TV Checkup

HOUSE: Jarred Memories

2008-05-13T01:21:00.010-04:00

The fourth season of House concluded with a two-part finale. The first part (Episode 414, House's Head) has an amnesic Dr. House retracing his steps after realizing he had survived a bus crash four hours earlier. Many passengers sustained severe injuries. House is convinced that, moments before the crash, he recognized a person with diagnostic features for a life-threatening illness. But, which passenger and what illness?

House himself sustained a bone fracture involving the base of his skull with cerebral edema, yet he was able to mobilize his team and begin assembling clues. Most skull fracture survivors take to their bed and stay there. House underwent hypnosis in an effort to illuminate his misplaced memories and resolve his amnesia. Clever editing combined hypnotherapy and Vicodin-induced hallucinations. It was often hard to distinguish which events were recollections and which were fantasies.

A lot of time and energy was devoted to the bus driver. House theorized perhaps it was the bus driver who had an occult health condition that caused him to temporarily blackout. By the end of the episode House flushed the bus driver scenario - the passenger in greatest danger remained unidentified. Can you say 'cliffhanger'?

Now, don't worry about any spoilers because none are divulged in this blog post. Who knows what trivial plot details in this week's episode become the pillars of next week's closer?

What interested me most about this episode was the recognition that physicians often continue working despite illness or injury. Is it professional duty or fear of lost revenues? In my opinion it is a devotion to patient care that drives most physicians beyond their own sickness - even beyond the point of good judgment. I believe this is part of the reason why doctors make the worst patients. Watching the progressively disoriented House carry-on after sustaining serious head trauma, my wife quietly remarked, "...reminds me of February 1984".

Ouch, that hurt!

In February 1984 I was Ophthalmology Chief Resident: lots of patients, lots of surgery, lots of responsibility, not much money. For three days I kept working around the clock despite fever and abdominal pain. My wife repeatedly warned me that I needed to get help. I reassured her that I'd felt worse before. Denial reigns supreme! On the fourth day I collapsed from peritonitis due to my untreated ruptured appendix. Finally, I saw a doctor, had long-overdue surgery, and spent 10 days in a hospital bed hooked up to IV antibiotics. Had I gotten help sooner I never would have made myself so sick. Looking back at that experience I recall several hospitalized patients telling me, "Doc, you should be in this bed. You look worse than me!"

Professional journalists would howl that I have inserted myself into this story, which is supposed to be about House. What can I say? House's behavior is not unlike other doctors. You know, other doctors like me! It's great that I am not a professional journalist - just a medical blogger.

I dare not spill any beans regarding storyline specifics. Let's wait until Part 2 airs and we can wrap the entire season finale with one big ribbon (or head bandage!) TO BE CONTINUED...

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HOUSE: Judgment Day for Princeton-Plainsboro

2008-05-06T01:07:00.012-04:00

The portfolio of unpunished felonies continues to pile up for Doctor House. In addition to the routinely scheduled residential break-ins, Episode 414, 'Living the Dream,' opens with House perpetrating a kidnapping in order to confirm his suspicions that a popular soap opera actor has a brain tumor. The unsuspecting actor ends up in Princeton-Plainsboro and endures a lengthy series of invasive tests and near-death medical emergencies: cardiac arrest, kidney failure, extreme fever, coma, etc. Spoiler alert: dude had a rare allergy that was previously used in an ancient episode of Murder, She Wrote.

Do not despair. Even without Angela Lansbury this episode still had some entertaining drama.

For those in the medical community, the real plotline involved Dr. Cuddy's efforts to guide the hospital through its reaccreditation inspection. Every time House behaved at his worst the inspector was a witness.

Reaccreditation is a lengthy, expensive, time-consuming show-and-tell. The agency in charge (typically JCAHO - Joint Commission for Accreditation of Health Care Organizations) inspects every hospital with announced and unannounced visits. Ostensibly, the reaccreditation process is promoted to improve patient care delivery but, ironically, an upcoming inspection cycle often distracts many hospital employees from their real responsibility...helping patients. The reality is that most health care professionals see reaccreditation as a colossal waste of time.

Nurses and administrators maintain underground communications with their counterparts at other recently inspected hospitals to discover upcoming key areas of scrutiny. For example, one year such advance 'intelligence' warned that inspectors were particularly concerned about hospital staff knowledge regarding steps to take in the event of a fire. Sounds reasonable, right?

Many thousands of manhours were devoted to briefing (and rebriefing) employees, printing clip-on cheat cards, and mounting laminated signs on both sides of every door and approximately every 10 feet along both sides of the corridors. Good news! If you can just crawl 10 feet away from that blaze you will find laminated instructions that will help you escape...so long as they haven't melted! Every experienced clinician has 2 or 3 wild reaccreditation inspection stories to share. On inspection day nobody was asked anything about fires, but the outdated anesthetic ventilation system in the operating rooms took a big hit. Ooops!

Back to the show, the unyielding inspector learned about House's radical (read hair-trigger) approach to patient care: treat first, diagnose later. The soap-opera patient survived but it had no impact on the inspector's evaluation. Cuddy's hospital was cited and got socked with a fine but House got to keep his job and survive to violate his Hippocratic Oath one more time.

Hmmm, how often should prime time fictional medical dramas get reaccredited?

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HOUSE: Misleading Lab Results

2008-04-29T10:20:00.006-04:00

Well, the television writers are back at their word processors, the actors are back on set, and so now I've got to get back to work and share my impressions about this latest episode of House titled "No More Mr. Nice Guy."

Just as a quick aside, I couldn't help notice that the opening scene involved striking nurses with picket signs hauntingly similar to the Writers' Guild of America placards - coincidence?

This week's puzzle involves an overly friendly guy named Jeff. He works around lots of cleaners and solvents. House discovers him in the Emergency Room. He has been sitting patiently for hours for a fainting evaluation. Jeff also has a history of dysgeusia (impaired taste) wherein everything he eats taste likes lemon meringue pie.

House is convinced that Jeff's peaceful, noncomplaining demeanor indicates occult pathology. In short, healthy people are not so placid. Since House is a lumper (tends to attribute most of a patient's symptoms to one central disorder) Jeff's demeanor and unusual taste phenomenon share a common cause.

Untreated syphilis becomes a central diagnostic consideration. If the bacterium involves the brain (neurosyphilis) there can be changes to mood, mentation, and motor skills. Blood is drawn and Jeff's serology tests are positive for syphilis. Shortly thereafter a tube of House's blood is inexplicably tested and it, too, is positive for syphilis.

We can skip the moral outrage concerning unauthorized testing of co-workers. Hey! This team performs routine home invasions of its patients to search for clues. "Mrs. Kettle, have you met Mrs. Pot?"

It's good to see that the writers have not lost their stride, pacing Jeff's various ICU crashes to precede each jumbo commercial block. Eventually it is discovered that House's sample was not his blood (meaning someone is still roaming Princeton with undiagnosed syphilis!) Jeff becomes hostile and mean-spirited while his overall medical condition continues to deteriorate. Repeat brain imaging reveals new lesions suggestive for a different kind of infection, a bug that could generate positive syphilis serology. We call this finding a false positive (tests confirms presence of syphilis where there is none).

Lots of medical conditions can generate a false positive syphilis test. Alternate testing like PCR (gene amplification) and selective immunoassays can help clinicians get to the truth. In Jeff's situation, he had contracted Chagas' Disease (a bloodborne protozoan that favors the heart and brain) while living in Central America many years earlier. It remained undetected for over a decade and insidiously caused his mood and taste abnormalities. Antiparasite medical therapy will eliminate the infection and hopefully normalize his central nervous system.

Here's a helpful take-away point: Whenever a physician informs you of unexpected lab results don't hesitate to ask if a second round of confirmative tests or alternative studies would be beneficial. It is never wise to base important health care decisions on a single tube of blood, especially when it might not even be your blood!

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The Biggest Loser - Couples: A Finale of Just Desserts

2008-04-16T15:27:00.000-04:00

Well, it's over. We made it. And in the end, it was worth the weight! (You know we can never resist a good pun.)

In a season marked by overt sexism, blatant conspiracies and macho madness, the fact that "The Biggest Loser" was a woman, for the first time ever, was justice served. "1, 2, 3, PRIDE." Not so much.

The first few minutes of last night's finale was devoted to revealing whether Mark or Roger would be the third contestant in the running for the grand prize. Remember, "America Voted", and in another blow to Mark's fragile ego, Roger won the vote. Mark was relegated to the larger group of eliminated contestants, awaiting a lesser prize. Roger was a nicer person, and also a greater threat to win the prize. Mark didn't cry; we were very grateful.

We watched in amazement at the parade of contestants, their pounds having been shed both on screen and off, as they took to the scale for the final time. In addition to the grand prize of $250,000 and the the title of "The Biggest Loser", a secondary prize is awarded to a contestant who had been voted off but who achieves nonetheless the greatest percentage of weight loss among other ousted contestants. Again, justice was served, as Bernie won. Bernie, you may recall, was part of the duo of Bernie and Brittany, the two that did not know each other when the show began. And when it was crunch time, Bernie gave Brittany the opportunity to stay on campus rather than himself. He was sweet and supportive and clearly a fan favorite. And the taste of Bernie's victory was that much sweeter because he beat Mark, the ring leader of the macho blue team, by a single pound.

Bernie was one of Jillian's charges. Score one for Jillian.

Some of the contestants looked great; some less so, but all of them demonstrated some measure of change and we applaud them all for their efforts.

But in the end, Ali, once a champion synchronized swimmer, reclaimed her athletic soul, and pushed herself to achieve extraordinary results. She lost an amazing 112 pounds, 47.86% of her weight. She looked like the woman who was trapped inside the person who arrived nearly six months ago, and her transformation clearly took place on the inside as well as the outside. And Ali was also one of Jillian's people.

It was a victorious night on many levels. But the kudos go to Ali for her strength, character, and persistence. And oh yes, for kicking the butts of the macho men who worked all season to eliminate the women, one by one.

Go Ali. Go Jillian.

Wonder if those "Pride" tattoos can be removed?

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The Biggest Loser--Couples: The Weight is Almost Over

2008-04-09T07:12:00.004-04:00

OK, last night was pretty good again. Still way too long, hence very dragged-out scenes with the remaining four contestants reliving their "journeys" from fat to fit. But seeing the transformations is really quite incredible and there is little to do but applaud their determination and their progress. All four: Ali, Kelly, Mark, and Roger have reason to be so proud.

And everything about this episode was designed to make them fully face their transformations and embrace their new selves. Even the final challenge of the season--putting on a fat suit that replicated exactly their original size and shape and running a foot race--made them all feel they were leaving behind the worst of themselves forever. They all vowed never again to be the people they were when they arrived. And they all discussed their transformation not only from a weight loss and fitness standpoint, but equally important from the point of view of the emotional weight they dropped as well.

Side Note: Speaking of emotions, Mark acknowledged what we all have been observing for some time now--that his emotions are a bit out of control. In Mark's case, his weight was blocking his emotions (and tear ducts!) and having unlocked that part of him, he has been some sort of human geyser, overflowing with tears and emotions each week. We also suspect that Mark has a little guilt over his brother Jay falling on the sword for him last week. Even Mark's wife, remember, told him to "Snap out of it." Mark should have an interesting homecoming.

Back to the show.

As with every episode, there is some sort of gratuitous product placement. The gum was replaced last night by Rocco DiSpirito, who is clearly being groomed as some sort of Biggest Loser chef in residence. He returned to transform each of the contestants' former favorite meal item into a healthier version of that very meal. Everything from pepper steak to ice cream. This was useful and fun information and it teed up the new "Biggest Loser Meal Plan". There is even a home delivery option. Second product placement plug.

Back to last night. Mark, of course, won the challenge, racing up that hill for the last time carrying a flag that read...well..."Mark." His prize was that when he gets home, he'll be provided with the "Biggest Loser Meal Plan" home delivery so all of his meals will be carefully created for maximum health and weight control. He also got $10,000. This gives Mark a decided advantage for the finale...except for one little problem: he was below the yellow line and therefore marked for elimination.

In fact, in what could only be characterized as the final irony of this season, Ali and Kelly were the two contestants to make it into the finale. Ali won the weigh-in again--that's four in a row--and Kelly was second. Both Roger and Mark, feeling fairly cocky as always about their "numbers" were shocked to realize that they were both below the dreaded yellow line. Truth is, all of the contestants put up great numbers, and they worked all week without their trainers.

But here's the twist: instead of Kelly and Ali determining Mark and Roger's fate...we will! America will vote, online, at The Biggest Loser, and that vote will determine whether Mark or Roger joins Kelly and Ali in the season finale. The results will be announced live in the first five minutes of the season finale next week. For all that Blue Team bravado, all those shouts of "1, 2, 3 PRIDE!", all that conspiratorial plotting against "the girls", look who's lobbying for votes now!

The show ended, as they do every season at this time, with each contestant saying goodbye to their trainers, alone in the weigh-in room, face to face with a cardboard cut-out of themselves as they looked when they arrived on campus. Standing side by side with their former selves, it's hard not to jump up off the couch and yell, "1, 2, 3, PRIDE!"

Remember to vote online and tune in next Tuesday to see if Ali or Kelly can become the first female Biggest Loser in the history of the show.

(c) NBC Universal.

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The Biggest Loser--Couples: Down Under

2008-04-02T15:26:00.001-04:00

Without being overly optimistic about the future of this show, last night's episode was much more like what we remember fondly from seasons past--a focus on exercise and weight loss, genuine teamwork and interesting challenges. We think the contestants liked it better too--they seemed proud and engaged and determined. What a nice change!

The remaining five contestants spent a week in Australia with their trainers. Turns out Jillian and Bob are the trainers for the show in Australia so they were very familiar with the territory. Many of our fine now-slender friends had never left their home states, let alone traveled to the other side of the world. There was great excitement and anticipation and for once, it was not met with disappointment. They all had a great time. The stunning beauty of Sydney figured prominently in their experience and they learned very handy survival techniques for staying on a healthy course while traveling. Going to local farmer's markets to find fresh, healthy and inexpensive food to keep in their rooms; eating fish and vegetables when dining out; even dancing to burn a few extra calories. All of these options were presented in a very welcoming way and the show, as a result, was one of the most successful of the season.

The challenge was a modified triathlon, which all of the contestants completed. This made them feel like the champions they are, and we were impressed with their performances. But perhaps the most impressive moment last night came when Mark, who along with Ali is the most competitive and successful contestant, was just about to win the challenge. He has made it up that final flight of stairs, with only a few steps to go to reach the finish. In what can only be termed "uncharacteristic", he waited for Ali, who was very close behind, so they could cross the finish line together. In fact, Ali carried Mark piggy back over the line! It was miraculous--a real change of personality for Mark. And he talked about the difference in himself. The whole experience had more meaning for him because he finished with Ali. Is this the Mark who conspired to eliminate the "girls", one by one each week? The Mark whose only alliance was with the "guys" on Bob's blue team? You know, "1, 2, 3, PRIDE!"

Well, whatever caused this change in Mark, it was a welcome relief and it really did elevate the experience for Mark, for Ali, and for the audience as well. In sharing the glory, Mark also shared the prize--a sunrise seaplane ride, a brunch by the beach, and a call home.

Side note: Mark cried, of course, when he called his wife. You remember, he's the big crier. Maybe even The Biggest Crier. We were amused when his wife said, "Are you crying again? You've got to toughen up. Snap out of it!" We agree.

In the end, Jay, Mark's younger brother, and Mark both fell below the yellow line, each of them having gained a pound. In another embarrassingly tearful scene, Jay fell on the sword for his brother and went home, leaving four strong, competitive contestants to go on.

Next week the contestants will work without their trainers. Should actually be interesting. Two weeks in a row that are interesting? Fingers crossed.

(c) NBC Universal

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The Biggest Loser--Couples: This One Takes the Cake!

2008-03-28T10:08:00.004-04:00

There are only two shows left in the season and it's hard to know where the producers can go from here. They say, "When you hit bottom, there's no place to go but up." We certainly hope that's true, although there appears to be a special place reality television goes, and it's below bottom.

It was hard to watch the latest installment of Biggest Loser--Couples, and not wonder what aliens from a far off galaxy landing on earth might think. For argument's sake they land on "campus" only to find a man carrying around a slice of chocolate cake as a pet, while his compatriots tease him and hide his cake in the laundry to teach him to better protect his pet. And then these same people run up and down stairs, gathering junk food and placing it on tables, occasionally taking a bite. The point here was to put as many calories on someone else's table so they could lose the challenge.

The aliens would likely think they had landed on a planet where intelligence was not valued, but a high premium was placed on trans-fat. They would not be entirely wrong. But in watching the episode we felt more like the aliens.

A solid hour, we're not kidding, was spent on Dan's relationship with a slice of cake. He carried it with him everywhere. There were shots of the cake in the gym. Shots of the cake in the kitchen. It was downright bizarre. And idiotic.

And as if that were not idiotic enough, the second hour was centered around a challenge that was not only insulting and inane, but also infuriating. Infuriating because despite the fact that there are no real teams left, Bob's blue team remains strong and intact, and viciously determined to wipe out "the girls." They work out together, strategize together, and still raise their unified voice in "PRIDE" whenever they get the chance. And they approach each task with an eye toward how they can eliminate one of the remaining two women and strengthen their hold on the game. And because there are four of them and only two women, the women barely stand a chance.

The two remaining women, Kelly and Ali, have not exactly been united. Kelly is the sole remaining member of Jillian's black team, and Ali came back in that strange twist a few weeks ago, and still wears her pink team shirt with pride. This week, disgusted and demoralized by the men's behavior, the women decided to unite; Jillian gave them pep talk after pep talk and they rallied, determined not to be eliminated. In the end, the united men could not save Dan from elimination, after he lost only a pound. The women, in fact, were first and second at the weigh-in.

There were the teary goodbyes, now customary for the men. Weeping, vowing eternal love, pledging PRIDE despite the fall. Ugh. We're so sick of the men conniving and conspiring to gang up on the women, macho, mean, and ruthless, and then collapsing into quivering, sniveling babies at the end.

We have been saying for awhile now that this show has lost focus; this week proved once again that weight loss, exercise, healthy eating, changes in lifestyle--all take a backseat to pet cakes and boys versus girls sexist mentality.

Two episodes left. Four more hours. 240 minutes. But who's counting.

(c) NBC Universal.

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The Biggest Loser--Couples: From Fierce to Farce

2008-03-12T17:08:00.001-04:00

It's time NBC renamed this show "The Biggest Kvetcher". Seriously, if we have to continue to watch grown men and women crying over their interpersonal issues, we're going to start crying ourselves.

There is absolutely nothing of substance to talk about. Last night this show hit bottom. For no apparent reason, all of the previously eliminated players reappeared for a "special" weigh-in. The eliminated man and woman with the highest percentage of weight loss would come back on the show. This pissed off almost all of the remaining contestants, who thought they had long ago disposed of their fellow teammates and had reached the status of "final six".

Side note: the players who had been eliminated did not look very good. Other than the two who won, not much change to report.

Mark and Ali were reunited with the group. Mark, crying as always, over his brotherly love, easily assimilated back into Bob's team. One, two, three, PRIDE! It was another story entirely for Ali. She and her mom, Bette Sue, you will recall, had serious issues, but Ali was a fierce competitor and a friend to many of the men on the blue team. She chose to wear her original pink clothing, rather than adopt Jillian's signature black. Ali was keeping her options open. She was more interested in wearing pink as an homage to her mother than giving that up and joining the women in black.

And who could blame her?

Those women in black? Simpering, annoying, emotional wrecks. Crying, over-eating, barely moving on the treadmill...what's going on? Why isn't Jillian kicking their butts into high gear? And what about Jillian? She used to be fierce. She seems on the edge herself. She lost her cool completely at the final weigh in, swearing and glowering at Alison Sweeney, the usually sweet host. Alison seemed unprepared and inarticulate, but the whole scene just confirmed the soap opera status to which this show has sunk. At least Alison is back in her milieu.

As if we hadn't suffered enough, we did not get the satisfaction of anyone being eliminated! Ooh...that's for next week...we're on the edge of our seats.

So here's what was really lost this week on The Biggest Loser:

storyline (this was weak to begin with; now it's gone completely)

focus on weight loss (remember when that's what this show was about?)

direction (no one is in charge)

patience (even the trainers are at the end of their ropes)

sense of humor (ours, not theirs)

And oh yes...actual weight loss? Not so much. Not figuring very prominently anymore in this show. It's true that a couple of the men have lost over 100 pounds each. That's remarkable. And we applaud their commitment and results. But that's a tiny part of the show. More time is spent on Extra gum than on significant weight loss.

C'mon NBC. Wake up and get back on track. You don't have much time to lose. Nor much of an audience either.

(c) NBC Universal.

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The Biggest Loser - Couples: All for One, One For All

2008-03-05T13:16:00.000-05:00

And everyone for that vending machine!

Oh what a night. A boring, boring, boring night. This show is so far off track it's hard to know what to say anymore. Let's just say The Biggest Loser-Couples is having an identity crisis. As we've mentioned in our previous posts, this show is no longer about weight loss, exercise and achieving better health. Not that these things are not important to the contestants; they're just not important to the producers.

Yes, we went with everyone to the doctor and were impressed with the results of their hard work--they've all been "upgraded", medically, from "critical" to "fair". It is genuinely good news and very encouraging. And as we revisited their early medical appointments, we were reminded of their astounding progress. So why isn't that enough? Roger reached a milestone last night of 100 pounds lost. Dan is at 99. Not dramatic enough television?

Instead we watched each contestant face a vending machine filled with snack food, shameless product placement gum, and rewards including cash and "one pound pass" cards to be used at the weigh-in. If they hit the wrong combination of letters and numbers, out dropped a Twinkie and they had to eat it. Honestly, is this appropriate for a show that used to be about weight loss? The lucky ones got the shameless product placement gum and the cash. The unlucky ones ate over a thousand calories worth of trans fats. It was ridiculous.

The challenge had each contestant fly over a canyon on a zip line, pulling off flags along the way. This is where the identity crisis really took hold. Now the show is part Amazing Race, part Survivor, part Queen for a Day. Uh-oh. Showing our age. Google it if it doesn't ring a bell.

The one shining light in all of this was Bernie. Sweet, bandana-clad Bernie. Bernie and Brittany, you may remember (if you are able to stay awake for the full two hours each week), is the lone couple who began this journey as strangers. Early on we suggested that this fact could prove beneficial. And it did. They were the last couple standing intact. And they have been the two people genuinely and consistently cheering for each other and supporting each other through...well...thick and thin. So when Bernie won "Biggest Loser of the Week" last time and claimed his reward, he chose "game play" and was given the opportunity to grant immunity to any contestant on either team, just not himself. And rather than "play the game" and offer this great gift to someone in an effort to improve his own chances, he selflessly awarded the prize to Brittany, because they're partners and friends and he wanted to be sure she would live to play another week. As it turned out, in the words of Elfaba from "Wicked", "no good deed goes unpunished" and so Bernie was eliminated. And the "big twist" at the end was that there are no more teams--it's every one for themselves now. This will likely have the biggest impact on Bob's blue team of macho men, who still high-five and cheer "pride" after every workout.

We're glad this season has passed the halfway mark. We desperately hope that next season will see a return to one hour episodes focused on exercise and healthy eating, support and encouragement. In other words, we're hoping for a miracle. But hey, you gotta believe, right?

(c) NBC Universal.

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The Biggest Loser--Couples: Pride Goes Before the Fall

2008-02-27T06:35:00.007-05:00

And evidently, before the tattoo! Last night we watched four grown men go from macho-frat-boys in Vegas, to sniveling-melodramatic-wrecks in just two hours. What does any of this have to do with serious exercise and weight loss? Absolutely nothing. Which is the biggest problem with The Biggest Loser.

Last week the younger of the brother duo on Bob's blue team, Jay, was the biggest loser of the week. He took the customary walk up the mountain to find the three envelopes awaiting his choice, and he chose envelope three, which held a card that read "Vegas, Baby, Vegas". He quickly learned that he had won an overnight to Vegas for his entire team. The news was a welcome and surprising gift, until Bob rained on their parade, wishing he could stop them. He was afraid, of course, of all-you-can-eat buffets, being away from the gym and losing focus. The whole show has lost focus, so they might as well be in Vegas!

Anyway, in their usual style, the blue team talked, determined to stay on course and to win the weigh-in again, regardless of the temptations in Vegas; after all, they had kicked some serious butt last week, and that was after spending an entire week at home. They were not worried, simply looking forward to a boy's overnight. Unfortunately, we had to go along for the ride.

Side note: Why did we have to listen to Dan playing the guitar and singing? We get that he is the young, long-haired, Dan-cam-toting dude. But spare us the musical interludes, please? We have enough to endure.

Dressed like the gentlemen of Ocean's Eleven (courtesy of the suits provided by Bob), the four members of the blue team strode handily from gym, to casino, to healthy meals to the tattoo parlor. Tattoo parlor? Each of the team members got a tattoo featuring the word, "Pride", which is what they all shout after placing their hands together, one atop the other, in their unified pre-and-post challenge rallying cry. Full of bravado and male bonding, we watched as the four team members permanently etched their skin. Bob, you no doubt have noticed, is covered in tattoos. We're guessing this is the point at which Jackie is actually pleased she got eliminated from the team.

Long story short. They had a blast in Vegas, and came back to the ranch and won the challenge, which was all about brute strength, which to us is enormously unfair at this point. The black team is made up of three women and Bernie, who is a small (by these standards) man. The blue team is four big guys. Last night's challenge was a snap for the blue team and each team member won a trip for two to Puerto Rico. First Vegas, now Puerto Rico. This team was pumped. Dan described them as "unstoppable." Until the weigh-in, that is.

Jillian's black team had worked very hard all week in hopes of increasing their numbers at the weigh-in. They did not want to have anyone eliminated, because they already feel fairly disadvantaged by the difference in the physicality of the teams. Women have a much harder time losing weight, and their numbers demonstrate that week after week. But Jillian pushed them very, very hard and it paid off. The black team won, and Mark, the central figure of the blue team, the older brother and devious game-player, lost only one pound. Oops. Maybe not so unstoppable after all.

Roger reminded Mark that he had promised to leave voluntarily if he hit a wall with his weight loss. Mark fought back, trying to wiggle out of that commitment, but in the end, he had a crisis of conscience and told everyone, including his brother, to vote him off. To say that the last twenty minutes of the show was unbearable is an understatement. Crying, hugging, vowing eternal brotherhood, more crying, long and dramatic speeches. And then it was over. And Mark was gone. Leaving Brittany and Bernie of the black team, the only intact team from the beginning. And they are the two that were strangers when it all began.

How will Jay do without his overbearing older brother?
Will the blue team regret those tattoos?
Will Mark come back the winner of the voted-off biggest loser competition?
Will Dan actually learn to play guitar?
Will we care about any of this?!

We still cheer for the contestants and their accomplishments. And while Mark has never been our favorite, he has demonstrated the greatest change physically and his determination will no doubt carry him further on his weight loss path. We wish them all luck.

But we long for a simpler time. When the show was an hour. When the focus was weight loss and how best to achieve it. When the contestants cheered for each other rather than conspired to "play the game" only to win the money and the weekly prizes. When Bob and Jillian were trainers, exempt from the melodrama.

Sigh. What's been lost from this show is more than weight; it's lost its soul.

(c) Photos courtesy NBC Universal.

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The Biggest Loser-Couples: Better to Have Loved and Lost?

2008-02-20T06:58:00.008-05:00

Last night was not a good night for Paul. He seems to have suffered a setback not only in his weight loss, but in his emotional loss as well. Paul, you remember, teamed up for this show with his ex-wife, Kelly. Together they have experienced quite a roller-coaster journey on The Biggest Loser, but Kelly has been a key reason that Paul has consistently "put up good numbers" as they say in "weigh-in" jargon. Kelly, along with Jillian, helped motivate Paul and reminded him why he was there and why he had to get healthy, literally to save his life.

But last night's episode was very revealing: reality TV met reality, as the contestants were sent home for a week to see how they would fare in the real world. Away from their trainers, the gym, their partners and new friends, and the kitchen that is stocked with only healthy, approved food items. The results were dramatic.

Bob's blue team, who have spent the previous two weeks facing elimination, had been humiliated and demoralized by their consistent loss (not the good kind), both in the challenges and on the scale. So they left the campus with strong determination to continue their progress at home and to come back and post significant weight loss. They did not want to go to the elimination room again. It's also worth noting that while Bob provides support and oversight, he is not as connected to his team emotionally. These four macho guys are very independent and self-motivated.

Jillian's black team, by contrast, had been eking out just enough weight loss to win the weigh-ins, but they seem especially dependent on Jillian for the push that makes the difference. Jillian, you may remember, forces her team to face their emotional dependencies on food and has created strong bonds with each of the members of her team. As a result, Jillian called each of her "people" when they were home, twice a day, to check on them and remind them of their goals and potential pitfalls. Of all the members of the black team, only Paul refused to speak with Jillian while home. This proved a tragic mistake.

The homecomings were interesting and touching and some people, like Mark, the overbearing control freak who has been at the center of much of the controversy on campus, immediately pulled donuts out of the mouths of his children and threw away everything in the house that could prove a temptation. His kids were crying, his wife was surprised, but he was determined to go back to campus a winner. Uh, a loser. This is where it gets confusing.

Mark also pushed his brother Jay, both of whom live outside of Boston, and while this sometimes annoyed Jay, he listened to his older brother. After last week's episode, where the blue team lost the weigh-in by a pound, Jay, who had the lowest weight loss felt entirely responsible. So he was also very determined to do well while home. This determination, coupled with what they learned on campus, proved a powerful combination. Jay lost the most weight of anyone and at the weigh-in, Bob's team demolished Jillian's team and for the first time in weeks, the black team headed to the elimination room.

Paul, marked for elimination for a variety of reasons, including his own defeatist attitude, was sent home. This leaves Kelly alone on what used to be the yellow team.

Paul. A big guy with a lot of emotional issues, many of which were exposed on the show. But perhaps the biggest issue was that he was still in love with Kelly, his ex-wife and partner on The Biggest Loser. So as long as Paul was with Kelly, he rose to every challenge, lost a lot of weight, and kept the promise he made to himself to get healthy and live longer than his father lived. But as soon as he went home, his unhappiness made him vulnerable to his emotions and his loss, and he ate three massive plates of buffalo wings, large glasses of soda, and mountains of cake. He also refused to answer or return Jillian's calls. And in that scene at the very end of the show, where we get to see how the eliminated player is doing, we learn that Paul came down with double pneumonia as soon as he got home and actually gained six pounds.

We don't have a lot of hope for Paul. His issues are deep and his coping mechanisms are not exactly finely honed. He has a long way to go.

So the question remains: is it really better to have loved and lost? In Paul's case, we're not so sure. But we wish him luck and hope that he makes healthier choices now that he's home.

(c) NBC Universal.

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The Biggest Loser-Couples: "Walk It Out or Talk It Out"

2008-02-13T14:59:00.006-05:00

Well, last night "The Biggest Loser-Couples" took a very interesting turn. Jillian's team, under her strong and kind leadership, looked deep within themselves to find the root cause of their obesity. They touched on nerves long deadened by trans fats, and what they unlocked will most likely serve them well in future weeks. By contrast, Bob's team, now comprised entirely of men, many of the macho variety, decided that looking deeply into their issues wasn't for them, and quickly high-fived themselves right into the elimination room!

Here's what happened.

In past posts, we expressed concern over Jillian venturing into territory for which she had no credentials--like psychotherapy. She must have read our blog, because rather than trying to help her team deal with their issues herself, she called in an expert, her mother, an experienced therapist who cares about people's mental health like her daughter cares about their physical health. (Hmmm...maybe that new show we've been hypothesizing about will be a reality show featuring Jillian and her mom...mental health, physical health....Oprah....are you listening?)

Side note: When Jillian introduced her mom, she squealed in the voice of a four year old, "Mommy." It was too cute not to mention.

OK, back to the show. And to what really proved to be compelling television. Jillian's mother, through a winning combination of kindness and expertise, got the black team to talk about the pain in their lives that triggers their eating. She helped them to see the connection and she offered them support and insight, both of which were welcomed and appreciated. This should have a profound and lasting effect on the black team's success, both on the show and well after.

Meanwhile, back at the ranch, Bob's team was feeling pretty disjointed after last week's nasty deception which resulted in Jackie's elimination. Her son Dan was left to pick up the pieces, and while Bob was supportive to him personally, he did not make any effort to bring his team together to mend their feelings. (We suspect Jillian would have made them talk.) So Dan, feeling very much the outsider, called the group together and they all talked and resolved to work together and they seemed to really achieve that, thanks to Dan. And no thanks to Bob.

However, the weigh-in--that incredibly tense and defining weekly experience--proved difficult for both teams. Jillian's team went first and racked up decent totals, but two of the five people had very low weight loss. This put smug smirks on the faces of the macho-therapy-trashing-we-got-this-in-the-bag-group of men. Oops. Lost by a pound. Bummer.

Lucky for Bob's team, Trent, the incredibly sweet but impossibly homesick ex-football player (pictured here) wanted out. He has said repeatedly that he was in this only to lose weight and change his life for himself and his family. He had little interest in the money or the game-playing. He also wanted to get proper medical attention for his bad knee, which often caused him to do poorly on the challenges. So he volunteered to leave, and after many conversations and much emotion (hence, the two hour show!), the team agreed to let him leave.

The impact of this week's episode will likely be felt in weeks to come. And one therapy session, no matter how powerful, does not a life change make. However, this is reality television. And the therapy was sincere. And even if Jillian's mom opened just a little, a door that had longed been locked in each of these contestants, surely Jillian will make certain they walk over that threshold with their heads held high.

And then Bob's team might one day realize that if they don't "talk it out" the only place they may "walk it out" is in the elimination room.

(c) NBC Universal.

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HOUSE: Unexpected Droop

2008-02-06T12:43:00.000-05:00

Ptosis is a funny word. It has Greek origins so the 'p' is silent (say TOE-SISS). Same goes for the pterygium (a noncancerous eyeball growth) and the prehistoric pterodactyl.

As an ophthalmologist, when I hear about someone with 'ptosis' I presume they are talking about 'blepharoptosis', a droopy eyelid. Episode 82 of House, "Don't Ever Change" is all about a different kind of droop.

Former rock producer Roz Viner collapses from a fall during her Jewish wedding and breaks her leg. She demonstrates multiple paradoxical states such as pain in her noninjured leg and hypothermia when occupying a heated chamber. She repeatedly crashes and requires multiple different resuscitations - all of them timed to occur immediately before the next 4:00 minute block of commercials. Oy vey!

It seemed like this House offered disproportionately more nonmedical theatrics than typical episodes. The return of former applicant (cutthroat) Amber was an unexpected twist. Maybe one of my favorite fellowship candidates, the old nonphysician Henry Dobson, will enjoy a reprise! As earlier readers have commented, "Relax, it's just a fictional story!" They're right.

Things continue to deteriorate for Roz: bloody urine, rigid abdomen, unstable vital signs. Roz and her new husband observe their first Shabbat together but it won't be their last. Without explanation House performs a simple physical exam technique to divine the diagnosis. When hand pressure applied to the flank is released Roz again heads for the floor. Eureka!

House announces that all of Roz's problems are attributable to a droopy kidney, something called nephroptosis. The kidney was injured during the hora, the elevated chair dance that was performed after the wedding ceremony. The dislodged kidney (and neighboring adrenal gland) were responsible for the entire constellation of problems. Surgery can reposition the wandering organ.

It's good to know that your organs are not firmly anchored; they all have a little 'play' in them. The kidneys can travel an inch or so when rising to a standing position. Same applies to the spleen, the heart, even your eyeballs. Some flexibility is good for everyone.

Speaking of flexibility, are we to believe dancing the hora could dislodge a woman's kidney? "Relax, it's a fictional story!"

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The Biggest Loser-Couples: Cooking Up Karma

2008-02-06T09:58:00.000-05:00

We're happy to report that last night's episode was pretty good. At least, on a relative scale. (You know we can never resist a pun.) For once the emphasis was nutrition rather than exercise and it proved an interesting topic, offering some real entertainment value. We were as surprised as anyone!

But before we go on, we have to say "We told you so". We have believed, and repeatedly stated, that the contestants' emotional well-being had a direct correlation to their success on the scales. We know this is not a new idea, but it's easy to lose sight of the emotional aspect of this kind of life change when we're presented with a contrived set of circumstances in which to view it. We have been concerned about how these people were doing emotionally, and have expressed upset when the producers were playing around with people's emotions in an effort to boost the drama quotient. This episode proved our theory. Jillian's black team had been fairly demoralized and made to feel quite inferior to Bob's blue team. But after inspiring them, consoling them and motivating them to get back in the game, Jillian was able to turn her team around. And the results were impressive. Here's a two minute video synopsis, courtesy of NBC.

So this show was about the tides turning and the black team regaining their sense of self and their sense of self worth. You know there was no way Jillian would let her team feel like losers (the other kind) for too long. So black triumphed.

And while black was kicking butt, the blue team was having a crisis of their own. Mark, the aggressive controversial figure on the blue team discovered he had a stress fracture in his leg. This limited his options in the gym but he nonetheless managed to lose the most weight and secure immunity. But when the blue team lost the challenge and had to select someone to leave, Jackie organized the group and, with Trent on board, decided to send Trent home - he has been famously homesick and he was OK with leaving, telling everyone he'd continue the work at home and come back a winner. Jackie, suspecting Mark and Jay (the brothers) were not always men of their word, extracted from them a vow to vote for Trent - they both swore on their children's lives. Never a good idea under any circumstances; especially not a good idea on a reality show!

The votes were cast and Jackie was eliminated. She didn't leave quietly; and she reminded Mark and Jay that they had sworn on the lives of their children. They are surely cursed now and it will be interesting to see if they get "theirs".

So, moral of the story: don't mess with reality show Karma.

It never works out well. If you play politics too long on Survivor, you get kicked off the island. If you "U-Turn" someone on The Amazing Race, you end up going home. You mess with your teammates on The Biggest Loser...we'll see. But Mark may very well get a little taste of what he's been dishing out.

(c) Video courtesy of NBC Universal.

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HOUSE: Remote Possibilities

2008-02-04T10:56:00.000-05:00

A female psychiatrist stationed at the South Pole develops severe flank pain but lacks the vital medical resources to establish the diagnosis and initiate effective treatment.

The story line in Episode 81 of House, 'Frozen,' reminds us of the peril involved when working in remote locales.

Did you know that in the real world personnel assigned to polar duty for the winter must have their appendix removed beforehand to prevent a similar crisis?

Cuddy assigns the emergency case to House and much of the drama occurs in the Princeton-Hillsboro teleconference suite. House quickly develops an emotional attachment to Dr. Cate Milton, a sharp-tongued, witty and highly intelligent patient who condemns House's shotgun style of medicine: speculate, test/treat, manage complications, regroup without apology. As a viewer, the confrontation between patient and doctor was far more instructive and compelling than all the other hoopla: urine tasting, self-performed thoracentesis, self-performed needle biopsy, Black & Decker craniotomy...ugghh!

Every time House wanted to begin empiric treatment for another unproven suspect diagnosis Dr. Milton challenged him. She refused to waste the outpost's limited medical supplies without valid justification. This woman was tough - we should be as tough with our own doctors! Granted, we essentially have unlimited access to diagnostic tests and medications, but that should not encourage lazy thinking or waste. Excessive procedures and prescriptions carry risks of severe complications. Doctors are expected to narrow the possibilities to clarify the real diagnosis.

An equally valuable lesson was saved for the final scene: You tend to find what you're searching for in the last place you look. Had House performed the complete 'video physical' as promised early in the episode he would've discovered the bruised, broken great toe on Dr. Milton's foot. Fat emboli from a the marrow of a non-healing bone fracture ended up being the true source of this patient's problems.

How can you apply these lessons in your own health care universe?

Never hesitate to talk back:

Please explain to me what you are saying.
What other options are available?
What kinds of problems will happen if I choose not to receive treatment?

Never hesitate to ask direct questions:

What did my MRI scan show?
Did you receive my biopsy results yet?
Is it time to get a second opinion?

Busy doctors can easily overlook previous orders and diagnostic studies. These oversights can lead to an unnecessary delay in getting you the help you need. On more than one occasion a gentle reminder from a cooperative patient saved the day for both of us.

You don't need to travel to the ends of the earth to benefit from these valuable lessons.

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The Biggest Loser-Couples: The Scales Have Tipped!

2008-01-30T06:22:00.000-05:00

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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HOUSE: Sabotaged by Striking Writers?

2008-01-30T01:08:00.000-05:00

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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Technorati Tags: House, TV, medical shows, cancer, paraneoplastic neurologic syndromes, writers strike

The Biggest Loser - Couples: Game On!

2008-01-23T17:19:00.000-05:00

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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Biggest Loser-Couples: Shedding Baggage and Weight

2008-01-16T14:43:00.000-05:00

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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