A placebo MUST be indistinguishable from the drug. If it’s a tablet or capsule, should be same taste (bitter, sweet, none), size, color, etc. If an IV, similar smell, sting, no sting…. If a nurse changing an IV bag can tell the difference between the placebo and the real thing, then it’s no longer double-blind, or blind at all. The administering doctor then knows, and that might be subconsciously communicated to the patient — or patients chatting in the IV room or waiting room might accidentally bring up “Wow, that stuff smells”. “Huh? Mine doesn’t.”

That whole sub-plot ruined these series of episodes for me. Foreman shouldn’t have been treating Thirteen; the placebo should have been indistinguishable; Foreman escaping with his license intact was terrible, and the disqualification of Thirteen’s brain tumor because the protocol was broken — so now, “If any more patients get brain tumors, they’ll put a warning on the label”. Gee, thanks, Foreman, for costing us a possible adverse event logging.

And House and Foreman doing Thirteen’s radioactive implant surgery? See above about surgery on those to whom you have any connection, much less live with.

The only thing that redeemed this whole sordid mess was House’s comment as he removed the radioactive pellet from its container: “Nukie, nukie”. LOL! (pun on “nookie”, just in case anyone missed it.)

According to darcy’s law, flow in circulatory system is analagous to electrical circuits – multiple branches along the aortic arch, a structure offering minimal resistance, should receive identical pressure heads, relative flow determined solely by relative arteriolar resistances. Therefore, an intermittent branch (PDA) into pulmonary trunk may well reduce total flow to the systemic vessels but relative flow must remain the same regardless of the defect’s exact position.

However, if reversal occurs due to eisenmenger complex, pressures from pulmonary trunk will equate to pressures in aortic arch, resulting in a degree of right-to-left shunting and a large amount of turbulence in the system as 2 equal pressure heads collide. It may well be that the resultant flow to the left common carotid, lying opposite to the PDA, contains more deoxygenated blood from the ductus (this blood has passed into the right atrium via systemic veins) than the right brachiocephalic branch – a cm or so upstream.

However, eisenmenger complex requires right ventricular hypertrophy – Kuthner’s “no structural defects in her heart” seemed to rule that out….

Only solution seems to be that turbulence with the ductus occured before eisenmenger and the subsequent shunt could develop, sufficiently so in order to divert a significant proportion of blood to what is now the least resistive path, the upstream right brachiocephalic.

One of the tech advisors to the show is a cardiologist anyway, he probably knows what he’s talking about :P

otherwise, a nice episode!

I have got concerns about the “left side” explanation. I know what it’s said usually about left and right brains (right, warm&easy-to-get-on-with, left, cold&aloof), but I understanded, after reading “The Wisdom Paradox” by Elkhonon Goldberg, that left brain damage sometimes led to depression and anxiety while right brain damage led to manic behaviour.

Goldberg affirms that this is explained because left brain emotions are “positive” (make us feel fine), opposed to right brain ones. According to this, right hemispher should have been the deprived one. I’m not a doctor, but Goldberg is a renowned neuropsychologist and author of “The executive brain”, so I suppose he knows what he’s talking about.

Thanks for all this excellent work (and sorry for my poor English).

I’m not too much enjoying the Cuddy sub-arc myself. Everyone’s said it already, but how can ANYONE not be annoyed by a baby’s yelling?