House – Episode 3: “Occam’s Razor”
This week’s episode of House was the best so far, at least in terms of the medical mystery at the heart of it. The solution was plausible and not as far fetched as the first two episodes. Dr. House and the young guns didn’t bounce around from diagnosis to diagnosis as much as they did in previous episodes. However, I was confounded by their tendency to start treatments for diseases without running simple (and quick) confirmatory tests. It’s hard to believe that this very sick patient was in the hospital as long as he was without anyone drawing a simple blood count — a test that takes maybe 15 minutes to run. I can only assume this is because the young guns persist in doing every test and procedure themselves; the hospital is bound to have a lab and specialists — use them!
The title and theme of this episode was “Occam’s Razor” — a medical “law” taught during medical school. The scene where the doctors were writing all the patient’s symptoms on the board and trying to figure what conditions would cause them was eerily reminiscent of my internal medicine rotation in medical school.
Hugh Laurie continues to fascinate as Dr. House and Omar Epps is the strongest of the young gun doctors (by the way, their specialties are neurology, immunology and oncology). Sean Patrick Leonard’s Robert Sean Leonard’s character is actually developing a personality — a first for him. The other two young guns are getting stronger, but are still mere shadows next to Epps and Laurie.
You want some medical nit-picks? Well, OK. I’m happy to oblige.
1. Protein, DNA and RNA gels take several hours to run.
2. Even though an infection may not have been at the heart of the problem, the patient still had a dangerously low white blood cell count and needed to be in isolation — isolation which was broken by Dr. House storming into the room in his “Eureka!” moment.
3. Thyroid hormone replacement is an oral medication, not an IV medication. It needs to be started slowly and gradually increased, not slammed into the patient full strength.
December 1st, 2004 at 4:59 pm
Robert Sean Leonard. Sean Patrick Flanery starred in “The Young Indiana Jones Chronicles.” (Which doesn’t make your commentary any less interesting, of course. Heh)
December 1st, 2004 at 7:48 pm
Oops! Why can’t actors have simple names any more?
December 1st, 2006 at 12:30 am
Ahhh… The legality issue actually. SAG (The Screen Actors Guild) or someone like them makes actors have names that are not the same as any other actor. Example, Michael J Fox is named such because an actor named Michael Fox was in some tiny movie before MJ Fox was an actor.
December 9th, 2006 at 8:23 pm
I’m pretty sure that the reason House doesn’t use lab specialists and stuff is because he doesn’t trust them and he wants his people to do the tests and everything.
December 11th, 2006 at 12:11 am
Dr. Chase’s (the blond Aussie) specialty is intensive care. Dr. Wilson is the oncologist.
Just thought I’d point it out. Fascinating blog, and a very engaging show, even if it takes sometimes substantial liberties with the medicine.
December 27th, 2006 at 5:03 pm
In my humble medical opinion, I think that in some episodes the therapy is taken into account too often as a diagnostic tool. I was taught, first the diagnosis, then the therapy. Most of the things going wrong caused by side effects of “If-it-works-we’re-right” could’ve been preventible if just the tests that were run _after_ things got worse would’ve been done before. Or, as my senior resident used to say, “Do the math before you stick sharp pointy things in fellow humans”.
So much for nit-picking, however, great show, and great acting done by Hugh Laurie (By the way, watch Black Adder for a quite different Hugh Laurie.)
Of course, these are just my 5 cents…
January 19th, 2007 at 3:34 pm
I think the show producers screwed up with the pills. The authentic cough pills that Chase picked up in the pharmacy had no letters on them. The authentic cough pills that Brandon recieved at the end of the show did have the letter on them. I’m sure the audience all got the point, but if you go back at look through the show, you’d see that the show actually screwed-up the screw-up.
February 24th, 2007 at 4:53 pm
As a European (we use to get prepackaged drugs here, not these orange pill containers) I didn’t get the whole thing with the unlabeled pill box Brandon received.
Anyone mind to explain? :)
March 10th, 2007 at 10:19 pm
I take slight objection to saying Occam’s Razor is a “medical law”, as it’s really a logical argument and seen most often in things like philosophy of religion and forensics rather than medicine (typically diagnostics)
March 16th, 2007 at 9:23 pm
TTS has a point: I would have expected Chase to have turned the pills over so that they could check the other side; they wrongly rejected the screw-up as an explanation based on the one-in-eight-chance that all three pills were blank-side-up and it may have been intended to look that way.
March 17th, 2007 at 2:14 pm
Ok, here’s my two cents:
- one of the first things House says is “CBC is unremarkable”, and CBC=Complete Blood Count, so yes, obviously they did a blood count ;-)
- indeed, the 1 in 8 chance (12.5%) for the 3 pills in the pharmacy showing the non-letter side means it’s quite realistic to assume that this is exactly what happened here. Otherwise the mother and girlfriend would have noticed there that the pills look different, and so for the show it was the only consistent course of action in order to keep up the suspense in this way … ;-)
April 4th, 2007 at 10:45 am
chase is not an oncologist. he is an intensivist. they are very very different.
April 7th, 2007 at 3:16 am
Re: your nitpicks.
Polyacrylamide gels CAN take hours, they can also be relatively quick, it all depends on
a)whether you’re using precast gels (which I’d assume in such a context, please correct me if I am wrong)
b)what type of equipment you use. Electrophoresis equipment with maintains constant temperature, while more expensive, can allow much higher voltage (and consequentially quicker runs) without harming the resolution significantly.
c)of course: the size of the gel. They come in all sorts of sizes, after all, from small minigels to huge gels used mainly for sequencing.
And, of course, there’s agarose gels for DNA and RNA which, especially in minigel format, are very quick especially for DNA.
So, since we’re nitpicking, you’d have to specify specific types of protein/DNA/RNA gels in a specific context in order for the statement that they take several hours to be true.
Oh, and Occam’s Razor is a basic principle of epistemology, i.e. the theory of knowledge.
May 23rd, 2007 at 12:33 pm
Ok, what about this leukopenia? Correct me if I am wrong, but most of the viruses actually CAUSE a leukopenia.
So this doesn’t exclude the viral theory at all.
They didn’t mentioned differential there (or at least I didn’t hear so). It might have been usefull if there was a lymphocytes count…
Strange…
May 26th, 2007 at 7:43 am
just curious what kind of cough medication comes in pill form. i am only familiar with over the counter cough medicine, and only know of liquid medicine–the idea being, i guess that coating the throat helps with the cough, or the tickle that generates the cough. i don’t think the liquids really helf for more than a few minutes. so there must be a different type of medicine that is prescription only.
but what is it and how does it treat a cough?
July 10th, 2007 at 8:04 am
Hey…everybody hear seems to be way smarter than me so I wont argue medicine.
One thing i’ve noticed in these blogs is that you keep seeming to mention lots of other tests to run…
Or complaining that the 3 ‘young guns’ do all the tests themselves.
From an actors/producers/directors point of view, It’s a character show. You dont see 2 nameless people do an MRI becuase it would be boring to see 2 nameless people do an MRI. As for the former I’m sure you could all understand that with a show that has a 42 minute run time not everything can be shown.
If you wake up in the morning with a muddy front yard and a wet car, you might not have seen it rain, but it’s safe to assume that that’s what happened
March 6th, 2008 at 10:19 am
Hey. I’m not a doctor but still I get the feeling that they’re playing it by ear.. I mean, they try the cure first and if it sticks, yay, if not, next diagnosis! I keep reading these posts and I kinda get how annoying it must be for those who know, to see all the medical mistakes or intended inaccuracies. I get pissed when I see somebody get shot and thrown through a window (can’t happen, the shooter would be pushed back just as far), but hey, that’s movies.
But for the love of sanity, what is the deal with the pills? I’m from Europe and we buy them prepackaged… why did the ones at the end have a letter, and what did it mean!?! Were they real, and the other ones, from the pharmacy, fake?
Thanks.
April 7th, 2008 at 4:31 am
The pills!! If you get a chance to look at a MIMS (or something like it – a medical book that has all medications available listed in it), it will have pictures and descriptions of all tablets, capsules, etc so that you know, if you’re unsure, that you’re giving the correct medication. Although, have to admit, here in West Australia our medications are usually prepackaged as well.
June 9th, 2008 at 9:14 pm
I’ve also noticed in many films that commercial pharmacies in the United States are like supermarkets, where one can walk in, take something, go to the register and pay. In Europe it is the pharmacist that deals with the medicine, and the customers only receive it when the transaction is over. Much more responsible, if you ask me.
And did you notice how House sympathised with the first Clinic patient? The one who was about to get fired? “I just don’t like being told what to do”, she said (or something similar), and this might have a little to do with it.
July 1st, 2008 at 9:57 am
Duke,
Yes, you can do that here, but only with non-prescrpition medications, like aspirin, first-aid ointments, cold pills, and eye drops.
All the regulated medications go through the pharmacist, who will not give them to you until you’ve heard the speech about proper use and signed the form which says you’ve heard the speech.
The last time I got “real” medicines, it even came with a description of what it should look like. Perhaps to prevent the very scenario presented in this episode.
July 1st, 2008 at 10:13 pm
It makes sense, but it still shows a different mentality; people here seem to know better than not to follow the doctor’s instructions. And I recently read in the BBC website that the US is probably the only country where they actually advertise prescription drugs on television. No offence to any Americans, but it sounds to me like drugs are too commercialised over there.
July 3rd, 2008 at 10:22 pm
[...] House disagrees, saying that simultaneous development of hypothyroidism and a sinus infection is more likely.They treat him with intravenous levothyroxine (an artificial thyroid medication) and Unasyn, a pencillin to treat the sinus infection. Again, bollocks. Levothyroxine is given orally. Polite Dissent has also pointed this out. [...]
July 19th, 2008 at 4:59 am
Duke,
“people here seem to know better than not to follow the doctor’s instructions”
Your logic is as vapid as it is narcissistic.
November 22nd, 2008 at 1:01 pm
Since about ten people have now expressed dubious statements about what Occam’s Razor is or isn’t: it is not a principle specifically concerned with medicine, it is also not mere logic, neither is it a principle of epistemology. It is a methodological principle. Occam’s original statement was roughly: Do not multiply entities beyond necessity. (http://en.wikipedia.org/wiki/Occam%27s_razor – unfortunately, the wikipedia article is in many respects pretty bad.) A less mysterious sounding reformulation: do not posit the existence of certain things / things of a certain kind until you have shown that assuming them to exist helps explain data / genuine phenomena in need of such explanation.
What Occam’s Razor certainly is not is the (utterly silly) claim: the simplest explanation is always the correct one. (As Chase seems to think.) It is not even the much less silly version you obtain by substituting ‘often’ for ‘always’.
That being said: great show, love it.
February 17th, 2009 at 9:48 pm
?’s
I have recently started watching this show.
I am a RN and by no means a doctor but I have several ?’s…
Several times watching, I have seen patients “heart stop” i.e. asystole on the cardiac monitors and “the team” debrillates them back to NSR. This is sorta … wrong … debrillation is exactly what it means, it is to stop fibrillation NOT jump start a heart that is dead, no pulse… meds are given to “jump start the heart” in addition to CPR.
I have looked for a site that lists the “medical errors” on the show but i haven’t found it yet so I post here.
On this episode, the “jump started” a heart in asystole and they keep saying “cc” instead of mg (milligrams)… cc or ml is a fluid amount of medication, has nothing to do with how much medication is given. In other words… 1 cc of epinephrine can contain 1 mg of the medication or 10mg of the medication or even 100mg. So when it was said “i gave her a cc of epi” doesn’t tell us anything except it was 1 millilter of fluid….
thanks for listening
June 21st, 2009 at 10:09 pm
“just curious what kind of cough medication comes in pill form. i am only familiar with over the counter cough medicine, and only know of liquid medicine–the idea being, i guess that coating the throat helps with the cough, or the tickle that generates the cough. i don’t think the liquids really helf for more than a few minutes. so there must be a different type of medicine that is prescription only.
but what is it and how does it treat a cough?”
Although cough medicines are more common as syrups than as pills, they still work by acting on the brain, not on the throat. The whole “liquid” thing is just a marketing gimmick. Furthermore, you can get cough meds in pill form without a prescription.
“And I recently read in the BBC website that the US is probably the only country where they actually advertise prescription drugs on television. No offence to any Americans, but it sounds to me like drugs are too commercialised over there.”
You obviously haven’t seen the ads in question. For every minute-long ad, about 15 seconds will be advertising and the other 45 will be explaining the possible side effects and interactions (”taking X with alcohol may cause severe complications, like seizures or death, so talk to your doctor…”).
“Several times watching, I have seen patients “heart stop” i.e. asystole on the cardiac monitors and “the team” debrillates them back to NSR. This is sorta … wrong … debrillation is exactly what it means, it is to stop fibrillation NOT jump start a heart that is dead, no pulse… meds are given to “jump start the heart” in addition to CPR.”
Welcome to the wonderful world of TV and movies. You obviously haven’t seen ER, Scrubs, or any other show or movie in which defibrillators are used… ever.
July 25th, 2009 at 1:38 pm
Defibrillating asystole is such a common “TV Doctor” mistake, and I’ve moaned about it for so many years that my wife (with no medical training at all) now recognizes when it happens in shows!
For the public, it’s simple. Flatline is bad. Shocking is good. So we shock flatline! Easy (but wrong).
The other thing I kind of have enjoyed watching over the years is the various ways that the actors react when they are apparently ‘defibrillated’. Sometimes they arch their back and hold it for a few seconds, sometimes they kind of spas out all their limbs. I even saw a guy moan once. Makes you think he might not have been dead!
Still it’s fun.
January 11th, 2010 at 9:50 am
I DO think TV shows should spend more attention to the methods that are being used to revive a person.
I can’t stress enough how our common CPR method still refuses to distinguise between different heart treatments. That is: heart rythm trouble and heart stopping trouble.
For lets say: heart attack-, overdosis-, and drowning victims.
If blood is still circulating through the body, (which means the brain is still getting oxigen), the CPR treatment should focus far less on mouth-to-mouth breathing.
Too much time is spend on senselessly trying to get more oxigen into the victim while it takes at least 2 minutes for a human body to use up too much of the oxigen that’s already present within the bloodstream.
Why would you try to start a heart that never stopped working?
Shocks can be applied to reboot the heart so it beats properly again, but heart massages and mouth-to-mouth are useless if the blood is still flowing.
Even if the heart is just beating in an irregular rythm, CPR should focus on buying time for the victim and on the prevention of brain damage.
This could in fact increase the survivalrate of all heartinfarct victims twothird and extend the survival of the everage CPR revival victim by at least 4 to 7 minutes.
ps. my first language isn’t English so please don’t get sand in your vegina about my grammar or spelling.
January 25th, 2010 at 8:52 pm
Maybe it’s just me… but I’ve never seen colchicine tabs that looked like the ones in the episode.
All the ones I’ve seen are tiny round white pills… and, from my limited pharmacy tech experience, hard to mistake for anything else.
February 16th, 2010 at 10:49 am
I’m just now watching the first four seasons again, and spotted another nit to pick…
It’s been a number of years since I thumbed thru a PDR, but don’t they still have a section of color plates that show the appearance of various pharmaceuticals? Why is House in the pharmacy looking for “small round yellow” colchicine tablets, similar to the “cold medicine”. Wouldn’t it have been much simpler to sit at his desk to look?
March 20th, 2010 at 9:16 pm
I have never watched the episodes sequentially since I just watch reruns. However, Bravo is playing the early episodes in order tonight, and I noticed that in the previous episode, Cameron printed her “G” with a curl on top (when she forged House’s signature and on the white board). This episode her “G” didn’t even have a top on it.
March 21st, 2010 at 1:07 pm
About the main characters doing all the lab work, MRIs etc…
I imagine it is both for monetary reasons (why hire extras to do the tests while the ones getting the big bucks sit around doing nothing?), and watching the main characters interact wlile doing the tests adds to the dramatic content of the episodes, and allows the writers more exposure to develop their characters.
March 21st, 2010 at 8:38 pm
The episode seems to indicate that pharmacists choose colour and shape as the criteria for dispensing drugs. Wrong! The name of the drug is slightly more important.
It may be, that since the elapsed time since I was in pharmacy the word “drug” has a different meaning, Sorry.
March 24th, 2010 at 8:07 pm
Jan, all that had to happen was for someone to get distracted while stocking a new shipment of the pills. People lie and people screw up. Pharmacists are people. Hence, pharmacists screw up.
March 24th, 2010 at 8:15 pm
Also, I don’t think Occam’s Razor is a medical law. I think it’s just a scientific law in general.
May 22nd, 2010 at 3:38 pm
Another nit pick I came across after re-watching:
Foreman admits to House that Acute Interstitial Nephritis rules out a reaction to the drugs. I was under the impression one of the most common causes of AIN was drug allergy (generally beta-lactams and NSAIDS).
June 20th, 2010 at 4:37 am
For what it’s worth, my hospital does indeed stock intravenous levothyroxine. It’s very rare that we get a call for it, but I’ve dispensed it at least two or three times in the last few years as a hospital pharmacist.
June 26th, 2010 at 2:51 pm
Can someone clarify what is the deal with those pills. Because I’ve watched this episode twice and I still confused.
June 26th, 2010 at 5:53 pm
Had Brandon been given goat medicine?
June 26th, 2010 at 5:54 pm
Sorry,I meant GOUT.
June 27th, 2010 at 9:52 am
Finally,I ve figured everything out.Forget my stupid questions.
September 19th, 2010 at 9:21 am
He said that viruses cause leucocytosis. This is not true..
Does carditis cause ischaemia of the stomach and gastric pain ??? The stomach is not sensitive itself. Dunno.. but the whole episode deals lightly with medical facts… Is there really a medical cosultant out there ?
The autistic guy said something important about defibrillator and CPR.
September 19th, 2010 at 9:22 am
Is Colchicine used for withdrawal symptoms of narcotic drugs ?…
December 24th, 2010 at 6:44 pm
In “Occam’s razor” House is wrong. He simply multiplied frequencies. This not make sense. He should use conditional probabilities.
March 3rd, 2011 at 6:43 pm
The “autistic guy” said, basically, is that in those emergency situations, one should proceed immediately to chest compressions before giving mouth to mouth.
I’ve taken a first aid course to get certified, and they are indeed teaching this now! The logic is indeed as he mentioned above, that there’s still a lot of blood with oxygen in one’s body, even if you haven’t drawn breath for a short while. So, the priority is to get that blood to one’s brain as soon as possible. Since there’s oxygen, m2m is unnecessary and only wastes precious time that should be used for chest compressions instead.
August 9th, 2011 at 8:46 am
[...] House – Episode 3: «Occam’s Razor», Polite Dissent, 30.11.2004 Возможно, вам также будет интересно почитать проHouse M.D. — S01E02 — Paternity [...]
Leave a Reply
Contact Me
About
Subscribe:
The Best Of...
Special Topics
Archives
Categories
Twitter
See Also
Comic Blogs
Medical/Science Blogs
Currently Reading
Arbitrarily Interesting Medical Condition
Syndrome
The Net:
Contents may have settled during shipping. Past results are no guarantee of future performance. No animals were harmed during the production of this product. Void where prohibited by law. All rights reserved. Not valid with other offers or specials. Professional driver on a closed track. Your financial institution may impose other fees. All models are over 18 years of age. Employees must wash hands before returning to work. Results not typical. Many suitcases look alike. 18% gratuity added to tables of six or more.
Do not taunt Happy Fun Ball.
© 2004-2012 Polite Dissent. Powered by WordPress