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We're obsessed with television. As employees of America's number one health site, we often find ourselves questioning the medicine behind our favorite medical TV shows. Do the docs on ER and House really know their stuff? And just how common is that rare disease on last night's Grey's Anatomy?

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Wednesday, January 30, 2008

The Biggest Loser-Couples: The Scales Have Tipped!
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When this season began, we were really looking forward to writing this blog. Being fans of this show from the beginning, we were interested to see how the couples would fare, how their relationships would impact their weight loss, how the interactions and interpersonal issues would get dealt with and resolved in the house. We even for the most part liked the contestants and as with every season, we had our favorites and were cheering them on, as they struggled through their intense workouts and challenges.

But beginning last week, The Biggest Loser took a turn and last night that turn went entirely in the wrong direction.

Perhaps because no one knows how to fill two hours each week (this show was decidedly better when it was an hour), or perhaps because the reality show competition is more heated than ever, or perhaps the producers actually no longer care at all about these contestants and their struggles. But whatever the reasons, The Biggest Loser has crossed a serious line and broken a trust not only with the contestants, but with the audience as well.

Last night the show began with Bob and Jillian being pitted against each other in a challenge - running up and down an escalator ten times. The first person to do it would win something, what that something was no one knew.

Surprisingly (especially for those of us who think of Jillian as being able to kick anyone's butt) Bob won the challenge quite handily, but his reward was to choose what would become his blue team for the rest of the competition. This meant that the contestants were once again in a position to be "chosen" or "left behind." Reluctantly, Bob made his choices, and each one had consequences. Jillian, showing more emotion this season than in the past, wept as favorite people, with whom she trained from the beginning, were handed blue tee shirts. The "leftovers" were given black shirts and they became team Jillian.

In the past, it was preferable to work with Jillian. But either because Bob won the challenge, or because this season Bob has stepped up his game and become more strategic and successful, Bob was the trainer to get, so the black team felt like second class citizens. One team in particular, Bernie and Brittany - the two who did not know each other at all when this began - were especially demoralized by Bob's choices; they had felt very close to Bob and they were crushed when they did not get chosen.

Jillian worked hard to inspire her team and tried to make them work as a cohesive group, but their emotions - expressed mostly as disappointment and despair - impacted greatly their performance, both in the challenge and the weigh-in. Jillian's black team lost, and then it was announced that rather than eliminating a "team" as in past weeks, they would now vote off an individual, thus breaking up a team and leaving someone on their own.

It was a striking, depressing, disillusioning weigh-in, with dismal results for the black team. Not only did very few of them lose weight of any significance, Kelly lost none and Paul, who only last week felt like his old warrior self, actually gained three pounds.

So what happened?

Emotional upheaval, that's what. And not the kind that might naturally occur in circumstances that are already contrived to say the least. But the kind that comes from a group of earnest, hard-working people, struggling with their demons, being manipulated by producers more interested in contrived drama than in people getting healthy and achieving their goals. And it was a sad night for us all.

It was not weight that was lost, but principles. And the victims were the contestants, who surely signed on for quite a different experience.

As the producers go about sabotaging these contestants, we are left watching these poor people struggle with more than their weight loss - they are struggling against the twists and turns of a reality show run amok. And this was one show where the central goal was the drama. Even Jillian and Bob seem confused and unhappy about the show's ever-shifting rules and the ways in which even they are being manipulated for dramatic effect.

The Biggest Loser - Couples proved two things last night:

  • One--it really is mind over matter - when you're miserable, no matter how hard you work out, you're not likely to lose weight.
  • And, two, television producers and networks are willing to sacrifice anything - even people's emotional well being - for the appearance of drama.
Shame on us all.

(c) NBC Universal.

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Posted by: Nancy Davis, Safety4Kids at 1/30/2008 06:22:00 AM

HOUSE: Sabotaged by Striking Writers?
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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?

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Posted by: Dr. Lloyd at 1/30/2008 01:08:00 AM

Wednesday, January 23, 2008

The Biggest Loser - Couples: Game On!
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Well, well, well. No more Mr. or Ms. Nice on campus! This week's Biggest Loser episode created more tension in the house than a Domino's delivery. In a stunning turn of events, the teams that were left after last week's elimination had to immediately choose a team to eliminate again.

Reminder: early on the black team made clear they were there to win the prize money as much as they were there to lose weight. This set a tone that is unusual on The Biggest Loser and the rest of the teams were not happy about it. The black team is also fairly aggressive, and the others have been looking for a way to give them the boot.

Conversely, the yellow team (ex-husband and wife) were nearly eliminated one week which fueled them to focus and work harder, the results being a turn-around in the results. Last week they were number one. This put them in a position of being admired, but also feared.

Back to this week. After deliberating strategies, reviewing alliances, and considering real feelings, the yellow team of Kelly and Paul were singled out as the greatest threat.

They began to weep and say their goodbyes, when Alison (our genial host) delivered the good news/bad news. The yellow team was not leaving the campus (good news); but they were going to spend the next week working as an island unto themselves (bad news). Every other team would be working together against the yellow team. At the next weigh-in, if yellow's percentage of weight loss exceeded that of the average of all the other teams put together, they would be safe (good news) and they alone would chose which team to send home. If they lost, they'd go home immediately (bad news).

One last piece of good news for the yellow team - they got to choose which of the trainers they would work with exclusively, leaving the other trainer for the other teams. They chose Jillian - SHOCKER! (Remember our prediction from last week...Jillian on her own reality show...you heard it here!)

To make a VERY LONG STORY short, the yellow team triumphed, both in weight loss and humanity, but the show itself took a nasty turn. The focus was on game-playing, not weight loss, and the resulting behavior was strange indeed. Like when most of the teams, unified in their dislike of the black team, ganged up and decided to "throw the weigh-in" just so the yellow team would have the power to toss out a team of their choosing, which they agreed would be the dreaded black team. So of course, in yet another reality-show moment, Alison announced that the team with the highest percentage of weight loss for the week would receive immunity. So who won immunity? The black team of course, thus rendering the grand scheme moot.

So it was so long to Bette-Sue and Ali. The black team was more smug than ever and the previews for next week show that contestants will no longer play as teams. Oh the fun never ends.

If you follow this show, like we have for the years it's been on, you may remember a simpler time, when contestants faced their issues about food, regained control of their eating, worked out with the tough love of their effective trainers, and cheered for each other as the pounds melted off.

It was a positive, life-affirming, inspiring show. And at its core was a supportive atmosphere that generated heart-warming results. So what happened?

Who decided that The Biggest Loser did not have enough drama? If baring your soul (and your considerable girth) in front of millions of viewers each week, sweating and crying and living with strangers, leaving behind the support of family and friends, and putting your trust - and literally your life - in the hands of a personal trainer does not equal televised drama, we're not really sure what does? Eating live bugs? Is The Biggest Loser headed down that slippery slope toward Survivor? Are alliances and strategies...well...outweighing (sorry) the whole point of this show?!

If this week is any indication, then the answer is a resounding "Yes!"

Alas, we live in a world of reality television. As writers wither by the wayside awaiting their just rewards, networks are scrambling more and more to create shows that depend less and less on writing. And it shows. The Biggest Loser has always been different from the other mainstream reality shows. But this week they officially entered that television sinkhole, where the producers "trump up" (there's an old phrase with new meaning!) twists and turns and pit one person or team against another until the result is exactly this kind of nasty, mean-spirited, back-stabbing behavior, thinly veiled as "strategy."

And in the end, who's really the biggest loser? The audience.

(c) NBC Universal.

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Posted by: Nancy Davis, Safety4Kids at 1/23/2008 05:19:00 PM

Wednesday, January 16, 2008

Biggest Loser-Couples: Shedding Baggage and Weight
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Well, it's week three and there appears to be no relief in sight for the boredom. There was some interesting inter-personal drama, which undoubtedly is the hope of this couples edition, but they really need to give the hour-long weigh-in a rest! It would be more interesting to see an expanded view of the challenges, learn more about their nutrition, how they deal with medical issues, etc., than to spend close to an hour on that parade to the scale.

However, there was some real progress last night, which while not related to physical weight loss, nonetheless had to do with shedding baggage.

The mother-daughter duo of Bette Sue and Ali have had relationship issues for years. Jillian, teetering closely on the edge of over-stepping her role as trainer and venturing into the role of therapist (for which, as far as we know, she has absolutely no formal training) took Ali aside and encouraged her to face the issues that brought her to her current weight. (If this sounds like a familiar scenario, it's exactly what Jillian did with Neill last week.) So Ali revealed to Jillian that her parents divorced when she was young, and that she'd always felt alone. She used her weight to protect her, believing that if someone left her, like her father did, then it was because she was fat. Ali's issues with her mother were also around abandonment; Bette Sue evidently had a string of boyfriends (losers not in the positive sense), and was not around much. Jillian wisely encouraged Ali to embrace this self-awareness as an opportunity, in Jillian's words, "Dig it up and deal with it."

Uh-oh. "Deal with it!" That was the recurring phrase spoken by Taylor, the ten year old supreme brat on "Kid Nation!!!" Is it possible that Taylor could grow up and be someone as terrific as Jillian? Nah, not possible.

Apologies for the digression. Okay, back to The Biggest Loser.

Anyway, Ali's personal confession seemed to help her with the task at hand. In a later scene, Jillian approached Bette Sue, shared with her the conversation with Ali, and offered to mediate a conversation between the two of them, where they could share their feelings in a non-threatening environment. Again, we fear for Jillian's overstepping and worry about her playing therapist. After all, these people are incredibly vulnerable and going through a tremendously difficult time. But Bette Sue responded beautifully to Jillian, whom she clearly respects, and mother and daughter talked, cried and took steps toward repairing their fragile relationship.

There were other relationship issues that arose in the house. During the challenge, which pitted teams against each other in a more obvious way, the black team--brothers Mark and Jay--had a verbal sparring, which left the other teams feeling threatened. Mark, the clear leader (older brother) of the two, called a "town hall" meeting in the house and all the contestants sat around the living room airing their feelings. The black team, by virtue of their success thus far in the show, is the team with a target on their backs. Anger was expressed, apologies made, and the group seemed to have dealt with the problem best they could. Still, there were residual feelings about Mark's behavior.

At the weigh-in, the big news (pun intended) was that the yellow team--divorced couple Paul and Kelly--won! Last week, they were almost eliminated. Working together, working harder, and determined not to go home, they triumphed. But it was bye bye to Neill and Amanda. It's fair to say that the other teams felt sorry about Amanda, whom they liked and felt deserved to be there, but Neill had consistently demonstrated apathy about the entire process and no one felt he should be there any longer.

Moral of the story: it's important to deal with the underlying issues surrounding weight problems if you're going to get the weight off and keep it off. This is not specific to couples, obviously; it's a very individual process. But having a significant other along for the ride, sometimes bringing those issues to the forefront faster, may be the greatest attribute of this season on The Biggest Loser.

Okay, here's our big prediction. When this season is over, someone (yoo hoo...Oprah...?) will be creating a new reality show starring Jillian Michaels, where people's physical and emotional health are "dealt with" and great results are achieved. The next Dr. Phil? We'll see. But don't say we didn't warn you.

(c) NBC Universal.

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Posted by: Nancy Davis, Safety4Kids at 1/16/2008 02:43:00 PM

Wednesday, January 09, 2008

The Biggest Loser--Couples: Week Two
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Weight is Not the Only Thing That Has To Be Cut in Half!

Whoever decided that "The Biggest Loser--Couples" had to be two hours each week was clearly ill-informed. In order to fill that time, we are now subject to nearly one hour of the "weigh-in", which on a good night is a tense and often painful experience. And that's just for the audience. This week the average weight loss was about a pound. This surprised everyone, including Bob and Jillian, who for some reason joined forces to become the self-described "dynamic duo." (We have our own thoughts on why they might have teamed up.)

The only thing there was less of this week was interest. But there were a few things worth discussing.

There was the dramatic visualization across three enormous screens which showed each couple just how much fat, sugar and calories they consumed over a day, a year, their lives to date. It was shocking. And hopefully, a wake up call. If you're like us, you were imagining your own screens and wondering what they would look like!

In the gym, Jillian, clearly the most popular trainer and the one who gets the greatest results, reached the end of her rope with Neill, the laziest and least motivated of all the contestants. His wife, Amanda, works very hard and is always frustrated by her husband's attitude. Jillian took him aside and rather than simply berate him for his lack of desire, she went for the jugular, forcing him to face his demons and helping him to see that his emotional issues have stopped him from feeling anything. He broke down and it seemed to be a turning point for him. Jillian may have been the first person to break through his considerable defenses and as a result, everyone noticed Neill's improved performance.

The big challenge this week involved the teams completing 100 reps on a seesaw. Up and down 100 times sounds almost like fun, but the teams struggled to gain the momentum necessary to complete the task. The black team--the brothers Jay and Mark, won the challenge and the much desired reward--calling cards with which to call home. Jay and Mark are clearly the team to beat, as they have come in first before. They seem to communicate well, which we think will be key to this season. Once Jay and Mark won, only a couple of other teams bothered to finish the task. In a surprising twist, Jay and Mark, in addition to their own calling cards, were given three other sets, to present to three teams of their choosing. This was an understandably difficult decision, but in the end they gave the cards to the ex-football players, the loving parents, Mallory and Curtis, and Neill and Amanda. They explained their choice of Neill and Amanda, by saying that Amanda works hard and deserves it and Neill needs some incentive to get back on track. And, importantly, these teams all had left young children behind to come on the show.

Part of the LOOOOONG show was the way the phone calling was dragged out over several show segments. Emotions were running high on The Biggest Loser campus, as the tearful calls to home were made.

As the weeks go on, we'll be looking a little more closely at people's motivation for becoming contestants on The Biggest Loser. Many of them say they are doing this for their children--so that their kids don't grow up with a bad role model or no parent at all. This is obviously of great interest to us at Safety4Kids. It's also of interest to us how exactly any of these people got here--the choices they made, the emotional issues, other factors that brought them to a place where their lives were in jeopardy.

Back to the show. Another interesting segment related to the "temptation." This is a challenge where the contestants are tested to see how they will do faced with a real life temptation. They have to choose their own course of action and live with the consequences. In this temptation the couples were separated, and each person was given four minutes at which they could graze at a massive buffet, filled with corn dogs, cookies, cakes, and other high fat, high sugar, hugely caloric foods. The kicker was that the couple that consumed the most calories would win $5000. The temptation took place the night before the weigh in. Of all the people, only three actually ate anything--Mark, Mallory, and Paul. And once again, Mark, representing the Black Team, won the challenge.

So here's the thing: two out of three of the people who consumed the crap had called home. Perhaps after hearing their kids' voices and getting in touch with just how much they missed them, subconsciously they wanted to go home. Or perhaps whatever reason they overeat in the first place was triggered by a call home. Interesting...

We're beginning to think that the original "team concept" pitting Bob's Blue Team against Jillian's Red Team got better results. It's possible that having a loved one with you on this journey is emotional and supportive, but perhaps not as competitive an environment as when you're there relying on yourself, with your teammates being your support. (This is why we'll be paying close attention to the team who were total strangers before this began.) After all, the results this week were dismal.

And what about the teaming up of Bob and Jillian. We think Bob is losing his popularity and Jillian is clearly the more effective trainer. As a result, the producers decided to put them together thus making it more difficult for us to see which of them is actually getting the job done. Poor Bob. He's very sweet, but it seems that in the gym, sweet just doesn't cut it. Let's see how the rest of the couples do!

(c) Photo courtesy of NBC/Universal.


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Posted by: Nancy Davis, Safety4Kids at 1/09/2008 09:56:00 AM

Wednesday, January 02, 2008

The Biggest Loser - Couples: The Weight is Over!
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We couldn't resist. If you've been bemoaning the seemingly endless writer's strike and fearing a world with nothing but reality TV, you're not alone. But "The Biggest Loser-Couples" is different. It actually has a good deal of drama, intense interpersonal relationships, societal pressures, family issues, hope, dreams, and a group of dedicated people trying to change their lives. Not too shabby.

If you're a fan of this show, and we are, you'll be happy to know that this new aspect of the show--trying to lose weight as a member of a two-person team--really gives this show added dimension. Now in addition to each person striving against all odds to lose an enormous amount of weight, they also have to deal with very real issues related to being part of a duo. And it is the combined weight loss that determines the couples' success.

The teams represent various configurations--a mother and daughter, a father and daughter, brothers, ex-'Bama footballers, two best girlfriends, a mother and son, husbands and wives, even a divorced couple. And just for good measure, and to add another interesting twist, one team of total strangers--two people who met for the first time on the show. Presumably this gives us the chance to see whether or not strong ties provide additional support or simply..well...heavy baggage.

And the interesting question for us is this: Will the team dynamic impact the weight loss positively or negatively?

This is genuinely interesting from an interpersonal perspective. And not incidentally, it's pretty good TV. The first episode offered a preview of this central question and how it might play out. The first team to be eliminated was the father/daughter duo. The father, Lynn, was unhappy on "campus" and made his feelings known. He complained constantly about how hard it was to keep up with the demands of the program. His daughter struggled with her dad's unwillingness to step up to the challenge and at the very least "do it for her". Their relationship was strained and whether as a result of that stress or not, the daughter, Jenni, lost the least amount of weight of anyone. Was she worrying too much about her father's workout regimen, taking valuable time away from her own? Did she lose time chasing after him trying to convince him to come to the gym rather than sleep?

What proved true was that Lynn's obvious displeasure at being there cost Jenni the chance of a lifetime. And she was ticked. The other teams voted almost unanimously to send them home, realizing that Lynn's dissatisfaction and Jenni's strong desire to stay created a contentious team and one not likely to succeed. They left the campus and vowed to carry on the good fight. In the clip that shows the people six weeks after they leave the show, Jenni is clearly carrying on the good fight, while Lynn is having trouble getting himself to the gym. Jenni now has a group of friends as her support, not her father.

This season the contestants stand to lose much more than weight.

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Photo (c) The Biggest Loser. NBC.

Posted by: Nancy Davis, Safety4Kids at 1/02/2008 03:27:00 PM

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