House — Episode 6 (Season 7): “Office Politics”
An uninspired, uninteresting, and frankly boring episode of House. It’s as if it was written by someone who’s heard about the show, but never actually watched it.
Joe Dugan is the campaign manager for a senator running for re-election. After he develops severe itching and purpura (red/purple discolorations of the skin), he is admitted to House’s team for diagnosis and treatment. His liver functions (ALT and AST) are elevated and he is showing cryoglobulins (abnormal proteins that “thicken” the blood, especially when cold). There is no history of alcohol or drug abuse. The team’s initial diagnoses are hepatitis C (but the tests for hepatitis were negative), or a toxic exposure. A search of Dugan’s house reveals some unpasteurized apple cider, from which Foreman concludes that Dugan has an E. coli infection (there have indeed been multiple cases of E.coli from unpastuerized cider). House starts him on Aztreonam (an antibiotic) and plasmapheresis (to clean out the cryoglobulins). However, while the plasmapheresis is being set up, Dugan becomes paralyzed. The paralysis resolves after a few hours and Chase refers to it as a transient ischemic attack (also known as a “mini-stroke”). The differential diagnosis now consists of Wilson’s disease, a neuroendocrine tumor, or disseminated intravascular coagulation (DIC). House considers the last two both likely possibilities, so tests are run for both — and, of course, both tests are negative.
Luckily, a new symptom occurs: hematuria (blood in the urine), which the team takes as a sign of renal failure. TTP (thrombotic thrombocytopenic purpura) is suggested as a possible diagnosis, but discarded in favor of HSP (Henoch-Schönlein purpura). According to new team member Masters, the treatments for HSP are steroids or chemotherapy. House prefers the latter, but Dugan chooses to go for steroids instead. Nevertheless, House switches medications so he gets the chemotherapy after all. It’s all a moot point when Dugan develops yet another new symptom: pulmonary edema (fluid build up in the lungs). The team’s suspicions turns to infection, especially schistosomiasis, which Taub thinks Dugan might have caught from snails in his fish tank — except there are no snails there, so that idea is out. While at Dugan’s house, Foreman, Taub, and Chase are busted for breaking and entering and carted off the jail, so House turns to Masters for help coming up with a plausible differential diagnosis. They discuss primary sclerosing cholangitis (an inflammatory disease of the bile ducts) and cholecystitis (gallbladder disease), but neither quite fits. After seeing a press conference with the senator on television, House decides Dugan has hepatitis C which he must have caught from the Senator, since House saw signs of hepatitis infection in the senator. House tells Dugan that his negative test was a false negative and starts him on interferon, the a common treatment for hepatitis C. The interferon doesn’t work, so now House and Masters want to infect him with hepatitis A as this, according to a small study cited by Masters, cures 15% of people with hepatitis C. Of course, the other 85% died. Cuddy won’t let them proceed until they can prove Dugan has hepatitis C, but thanks to the false negative test and the subsequent plasmapheresis, the tests would all be negative. House is able to fake a positive test using blood from the senator. This convinces Cuddy and Dugan agrees to the hepatitis A protocol. As the episode ends, Dugan’s condition is already starting to improve.
As usual, major complaints are in red, minor complaints are in blue, and nit-picking ones in green:
As I’ve mentioned before, hematuria (blood in the urine) is not a symptom of renal failure. It can be a symptom of many other kidney problems, but it is not the presenting symptom of renal failure.
You could argue that the patient showed oliguria (low urine output), which can be a symptom of renal failure. But Chase mentioned hematuria, so that’s what I’m going with.
Sharing cocaine/cocaine straws is not a risk factor for hepatitis c infection, which is for all intents and purposes a blood borne disease — unless House is suggesting they both used cocaine so much their noses were raw and bloody, and blood was exchanged this way.
Schistosomiasis is not a bacteria. It’s a parasite.
It’s entirely possible to have a neuroendocrine tumor without “diminished mental capacity” or “loss of judgment.” Pheochromocytoma (a neuroendocrine tumor) has been suggested many times as a plausible diagnosis on the show in people with normal mental function.
Neuroendocrine tumors can occur in the head/brain area, so a CT scan of the neck to abdomen might miss one.
I suspect somewhere out there is a paper which discusses hepatitis A infection curing hepatitis C, but if so, it’s fairly obscure (i.e. I couldn’t find it easily). What I did find was paper after paper noting that hepatitis A superinfection on top of hepatitis C is extremely nasty and, in fact, vaccination against hepatitis A is recommended for patients diagnosed with hepatitis C.
Kayser-Fleischer rings only occur in about 2/3 of patient with Wilson’s Disease, so a normal cornea does not rule out the disease (especially for someone who thinks 15% cure versus 85% death is an acceptable rate).
Hepatitis C treatment with interferon takes weeks (24-48). A few hours is way too soon to tell “it’s not working.”
Seven years of House’s weekly flagrant disregard of ethics and morals, and now we’re supposed to believe he is experiencing a moral dilemma over this patient – a political advisor? This writer has never watched the show before, right?
The medical mystery was rather pedestrian this week (rash and an itch? Oh, and liver failure). I give it a D, which is probably generous. The final solution of hepatitis C almost fits, but the hepatitis A superinfection scenario was far-fetched; I give it a weak C-. The medicine was, again, below average. Jumping from diagnosis to diagnosis without any underlying logic, and totally misinterpreting common symptoms: C-. The soap opera also underwhelming. Wilson seemed to show up just as a contractual obligation, there was no House/Cuddy chemistry, and the new team member is uninteresting at best (more frequently annoying). It also earns a C-.
The review of the previous episode of House
A list of all prior House reviews
November 8th, 2010 at 10:18 pm
Wow, so no fallout whatsoever from Cuddy for House letting her daughter eat a dime on his watch?
November 8th, 2010 at 10:19 pm
Hey I’ve read all your House reviews and found them to be very accurate and interesting. While the medical stuff that you wrote is spot on, I have to say I was completely intrigued by Masters, and I think she’ll be the perfect complement to House for future episodes. I think I’m happier about this relationship than House/Cuddy, and that was a really touching episode.
November 8th, 2010 at 10:27 pm
My DVR cut off short. Did anything happen after Cuddy found out about the fake test and started walking towards the camera?
November 8th, 2010 at 10:32 pm
Oh, Scott, as much as I enjoy and learn from your medical reviews, I’m thinking that it’s about time you stopped watching House for the medicine. But then you’d probably stop watching House. And then there’d be no more Scott reviews, so… never mind.
Anyway, I’m with James on Masters — she’s the first interesting thing that’s happened on House in a long time. Also, House wasn’t having any kind of ethical dilemma about methods of treating the PotW, Masters was having it for him. And the character was done well enough that it was almost believable that her protests might have momentarily attracted House’s attention.
I suppose House did have a minor inner quibble about lying to Cuddy to get what he wanted — but he did it anyway and THAT’S going to start a whole fracas and NOBODY cares, so…
November 8th, 2010 at 10:40 pm
… I can’t help but feel, after watching this episode, that you’ve decided to really lay off critiquing the medicine except for a few points. I spent every few minutes swearing at my television over this particular episode. DIC? Yeah? Caused by WHAT? DIC is not a cause, it is a symptom, and usually from a septic patient at that. And where the heck did they pull TTP and HSP out of? The HSP in particular made me laugh, given how the patient isn’t exactly a 6 YEAR OLD CHILD. Grrrr. Yes, I accept that they will always treat without diagnosis. Yes, they will usually commit B&E. Yes, their idea of diagnostics is painful to watch. But come on, what did the writers do, flip to the ‘rash’ section of a pathology book and just write down the most impressive sounding names they came across, or what?
These days I think it’s this show that needs the countdown, not Fringe. :P
November 8th, 2010 at 10:43 pm
Hey, Pubmed searching easily turns up lots of papers about HAV clearing HCV. Here’s the simple search phrase:
“hepatitis A” AND “hepatitis c” AND (clearance OR clears)
November 8th, 2010 at 10:47 pm
Nothing happened after that Pimanrules, all you missed was the closing credits.
I find Masters to be likable, but I’m not sure what they are going to do with her that they didn’t already do with Cameron. Maybe they will go with that angle — Cameron left because she couldn’t stand House’s lack of morality and what she felt it did to Chase, and she TOLD House that in no uncertain terms. Now House gets to challenge/punish her by proxy.
In any case, I’m assuming she will be going when Olivia Wilde gets back. (Does anybody else feel that Thirteen’s absence leaves a void at the heart of the show?)
I could REALLY have done without the grandstanding on the immigration issue. They opened the show with a fake political add for God’s sake! Totally gratuitous and self-indulgent. One of the reasons I’ve always liked the show is because they generally steer clear of that kind of topical preaching.
November 8th, 2010 at 11:04 pm
Official Comment
Good suggestion, but even those searches return a grand total of 2 papers, one of which is a single case study, and the other has a fairly small n of 17, of which only 2 showed anything resembling a true cure.
November 8th, 2010 at 11:06 pm
@Pimanrules – no, that was the end of the episode.
I liked Masters. The comment about “she’s basically the same age as 13″ made me interested to check their ages, and Amber Tamblyn’s actually 10 months older than Olivia Wilde. That really surprised me. I like her better than 13, if only because she’s newer. Kind of a shame that she won’t last more than a few episodes.
Wasn’t interested in the psychoanalysis of Taub, nor him and Foreman playing basketball. They should have had this patient before the election, not after (major groan when the episode started with a campaign ad). Apart from Tamblyn’s debut, this was an entirely forgettable episode.
November 8th, 2010 at 11:20 pm
@Nonny Amos – kid eating a dime on his watch = relatively normal parenting incident. Faking a blood test = extremely serious medical malpractice incident. Like the ships in Star Trek, real-world rules apply to House at the speed of plot.
November 8th, 2010 at 11:33 pm
Back from my hiatus over the last several weeks and my general take on the last couple of episodes is that the writers are actually trying to make a difference this season..
Sure they fall back every now and again on the old tried and true cliche’s but they’re trying to think outside of the box which shows hope that they can keep the viewers interested.
One thing I don’t get is why House had to lie to Cuddy about the test… He can have anything she has to offer within reason so why jeopardize that unless it was lying for the sake of…
Other than that another episode with maybe 3 minutes of Wilson in it, not something I like to see them going back to because Season 6 was littered with episodes that had scattered bits and pieces of him…
I guess they may feel that in season’s past they overused him a bit but to do a complete 360 to almost no air time for Wilson is not only cheating the viewers who like watching him interact with House, but they’re also removing a possible vector for interesting plot points..
November 8th, 2010 at 11:38 pm
Just FYI, House asked Masters not for Oiler’s number, but for Euler’s number.
http://en.wikipedia.org/wiki/E_(mathematical_constant)
November 8th, 2010 at 11:42 pm
(1) As for HCV from cocaine straws, that’s been bandied about in the literature for some time. This Pubmed search gets close:
“hepatitis c” AND transmission AND cocaine
One of the resulting papers says that HCV is detectable in nasal secretions of at least some infected patients… that’s all that’s really needed to make transmission plausible:
http://www.ncbi.nlm.nih.gov/pubmed/15132748
(2) And it was really interesting with the hematuria. After seeing the urine bag I was watching to hear them trip up and say “renal failure,” but they never did. They said kidney *problems*, which is fair enough.
November 8th, 2010 at 11:47 pm
I forgot to add that this episode while positive for the reason I mentioned above, still failed on many levels and I can’t wait for next weeks smallpox outbreak at PPTH to see if it can ‘kick the series up a notch’.. 1 step forward and 2 leaps back and all that… :)
(not a spoiler, it was a Fox preview at the end of the episode)
November 8th, 2010 at 11:54 pm
I found the episode annoying, Masters to be inauthentic, and the medicine horrific. (By the way, I personally think the Smallpox thing won’t be smallpox)
November 8th, 2010 at 11:59 pm
This episode was pretty interesting for me as a non medical viewer. I realise the writers have been solving the cases much earlier and then using the remainder of the time with decisions. I know all the medicine may not be on par however the show has been running for 7 seasons; there’s only so many medical mysteries. I hope every 1can appreciate the show for what it is: good writing and an enjoyable, although not realistic, plot.
November 9th, 2010 at 12:18 am
Why do you find it unbelievable that House would have an ethical dilemma over this particular treatment? During his conversation with Wilson he in no way indicates that he has a problem violating his patient’s trust. He says that he has lied to Cuddy “1000 times” and wonders how much one more time will hurt. He is worrying about violating Cuddy’s trust, not his patient’s.
If you have been watching the show then you must have realized that the central theme of the season thus far has been House coming to terms with his relationship with Cuddy, particularly in terms of her ability to trust him.
Her reaction to the discovery that he faked the positive Hep C test makes her feelings about this betrayal of her trust quite clear.
Just thought I would throw that out there because I found this episode to be the best this season.
November 9th, 2010 at 12:29 am
He wasn’t experiencing a moral dilemma over the patient, he was experiencing a dilemma between the two options he had to choose from, which Wilson very succinctly summarized: be honest and face the medical consequences (lose his patient, something House would never tolerate), or lie and face the personal consequences (straining his relationship with Cuddy, which he values very much). There was no ethical dilemma.
November 9th, 2010 at 1:02 am
I was so frustrated when they called schistosomiasisis a bacteria!!!! That’s such a simple thing to check and it makes me worry about the quality of research going into the show when they can’t get such basic stuff right. I love the show but… Also, I’m a vet tech but I’ve never heard ALT pronounced “alt”, human med people is this a standard/acceptable thing?
November 9th, 2010 at 1:08 am
Turns out you might be right! The writer for this episode is Seth Hoffman and he has never written any episodes before this, which makes this his first episode!
November 9th, 2010 at 1:23 am
zzzzzzzzzzzzzzzzzzzzzzzz ….. oh! The episode’s over?
Agree wholeheartedly with Scott. Amber Tamblyn’s presence onscreen was irritating at every turn. She seems to have two modes, simper or pout. Her acting is soapish, not up to the standards of this show. You can really see her “acting.”
And what’s with the mini-lab coat? A precocious kid would be trying to look more professional and mature, not like a teenybopper with bad taste.
As for the medical mystery….wait, there was a medical mystery?
November 9th, 2010 at 1:24 am
To be completely honest as a whole I liked this episode BUT! what I did not like was the fact that so much ethical/relationship drama was so well hidden beneath a rubble of crappy medicine. What was interesting in this episode and how the writers handled it:
1. House needs to decide whether he should lie to Cuddy (AGAIN!) or let his patient MAY BE die. Yes may be because Hep C while this advanced might be cured by regular means (like interferon) if you give it a chance. His decision was risky brash and totally in character…the consequences will be far reaching… I cannot wait. But why oh why did they crammed it out in 3 minutes of TV time? It is like Huddy is a background noise now and we need to be reminded by stuff like this?!? Come ON!!!
2. The fact that House used to lie to Cuddy about pretty much everything in his job was hurting but the way he/she treated it this time was VERY important. So just a hint? Cuddy walking slowly towards the camera? that is it? Come ON!!! There is so much U can get form drama here – this show is about charachter and drama now so why skimp?!?
3. The new fellow – kind a like Cameron revised but younger and more idealistic (and not so screwed up yet!). There is tons of fun here and they managed to show it off but still burried it below the crappy medicine. Come ON!!!!
I will not coment on the medicine before I wathc the show woth translation so tata for now. But I must say that drama wise it was a D – the writers really really focused on the wrong stuff here (and where the hell was Wilson?!? 1 minute screen time?!? Come ON!!!!)
November 9th, 2010 at 1:46 am
Yeah, not one of the better episodes. New fellow was underwhelming, but we’ll see how she is after a few shows. I wonder if Chase will hit on her at some point… Seems almost wrong.
Also, as an aside, my parents own an apple orchard, and the idea of cow feces with apples is rather unlikely…
Yes, any apples left on the ground after general picking ARE the juicers… and that includes the wormy, the windfalls, and the bird-pecked ones. Drink hard cider, no bacteria can live in alcohol. :) And not a bad idea to investigate non-pasteurized cider just to be safe.
But excrement, no. A farmer would never let his livestock around fruit trees; it’s easy to knock apples off by just brushing the branches, and cows would eat the leaves and fruits. Ranching and fruit growing are also completely separate fields, literally and figuratively.
November 9th, 2010 at 1:55 am
Oh, Dr. Bulgaria, you’re such an incurable romantic! They can’t just END the Huddy relationship; it has to unravel. I think they are just pulling the first string. House didn’t seem to be too broken up about the fact that he wasn’t broken up about lying to Cuddy. As for the “drama,” it’s always sudsy, they just added a little water to the mix this week, is all. And as for Wilson’s lack of screen time: he doesn’t have tits and that doesn’t fit in with where the show is heading these days. You’ve been a hard-core “Huddy” fan from the get-go, but you failed to see (but are probably becoming aware of it now) that when you change a TV show’s dynamic in such an acute fashion, you change (screw up) the show. Sorry, man.
@ Lisa: Didja have a nice nap? And the answer to your question, “WAS there a medical mystery?” is “Yes.” The mystery is “Who writes this crap?”
November 9th, 2010 at 2:05 am
Love Amber Tamblyn but initials of MMM? Really?
2 seconds of Wilson? Gah.
Only part of theshow I loved was the b-ball game between Taub and Foreman LMAO. Somehow the interview is not the only connection I think.
And jail AFTER they already broke in before? WTH? (again, Taub was HYSTERICAL….so underused).
I miss 13 terribly. As much as I think Masters would add something to the show–a mini-Cuddy–she’s too much like a Cameron-lite.
So…that’s it…the beginning of the end of Huddy?
Next week–it’s Euphoria all over again.
Sadly this season is my least favorite of all :(
November 9th, 2010 at 2:18 am
I quit watching in the middle for the first time for this show.
The characters were caricatures of themselves from previous seasons.
I don’t know what they’re trying to do with 3M. They hire her because she’s a progeny, or because “sausagefests” are no good for diagnostics departments?
They should have used CGI to make Taub look competitive at basketball. It was as bad as the beach volleyball scene in Top Gun.
November 9th, 2010 at 3:29 am
Thanks for the review. Just wanted to add that:
“Scott November 8th, 2010 at 11:04 pm
Official Comment
Good suggestion, but even those searches return a grand total of 2 papers, one of which is a single case study, and the other has a fairly small n of 17, of which only 2 showed anything resembling a true cure.”
A 2 out of 17 cure rate roughly equals 12%. The show mentioned a 15% cure rate, so it’s entirely possible that the paper you stumbled upon is the one the show was thinking of.
November 9th, 2010 at 5:17 am
The cases of infection from unpasteurized cider I remember (possibly from the 1990s) involved orchards that had been fertilized with manure, not animals actually roaming. I can’t imagine there’s a huge risk from cider that isn’t made from drops (and there’s a definite taste difference: even very fresh pasteurized cider has a slightly cooked taste, slightly sweeter, whereas unpasteurized tastes amazingly like a fresh bite of apple).
Schistosomiasis is caused by a bacterium? Yes, “House” writers, now let’s go study up a bit before we try to sound medical again, shall we?
Also, “House” writers, most highly-intelligent people don’t actually have an encyclopedia in their head. Masters is incredibly irritating.
Now, is Cuddy devious enough to have called the police to force House to pick Master’s brain, is House evil enough (we know he’s devious enough) to call the police to give himself a more-graceful way to go back on firing Masters, or did the “House” writers just throw that in there without realizing the extra humorous potential?
November 9th, 2010 at 5:27 am
Precocious bambina med student joins elite ddx team at the insistence of the dean of medicine??? The premise is even lamer than the medicine in this ep.
November 9th, 2010 at 6:23 am
@Adamantyr: There was at least one case I know of where deer entering orchards at night caused an E Coli outbreak in unpasteurized Cider. It affected enough people to make the news a while back.
I had an E Coli infection this summer. It entered through a JP I had installed after surgery. My symptoms were fever, vomiting, and uncontrollable chills. I was treated with intravenous antibiotics.
I know two people with Hep C. The treatment takes months and only then do the doctors know if it worked or not. To know after one injection seems preposterous. Also, isn’t a transplant the preferred treatment if progression of the disease has made liver failure imminent?
I liked the soap in this one. House has always found it easy to lie to his friends and patients but lying to Cuddy. . .? How much does he really love her?
November 9th, 2010 at 7:07 am
headacheslayer
November 9th, 2010 at 2:05 am
“Love Amber Tamblyn but initials of MMM? Really?”
Hey…..My initials are M.M.M. ! what’s wrong with that?
Scott, they mention that the test for Hep C was false negative and would stay negative because of the treatment and plasmapherisis, but I was of the impression they never did plasmapheresis because he became paralysed while they were setting it up?
I didn’t hate Masters but found her a little annoying (like Dogie Howser MD) and yea over all bad medicine, but Taub and Foreman playing B-ball were great and Taub and the prison potty was good too.
November 9th, 2010 at 7:34 am
Terrible episode except for Taub. What’s next after the precocious med-school student? A talking monkey?
November 9th, 2010 at 7:52 am
I thought the Hep C cocaine was a bit of a reach until I googled it. It seems even without sinuses like hamburger it’s likely to transmit.
This episode had a few things working against it being a good one. First they are setting up a character. She is going to be a foil for House, and a conscience on the show. Second they set up Cuddy/House break-up or a major fight. Thirdly they had a guest star which tends to lower the quality of the writing as they try to showcase the star (Jake Coleman HRG from Heroes)
As for the politics about the immigration ad, the whole show seemed to show it as cynical ploy at a level of cynicism that even shocked Chase.
November 9th, 2010 at 7:58 am
So that’s Amber Tamblyn? I thought she was refreshing. It was a retread of the Cameron “moral conflicts,” sure, but without the sexual tension–instead the intellectual competitiveness (yes, I am 2 1/2 feet tall and a girl and just a med student but I am very very smart and I can play your games quite well).
The medicine was confusing and even though the soapery was minimal the medical dilemma seems to have been twisted to fit the soap–i.e. to put House in a position to lie to Cuddy.
Ok, doctors: A is an associate of B and A is sweating on TV (and may also have purpura signs, if I heard right, the symptom for which he sent Dugan aka B to the hospital), therefore A has Hep C, therefore B has Hep C, but I can only prove this by pretending A’s blood is really B’s, which will allow me to start a treatment that is 85% fatal on B, while of course leaving A untreated…? I just didn’t get any of this. Even aside from the bizarre “sharing straws” thing, and the fact that the interferon presumably would cure Dugan if they gave it time, how come Dugan is dying and the Senator doesn’t even need to know the results of the blood test?
Taub was great. He is such a huge resource and it was nice that they actually used him. His face when she acknowledged that she had recognized him….!
November 9th, 2010 at 8:09 am
Great episode! and to the reviewer…the episode was not boring, it was interesting
November 9th, 2010 at 8:13 am
After firing and re-hiring the 3rd year medical student a half-dozen times, this episode should have been titled: ‘You’re fired….again!” The important thing, though, is that it certainly made me chuckle.
November 9th, 2010 at 8:55 am
I’m sorry Dr. Scott. While I have disagreed with your opinions on some other shows before, this is the first time when my respect for your analysis was diminished because of it. This was an elite episode, with an ultra-realistic P.O.T.W., a great ethical dilemna which cut across both medical and soap opera aspects, and a new, upgraded Cameron with principles grounded in ethics, intelligence and reason. This was an episode that makes me proud to be a House fan, and the fact that this was written seven seasons in is a testament to the strength of this series.
November 9th, 2010 at 8:57 am
@Adamatyr. We’ve had some huge e-coli contaminations of produce –like remember the big lettuce recall?–because of runoff from upstream ranches to farms.
btw, one other error about this episode that struck me as odd for the writers of House is differentiating school-type brains from great analytical brains. MMM can memorize everything and knows math, but she actually seems on the dull and slow side when it comes to applying her knowledge to problem-solving.
Didn’t you KNOW that at the end of the show, she was going to make clear that she’d remembered Taub all along?
November 9th, 2010 at 9:23 am
Scott, you’re not considering the Cuddy factor when it comes to the morality. Heck, the only reason House even CONSIDERS the situation a ‘moral dilemma’ is because of his relationship with Cuddy, and the potential fallout.
November 9th, 2010 at 9:32 am
I don’t think she remembered Taub – I think Foreman told her to mention it to Taub, to help smooth things over.
November 9th, 2010 at 9:32 am
you all do realize the show its in its seventh season right?
i think the show is doing fine. you got a whole lot if Wilson last episode, i’m guessing that isn’t enough. and to those of you hating on how the show has changed. you are all pathetic, grow up, life changes, and to the author of this article…. the show is fine, stop whining….gosh!
November 9th, 2010 at 9:54 am
I’m a 4th year medical student and the more I advance through school the less I like House! The methods they use are entirely inplausible, unethical and illegal! But we all accept this for the sake of the entertainment.
The thing I cannot accept is twisting the medicine upside down! Like in this episode with Shistosomiasis, renal failure, ultra speedy test results, Wilson’s disease…Not to mention the hep A treatment. Their differential diagnosis is terrible, it’s like they don’t have doctors in the writing staff.
I know that this show is not for doctors, but ppl might get a wrong perspective on medicine!
November 9th, 2010 at 10:23 am
@Lisa, she wears a shorter white coat because she’s a student. Next time you’re in a teaching hospital, look around; anyone wearing what looks like a mini lab coat is a 3rd or 4th year med student on clinical rotations, and the long coats are the actual MDs or DOs. In fact, med students are often referred to as ’short coats’
@mianmar, me too! Also a 4th year. How’s residency application treating you? I used to love this show, but now watching them bandy diagnoses around with no rhyme or reason drives me insane. And what do they mean they ‘hired’ a third year? That’s ridiculous. So is this like an elective rotation, or is she dropping out of school or taking a LOA? It’s absurd, I don’t care how smart you are, the first two years do NOT prepare you to be a clinician. Thinking about this is making my brain hurt. Ugh.
November 9th, 2010 at 10:35 am
The mystery was awful, but I think the point was to further develop characters, which seems to be all they do lately.
I too could care less for 3M but I see a potential for this character to interact more appropriately with House. I can’t imagine her telling on House everytime. Think of each episode how awful things would turn out if patients knew everything that House was trying. Maybe there will be a middle ground and get the genious with a dash of personality.
Despite the downsides, I never laughed so hard. The basketball was good and the constant jabbing at Taub was great, but what made me laugh the most was Chase… yep, Chase. His character has become someone that just enjoys every bit of his job and finds all the comical nuances associated with working for House and dealing with over the top patients and an over the top boss. His comment about the bunny to the buzzsaw was hilarious and well put.
November 9th, 2010 at 11:02 am
1. Perhaps M.M.M. is an intentional “cutesie” since M is the 13th letter of the alphabet, thus making her 13.13.13.
2. Did I miss the explanation of WHY Cuddy was so insistent on House “hiring” a 3rd year med student? Why didn’t she pick a qualified female if she was so anxious for House to replace 13 with a “non-sausage”. And hiring a med student is ridiculous at best regardless of how brilliant she is. Does it mean that anybody with a genius level IQ should be allowed to practice medicine with minimal medical training?
3. How the heck can Masters and 13 be “basically the same age” on the show? Unless I missed something, Masters is supposed to be about the right age for a 3rd year med student because she “spent her time waiting to start med school earning 2 Ph.D.’s” On the show with the way they make her act and dress and the way they talk about her, she is supposed to be a relative “youngster”. Unless 13 is also a genius who did accelerated studies, she would have graduated med school at 25 or 26, then done a residency of at least a couple of years, and has been working for House for 3 years. And that makes her 30 or so.
November 9th, 2010 at 11:33 am
If I’m recalling my House history correctly Dr. House has been working for Cuddy for the better part of a decade, maybe longer. For seven of these years we’ve seen a little over 130 of House’s patients. With a majority of these patients we’ve seen House march into Cuddy’s office with a radical solution that carries with it a potential for death. (In this case death is a certainty with no treatment and mathematical likely hood with treatment) Cuddy says “get me proof” and in every single one of these situations House has lied to comities, faked tests, lied to patients or just out-right done it anyway. So when she tells House “get me proof” and he shows up with it she should know full-well this “proof” under the guise of “Er, we found a way to get it,” is about as genuine as a supermodel’s chest. But NOW she has a problem?! Another mark goes under the “Not Realizing the Main Character is Always Right” trope.
November 9th, 2010 at 11:53 am
One of the things that intrigued me to House when it first was aired was when they went in and showed anatomically what was happening. Remember what I’m talking about? The CGI of the cells replicating or virus attacking or heart stopping. I know they haven’t done it for a couple of seasons, but does anyone else miss this? I still enjoy the show, but I think that is a piece of it that is missing.
November 9th, 2010 at 12:22 pm
@Ryan When House was first invented, it was meant to be like a medical spin-off of the CSI franchise. Turns out it moved way beyond that (and pdq at that) (which is a good thing) and by now, it’s a fair bet the demographic is way more fascinated with the soap and the characters than extraneous CGI fireworks (which also have become commonplace, and thus boring, if not skillfully embedded into a significant concept.)
About Masters, it’s way overdue to team House “everybody lies” up with someone who strives never to lie, on principle. And call me a sadist but the pained expression on her face each time she realizes she has pushed another bunny into the buzzsaw is priceless.
Am I the only one who was certain it must have been her who sicked the cops onto the other three on their second burglary of the episode?
November 9th, 2010 at 1:33 pm
i think amber’s character is a parallel of house himself.
November 9th, 2010 at 2:34 pm
Recently “Shistosomyasis!” has become one of my favorite expletives!
November 9th, 2010 at 2:36 pm
The CGI of “innards” is sometimes called TMI-cam (where TMI means too much information) but I miss these bits too. I first saw them on CSI and they have probably been used on other shows. Probably expensive.
November 9th, 2010 at 3:02 pm
I find it ironic that this episode, which inveighed against libelous political attack ads, was produced and aired on the Fox Network, whose Uber-Fuehrer Rupert Murdock also owns Fox News, one of the chief purveyors of libelous political attack ads.
November 9th, 2010 at 4:11 pm
Brian, yes – it seemed to me that, since Cuddy is familiar with House’s behavior and ethical code, she must have actually asking him to provide her with something that she could point to as proof rather than proof that she herself would actually believe in. Surely she couldn’t be so naive as to think he wouldn’t prevaricate a little in the cause of curing the patient? And then at the end of the episode it becomes clear that the writers meant us to think exactly that. It’s a new low in terms of their portrayals of Cuddy as completely incompetent.
November 9th, 2010 at 4:12 pm
I always leave my comments -before- reading the replies others have left so as not to be influenced when leaving mine. (and am sometimes VERY surprised to be 180 degrees off from just about everyone else!) But I watch as a person who has little to no awareness of the accuracy of the medicine, thus am providing an opinion based mostly on the “entertainment” value of the episode. With that said….
FINALLY a great episode after waiting through the first six! I liked the new Med student, the plot was interesting, good humourous moments; (Taub stressing over the fellow inmate using the toilet, the one-on-one bball game between him and Foreman) the campaign manager was an interesting character and did a good job; the Senator seemed sleezy right from the get go (in character) and proved to be exactly that eventually; good Cuddy/House subplot. Only complaints were NOT ENOUGH WILSON (!), and Chase is getting more and more unlikeable as time goes on: what a miserable person he is becoming.
November 9th, 2010 at 4:32 pm
If I recall correctly we did gets some “TMI Cam” moments last season. But, yeah, none so far this season and its use has dropped a lot as the series has marched on.
November 9th, 2010 at 4:44 pm
- Sigh -
Thanks for your reviews so far.
As a 4th year medical student myself, I can’t help but feel completely disappointed by what they’ve decided to do with the series. The diagnoses are making progressively less sense episode by episode, season after season, with this episode hitting absolute rock bottom with the Hep C diagnosis. Oh, the patient now has pulmonary oedema? Couldn’t be because you bombed his system with chemo which is known to cause pulmonary edema, no. It has to be this other thing where you have about 20% chance of it even being the right diagnosis and you’ve going to treat it with something that is nothing short of a miracle if it works. And then you’re lauded for being a good doctor.
Back during the first seasons, our anatomy instructor would tell us that House is a good series to watch if you want to learn all the exceptions to the rules. Since about season four or so, every diagnosis has actually followed the “rules” ad absurdum – like no KF rings ruling out Wilsons, or no altered mental status ruling out tumor. Come on, that makes my brain hurt. Diseases don’t play by the rules and House of all people should know that. The characters used to find things nobody else would find – now they’re just riding on sheer luck and would be sued for how they practice before they even got started.
To top it all off, the new character is completely uninspired. A prodigy? Seriously? That was the trump card you had up your sleeve? So now the team of unparalleled super special omnispecialists gets an even more special doctor that is so special that she has two PhDs in unrelated subjects and it somehow helps her practice, and is given special permission to practice medicine without a licence. Actually she’s so special she even makes all the older extra special unique genius doctors think about their ethics. What am I watching, Naruto? Not to mention her lines were thoroughly bad and didn’t feel like they added anything one single time.
This used to be a show doctors could enjoy, too – one you could talk with your teachers about. There’s no special money in that, evidently, but it sure was a nice thing to have and to discuss with friends. The latest seasons, you’ll just be ridiculed for even thinking it resembles anything like real world medicine. Now — series = dropped if next episode is equally unentertaining
November 9th, 2010 at 4:45 pm
@Devon. thanks for the lab coat info.
One more whine about MMM. If she’s so brilliant, why does she not know the correct usage of the singular first-person pronoun? Should be “shoter than I” or “smarter than I” rather than “me.”
November 9th, 2010 at 4:57 pm
Triple M is cute ;)
November 9th, 2010 at 5:11 pm
There’s just no magic in this show anymore.
My theory is: the show’s premise used to be “Sherlock Holmes in a labcoat”. That is, metaphorical labcoat, I am in no way implying House should actually wear one. I mean, his reasoning for why he doesn’t is part of what makes him House, and therefore awesome.
*cough* Anyway, the premise. It was good. The mystery, and solving thereof, was the central point, the whole idea. The show thrived on it. House’s personality, the quirky patients, all the little clever tricks, reverse psychology, the analytical approach to everything, it all fueled this atmosphere. It was like watching a no holds barred battle of wits between everyone involved.
What made this good premise into a great show was the additon, for a want of a better word, of the drama. That is, cast interaction not explicitly connected to the case at hand. It was what held the show together, made it not exist in a vacuum. Various, well pronounced characters fleshed out the cases, allowed us to look at the mysteries from all the different angles. Also, the drama provided additional views, wants, tactics and agendas for the aforementioned mental warfare. House needs someone to spar with, and lo, there’s a team of doctors willing to undermine him just as he undermines everybody.
The point is, the drama identified the premise and built upon it. It, like Wilson, was an “enabler” – allowed the producers to do more and more varied things, while staying within the philosophy of show. Which I would, incidentally, personally describe as “Throw logic at it until it breaks.” And let me tell you, that’s a fine, fine philosophy.
But now? Something has changed. The soap opera elements actively hinder the main idea, to the point of sometimes eliminating it completely. Where’s the mystery, the traps, the intellectual angle? Where, god dammit, are the puzzles? The lateral thinking, turning the case on its head, unconventional approach not to the medicine, but to the very process of tackling a problem? It’s as if the once disturbed status quo has not restored itself even now, and the show is tumbling blindly is search of its own premise. It discarded what it had, hoping to intoduce more variety, but is it a move that truly paid off?
Now, I’m not saying that change is bad. Perhaps this was the only way forward. And maybe a show like House just can’t go for seven seasons and retain its spark. But then it might have had been for the best to end it while it still shined, because what we see now is a mere shadow of what used to be a damn good entertainment.
Oh, look at all those words. I sound like some kind of priest. Didn’t mean to go all evangelical on you, but it’s a shame, seeing such an exceptional franchise get the zombie treatment. House might yet go and exist for another ten seasons, but I hardly see any life left in it. Sometimes it’s better to just let go and hope the idea itself prevails in some new, other way. Here’s to the future.
November 9th, 2010 at 5:24 pm
I think we can give the Hepatitis A superinfection treatment a pass. After all, it’s not as if the way House practices medicine would be acceptable in any real-world treatment scenario. Maybe it would be extremely unlikely to be effective in the real world, but “far fetched” isn’t a reason to knock off points for House. If he cured him with chicken soup, love, and affection, then maybe. But risking killing him? That’s right in line with the character.
November 9th, 2010 at 5:26 pm
Oh, and I’ve known quite a few heavy cocaine users and many of them are unwilling to share straws/bills for fear of transmitting [something]. If the advice has made it out to them, it must be going around the clinics pretty heavily.
November 9th, 2010 at 5:28 pm
Not sure if anybody else mentioned this, but “ALT” should be pronounced “A-L-T” by its individual letters, not the way MMM said it like a word rhyming with “halt”.
And how come nobody considered a liver transplant for the patient at any point?
November 9th, 2010 at 7:19 pm
At the end of the episode when Taub and 3M are talking in the locker room I can not understand what he said to her. Apparently she didn’t either and he then told her not to worry about it. But what was it?
November 10th, 2010 at 12:32 am
@ Randall: That was a pretty good synopsis of what was right and what now is wrong with this show. I think what you were trying to say at one point is that House is no longer a “critical thinker.” He just “throws it out there and hopes something sticks.” That points to a lazy writing staff.
Maybe everyone is losing interest…
November 10th, 2010 at 12:55 am
@Nonny Amos
That’s how you pronounce Euler.
Also, I enjoyed it, although I think I was just fond of the maths nerd in it <__>
November 10th, 2010 at 4:38 am
@Jeremy,
I was wondering that, too – something about grandma and a tea cozy?
November 10th, 2010 at 5:21 am
1. I think Scott’s point about the unlikelihood of Dugan contracting Hep C from cocaine use being unlikely shouldn’t be overlooked, but that it actually wasn’t a problem at all. Because I don’t think he got Hep C from cocaine. The longing look Dugan gave the Senator at the end wasn’t just from getting fired in the name of winning an election. I think he did get it from having sex, and conveniently used the cocaine thing as a cover (it’s never really proven that either of them used).
I suppose the “everyone’s a closet homosexual” thing is becoming cliche on TV these days, but it was the former governor of the very state of New Jersey who came out just a few years ago. This wasn’t spelled out explicitly by any stretch, which is why no one’s picked up on it here. But add “everyone lies” to the fact that it’s much more likely he got Hep C from sex than cocaine use, and the longing looks at the end and the wife coming out of nowhere, and I’d say the conclusion was pretty obvious.
2. Yeah, the ad at the beginning was jokingly terrible, but sadly not far from what we had to endure in the month before the election (and this episode really needed to air last Monday to be more effective than the afterthought this political stuff seemed now). But you’ll notice how they never stated which party the Senator belonged to. Yeah, a sleazy political guy does seem cliche again, but the truth is we don’t really know what goes on in campaigns behind the negative ads, and don’t realize how much image and perception become reality in the political world. The Senator apparently leaked a negative ad he didn’t like and was obviously preposterous and based on flimsy evidence, fired his excellent campaign manager who wanted to show the ad in the first place to save face, might be a cocaine user, and apparently cheated on his wife with a man, picked up hepatitis C, and made sure his doctor put a fake name on the test results so that no one would know he was there. And yet his squeaky clean image remains intact and he takes the election.
3. Amber Tamblyn’s acting probably seems soapish because that’s where she got her start, on good old General Hospital. And yes, it did seem a bit over the top to me compared to who she was around, but at the same time she didn’t seem like anything I’d seen her in before. I could forget who I was seeing on the screen, and yes, this is a sign of good acting (generally). And since it’s obvious she’s intended as a foil, I don’t actually see this as a problem.
I think the greater problem is what I’ve been harping about for years, and still remains a problem with the show. This is of course the unceremonious booting of that other Amber from the show at the end of season 4. This was a move made for purely monetary reasons, and look what has happened afterwards. Kutner doesn’t make it through a full season of the show before leaving, and they decided Cameron was unnecessary and fired her too. So they had the money to keep Anne Dudek, and could have at least brought her back if they hadn’t stupidly decided to kill her (although this didn’t stop them from bringing her back anyways).
But then of course, they couldn’t have House in a relationship because they didn’t want to ruin his loner status. So what do they do? Force a relationship with him and Cuddy instead, that came out of nowhere and is obviously doomed to failure. This is something House has known for years, but is now apparently ignoring because of his desire to have sex with Cuddy. So we’re supposed to believe that Cuddy knows that House just wants to have sex with her and is okay with that and left her boyfriend who’s nicer and cares about her and her daughter for this.
So not only did they have the money to keep Anne Dudek as a cast member, they also could’ve explored a relationship between her and House without destroying his character, as apparently the plan was (or quickly became) to allow House to have a relationship after all. Wonderful.
I still maintain that House jumped the shark with the killing of a minor character who hadn’t been on in any previous season, hard as that is to believe. And I also realize that term has become cliche and is definitely overused and misunderstood. Jumping the shark isn’t because of a subpar episode, which will happen on most series from time to time. It’s when a series is irrevocably changed for the worse. Some may feel this was much earlier medicine-wise, and maybe there’s an argument for that. But soap-wise, season 4 was wonderful, with House’s Head still standing as the series’ best episode.
But the truth is that a true romantic interest for House has been lacking since then, and nothing that’s happened story-wise has been able to make up for that. So I’m certainly willing to start the Hamber up again, even though obviously there won’t be anything developing along those lines here. And I guess I should admit that I’ve got a thing for quirky girls like the one Tamblyn is playing. But even though Cuddy’s blatant sexism is amusing for its irony, she’s actually kind of right that the show has been missing an engaging female personality to go along with House (yeah, Thirteen’s sorta hot, but she’s practically one of the boys when it comes to strip clubs and making out with chicks). True, a lot of the criticisms about 3M are valid (her morality is probably a bit too similar to Cameron (so why was she let go again?), and having a med student on a team with multiple doctors (even if she’s technically a doctor in other disciplines already) who make life or death decisions and perform all their own tests is difficult for even the layest of men to believe). But I’ve got no complaints about this direction, even if it’s only going to last for a few episodes.
November 10th, 2010 at 6:19 am
@ Joseph Fischer – You don’t sound like a person who watches Fox News, so I’m just wondering how you know what kind of ads they run.
November 10th, 2010 at 7:01 am
Dr Scott: You deserve a medal. To be able to still watch House after most fans would agree (and have agreed) that the best episodes are behind it (Seasons 1-3) is extraordinary. I no longer watch House nor do any of my colleagues, however, I have enjoyed your reviews and comments when I do occasionally (once every few months) drop in on the blog. Good to see some of the usual suspects are still here.
@Linda: Yes things do change. Why does that necessarily mean they have to change for the worse! That 7th season excuse is a load of nonsense. They’re not running the New York marathon!
Finally. Schistosomiasis! A bacterium? LMAO. Only if its in Austin Powers as a joke. Even Grays knows better and they spend more time having sex than practicing medicine.
November 10th, 2010 at 8:44 am
Lisa–Teachers correcting people for saying “Shorter than me” and “Charles and me went” has led to people saying “between you and I” with no clue as to why it is not correct. .Why don’t we just redefine “than” as a word that can be either a conjunction or a preposition, instead of contributing to the loss of the objective pronouns by convincing people that the nominative form is somehow more correct in cases where the objective comes naturally?
November 10th, 2010 at 8:56 am
I am not in the field of medicine.
I would like to point out one thing though…
The hep c link came from the politicians wife, sorry.
1) Campaign manager did not admit… infact he said he would deny it after questions of that even being possible.
2) The end spot of campaign manager watching the tube where the politician thanks his wife. There is a key reaction to the wife. Not a reaction from the campaign manager because he thought he should have been given that credit.
He is a campaign manager…. he knows that is the thing the politician should say there..
November 10th, 2010 at 8:58 am
@ Jeremy, Taub asks ‘Is this Grandmas tea cozy?’ in reference to House asking Masters if her Grandma gave her a cruddy tea cozy for x-mas would she lie and tell her Grandma she liked it. Taub is asking if Masters is lying to him to be nice and spare his feelings.
November 10th, 2010 at 9:43 am
I’m glad there are so many good, well-thought out reviews and opinions. Scott has a very literate crowd of followers and I enjoy their reviews and opinions every bit as much as his. I’m glad for all that because all I can think of to say is that I hated the episode, I hated Masters AND Amber Tamblyn (sorry, Russ,) I hated Taub’s and Foreman’s competition (the “Lockdown” episode last season was much better between the 2 of them) and I even hated the medicine, even though I’m not qualified to have an opinion on the medicine. I’m mad at Hugh Laurie for agreeing to film the script, when surely he must know better by now. BUT– and this might be a huge BUT– if this episode leads to the end of the “Huddy Catastrophe,” I will happily give ALL of it an A+! :)
November 10th, 2010 at 11:10 am
TO THE MEDICAL STUDENTS HERE WHO SEEM TO USE THIS SHOW AS SOME SORT OF EDUCATION, YOU PEOPLE NEED TO STOP. THIS IS ENTERTAINMENT AND IT’S FICTION. THE SHOW IS DOING GREAT, NO LIKE PREVIOUS SEASONS, BUT IT HAPPENS TO EVERY SHOW. IF YOU GUYS WERE TRUE FANS YOU WOULD SUPPORT THE SHOW ON WHATEVER DIRECTIONS IT TAKES. I HAVE A FEELING THE ENDING WILL COME AS A SURPRISE AND SATISFY US FANS..HAVE PATIENCE! ALSO REMEMBER THIS IS ENTERTAINMENT. HOUSE RECEIVES TOO MUCH CRITICISM FOR A SHOW THAT HAS BEEN AROUND FOR SEVEN YEARS. I JUST HOPE IT END WITH A SEASON 8 SO THE WRITERS CAN FINALLY BE AT EASE, AND NO MORE TRASH TALKING ABOUT IT.
November 10th, 2010 at 11:58 am
Unfortunately Fox will keep making this show until Hugh Laurie decides he’s had enough. What else could they replace it with anyway? One of their prime time shows is a cooking show.
November 10th, 2010 at 1:19 pm
A bit shocked you didn’t think much of the soap, Scott, as I usually tend to agree with your grades there. While I can’t say I “like” Masters, she certainly didn’t come off as annoying, just a person who isn’t screwed up, but happened to be in a room with House. House’s “moral dilemma” really wasn’t a dilemma or OOC; if he wasn’t with Cuddy he wouldn’t have hesitated to fake the test. I didn’t notice anything out of the ordinary with the PotW either, he gets cured, personal matters make it bittersweet, play some indie music, life goes on. it didn’t seem to be handled any better or worse than a typical episode.
As far as medicine goes, I think someone is reading this blog, as the entire season so far has been giving the medicine a “season 3″ type of spotlight. Certainly more so than the last two. But I guess the more medicine, the more apparent the flaws in the differential are.
November 10th, 2010 at 1:26 pm
@Ben: Clearly you are not in any way affiliated with the health care industry. Most people in our field don’t watch TV medical dramas because of the old “Busman’s Holiday” analogy. However, you must understand that health care providers have chosen a difficult and demanding profession, and certainly a noble one. The few TV medical dramas I have watched over the years have some modicum of truth or realism to them; however, there are always a lot of “procedural mistakes” or situations where such-and-such a thing would not occur in real life. However, the whole premise of House is that he diagnoses the exotic and little-known diseases, or at least figures out what no one else can. The problem with this is that you need to be very careful – the body works the way it works, you can’t change that. And most diseases attack, or affect, specific systems. Attempting to throw red-herrings into the mix, as House does pretty much every week, doesn’t make the story line more interesting, it makes it more ridiculous. Medical students are taught to think a certain way, to trust the science. And that science is supported by emperic and laboratory evidence. House often makes a mockery of that and of our profession as a whole. That’s insulting. (I have friends who are paramedics and were standing on their chairs screaming at their TV sets during last season’s finale; the episode made medics look like total idiots. They no longer watch.) In any event, I do not know one medical student (and I work with quite a few) who holds House up as a professional standard or uses the show as a training tool. They like it because of HL’s talent and humor, primarily. But it is a very good example of what NOT to do, as a health care provider. Nonetheless, for people in our profession, sometimes the “medicine” in this show is difficult to swallow. Pay closer attention to Scott’s reviews; he’s pretty much spot-on in his criticisms.
November 10th, 2010 at 2:30 pm
“unless House is suggesting they both used cocaine so much their noses were raw and bloody, and blood was exchanged this way”
yeah i imagined that that was his suggestion.
November 10th, 2010 at 6:01 pm
Where’re the challenge scores
November 10th, 2010 at 6:16 pm
Boy, I miss Thirteen (and Cameron, by the way!)!!!!
I hope it’s really a temporary replacement, 3M is just boring, not to mention that Amber Something’s acting skills are ludicrous. I liked those episodes with a “Female Doctor of the Week” much better.
Anyway, I’m enjoying 7th season, House and Cuddy’s relationship is very interesting, we can see he hasn’t changed his anti-social and positively crazy self, but he’s trying not to hurt her with his actions, and that’s apparently the best he can do. This episode was the weakest so far, but I hope it’ll get better.
@ Ben: “IF YOU GUYS WERE TRUE FANS YOU WOULD SUPPORT THE SHOW ON WHATEVER DIRECTIONS IT TAKES.” Boy, could you be more wrong? Fans have no obligation to support a show if it changes for worst. The writers have the obligation to keep doing a great job, specially for a show that has lasted more than six years and is making a HUGE amount of money. And please, learn to use Shift and Caps Lock, will ya?
Scott, love your reviews! Even when I don’t agree with them, it’s great to have a different perspective. Keep up the good work! :)
November 10th, 2010 at 6:25 pm
I actually liked Masters and this episode. I’ve always been interested in how medical students are “broken in” in the real world. I visualize that “deer in the headlights” look whenever the thought comes to mind. When Masters had just that look on her face, it felt real to me. I think she’s a good actor.
Here we have a med student being tossed right into fast-paced diagnosis. To me, that’s interesting, especially with the added notion that she’s a genius of sorts.
I want her to stay. 13 is totally uninteresting to me. I was hoping the Huntington’s would have killed her by now.
November 10th, 2010 at 6:37 pm
Actually…. Foreman never said the patient’s kidneys were failing when him & Taub discovered the blood. His exact words to the patient were “It looks like your kidneys are having problems too.”
Kidney “problem” is also the term the team uses when discussing the symptom.
November 10th, 2010 at 11:45 pm
How hard would it have been to actually test the apple-cider residue for E. coli rather than just guessing that it might have contained some, and then treating on the basis of that guess? Even if you call it a deduction rather than a guess, surely it’s not that hard to run a test, or even put it under a microscope?
November 11th, 2010 at 2:57 am
House is off the pills and has started dating Cuddy. Those changes, along with many other small hints, suggest the writers are daring to allow House’s character to change. As he is the main character, as opposed to some flat supporting role, this should be welcomed by viewers as more true-to-life, not to mention more interesting. Would you rather they leave him completely static like some statue, so we can all see the same thing every week for years on end? I suspect many would answer, “yes.” Nevertheless, I think the writers have done a good job incorporating some gradual change in the character while not losing some of the fundamental character traits that have made the character attractive to viewers.
So, that’s to say, I do think the writers of this show have seen the previous episodes.
November 11th, 2010 at 9:09 am
An opened container of cider sitting in the garbage in a warm house would probably be overrun with air borne yeast and lactobacillus. The treatment for e coli will start to work before blood tests confirm and is basically harmless unless the patient is allergic.
November 11th, 2010 at 9:21 am
@MEDMAVRX…YOU MEAN TO TELL ME PEOPLE WATCH GREYS ANATOMY TO HELP THEIR MEDICAL FIELD. IT’S FOR ENTERTAINMENT. I KNOW A LOT OF PEOPLE WHO WATCH GREYS ANATOMY AND THEY WATCH IT FOR EVERYTHING, THEY DO NOT CARE IF A NEW DOCTOR IT’S ON THE SHOW AS LONG AS THE WRITERS ARE GOING SOMEWHERE WITH THE DOCTOR. THEY APPRECIATE THE SHOW AND REALLY DON’T COMPLAIN ABOUT CHANGES. HOUSE FANS SHOULD TOO INSTEAD OF SAYING THE SHOW IS NOT THE SAME AND I QUIT WATCHING IT. I HAVE BEEN WATCHING THIS SHOW SINCE THE PILOT AND ALL I CAN SAY IS THE WRITERS HAVE DONE A GOOD JOB FOR THIS LONG.
November 11th, 2010 at 11:09 am
^ lol he mad
Writers write the show, producers produce it, directors direct it, a network buys it, and we watch it – which pays for the network’s expenses in ad revenue. Nobody owes said people anything if they start doing a bad job. Get over yourself. All true fans are fans of a show’s qualities, not its name; if it loses those qualities, there’s no reason to stick around.
November 11th, 2010 at 11:57 am
What happened to the House Challenge?
November 11th, 2010 at 2:34 pm
this was a horrible episode period. end of story.
November 11th, 2010 at 2:45 pm
@Ben: Gray’s Anatomy is schlock. It’s basically an orgy with a little medicine thrown in – at least it appeared that way to me the two or three times I was able to actually sit through an entire episode. The only thing a med student would learn from that show is how to get laid.
House had some intelligence and uniqueness to it. He was a physician unlike any other you see on TV, or in real life. It was interesting because he, himself, did not see patients; he was rude, disrespectful and generally an all-around pain in the ass. Obviously, in the real world, a real health care provider would not be allowed to even hold a license with the crap House gets away with. He mostly represents what a lot of us feel, what we wish we could do or what we wish we could say, at least from time to time. “Real patients” are not “real people,” they’re PATIENTS, a whole different subset of the homoerectus population. Pain, illness and fear turn normally nice, well-behaved people into not-so-nice, not-so-well-behaved individuals, who are sometimes not so easy to deal with.
The point I was trying to make to you previously is that all health care providers are expected to maintain a certain standard of care and we are bound by a code of ethics. As I stated, it is a noble profession, but House doesn’t even come close.
I have a friend who is a malpractice attorney and he amuses himself by watching House and counting the lawsuits. I got into the show because of its ambitious challenge of developing the characters based on their reactions to the POTW; however, TPTB were unable to sustain that. As a result, they veered off into Fantasy Land: the medicine has become more and more outrageous and ridiculous as time goes by. Go back and reread Scott’s reviews of the earlier episodes and you will see what I mean.
What was once a sharp, quirky and engaging show is now an exercise in absurdity. Science has been sacrificed for soap. And I guess I feel a little cheated as a result.
November 11th, 2010 at 7:11 pm
Even though this entire episode would have been horrid without the schistosomiasis bit, calling schistocytes bacteria might just be the tipping point for me. Not sure if I’m going to watch the next episode.
November 12th, 2010 at 2:38 am
I have no medical background, but the cocaine/hep thing reminded me of something like the AIDS from…a toilet seat, or kissing, or etc. Was it that bad?
Overall, I side with the thoughts that it was at least a mediocre episode, if not a bad one. However, they can’t all be the best, like the “Three Stories,” or whatever it was called…the writers probably have to fluctuate between those big emotional shows and some in-between-ers. Can’t write one of the best every week; plus, the bridge shows help accentuate the highs.
Medically, anyway, it’s a tough premise to go on for so many years. Medical mysteries that only one or a few doctors can solve?…hard for writers, even when advised by doctors, to come up with true winners on that sort for so many years.
DISCOVER magazine’s “Vital Signs” usually presents an interesting story along those lines once a month. If you’re looking for interesting medical cases for the avergage person, that’s probably a better source than House.
That said, I still appreciate the value of the medical evaluation of House.
November 13th, 2010 at 5:11 am
Love the Medical review on the team’s logic. Lately the “keep it believable” is taking a toll from its “keep it interesting” side. After years of shows I can understand how the conditions are now in a repeat cycle: my complements to the writers for not giving up.
I am liking Masters as the team dynamics go back to Season 1 (at least for her that is). The youth and idealism is feeling kind of nice.
She has the excuse to use a knowledge base out side of common medicine that Lucas had, but to a new level of book wise instead of street wise.
Missing Cameron and Thirteen a lot, but with Masters on the team, Chase could be removed as he’s psych profile has changed and replaced with thirteen.
The basketball match was fun, but also felt weird. perhaps more 1×1 events among characters would make these scenes look not so out of place.
I can’t wait to watch the next one.
November 13th, 2010 at 7:28 am
Hematuria can also be the symptom of prostate problems. Last year, I had three trips to the hospital, to deal with “Benign Prostate Hyperplasia”, or BPH, otherwise known as an enlarged prostate. My prostate was so enlarged that it was moving in on my bladder, making my urine bloody (frequently, it looked like it was all blood.) The handwriting was on the wall, as I suffered fron frequent urination for at least two years prior, but I ignored it until I saw blood in my urine. The problem was fixed with a “Trans-Urethal Prostate Resection”, or “TURP.” That was in August 2009, and I’ve thankfully been blood free since.
And, I’d rather have my hematuria come back than sit through an episode of “Gray’s Anatomy.”
November 13th, 2010 at 9:26 am
Just a dumb med student here… why would Hepatitis C have caused Dugan’s paralysis early in the episode? I am reasonably comfortable with the reasoning (in a vague hand-waving way) for the other symptoms and signs being caused by Hep C.
November 13th, 2010 at 5:05 pm
Actually it would be easier than you think to have a new and plausible mystery every week, if the writers just acknowledged that, and this is especially true for rare and complex diseases, diseases don’t present the same way in every person. In fact, the same disease can have entirely different presentations with few to no overlapping symptoms in two different people depending on their personal traits, circumstances and random chance, too. That’s what actually makes diagnostics challenging, not the problem of whether you can think of every possible disease.
November 13th, 2010 at 8:06 pm
Well, it would have been nice if they’d gotten schistosomiasis right, but given the quality of the medicine on “House” it would still be just a fluke.
November 13th, 2010 at 8:30 pm
@Judy. We COULD do that. Language and its use evolve. And I’m not a stickler, except with my kids.
I’m just surprised that a character who is supposed to be peskily erudite in all areas wouldn’t say it correctly. It seemed out of place. But then, the whole character seemed out of place on my TV screen and I can’t wait until she GOES AWAY.
November 13th, 2010 at 8:36 pm
@Randall. LIke you said.
November 14th, 2010 at 1:02 am
Nice one. I had to look up schistosomiasis to make sure you were really making the joke I suspected you were, but well done.
November 14th, 2010 at 2:17 pm
I liked that senator when he told about exciting the fringe to scare moderate majority into silence. Felt pleasantly educational. That new girl in the team had a more realistic personality than most other characters (compared to wilson).
November 14th, 2010 at 4:34 pm
I have a very naive question. If both the candidate and his handler have Hep C, why is one of them on death’s door while the other is happily running for office? I don’t know anything about the course of Hep C and what factors may effect the outcome.
November 14th, 2010 at 8:49 pm
I’d like to disagree with the point of House having a moral crisis over giving his patient Hep. A, I don’t think he even considered going against it. It was Masters that had the problem.
I also want to see Masters develop. Give her time.
November 14th, 2010 at 9:08 pm
Only one scene with Wilson. I was literally screaming where was he for most of the episode. (Come on, isn’t there always a time when we need more Wilson?)
But the basketball scene more than made up for the medical stuff in the episode for me.
November 15th, 2010 at 10:29 am
@ MedMavRx
I totally agree with every word you said.
November 15th, 2010 at 10:52 am
oh well, but the show didn’t precisely mention kidney failure at the sight of hematuria. Instead the expression was something like ‘kidney problem’ and ‘bleeding kidney’, so I guess it’s fair enough
by the way, isn’t ribavirin also a treatment for Hep C?
November 15th, 2010 at 12:55 pm
I thought that this episode was by far the best of the season. I admit that the medical case was a bit formulaic, but at least they focused more on the medicine than the drama (which is something they really haven’t done since season 3).
I do agree that House’s crisis was a bit weird. I did not view it as a moral crisis with the patient, but with his relationship with Cuddy. But as he said, he’s lied to her 10,000 times, and hims tressing out about one more lie seems REALLY out of character.
I can see why you found the new character to be annoying (my girlfriend did too). But I really like her a lot. She’s only one episode in and she obviously needs a bit more development, but I find her to be a fascinating contrast to everyone else on the show. I get the felling she’s just a temporary stop for 13 to come back, but I hope not (I’ve never liked 13’s character. I find her to be a really over-simplified characature of an actual human)
November 15th, 2010 at 6:40 pm
sorry quick question: have any episodes received an “A” for medicine? I was perusing through your reviews and haven’t seen a single one yet. If there is, I’d be curious to know cuz I want to watch it. Thanks =)
November 16th, 2010 at 9:48 pm
@Lisa
Merriam-Webster accepts “shorter than me” (as well as “shorter than I”) and goes into great lengths as to why. I guess if it’s good enough for MW, it’s good enough for MMM.
November 17th, 2010 at 7:20 am
Plus, tropical fishbowl snails are not among the snail species that host Schistosoma…
November 17th, 2010 at 3:34 pm
@Devon I’m a 4th year student in Croatia. My first clinical year. We have three preclinical and three clinical years. Then one practise year, and after that a specialization. It is different than in US, clearly. :-)
Contact me on my e-mail : dr.kihot at gmail.com . We can share experiances!
November 17th, 2010 at 4:21 pm
While annoying at times, the new girl definitely changes the dynamics of House’s team. I don’t think she’ll work out as a permanent character but it should be interesting if House can “break” Masters.
November 18th, 2010 at 8:19 pm
@Ben. As a 1st year medical student, I know exactly where the other med students are coming from. The reason we complain (and trust me, I’m about too seeing as we just finished our GI block and all this liver pathology is fresh in my head) is because before I knew better I used to love the show, loved how it was always a life or death decision, even when you knew it was sometimes impossible what they were doing. Now the fact that they miss the most basic things is what annoys us. It’s not the improbable things, it’s the simple ones. Like;
Firstly, I liked how they used the fact HCV can cause a cyroglobulinemia in this episode. That’s cool! It fits the bill, common disease with a rare complication. It can (rarely) cause kidney damage with a nephritic like syndrome due to immune complex deposition (although that’s more likely to occur with HBsAg antibody complex deposition in HBV)… but it couldn’t cause pulmonary oedema. That annoyed me. Of course, ascites from cirrhosis could potentially cause a transudative pleural effusion, but not pulmonary oedema. I have no idea where they got that one from.
The testing for HCV was completely off as well. Anti-HCV is a very reliable test, and some centres even test for HCV RNA as well, (the second one wasn’t mentioned). Also although I’m not sure, I don’t think the cyroglobulins would mess with the HCV testing. I’d always learnt that HCV testing messed with other autoimmune tests (like anti-smooth muscle in autoimmune hepatitis) which caused them to show false positives. And god forbid they ever take a liver Bx to stage or grade his disease.
Rather than neuroendocrine tumour, they could have (maybe) used the excuse of hepatic encephalopathy as the excuse for the advisers change of character? It’s an early, rare sign of hepatic encephalopathy, but it would fit better with the case. He also didn’t have many other signs of cirrhosis apart from jaundice. No hypersplenism? (Pt had a normal platelet count, mentioned towards start of episode), no ascites? No spontaneous bacterial peritonitis? Hepatic encephalopathy? Varices? Other signs of portal HTN? Was there even any mention of other symptoms? Fatigue, malaise, anorexia, RUQ pain or discomfort?
And as Scott has already pointed out, 24-48 weeks for PEG IFN Rx (depending on the genotype of the HCV), but they didn’t even consider ribavirin therapy, or a liver Tx.
And my last gripe is with the LFTs. They mentioned that only ALT and AST were really off. In that case, I’m surprised they would consider Dxs of primary billary cirrhosis and primary sclerosing cholangitis, as these diseases, being cholestatic disorders, primarily mess with ALT and GGT.
I have heard the next episode is good though…
November 20th, 2010 at 1:44 pm
Ben — please locate your Caps Lock key, and turn off the caps. Otherwise people will think you’re being rude for no reason.
Since Hep C has a low incidence of sexual transmission, it was odd House went to that first. I had the disease, and never did find out how I contracted it. Never had symptoms; treated it with a ten-month course of Pegylated Interferon and Ribavirin.
I don’t care how brilliant my doctor is, I want him to tell me the truth about treatment options. House should lose his license.
November 20th, 2010 at 7:59 pm
“Schistosomiasis is not a bacteria. It’s a parasite.”
Dr. Scott, I have a minor semantic complaint about this minor complaint. You’re right that the organism that causes schistosomiasis is not a bacterium, and that it is a parasite. Any organism that causes disease, including pathogenic bacteria, are considered parasites. Your comment would be more accurate if you said, “The organism that causes schistosomiasis is not a bacterium. It’s a parasitic flatworm, an animal.”
November 23rd, 2010 at 7:16 pm
House was being sarcastic in that he pretty much told the politician not to suggest to him that Hep C is contracted by a drinking straw (it was a joke so that the politician would know HepC is transmitted via either A) Sex or B) Drug use).
November 24th, 2010 at 12:35 am
Sorry Anonymous (above) but it wasn’t a joke about Hepatitis C (HCV) being spread through shared use of a “toot tube” or “snorting tube/straw”. As has been mentioned already HCV has been detected in the nasal mucosa, and it is well known that cocaine use can cause nasal micro-bleeds. It is a very possible route of infection.
Injecting drug use IS a much more common route of transmission for HCV..
Sexual transmission is theoretically possible if there is blood-to-blood contact (anal/vaginal/penile bleeding) however it is hard to prove because there tend to be other confounding factors when determining route of infection.
My nitpick is that the standard treatment for HCV is PEG-Intefereron (not the old style vanilla Inteferon) with oral Ribavirin yet Ribavirin wasn’t mentioned.
November 24th, 2010 at 3:03 am
@Wani
Yeah, I understand that Euler is pronounced “Oiler”. But I didn’t know that before the episode, so I thought I’d impart my newfound knowledge with anyone else who wanted it.
December 4th, 2010 at 8:47 am
“unless House is suggesting they both used cocaine so much their noses were raw and bloody, and blood was exchanged this way”
In my humble interpretation, the blood was exchanged through unprotected homossexual relations.
That’s why in the end they show the cadidate’s wife and the pacient watching with a smile.
Cogito ergo doleo
[]s
China
December 28th, 2010 at 9:48 am
i think its odd how you form your complaints, red green and blue. to me theyre all “game breakers” that breaks the illusion of autheticity. then again i am a writer and a perfectionist, and if i ever write medical dramas ill ask someone like you for help :D and i probably wouldnt have, if not for you.
January 11th, 2011 at 8:57 pm
How would hep C cause paralysis?! or hematuria ‘kidney problems’?!
Why didn’t they consider liver transplantation [like they always do]?! well i think the answer is to create the whole conflict with a treatment that’ll kill the patient and having to lie to cuddy.
Poor episode, just like the rest of the season.
January 26th, 2011 at 2:20 pm
Also there are a lot of new treatments for hep C that work WAAAYY better than interferon or ribaviring, like tenofovir and entecavir, with really really low resistance rates. Would cure him in a few days instead of giving him an additional disease.