immediate withdrawal. It is a risky procedure, but a real one and there are centers that specialize in it.
Alex suffers some sort of cardiac arrest during the coma. They refer to it several times as a “heart attack,” but it seemed more a rhythm problem than an actual heart attack (and if it was a heart attack, they did absolutely nothing to treat it or to prevent the next one). After she comes out of the coma, she has a problem with her short term memory, repeating the same questions over and over. The team is concerned that Alex may have suffered brain damage due to oxygen deprivation from her “heart attack.” House isn’t convinced. He feels she wasn’t without oxygen long enough to cause a problem; he suspects Post-Traumatic Stress Disorder (PTSD) because he thinks her father sexually abuses her. He orders an MRI and an LP (lumbar puncture) and he goes to have a chat with her father. The team tries to get an MRI, but Alex develops an uncontrollable muscle twitch so they can’t proceed with the test. They are able to perform a lumbar puncture which shows increased protein in her cerebrospinal fluid.
The doctors are now concerned about that Alex may have any one of a number of brain diseases including viral encephalitis, CMV (cytomegalovirus), and CJD (Creutzfeldt-Jakob Disease). House wants to proceed straight to a brain biopsy (instead of getting a CT scan, or sedating her for an MRI). The brain biopsy shows no white matter disease, so the team now starts to focus on the grey matter. Foreman lists off a whole string of rare neurological diseases and House suggests that it may be paraneoplastic syndrome. Paraneoplastic Syndrome is a rare disease that occurs when a person has cancer and their body attempts to make antibodies against the tumor. These antibodies misfire, and affect the person instead, causing a whole range or symptoms including weakness, memory loss, and problems with coordination.
Alex is given IV immunoglobulin and she stops twitching. This supports the diagnosis of paraneoplastic disease because the immune globulin is thought to block the antibodies causing the problems. She is now subjected to test after test trying to find the tumor House knows must be there. Small ovaries seen on a pelvic ultrasound, but every other test is normal.
House is still convinced there is cancer somewhere. The rest of the team are still thinking it may be PTSD since her father did admit that he had slept with her. House has a burst of insight and gets an MRI of Alex’s pelvic area. He discovers that Alex has “male pseudohermaphrodism” and has testes instead of ovaries. A tumor on one of these testes is what has given Alex her paraneoplastic syndrome and explains away all her symptoms. The tumor can be removed surgically, but what can be done for Alex who thought she was a she but may be a he (depending on how strictly you choose to define the terms). I think the psych consult was a good idea.
The mystery was interesting and the final solution clever. I have only one major complaint about the final diagnosis (or rather, how they missed it), which I’ll get into a little later. The rest of the medicine was not perfect, but at least passable. Well, except for that “heart attack” thing.
The soap opera this week centered on two things: House’s increasing pain in his leg, and the sexual abuse of Alex by her father. As for House, is his pain physical in nature or psychological. He believes it is physical, but Wilson believes — and Cuddy proves — that it is to a large part psychological.
Alex father admits to having had sexual relations with Alex once. When House does not report this immediately to the authorities (which he is legally obligated to do in every state, even New Jersey), Cameron does. When both Alex and her father deny it every happened, there is nothing the social worker can do. Cameron confronts Alex, but Alex surprises her by telling Cameron that she seduced her own father, as well as every other male authority figure in her life, so she could get what she wanted. What is it with this show’s writers and overly manipulative women?
Back to the medical: Male pseudohermaphrodism is an older term that has fallen out of general use because it is a non-specific term, and can describe several different situations. The condition House is describing is Androgen Insensitivity Syndrome, also known as Testicular Feminization Syndrome. In this condition, a male fetus is resistant to the effects of testosterone. It develops testes but proceeds little further in male sexual development. The testes will not descend, and normal female external anatomy develops. The individual in question appears to be a completely normal female, though they tend to enter puberty later than other girls. They never develop a menstrual cycle as there are no ovaries or uterus. I can understand why Wilson may have thought Alex had ovaries on an ultrasound, because that’s what he was looking for, but he should have noticed the complete lack of a uterus. And even if they were testes, the ultrasound still should have picked up the tumor because ultrasound is what we use to find testicular tumors.
This episode gets a B+ for the mystery and an A for the solution. The medicine earns a B, because I marked it down for the “heart attack” and the whole “whoops, I missed the uterus” thing. The soap opera aspects earn a strong B+.
February 21st, 2006 at 12:19 am
links for 2006-02-21
too big & heavy: Panasonic’s TOUGHBOOK-WIRELESSDISPLAY 2.6# XGA thin client Daylight-Readable Touchscreen Display with citrix or gotomypc style controls (tags: thin client tabletpc ultraportable) bookofjoe: BehindTheMedspeak: is not so sure narcotic …
February 21st, 2006 at 9:57 am
Why did Wilson do a bone marrow? (completely unnecessary)
And a simple CT scan would have shown any tumors or testes and the lack of a uterus (as you pointed out).
House’s bedside manner is just so outrageous that I probably wouldn’t know how I would respond and just gape at him. His patients though just talk as if nothing has happened, like they weren’t insulted.
February 21st, 2006 at 10:25 am
Wow! an A, two B+ and a B. This must be a first! But is it just me or is the “girl with a penis” story cropping up a lot on medical shows. Is it common or (what I assume) quite rare?
February 21st, 2006 at 10:43 am
Official Comment
Testicular Feminization (Complete Androgen Insensitivity Syndrome) affects about 1 in 20,000 live births. This makes it rare, but certainly more common than some of the diagnoses on House.
February 21st, 2006 at 4:09 pm
Great blog! I just found this via the House forum at Television Without Pity.
Oh, and not only did Wilson miss the missing uterus, Cameron gave the girl a pelvic exam and didn’t notice a shorter vagina and NO cervix. The writers really dropped the ball on this one.
February 21st, 2006 at 4:23 pm
Official Comment
Good point Mary. I was thinking along the same lines and nearly pointed out that none of the men that Alex slept with must have been particularly well endowed, but I couldn’t think of a non-risque way to say it (too late now I guess).
February 21st, 2006 at 4:37 pm
Care to comment on the B story about the father-to-be be going “all hormonal”? Seems to be another one of those medical story lines popping up on tv a lot lately too.
February 21st, 2006 at 6:58 pm
What do you mean “even in New Jersey”? *lol*
February 21st, 2006 at 7:45 pm
As founder and executive director of the International Paraneoplastic Association
(website: http://www.paraneoplastic.org), I must tell you that this episode is absurd. The writers used half truths and downright inaccurate information. Worse, they did a grave disservice to paraneoplastic sufferers by wrapping this disorder up with hermaphrodism, sexual abuse, and a host of other wild things.
First, paraneoplastic syndrome is only VERY rarely associated with testicular cancer.
Second, the type of paraneoplastic syndrome that is associated with testicular cancer DOES NOT affect teenagers.
Third, the symptoms used on the show are not typical paraneoplastic syndromes.
Fourth, paraneoplastic syndromes are now relatively easy to diagnose when they are suspected with a blood test for the antibodies. This was not done on the show, nor was it even discussed.
Fifth, while it is true that IVIG can IN RARE CASES temporary stop the worsening of paraneoplastic syndromes, it NEVER has an “instantaneous” effect like the show indicated, and it does NOT, in and of itself, result in the total cure implied on the show. A doctor cutting off an IV tube would also not immediately cause the worsening of symptoms in a patient undergoing IVIG.
This is medical television at its worse. The writers did not do even the most basic research on current paraneoplastic diagnosis, treatment, and symptoms. Unfortunately, the people who will ultimately suffer are the REAL paraneoplastic patients and those yet to be properly diagnosed.
Carolyn Lawrence
Executive Director
International Paraneoplastic Association
http://www.paraneoplastic.org
February 21st, 2006 at 8:19 pm
Hee, Carolyn, you expect realism here? House has his fellows break into patients’ homes on a regular basis to look for drugs and other assorted diagnostic tidbits.
February 21st, 2006 at 10:04 pm
Carolyn,
Thank you for your post. I hope you have also contacted the writers/producers of this show. I had no clue paraneoplastic existed as a condition until this show.
That said, I have been aware since the show premiered that it regularly sacrifices accuracy for drama. I know that the writers take great liberties with the various medical conditions and procedures, and hope that most viewers are aware of that as well. I watch House for the character of House as well as the novelty of the medical cases they present, however inaccurate they may be.
February 22nd, 2006 at 4:02 pm
I have long given up on accurate medical info and accepted that the medicine is simply a vehicle for character development and soap. It is what I watch for, not the medicine. I am slightly concerned that viewers may use the info with House inappropraitely but that criticism could be leveled at any show with medicine in it
February 22nd, 2006 at 5:31 pm
I just wanted to add that after re-watching this episode closely, only the father seems to have referred to that little incident as a “heart attack”. Foreman, House and the other fellows referred to Alex as having “flatlined” and not as have had a heart attack. I assume that the father jumped to the conclusion that it looked like a heart attack and so started calling it that. The writers probably put it in because it might be easier for an audience to understand that than just the patient flatlining.
February 23rd, 2006 at 12:55 pm
I had big issues with House’s shock/horror at Alex’s androgen insensitivity. She’s still a “she” whether or not she has XY chromosomes. And House’s use of gender stereotypes to diagnose that she had more estrogen and was therefore a “superwoman” — ugh. Is Cuddy not a woman because she stands up to House? Stacy?
House pretty much set back gender/sex research back to the 1960s.
February 23rd, 2006 at 1:20 pm
I’m with Jonquil — Alex is so very much a ’she’ — in fact, because of the androgen-insensitivity, no amount of testosterone will produce male secondary sexual characteristics for her, unlike XX women who desire to cross genders. She’s going to have to deal with being sterile, but beyond that for effects on her life… well, she won’t have to worry about a period, ever.
April 11th, 2006 at 6:50 am
Why criticize a great show?
April 11th, 2006 at 7:24 am
Official Comment
While House is a very good show, it is at times rife with medical errors. People get their medical information wherever they can find it, so I do my best to correct the bad science and ideas when I can. And don’t think people won’t get ideas from the show. I’ve had three patients who’ve been convinced that they had the “disease of the week” from the show and I know other doctors who’ve had the same experience.
There is no TV show that cannot be better.
May 3rd, 2006 at 11:02 pm
You’ve had patients who thought they had the disease of the week from House? I thought one of the reasons for the comic-relief “clinic duty” segments on the show was to teach viewers NOT to diagnose themselves. That’s strange.
Anyway, I realize that Wilson had to miss the lack of a uterus in order for it to be House who comes up with the big solution, but couldn’t the writers have thought up another way for them to not notice, rather than Wilson just plain missing it on an ultrasound?
May 4th, 2006 at 5:10 pm
Yes, I agree that the show is very medically entertaining; after all, they only have one hour to provide histories, symptoms, interject background and family, pinpoint the diagnoses and treatment options, and add the main characters’ personal-life histories! Just like firefighters cannot watch a movie about fighting fires (e.g., Backdraft, Ladder 49, etc.), without ‘critique-ing’ every turn of the movie, medical people will prove to be this show’s most loyal fans and toughest critics!
June 7th, 2006 at 5:20 pm
What was the name of the song used on the closing of epispde 13 ???
June 7th, 2006 at 9:12 pm
I could not get past the obnoxious bedside manner – worse than usual: just watch for how to break the news of a tumour, breaking the news that ’she’s a he’ nonsense, accusations of incest in front of the whole bleeding world. It was all quite revolting and overdoes the eccentric-nasty-but-brilliant House thing. Also, what was the point of the little dialogue about the underage girl sleeping with everyone as seductress/babe/hot etc. I guess the hot ones are all just asking for it to have their evil ways with the poor dumb men. Notice how as always in good old neocon America the ’scarlet woman’ gets her come-uppance by being deprived of a right to call herself ’she’? the politics and ethics of this episode sucked…
October 10th, 2006 at 11:53 am
Personally, I’m a big fan of the father’s reaction at the end. It’s okay that he slept with his daughter, but sleeping with his son…now THAT’S cause for alarm.
December 18th, 2006 at 1:48 am
I really wish that they would show an accurate cardiac arrest. Patients do not just go into flatline (asystole) but progress through fibrulation. I like the way they show a very solid sinus rhythm straight into flatline!
Question though: if a woman has this condition, that means that she doesn’t have overies. Is this not where all of the female hormones originate from? Apparently not… so where does she get all of the hormones to grow this great female body?
January 5th, 2007 at 8:38 pm
The Adrenal glands produce both male and female hormones as well, although of course less than ovaries or testes. Enough though for puberty.
But as for this episode, it is the only one so far that stank — even House (or maybe especially House?) should cut that crap about “This woman is ‘really’ a man” because obviously, she is not. She may be intersex, but appart from the few gramms the difference between XX and XY chromosomes make, and the lack of ovaries and uterus (which can happen in XX-women as well, afaik), there is not just a female body, but an unambiguous female gender identity (and gender role) as well. And unless we start calling people “Mam” and “Sir” only if we have seen a chromosome test, that is what counts.
January 9th, 2007 at 7:12 pm
Wilson as the voice of God was amusing.
January 25th, 2007 at 12:39 am
Are lumbar punctures a very common test? I ask because it seems to be the most commonly used medical procedure on the show. I was under the impression that it was a rather risky and painful procedure.
January 31st, 2007 at 7:31 pm
Jason – LPs are actually fairly common procedures and although sometimes really painful (spinal headache) everything doctors do is risky on some level. If I tried to order nearly as many MRIs as they do on this show, I’d get fired.
Okay, this was by far one of the worst episodes of House – for all those reasons mentioned above. Come ON – even WILSON would have noticed a missing uterus! and the bedside manner was downright criminal, even for House. But, it was the first time I figured out the DOTW (disease of the week) before they announced it! (well, after all, I am only a gynecologist)
March 11th, 2007 at 6:21 pm
If her bladder was empty(ish), he could have easily missed the lack of uterus on an ultrasound (hence the need to drink and not urinate before GYN ultrasounds as so to differentiate the bladder from the uterus), right?
April 11th, 2007 at 1:16 pm
Jonquil – I believe there’s a distinction between sex and gender (or at least that’s what they taught us in medical sociology), where sex is the biological/genetic difference and gender (in modern/feminist usage) is intended to emphasise the social and cultural aspects as opposed to the biological differences. Given that, Alex’s “superwoman” come under the “sex” definition and Cuddy/Stacy/etc would come under the “gender” definition? =) Though since I personally didn’t know the difference before I took the course…
Besides that – Scott, thanks for this website! I’ve been reading your posts/reviews after watching each episode and it’s great to get a medical perspective on the show!
April 29th, 2007 at 7:49 pm
One last gripe (just watched the episode again). Is it just me, or did her hair grow back awfully fast. First, when they do the brain biopsy, they drill through her hair. Then, you see her with a bandage on her, presumably, bald head. At the first MRI, she has short hair, then later it’s back at the length she started with. Hair takes months to grow that long, so I don’t get how it could have come back so fast.
May 31st, 2007 at 2:08 am
Actually, when I had an ultrasound, the doctor had no trouble showing me the bladder (see, it is empty) and the uterus. Maybe because it was the transvaginal technique. I think when the ultrasound is through the abdominal wall, a full bladder would be useful.
June 7th, 2007 at 11:03 am
While I’m a fan of the show, I had a real problem with the “she’s a he” thing as I watched the episode with a family member who has just been diagnosed with a similar disorder to AIS and has been working through her gender identity issues. For the issue to be handled so insensitively on a popular tv show does nothing for the people suffering these disorders, who already have to put up with intolerance and ignorance from the general public. I’d like to see a show present an intersex disorder in a less sensationalist manner.
June 23rd, 2007 at 9:38 pm
Cool site, am persuing the full list of episode reviews. Just have to comment on this thread; Some people need to relax! I found the episode highly entertaining and it is one of my favourites. I wonder if Carolyn Lawrence can actually produce any proof that an inaccuracy on a fictional medical drama has contributed to the suffering of patients with paraneoplastic syndrome? I think attacks like this on a simple TV show who’s prime function is to entertain, not educate, betray a mind that is carrying issues as opposed to just championing them. There are more important things to get worked up about!
And with regards to missing the uterus, maybe Wilson simply wasn’t in anyway expert in performing ultrasound and didn’t realise the uterus wasn’t there? With all these doctors doing their own diagnostic tests somebody is going to miss something big!
Oh and get over the ‘insensitive’ portrayal of intersex, if shows tried to please everybody we’d all be watching Barney.
August 17th, 2007 at 8:40 pm
I guess everyone is one point here, which is what makes this series different than other medical dramas. Dr. House is not all mighty, he is weak, his success is accidental. This is what this series wants to show, right? It is probably trying to undermine the general notion that medical doctors know it all and we can trust them.
His reaction to the girl, you are a man, bla bla, was Dr. House. He got confused, and thus angry. Suddenly he is able to do the right diagnosis, but this diagnosis clashes with the natural categories of sex, he is angry with how his effordeous precision will end up in a ‘grey area’ like hers. Conclusion, all fetuses begin with female and male properties, right? Therefore, nature isself does not consist of black and white. What is the difference between morphine and saline? what is the difference between man and women? Can a father do his daughter acceptably when he is drunk? And, oh, Dr. House is ‘racist’, and ’sexist’ isn’t he? No he isn’t. He is just out of such definitions. Thats why he is the one who always comes up with a solution. Because he remains to be intuitional. He is a full blown human being, not a doctor. When will the other doctors be brave enough to face this truth?
September 24th, 2007 at 1:35 am
House’s reaction to Alex’s gender identity is part of House’s character, not a comment on how such situations are or should be handled. I’m aware it’s a particularly senstive area, but it’s completely consistent with House to simply not care. Just like Alex’s dad was the only one to refer to the flatline as a “heart attack,” House was the only one to insist on refering to Alex as a male. He does have reason to, as that is the genetic gender. It’s just that most normal people would let such a person choose their own gender identity, and most such people would probably choose female since they are socially, emotionally, and externally already identified and conditioned as such.
December 14th, 2007 at 6:04 am
I can’t believe a poorly defined heart attack, *and* the inability to identify a missing organ, only reduces their grade by one letter. I see a job as a health inspector in your future should you need it.
To crudely reply to the “well-endowed” comment: you’d expect a girl so young to be tight.
To Decado: “Harm” is relative. You may not care until you’re stuck out in the waiting room, uh… waiting… because Doc’s still inside with his last patient explaining that IVIG really isn’t a miracle cure (or whatever Carolyn was trying to say. I didn’t really pay attention, I’m sorry… It seems more like a PR person latching on to the disease of the week’s publicity to promote her organization, but I really can’t blame her for that).
To Cat: A positive presentation would have done nothing to ease your discomfort. Even if it was an after-school special on the Disney Channel starring kittens and puppets, if you went in without expecting it, it would be shocking and uncomfortable.
As for the specific treatment it received on House: one character presented an opinion (however wrong it may have seemed) and other characters reacted to it. Since most sides were given a voice, it was handled fairly in my opinion. Now had all or even most of the characters parroted the same line, I would agree that it was abusive.
To Scott: I’ve been reading all night and I love this site. Thanks for taking the time to explain stuff.
December 19th, 2007 at 12:29 am
Carolyn,
From what I understand, sufferers of Paraneoplastic syndrome have a lot more to worry about than some bad PR on the part of a fictitious Medical Drama. I fail to see how misattributing symptoms to the wrong cancer type and demographic can harm anyone, unless “House” is used to teach in prominent medical schools.
Jonquil,
Testosterone and Estrogen. The former is associated with males, the latter with females. A person who is immune to testosterone and has abnormally high estrogen levels could very well be described as a “Superwoman.” There are behavioral and psychological behaviors associated with those horomones, and those were the behaviors which House was describing. This is no more sexist than saying a person on anabolic steroids suffers from increased aggression.
December 19th, 2007 at 2:34 am
Yes, I know “behavioral and psychological behaviors” was redundant. That’s what I get for not proof-reading my posts.
January 22nd, 2008 at 10:32 am
Like everybody else, I owe you my compliments on this site and the comments it’s attracted.
Now for my layman’s take on your point about the series repeatedly presenting females as manipulative: in the case of this transgendered person, my understanding is that her behavior could be viewed as determined by her genetic maleness rather than her hormone level. I’m thinking of that famous case of the circumcision accident, where the male organs were removed: many male behaviors and attitudes remained, despite hormone therapy.
So this apparently female person could have been experiencing the high sex drive of the 15-year-old boy, but accepted her physically and socially female role in choosing the form of her sexual behavior.
None of which makes less likely the makers of the show believing that females tend to be manipulative, of course.
February 3rd, 2008 at 11:12 pm
House is such a Jerk, that is the only thing I that gets be about this show, by now someone would have beat him to death with his own cane.
To Danny
Good point, but for the “girl” in the show. She was more of a girl than a boy. Because most of that stuff you talked about comes from social gender roles , and testosterone.
March 9th, 2008 at 9:43 pm
House’s cruelty to Alex was extreme even by his standards–but it was good dramatically,because it provoked her anguished,heartrending reaction. I would certainly “class” her as female,as she was defined that way both by the world and in her own mind.
March 17th, 2008 at 10:03 pm
“What is it with this show’s writers and overly manipulative women?”
“She” ended up being a he anyway. Granted the women in House are manipulative but they’re dealing with House. If I had to deal with someone so pigheaded….
March 25th, 2008 at 6:20 pm
“So this apparently female person could have been experiencing the high sex drive of the 15-year-old boy”
without testosterone? isn’t the testosterone responsible for sexual drive?
April 19th, 2008 at 4:18 pm
Thanks for putting up this site! It’s terrific!
I knew when they mentioned her lack of a menstrual cycle that they’d end up giving her testes. I thought it was pretty ridiculous that Cameron would have given her a vag exam and not notice anything wrong.
I’ve got to say (as a medical layman), lack of medical accuracy aside, at least this show gives viewers some interesting terms to look up as well as a bit of a challenge attempting to find the inaccuracies.
I also find the clinic duty amusing–seeing so many people act a certain way at a doctor’s office… it’s easy to scoff at someone who is refusing a doctor’s advice, but sometimes it’s really justified. Just the other day I went to the university clinic due to having difficulty breathing, and the doctor insisted that I had allergy-associated asthma. I was pretty sure it wasn’t (as I had a fever and congestion) and asked him to do a chest x-ray, which showed that I had pneumonia.
May 21st, 2008 at 5:52 pm
For people complaining about House’s presentation of final diagnosis to the patient and her father.
I would remark one thing: House is still a man with natural desires, a hot beautiful girl turning out to be really a “man” is a schock. I suppose that is his reaction to that fact, lets call it “primal reproductional anger”. *wink*
July 4th, 2008 at 12:05 pm
I picked up on the AIS diagnosis. A few other clues… Wilson asks House if he’s going to “invent” another organ (to have the tumor in). Also, the patient seems to have secondary sex characteristics associated with estrogen but not testosterone. Both men and women have some of both of these sex hormones, and they can interconvert. Androgen Insensitivity Syndrome would be due to lack of receptors or functional receptors for testosterone? And the patient would have abnormally high estrogen levels because the testosterone is being converted to estrogen?
July 25th, 2008 at 3:11 pm
“Scott
April 11th, 2006 at 7:24 am
Official Comment
While House is a very good show, it is at times rife with medical errors. People get their medical information wherever they can find it, so I do my best to correct the bad science and ideas when I can. And don’t think people won’t get ideas from the show. I’ve had three patients who’ve been convinced that they had the “disease of the week” from the show and I know other doctors who’ve had the same experience.
There is no TV show that cannot be better”
Actually, I disagree with this idea of yours. If you had patients who “had the disease of the weak”, they were probably individuals with a tendency to hypochondriasis.
Forgive me if that’s medically wrong, but the point is that it’s not like these people wouldn’t have somewhere else to get their medical information that’s way more wrong than House.
July 27th, 2008 at 5:11 pm
Rubbish rubbish show!! Have never seen this programme before and will never see it again. It is sheer out and out sensationalism, this character’s treatment of a patient is despicable and I am actually shocked at the screen writers’ thought process, thinking this was a good way to depict this rare condition. I thought it heartless, degrading and all over the place.
I have this condition (AIS) and I know this programme has undoubtedly affected some girl out there who will self-diagnose and suffer the trauma of this new information alone and in shame.
Shame on the makers of House.
July 27th, 2008 at 5:12 pm
ps. See http://www.aissg.org/ for decent support
August 29th, 2008 at 5:13 am
My take on the presentation of the AID diagnosis at the end, was that House was using a “tough love” approach… on a person who had already shown a high level of maturity and manipulativeness in her deliberate seduction of the male authority figures in her life (with the implied extortion angle).
September 1st, 2008 at 11:00 am
Oh, c’mon people, it’s house, do you really expect him to tap the patient on the shoulder and say that everything will be ok?
He diagnosed her/him and lost any interest in them. I believe that his seemingly outrageous behaviour while delivering the news was as exaggerated as his previous admiration.
Don’t forget that house is light years away from being politically correct, and I can only thank the makers of the show for that.
October 2nd, 2008 at 9:21 pm
Gus–
Actually, one would certainly not need to have “a tendency to hypochondriasis” to think they had “the disease of the week.”
It’s very common for medical students, for example, to think they have symptoms of every illness they learn about (sometimes called “First Year Med Student Syndrome,” among other things), and even though it could be deemed a form of hypochondriasis, it is unlikely that such a high percentage of med students are hypochondriacs, of any degree.
What makes it more complicated is that, as most illnesses have common base symptoms (pain, nausea, fatigue, etc.), the odds of having at least one symptom of any given illness are pretty good.
So it’s plausible that devoted fans of House could easily have First Year Med Student Syndrome (House Syndrome?) without technically being a hypochondriac or being predisposed.
However, I could be wrong, as my basis hinges on the idea that First Year Med Student Syndrome is not the same as hypochondriasis. If it is considered a form of it, then my conclusion would be entirely invalid.
October 17th, 2008 at 12:56 am
A couple of points.
1) First, regarding “What is it with this show’s writers and overly manipulative women?” and other such comments. Here’s what we need to remember. Just about *everyone* on House is manipulative. In fact, the main character, who happens to be man, is the most manipulative character of all. If men are allowed to have this character flaw, I see now reason to exempt women from it. Furthermore, many, many of the patients on house, male and female alike, regularly commit a variety of questionable deeds. I do not think the writers of the show are purposely singling out sexually attractive women.
2) I love it how several people complain about House’s bedside manner and the way in which he reveals the disease to Alex and her father. Have they never watched House before? This is the guy who mocks terminally ill patients on a regular basis. Do you think he’s suddenly going to become sympathetic and supportive in this situation? He’s going to be blunt, sarcastic, and insensitive as always. I’m not saying that his behavior was justified here. It wasn’t. But it certainly was consistent with his character.
November 25th, 2008 at 4:21 pm
Who cares if they blatantly missed it. Its a TV show. I love that fact that while she was being such a pain and control b**** in the show she turned out to be a he… no wait… hmm… let’s call ‘her’ it. Haha. That was such a gratifying moment.
December 16th, 2008 at 1:10 am
To everyone who responded to the unimaginably cruel bedside manner at the end of the show as simply part of House’s persona:
The fact is, while it may be in House’s nature to deliver a diagnosis in such a callous, sarcastic way, this episode was simply inexcusable. The difference between a terminally ill person and someone with AIS (specifically Complete AIS, there’s also Partial), is that anyone watching at home will inherently understand that it is wrong to make fun of someone with a horrible life threatening illness. Unfortunately, intersex disorders are still extremely taboo in our society and when it is talked about, it’s usually the butt of some ridiculous joke (using the archaic term ‘hermaphrodite’). Anyone dying of an illness doesn’t have to hide the fact from everyone around them for fear of being seen as a freak. By simply boiling the entire condition down to using male pronouns, House perpetuates the sensationalistic attitude our society holds regarding intersex conditions. The fact is, for girls with AIS, gender identity is rarely the problem – it’s the shame and secrecy surrounding the condition. House just encourages everyone to laugh at the fact that this woman is a “man,” reinforcing everything I’ve just mentioned.
If anyone should be ashamed, it’s Fox and the writers of House.
December 26th, 2008 at 12:11 am
Gotta love some of these posts. Are we really expecting a character whose entire personality is predicated on being an ASS, and whose “assiness” has been responsible for the success of the show, to behave deferentially just because the patient is the “pcow” (political cause of the week)?
December 28th, 2008 at 8:20 pm
There are very few cases in which House does not act like an asshole in an episode. Have you seen the episodes where he acts like asses to the overweight because he can get away with it? Or the deformed? So what makes this episode any different? I say that as long as he is treating all the patients with the same brush, that is fine by me. No one should get a free ride on House. Not even girls with AIS
January 3rd, 2009 at 10:15 pm
I find it quite implausible for the doctors on the show to have missed AIS for so long. I picked it up real quick and only because I saw it somewhere else on some other TV program, not because I have any formal medical training. They went to great length in talking about how they looked at her from head to toe and were still unable to find the cancer.
A quick look at Wikipedia says that it is possible for a person to have androgen insensitivity and still have a uterus and vagina. Presumably they would show in the exam but the description of the ovaries as “small” is unlikely. They would have to be too small to be seen and therefore described as “absent” (in the case of AIS) or “abnormally small” (in the case of similar conditions).
IMNAPO (In my not a physician opinion) I would give the medicine a “D”. The large breasts, tall stature (shown as taller than the father), sparse pubic hair, and no menstruation by age 15 sounds like a classic case of AIS.
The comments by House in insisting on calling the woman a “he” is not just House being House. I think he was trying to make sex between her and her father very disgusting to the father to prevent another occurrence, he even said so in the next scene. I agree that he went over the top in his presentation of the diagnosis, but he had a very good reason for doing so. Oh, he probably did it to take the young woman down a notch. He has a distaste for athletes, models, actors, and others that live off of the attention of others. He also may have wanted to get the young woman to stop sleeping around for her own good by pointing out that she is (on some level at least) not a woman.
January 25th, 2009 at 6:06 pm
I was appalled at the way House treated the patient upon finding out that she had testicular feminization. My father is a radiologist and many years ago he helped diagnose a woman who had testicular feminization. She was married and came in to the hospital because she was unable to get pregnant. This was decades ago, and they still wouldn’t have dreamed of calling her a man or suggesting that she shouldn’t live her life as the female she was accustomed to being. They offered her treatment to the extent they were able (to aid in genital lubrication during sex and such) and referred her to someone who could help her adopt a child. Basically they treated her as a woman with incurable fertility, not a freak or a female impersonator. Not only would it have been pointless and cruel to display that kind of insensitivity, it would also probably have cost them their jobs, as would any instance of a doctor mocking the patient for having been born with an abnormality.
January 25th, 2009 at 6:07 pm
Er, incurable *infertility*, that is.
February 22nd, 2009 at 9:49 am
I think your scale is way too lenient. If this episode gets a ‘B’, I suppose something like House doing a venipuncture for a blood test by applying a hacksaw to the occipital lobe would qualify for a ‘C’? The existence of the mentioned conditions/diseases are real, but almost everything about their depiction or their treatment was ridiculous (some glaring examples: the immediate stop-start muscle twitches, a whole uterus gone missing without notice, using the apparently fraudulent ultra-rapid detox procedure for no reason, with sufficient reason for it to be actually contraindicated, the out of the blue ‘flatline’, etc. etc.)
March 3rd, 2009 at 7:58 pm
“What is it with this show’s writers and overly manipulative women?”
Well technically….
:)
March 10th, 2009 at 6:29 pm
I was wondering if you might know this: Ringu, the Japanese version of The Ring has a female character who is also anatomically male and has testes that have dropped. She also has a penis and internal ejaculations. I was wondering if that is physiologically possible in a case of testicular feminization syndrome.
May 28th, 2009 at 8:39 am
First of all great website and it was nice to read what actual medical professionals think about this show. I am an idiot when it comes to factual knowledge so was blown away when i saw this episode for the first time.
I think in terms of Drama, the whole house not being sensitive in breaking the news thing is consistent with his character. House rejects doctors based on appreances in one of the earlier episode(I am new to this series, currently on season 2).
His reactions are a mix of irony reflected and his irritation from the as per his views ‘hardly human by actions aspect of Alex’ .
The most desired girl is a guy which in a way says, the whole cover model craziness is such a stupid act and people worship models and models go to any limits to get worshiped. House as a character is irritated by mindlessness.
Medically, i found this episode a wonderful watch. All i was thinking was that we limit ourselves with so much of definitions and meanings, but body, it speaks its own language.
July 9th, 2009 at 9:29 pm
The “testing positive for heroin” thing was the first thing I caught. Also, how knowledgeable she seemed to be about her anterograde amnesia was weird. I’m embarrassed that I didn’t notice her hair rematerializing though.
What I find interesting is that the actress that played Alex was in her mid-20s when she did this episode, and she’s older than Olivia Wilde (and just a few months younger than Jennifer Morrison, who had to give her the “you’re 15″ stuff).
August 1st, 2009 at 6:15 am
“I’m going to cut your balls off, and then it will be fine” – except for the fact that she has no womb and will never be able to bear children.
Yikes.
I’m interested in seeing what they do dramatically now. They’re pushing the point where the audience (at least THIS audience member) is starting to just think that he’s an a**hole and not worth my time watching. There has to be SOME connection to the character. We need to care about him in some way. I wonder where they’ll go with this.
September 14th, 2009 at 11:58 am
It is obvious that House’s final discussion with Alex
and her father was somewhat callous. Tact was never
House’s strong suit. In this case, I think that part of
House’s reaction was caused by the fact that he was
so smitten by the girl in the beginning of the show.
And he flirted with her shamelessly in front of
everyone. So to find out later that Alex is really
a man (genetically) makes House look more foolish than if he hadn’t flirted. Granted, the girl was quite attractive and nobody suspected.
October 13th, 2009 at 12:01 am
In my Genetics course, male was defined as not just XY but XY + having the testosterone receptors. Based on that definition, Alex is certainly still female, and it would not occur to me to think of her otherwise. I took that course not long after the episode aired, which makes me think that the writers for this episode were either fairly ignorant of AIS overall, or just went for the sensational approach.
No thoughts (I guess not at this late date, anyway) on House’s psychological pain issues?
October 30th, 2009 at 10:18 pm
I’ve read so many comments on here about how awful House was in this episode, about how cruel he was, or his bedside mannet being “worse than usual” but I haven’t seen anyone connect this to his pain – and I really, really think we were supposed to! (We the viewers that is). House’s pan level was WAY higher than we had heard about previously and his treatment of those around him, including the patient) was WAY worse – I just don’t think that was a coincidence.
November 20th, 2009 at 12:28 am
I’m questioning the part where you say House must report the abuse. I’m confused because I saw an episode of the Law and Order, SVU where a girl was rapped, originally told the two detectives, but not her parents. Despite being underage, the detectives were not able to tell her parents because it was forbidden by law. I later looked this up and found it to be accurate (varies by state).
This isn’t necessarily a contradiction of what you are saying, but to me, amusing because it represents yet another discrepancy in the legal systems.
January 5th, 2010 at 6:19 am
“And House’s use of gender stereotypes to diagnose that she had more estrogen and was therefore a “superwoman” — ugh. Is Cuddy not a woman because she stands up to House? Stacy?”
Perky breasts, lack of aggression, and clear skin are signs of estrogen dominance. sorry to burst your politically correct bubble but a lot of our emotions and features are in fact caused by hormones. Sorry your feminism doesn’t coincide with science.
“Notice how as always in good old neocon America the ’scarlet woman’ gets her come-uppance by being deprived of a right to call herself ’she’? the politics and ethics of this episode sucked…”
You are totally right, promiscuous people should be worshiped. As if modern pop/hip hop music and commercials don’t do enough of that already.
I also do not recall house being cruel when telling Alex she is really a he. He went about it the same way he goes about diagnosing all his other patient, matter of fact. What makes her more special than the people in other episodes who had more serious, even terminal illnesses?
January 28th, 2010 at 3:42 am
The portrayal of gender in this episode was extremely ignorant. A person who lives as a woman, who physically is not able to respond to male hormones, and in every way considers herself female is not told her diagnosis in terms of biological sex, but is instead given the news with the phrasing “You’re a man.” This is inaccurate and offensive to the point of ridicule. Way to drop the ball, House writers.
March 7th, 2010 at 2:42 pm
Rich: “It is obvious that House’s final discussion with Alex and her father was somewhat callous. Tact was never House’s strong suit. In this case, I think that part of House’s reaction was caused by the fact that he was so smitten by the girl in the beginning of the show. And he flirted with her shamelessly in front of everyone. So to find out later that Alex is really a man (genetically) makes House look more foolish than if he hadn’t flirted. Granted, the girl was quite attractive and nobody suspected.”
House doesn’t look foolish at all. Alex is, functionally and philosophically, a woman, and House knows that. He’s intelligent and educated enough to know that. I guarantee that if someone were to ask House if he’d still do Alex after it’s been revealed she’s a ‘he’, he’d say absolutely, and bonus, she can’t get pregnant. Either that, or he’d say something homophobic just to piss them off. And that’s the point: he only made his outrageous comments for the same reason he always makes outrageous comments: to get a rise. He said shocking things about Alex all through the episode because it was inappropriate and enraged people. He says racist things about Foreman, not because he’s genuinely a racist, but because it annoys him. He says sexist things about Cameron and Cuddy, not because he’s genuinely a misogynist, but because it annoys them. And he said inappropriate things about underage Alex, not because he’s genuinely a lecher, but because it annoyed Alex, her father, the staff, you name it.
The only thing I would have changed about the handling of the issue was to have a scene where House makes it clear that Alex hasn’t changed. Somebody could call him on it in an outraged fashion, tell him that Alex’s XY status doesn’t change her gender identity, and House would say “I know that” with his usual you’re-stating-the-obvious sneer. Then add a comment about the hypocrite father who won’t be abusing Alex again, depressingly due to homophobia rather than incest-taboo. A scene like that would illustrate that House wasn’t being a bigot, he was just exaggerating to shock the father (and the daughter as well, I guess, though she didn’t deserve it as bad).
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