House – Episode 7: “Fidelity”
There’s probably Spoilers down there, so be careful.
This was a good episode of House. It almost, but not quite, made up for the bad episodes of the last two weeks. The medical mystery was interesting and at least remotely plausible. There were several classic moments of House being House. There was a moral concept — adultery — underlying the episode, and there were no easy answers.
Dr. Cameron’s back story continues to evolve, as does that of Dr. Wilson (wives?)
The patient’s possible diagnoses, Paraneoplastic Syndrome, Tularemia and African Sleeping Sickness, were all likely candidates. A little bit of unneeded testing was done, but not as much as in previous episodes.
As the doctors point out, Chloramphenicol is a nasty drug. But why use it in the first place when there are many better options for treating tularemia? Melarsoprol, the drug used to treat late-stage sleeping sickness, is also a very nasty drug, but not quite as dangerous as the show made it out to be.
Let me just say that I wish my clinic patients were always as interesting as Dr. House’s (and while beta-blockers commonly cause impotence, they rarely affect the libido itself.)
Returning to a long-running complaint: I wish the young guns would stop doing everybody else’s job. Not only do they run an MRI this week (with way too many air bubbles in the contrast injection) and perform a mammogram, but Dr. Cameron takes over the Health Department’s job as well in the last scene.
December 5th, 2006 at 11:34 am
The African Sleeping Sickness disease was a fitting disease– for both partners were sleeping away their relationship, if you will. The very first scene prepares the audience for the rest of the episode. In many ways, it functions as a dumb show: the friend, the adulterer, tell the audience that his marriage is failing, he takes a side glance at a female runner, he asks probing questions about his friend’s sex life, and then makes fun of his friend. At home, Alice is asleep, and she slaps her husband– he feels rejected… These aspects, in this episode, render the science a second-interest. HOwever, medically, I see what you are saying. Thank you.
December 12th, 2006 at 1:35 pm
One thing I absolutely don’t understand is: How is it possible that Alice is infected and close to death, while the guy she had sex with is still walking around without any sign of the disease?
And furthermore: If afterwards she still had sex with her husband, mustn’t he be infected too?
Thanks for your reviews, which are always interesting to read! John
December 14th, 2006 at 3:10 pm
Is it possible that these parasites can be transmitted through sexual contact? The link you provided said nothing about being able to be passed person to person, only from the tsetse fly bite. Also, your “Melarsoprol” link seems to be down. Thanks for all the reviews, I learn a great deal!
February 8th, 2007 at 10:27 am
As Dr. House states in the episode, a previous medical article describes a case where sexual transmission occured. I should know, it was published in my country.
February 18th, 2007 at 4:08 am
I have thank this one a lot. it gained me a couple of extra marks on my first year microbiology exam, there was a question about is there an effective treatment for african sleeping sickness and i just remebered house and then it reminded me of the lecture so i said, no vaccine and only a harmful drug treatment.
i do think it is an interesting disease and i love the VSG on it and its evasion of the immune system. great little parasite.
April 30th, 2007 at 12:39 pm
One thing that bugs me was how surprised Cameron was at the mention of breast cancer. If the patient’s mother had died from breast cancer, wouldn’t that be one of the FIRST things they’d look at?
May 18th, 2007 at 2:46 am
Hahahaha, thank God someone noticed those air bubbles. I was mortified.
July 2nd, 2007 at 4:08 am
You mention that there were alternatives to Chloramphenicol, but wasn’t there also an alternative to Melarsoprol? Isn’t Eflornithine also effective and much safer?
August 15th, 2007 at 5:15 pm
eflornithine is the treatment used in the portuguese case cited by House and published in Lancet. See:
Possible cases of sexual and congenital transmission of sleeping sickness
G Rocha, A Martins, G Gama, F Brandão, J Atouguia
The Lancet – Vol. 363, Issue 9404, 17 January 2004, Page 247
November 14th, 2007 at 3:29 pm
It seems that House doesn’t know how to use stethoscope – it looks to be turned in wrong direction (5 and a half minutes into the show)… :)
January 8th, 2008 at 9:04 am
This post is actually less about the episode itself and more on the common complaint about Houses little helpers always running the tests themselves. While VERY unlikely, it does fit with the theme of the show. House is notorious for not trusting tests diagnosis or even histories taken by other medical professionals. It is “fitting” that he’d make his team do every test themselves. A lot of belief suspension is needed to believe that these uber doctors are more competent than the doctors and technicians that run these tests every day for a living but at least it keeps with the theme. Although, Cameron notifying the carrier in this episode does go to far. I’m not even sure if it’s ethical for her to do the notification.
January 11th, 2008 at 3:49 am
Eflornithine is the best drug for african sleeping sickness; unfortunately Avantis, one of the beloved drug companies, discontinued production because normally only poor people in poor tropical regions get the disease and the drug was not profitable. The WHO got them to restart making very limited quantities for a while by subsidizing the costs and giving them some nice PR, but the agreement expired in 2006, and now no-one is manufacturing it as a sleeping sickness treatment anymore.
But, all hope is not lost! The drug also causes hair loss and is frequently used by poor, unfortunate women with gross beards! It can be bought in the hair removal product Vaniqa. Too bad the formulation makes it completely impossible to use on the disease for which it’s best suited! Go drug companies!
March 23rd, 2008 at 1:13 am
I assume Soso is talking about the direction that the ear pieces of the stethoscope are directed into the ear canal, or in this case rather not directed into but perpendicular to.
April 18th, 2008 at 3:32 pm
“I wish the young guns would stop doing everybody else’s job.”
If other people did the tests, the writers would want to develop those people’s characters, and/or viewers would expect it, they’d need actors instead of extras, and the show would get more complicated than it already is, and (in my opinion) needlessly so. Long ago, a lit major friend of mine told me “it is the nature of drama to condense time”, and I think the same thing applies to essentially irrelevant bit-parts like people doing various tests.
I know this review is going on four years old, but I hope in the interveening time you’ve resigned yourself to the fact that in some ways Drs. Foreman, Cameron, and Chase are composite characters and wear more hats than real people would. (Similarly, the folks in CSI do a lot more than real crime scene investigators do.)
Regardless, I’m enjoying your reviews! Long Live House! :)
(Disclaimer: I’ve only gotten into House since January, but we’ve purchased the DVDs and are halfway through season 2.)
May 8th, 2008 at 2:59 pm
just to correct evan thomas above – eflornithine is still available to treat trypanosomiasis. It, along with other drugs are donated by the pharmaceutical companies who make them. the agreement that made this possible was renewed after 2006.
one complaint i’ve always had with this episode is that they didn’t delve into the fact that there are 2 types of trypanosomiasis – if patient had t.b.r, parasitemia should have been detectable, if she had t.b.g (chronic form), should have used eflornithine as the treatment not melarsoprol. of course if she had t.b.r, eflornithine would have been useless.
June 17th, 2008 at 2:57 am
same as TheClap said above. Although unrealistic, it has to be the main characters who do minor tests in order to simplify the process of storytelling.
Also, the audience is more emotionally involved in the challenges faced by the protagonists than the travails of “Lab Tech Guy #2″.
July 1st, 2008 at 12:33 pm
Eflornithine: German (but not English) Wikipedia (http://de.wikipedia.org/wiki/Eflornithin) mentions that the drug is effective against T.brucei gambiense but not against Trypanosoma brucei rhodesiense. House is right, learn languages !
The abandoning of drugs by Big Pharma is a serious problem not just for poor people in 3rd World countries but for many others who happen to have a rare disease. As a chemist I am infuriated by this and willto look into this matter to see if one can come up with something more creative than “does not pay” The perfect solution would be to train locals to make the drug and teach them some science along the way. Tough one though as anyone who knows Africa first hand will be able to tell you.
Did I mention that I think this a great blog ?
October 31st, 2008 at 7:07 am
“I wish the young guns would stop doing everybody else’s job.” Yeah, it’s kinda weard, but I don’t think House would rely on the results unless they were done by his people. Awesome blog btw. I just started and even though I’m not studying medicine, it’s interesting to read this.
January 4th, 2009 at 8:10 pm
Just how likely is it that a hospital in the US would have sleeping sickness meds in shop?? Wouldn’t they need to have ordered them or gotten them from somewhere else? How long would it take to get them?
January 4th, 2009 at 11:35 pm
Official Comment
The meds used to treat sleeping sickness are used for some other diseases as well, some of which are endemic in the U.S. (though admittedly only in certain regions, and New Jersey is not one of them)
January 29th, 2009 at 9:37 pm
Some episodes, I wish these people were real so I could punch them in the face. Usually that means House, but in this case it was Cameron, for telling the husband off. Not only was that unprofessional in the extreme, but morally repugnant as well. What, it’s “just a mistake” and therefore perfectly okay in small doses for the wife to have cheated, but some sort of heinous crime for the husband to be pissed about it?!? Whatever the backstory behind Cameron’s reaction (and I don’t see how the bit of it revealed here relates to these actions, anyway), that’s so twisted and backwards I can’t even *think* about it without working myself into a rage.
February 6th, 2009 at 10:01 pm
Thank You JP Cravon I looked up your sorce of sexual transmitted form of sleeping sickness. I googled trying to find it but couldn’t till I found this page. this article stated the patient – She had never been to Africa. Her companion was Brazilian and had been in the military; he had been on a mission to Angola 3 years previously. He was identified as a symptom-free trypanosome carrier and treated. A diagnosis of late stage sleeping sickness was also established in the 19-month-old son, which was probably due to congenital transmission. The child was successfully treated in our hospital. To me this explain the initial source not showing s/sx. I just wonder how often this really happens, it must be rare since it was impossible to google this a sexually transmitted.
I know everyone doesn’t like the young guns doing all the jobs and yes it is very unrealistic but lets you follow the course of diagnosis of the disease. Keeps your attention to the show. As a nurse I like to ask a lot of questions in other departments and some people like to show and explain while others do not. When we have test it is nice to know the little things to explain to the patient what to expect.
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