HOUSE: Sabotaged by Striking Writers?

Okay, perhaps I have nitpicked a bit too much about this medical drama in the past. All too often House plays it very loose with authentic medical knowledge, unlike the more accurate stories portrayed in competing dramas like ER.

Believe me, any previous criticism was nothing. This time I'm really going to pick some major 'nit'!

As you know, the 2007-08 TV season was interrupted by the writers' strike. Production companies cannot shoot new episodes without scripts. The regular season of House was halted at the end of November (sweeps month, very convenient) and Fox has relied on reruns during the interim. Fortunately there were a few unaired episodes 'in the can' so they have been dusted off as we head into the February ratings book.

It is my suspicion that screenwriters for House went out of their way to poison their last few pre-strike scripts with medical nonsense. Episode 80, It's A Wonderful Life, supports this theory. The story takes place on Christmas Eve because it was supposed to air in December. Viewers have to get past that disconnect, but if you really like this show it is a benign distraction.

Bring on the nit!

A single mom experiences paralysis in both limbs, bleeding problems, swollen lymph nodes, and sudden loss of vision in both eyes. She also developed rock-hard bones due to impaired calcium metabolism. Aha! This must be some type of paraneoplastic syndrome. Paraneoplasia is an abnormal tissue response to cancer elsewhere in the body. The storyline drags the viewers through all kinds of diagnostic possibilities but, sure enough, my hunch was eventually confirmed.

The neurologic problems, the blindness, the loss of platelets, even the bone hardening can be linked to the presence of cancer cell proteins (onconeural antigens) that triggered hostile immune responses in these target tissues.

The viewer learns that the patient underwent elective mastectomies years earlier because she carried a high-risk breast cancer gene. Lo and behold, the patient still developed breast cancer and that was the cause of the paraneoplastic syndrome.

How can a woman develop breast cancer without breasts? It's simple, she had ectopic breast tissue elsewhere in her body...a clump of normal breast tissue where it doesn't belong. In this case it was situated in her thigh.

This misplaced tissue phenomenon (tissue heterotopia) is a developmental error that happens all the time. Little wisps of thyroid gland can end up far from the neck. I've seen patients with tear-producing lacrimal gland tissue located inside the eyeball.

Now, get ready, it's time to excavate that nit!

Once the mystery is solved House instructs his team to schedule excision of the cancerous growth and start breast cancer chemotherapy, "...and all of her other problems will go away". Wrong, very wrong.

Among the diagnostic criteria for paraneoplastic disease:

• The paraneoplastic process itself is noncancerous


• The paraneoplastic process is anatomically remote from the cancer, and


• The clinical course of the paraneoplasia is independent of any cancer treatment.

Sadly, even if the patient responded completely to her anti-cancer therapy, the paraneoplastic consequences (paralysis, bleeding, blindness, etc.) would persist.

I suspect that such an egregious flaw in storytelling would not have occurred in the hands of happy, satisfied screenwriters. Is there such a thing as Writer's Malpractice?

Related Topics:

• Preventive Mastectomy: Questions and Answers
• WebMD Video: New Option for Breast Reconstruction After Cancer

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