House - episode 11
This episode of House looked at two separate medical issues. The first was a case of hemolytic anemia in a high school student. The second issue was Dr. House’s use of narcotic painkillers.
Various reasons for the patient to have hemolytic anemia were considered, including cancer, lupus and hepatitis E. Ultimately, it was determined to be liver toxicity from naphthalene secreted from an enormous colony of termites. Naphthalene is the chemical found in mothballs, and one would think the distinctive odor would be noticeable at a level high enough to cause symptoms. Still, it was an intriguing case and diagnosis (and it’s true that some termites do secrete naphthalene).
I was not as impressed by the handling of Dr. House’s use of narcotic painkillers. Dependence and addiction were treated as if they were the same thing when they are two different, though related, conditions. Dependence means that the body is habituated to the drug and the patient will suffer withdrawal symptoms if the drug is stopped. The patient may become tolerant to the medication and need higher levels to achieve the same effect. Dependence is not limited to narcotics, but can be seen in many other drugs including alcohol and such over the counter medications such as acetaminophen and nasal sprays. It is a physical diagnosis, not a psychological one (though there is also psychological dependence, but that’s another issue).
Addiction is a maladaptive behavioral change. Basically, a person is dependent on a medication, it interferes with their life, and they do things they know are wrong to get it or take it (such as stealing, lying, skipping work or school, and do on). While physical dependence is a part of the condition, addiction is more of a psychological condition than a physical one.
Just to confuse issues, House may also be suffering from pseudo-addiction. This occurs when a patient has inadequately treated pain and behaves in a way that leads people to believe they are addicted when all they really want is better pain control.
House is certainly dependent on his painkillers. He’s been using them for years and has needed increasing doses to kill the pain. However, I don’t see much evidence that he’s addicted. He’s unpleasant and unlikable, but I get the feeling he’s always been that way (despite what Dr. Wilson’s last minute speech would have us believe). He doesn’t do things that he knows are wrong in order to get his medication. His problem is more one of dependence (and pseudo-addiction) than addiction.
I give this episode an A for the mystery, a B+ for the result, and a B for the medicine (A- for the hemolytic anemia and D for House’s “addiction”.)
February 16th, 2005 at 12:04 pm
Sadly, I missed the episode… did House “kick the habit” or just make the attempt to detox? I’m a little disappointed they dealt with the issue so soon, since I was considering it a nice character bit.
February 16th, 2005 at 2:17 pm
He decided to admit that while he was dependant on the drugs, they weren’t causing him any problems, so he chose to keep using them.
February 19th, 2005 at 9:23 pm
i’m a diagnostic medical sonographer and i just LOOOOOOVE how the interns & residents & specialists all just “know” how to do vascular, cardiac, and abdominal ultrasound. i LOVE it. i also love how they get images of a pregnancy while scanning 1–2 cm below the navel. i guess it was a viable intra-abdominal ectopic pg, right?
i only say this because we get patients all the time who are retreads from the ED, where the residents have told them “you have gallstones” (they don’t) or “you don’t have gallstones” (they do), etc. that’s why MDs need us worker-bee techs. so. . . i doubt that the multitalented, dare i say miraculously talented, “young guns” on “house” can do an adequate U/S of much of anything. . .and all three of them? and by the way. . .does NO ONE on TV wear a glove when doing ultrasound? hello???
okay, i feel better now.
kcd
February 20th, 2005 at 8:49 pm
I liked it when Omar Epp’s character (a neurologist) did an ovarian biopsy last episode. Like he even remembers where an ovary is!
September 8th, 2005 at 8:12 pm
You’d think if House had an ongoing thing with pain and drugs that he’d want to get his scheme/program/whatever checked out every so often. ‘Course, then, I guess we’re into Gregory House and ‘Physician, Heal Thyself’.
December 5th, 2006 at 12:02 pm
Detox is an episode mainly about limitations. The first scene hints to this– when the young couple go for a joy ride and realize their limitations. House, similarly, has been on a fast-paced ride with his Vicodin. Yes. There is an elemnet of dependence. But House is also in PAIN. His attempt at Detox renders the audience at a complete sense of compassion for the abrasive doctor. The scenes where House’s face is rimmed with red-bloody nerve sensitive pain reception is excruciating. House, on some level, wants to believe that perhaps he is NOT dependent on Vicodin, that he can go beyond the limits of his body. But this is not the case at all.
January 12th, 2007 at 12:20 pm
i only say this because we get patients all the time who are retreads from the ED, where the residents have told them “you have gallstones” (they don’t) or “you don’t have gallstones” (they do), etc. that’s why MDs need us worker-bee techs.
Speaking as someone who was *told* by an ED that I had gallstones, and then told by two other doctors that I did not (I did, and I was 26, so the other doctors — not seeing me in the midst of an attack — believed I was too young to have them), i am forced to agree. I just wish it was easier to get to the folks who *can* do ultrasounds. I ended up in the emergency room because the ultrasound appointment was a month out and i managed to end up with a gallstone blocking my bile duct (*and* the worst pain I’ve ever experienced).
March 24th, 2007 at 4:32 pm
I really liked this one but have a question about the medical side. can a fat souble gas be stored in adipocytes? i cant think of any reason why not but i have never heard about it. house says that it is stored in the fat cells and is released as they fat in they is broken down. it sounds cool but i cant see it being true, is what house said true?
April 1st, 2007 at 5:15 am
He has in previous episodes mentioned to buy painkillers off the net in addition to the ones he gets in the pharmacy. It is unclear how serious he was about that at the time, though.
April 10th, 2007 at 7:59 am
“i’m a diagnostic medical sonographer and i just LOOOOOOVE how the interns & residents & specialists all just know how to do vascular, cardiac, and abdominal ultrasound. i LOVE it.”
That’s the same kind of thing that my dad was saying last night when we were watching this repeat. We still like the show but it does get distracting when we realize while they’re performing some of these procedures that, in reality, that type of doctor with a certain specialty wouldn’t be doing this other type of procedure that is out of their realm of training. They’d have a much more qualified person doing it.
April 10th, 2007 at 9:29 am
I can think of several reasons why the writers sacrifice realism in favour of drama when they show us lab and testing scenes:
1. It is much more interesting to show Cameron lifting her eyes out of a microscope in the realization that House is right than for her to read test results off a clipboard. It also speeds things up as the team doesn’t have to wait for results.
2. It gives the viewers a chance to get a good look at some cool lab equipment. :-)
3. The patient often crashes during the test they’re conducting. This could be because they aren’t qualified to conduct the test :-), but whatever the reason, it adds a lot of drama and suspense to the episode. (Although IMO, they have allowed it to become a bit of a cliche).
4. The most important reason for the lab scenes is to give House’s team a chance to talk about him without either him or the patient present. Without the lab scenes, the writers would have to contrive cafeteria or locker room scenes where the team could talk about the boss. While they’re waiting for test results to come back fromt the lab, I suppose.
April 16th, 2007 at 1:45 am
As a person who believes that the medical profession in the United States is a disgrace when it comes to treating pain, I wish “House” (the show) would deal more realistically with House’s chronic and, at times, seemingly severe pain. House takes a handful of Vicodin in an irregular and intermittent pattern that causes many viewers, including me, to wonder about the severity of his pain.
Also, it should be made clear that Vicodin is not in the same league as morphine. I know several people who because of this show think that taking vicodin is tantamount to shooting heroin. This is certainly what the medical community and the government would like us to believe. But it’s simply not true. Vicodin treats moderate pain in most people and severe pain in a few people, but only for a short period of time. It does give many people a high, particularly if they are not in pain and take more than is prescribed. BUT taking more and more Vicodin is not additive in terms of getting you high. At some point, you get groggy, slur your words, become very forgetful, and say things you don’t remember.
Right now, people are denied oxycodone because of bad publicity, even though used properly it is an excellent drug for treating severe and chronic pain. Most doctors don’t like to prescribe pain medication, let alone adequate amounts and kinds of it. As to this, I had serious foot surgery a couple of years ago and was given percocet (contains oxycodone) for a short period of time. My doctor then switched me quickly to Vicodin, which didn’t stop the pain (and I wasn’t even walking). We got into an argument about pain control, which ended in my favor when I asked him what he would do if his wife was suffering severe pain. Would he sit by and say “take a couple of aspirin and call me in the morning.”? He admitted that he had a double standard when it came to himself ( and to a couple of his friends, who needed pain relief). His real problem was that he didn’t like having to deal with patient’s pain, so he wholesale wrote off everyone as a potential addict who would move on to morphine if given half a chance. The bottom line is that doctors don’t care about people’s pain. Some fear the government will harass them if they prescribe pain medicine. Most are just pompous about it, unless–to repeat–the pain is suffered by the doctor himself, his loved ones or even friends.
Pain affects negatively the way people think, talk and act– but if treated properly with the right kind and dosage of pain medication, many people could be living much more productive lives in their jobs, their leisure activities and their personal relationships. Also, some people turn to alcohol to treat their pain and actually do become addicts, with their lives spiralling out of control.
One final comment: some doctors will prescribe Vicodin for moderate to severe pain, but almost always will underprescribe the drug. At least their hearts are in the right place, but not prescribing the right amount of medication that will effectively alleviate the pain is medical malpractice.
April 20th, 2007 at 2:06 am
It’s not just about the government against doctors: Down Under, I can’t find OTC codeine that doesn’t include para-N-acetylanimophenol, whose overdose point limits the amount of codeine we
can take, and it seems to be common practice in the US to include paracetamol in pain medication “to deter people from using it recreationally” or, of course, in sufficient dosages to
control the pain. Which is better, insufficient dosages or paracetamol hepatotoxicity?
May 19th, 2007 at 12:59 pm
hello ppl. just a quicky. love this show, hadn’t seen this episode in while, so just catching up. I noticed something though, while Cameron is confronting House, she mistakenly says Hep C instead of Hep E. hee hee.
June 4th, 2007 at 4:51 pm
Just wait until the third series, house definitely does things for vicodin which would show addiction…
July 19th, 2007 at 2:33 pm
John, I agree with you totally. I had those kind of doctors as well, as I’m a patient for chronic pain caused by the infamous fibromyalgosis. The result of not getting a light opiate was me taking ibuprofen for myself to even get through the day and be somehow able to function. I ended up taking 800 mg ibuprofen - 3 to 4 times daily at least. until the moment I got to get my first medical opiate for pain treatment and it felt godsend, especially as my kidney got better - they suffered heavily under my ibuprofen abuse, but what can I say? it’s not that much doctor’s fault, they are often miseducated or over catious, and they themselves usually have some access to stronger painkillers. my mother was treated with rheuma painkillers which almost killed off her stomach, until she got metamizole (ya I know this is not an opiate, however, it’s one of the stronger level 1 painkillers) which keeps the pain at bay - however, metamizole isn’t even released for usage in the US (I’m not from the US). where I life it’s prescribed pretty often and I personally do not know a single person who got agranulozytosis and most people forget that almost ANY medication can cause this). I had a friend who also had chronic pain in his right forearm, which was idiopathic. he didn’t get painkillers prescribed until he got out there to get himself tramadole.
oh and paracetamole… I’d never take that stuff in larger dosages as of it’s hepatotoxicity, and in the usual doses, this does not even kill any pain for me. it’s good for children I suppose.
September 18th, 2007 at 1:44 pm
John
How can one accurately prescribe the correct and reasonable dosage and type of painkillers? I do believe that you have a point, but is this issue as simple as “doctors are afraid of giving pain killers for patients that are in actual pain”?
December 13th, 2007 at 6:41 pm
I’m not a doctor, but one thing has bugged me from the very first episode: Doesn’t acetaminophen cause lots of bad things when it’s taken several times a day for long-term pain control?
My mother used to recieve a regular dose of vicoden until the doctors decided an equivalent dose of oxycontin would be better for her. (To protect her kidneys, I think?) So shouldn’t House have moved to a tylenol-free pill by now?
January 10th, 2008 at 6:20 pm
When I first saw this episode I loved it (blinded by the fact it was one of my first) Now I don’t think it’s as good. Probably because I’ve seen all the others. I wish i knew all these medical terms. Another reason I should go to medical school.
January 26th, 2008 at 5:58 am
Is it just a huge coincidence that the patient conveniently hallucinates the name of the cat? If the cat had been the cause of the disease I might just conjure some strange subconscious threat recognition, but the cat and the patient merely were infected by the same source. A little too “deus ex” for me.
February 28th, 2008 at 10:39 am
I have suffered from chronic pain for a long time.(8 years) caused by a fall. I have had the same trouble with the doctors around here! There was a doctor who I started out with who was giving me the right amount to control my pain, but not knock me out as to where I couldn’t function. Well the DEA started a investigation because there were a few patients who faked there pain to get high. they gave him a choice to retire or they would pull his DEA number. After that I couldn’t find a doctor who would touch me! They would say the same thing, “Were you a patient of Dr.Soandso?” and I would say yes and they would tell me they could not see me! I ended up having to travel (which is very hard for me to do!) to another state to see a Dr who would take me. My point is that a few people that want to get high ruin it for everyone else who need it! I also agree with Scott that there is a difference between addiction and dependency. I had some of mine stolen from me and had to go without them for 4 days until my next visit. I didn’t lie cheat steal for them, but my body was going though some bad detoxing!
April 2nd, 2008 at 5:16 am
@AlabamaHouse
People are going to abuse drugs and although it is a negative aspect in our society (and basically every other society ever) the issue can and should be dealt with in a manner that leaves patients under treated. I feel an overzealous DEA that harasses doctors and to a lesser extent patients, are really the ones that set up the barriers that block people from getting adequate pain relief. From my understanding, a very large majority of the pills being abused and diverted are not acquired from “pill mill” doctors and people feigning illness but they are disappearing off trucks, pharmacies are robbed, and other avenues that don’t involve doctors at all.
The “crackdown” however is really impacting the doctors and subsequently the patients. The DEA has shut down practices for years to “investigate” innocent doctors only to return their licenses 3 or 5 years later. Other doctors are indicted unjustly and this leads to many in the pain management profession and others to fear investigation or more severe repercussions that could destroy their livelihoods. My point is that we shouldn’t be railing against drug addicts to try to affect change but the DEA mounting the war on [doctors who prescribe pain] drugs.
painreliefnetwork.org is the website of a fantastic advocacy group fighting to change this situation. I am not in any way affiliated with them; I am just a chronic pain patient who is constantly fighting for treatment. I’ve had to deal with repeated, arbitrary lapses in my treatment with no medical assistance to handle the withdrawal from my opioid and anticonvulsant medications let alone pain relief during those periods. I know exactly how ‘Dr. House’ feels in those agonizing scenes and NO ONE should have to deal with that, especially if the reason is because OTHER people abuse drugs.
June 17th, 2008 at 4:45 pm
You have not seen House doing wrong things to get his meds, but he will in the third series; so I think it can be defined as an addiction.
October 31st, 2008 at 7:12 am
The difference between drup dependence and addiction is subtle, but there. I think the writers didn’t want to confuse the viewer.
November 2nd, 2008 at 10:41 pm
MASSIVE SPOILERS!!!
I have seen the entire third season (and most of the fourth, lapsed for a while there), and I am still of the opinion that House is not an addict to Vicodin, at least in the beginning of the show. When his pain goes away at the beginning of the third season, so do the majority of his more bizarre behaviors relative to pain management, and he actually becomes a halfway pleasant person for a few episodes.
House’s pain goes away, and he actually has hope for a pain-free life for the first time in the series, only to have the pain return, presumably at least as bad as before. The truly addictive behaviors don’t take place until after the relapse, and it is arguable that he is self-medicating for psychological issues and hoarding rather than showing signs of addiction even then. I suspect that he is back to just dependency by season four.
December 21st, 2008 at 1:41 am
If I were in House’s place, I’d relocate to California and switch vicodin for (medical)marihuana
However, to me personaly it never worked as a pain relief …
and yes, I know smoking is baaaad , but I rather be happy and not get too old,
than having to work till I’m 70 or die of boredom
January 17th, 2009 at 10:49 am
Hey there
Where shall i begin…
I love these reviews, I’ve read most of them already, but I, unfortunetly, have a few matters of contention.
House is unfortunetly both an addict and dependant on his vicodin. His behaviors, antics, and reactions are all classic indicators of an addict. Although it is not shown to a great degree in this and earlier episodes, you must keep in mind that this was still early in the first season. For instance, he is stated to have forged signitures on Wilson’s perscription pad to obtain Vicodin. He is also shown trying to steal oxy from a dead mans room. As I’ve stated, these are indicators of an addict. He lies, he steals, and it wouldnt surprise me in the least if he cheats. I’ve seen this countless number of times when people come to my practice. I’m a psychiatrist by the way. Other than this problem with the grading of the show, I’ve enjoyed reading it.
thank you
Luis
February 4th, 2009 at 12:44 am
@Luis
I would definately agree that there are some big red flags for addiction; his inconsistent usage schedule seems to indicate self medication of psychological problems, and he certainly resorted to some underhanded tactics to appropriate his pain medication.
However, it is important to remember that House is a long term narcotic analgesic user and would certainly have become bioconditioned to Oxycodone. His fellow physicians cut him off from his medication without warning and without any medication to treat discontinuation symptoms. This can actually be dangerous, and borders on malpractice. In the episodes you refer to, they do this to torture him (on purpose) until he yields to their will. That he would become desperate and steal pain medication while undergoing sudden and severe withdrawal is somewhat understandable. Sudden discontinuation is dangerous, and excruciating and no (good) doctor would force a patient to undergo it without good reason, and unfortunately blackmail doesn’t cut it.
When people are in severe pain they become desperate, and the fact that he experienced pain from sudden discontinuation is completely normal…it does not mean he is necessarily an addict.
Brett
February 4th, 2009 at 12:54 am
To clarify my last post, I meant that the withholding of pain medication as blackmail was unethical, not necessarily the discontinuation of it (although it should be tapered to be fair).
And I will concede that it is only rarely seriously harmful.
June 4th, 2009 at 1:24 pm
Witholding pain medication that you know is effective is exactly the same as causing the pain. That happens to have a more evocative name, “torture.”
Honestly as obnoxious as House is, law abiding I would have reacted violently to some ass torturing me. I’m funny that way.
June 4th, 2009 at 1:26 pm
I’m not in the chronic pain department, but I did have major problems getting meds after a freaking botched anal fistulotomy.
None of the pain meds did squat for me other than impare my judgement. It would have been nice if he told me that all those weird sounding names were all opiates. My family has an absurd tolerance to them.
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