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HOUSE: Finding It Hard to Swallow?
The guest star patient for this episode of House, M.D. (Adverse Events) had a bezoar. There! A top-line spoiler!I suppose if you've never previously heard about a bezoar the climactic diagnostic surprise remains intact.
Portrait artist Brandon is struggling financially and participates in new drug clinical research to pay his bills. Unfortunately he was actively enrolled in three simultaneous medication trials: an anticoagulant, an immune modulator, and an antacid. Brandon's art suffers because of drug-related visual changes.
Despite hemodialysis Brandon has recurrent bouts of drug toxicity. Even a slow drug taper failed to control a serious heart arrhythmia. He also displays hypersexual aggression and his hair changes color. Problems progress as if the medicines were never discontinued.
In the end, all of Brandon's problems do trace back to adverse interactions between those three experimental medicines. The antacid slowed Brandon's intestinal motility and a clump of undigested matter collected in his gut. Supposedly, many swallowed pills got trapped in the 'hair ball' (yep, lay terminology for a bezoar!) So, even when Brandon stopped taking the pills his bezoar continued to leech drugs into his digestive system. Yecchhh!
The cast members took their turns disparaging clinical trials. In all fairness, the current system is among the world's safest and most rigorously enforced, but we need to do better identifying unscrupulous researchers, indifferent medical journal publishers and dishonest corporate decision-makers. There was no mention of Phases I-IV which prioritize drug safety long before efficacy is analyzed. Truth be told, most new drugs never make it out of Phase II (human safety).
While we are on the subject of truth-telling, much of the dramatic subplots in this episode focused on issues of honesty. Brandon nearly died because he failed to disclose his failure as an artist to his girlfriend and he covered that lie by choosing not to disclose his unauthorized entry into three different drug trials. Surgery yielded a football-sized bezoar and Brandon fully recovered - enabling him to begin formulating his apologies. He can start with the hospital cashier. Nobody explained how unemployed Brandon will pay the bill for his week-long hospitalization!
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Labels: clinical trials, House
