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Review

Is there a scientist in the House?

House, MD on Fox

Bill Hanage 4 September 2005

www.lablit.com/article/47

Any resemblance between the reviewer and Dr. House is purely coincidental

House eschews the white coats, ties and chinos of his colleagues and regularly forgets his stethoscope...

British viewers may be forgiven for taking the mother of all double takes at Channel Five’s new import House, MD, in which Hugh Laurie, the former Prince Regent (Blackadder III) and dimblebrain Captain George (Blackadder Goes Forth), not to mention one of the more convincing Bertie Woosters, is reinvented as a bitter, cynical New Jersey hospital doctor, the eponymous Gregory House, with a double specialty in infectious disease and nephrology.

The idea of House is the old "maverick the suits would love to fire but can’t because he’s the best man they have" cliché. Beyond that, it is to do for medical dramas what Crime Scene Investigation has done for police procedurals. In other words, put back the science that drama normally takes out. The most obvious result of this is that at the slightest provocation, the camera plunges into the body, brain or bloodstream of the patient and shows cells puckering as osmotically appropriate, or aneurysms popping, or thromboses fragmenting and whizzing up the vessel to lodge in the lung and bring us to embolism city.

At another, very welcome, level, the show puts the differential back into diagnosis. The physicians consider evidence for and against hypotheses, searching for the unifying cause. Most of the time, they don’t actually know what is wrong. The plot includes, and the script attempts to explain, how pathogenesis occurs (e.g. immunopathology at sites remote from a tumour as a result of shared epitopes on normal and tumour cells). Scenes take place in laboratories where gels are run and bands interpreted. There is even a strong experimental component – House prescribes treatment for a diagnosis in order to see what happens and collect more data. If it works, it favours his idea; if it doesn’t, back to the drawing board.

In a way which will bring a smile to many a ‘basic’ scientist in medical fields, House eschews the white coats, ties and chinos of his colleagues and regularly forgets his stethoscope, which he only carries when he is likely to need it. His sartorial style is based around shabby jackets over untucked shirts, and only a passing familiarity with a razor (a look he shares in fact with me). The similarities go beyond this to the working style. House and his team spend a good deal of time sitting around drinking coffee while throwing hypotheses around. In this regard, they resemble nothing so much as lab scientists probing a problem.

All this is excellent. However… and it’s a big however.

The medicine is, not to put too fine a point on it, appalling. House leads a team of three junior docs who, it appears, are treating one patient at a time. Note, that is one patient between three doctors. The sole purpose of nurses is to hold patients down while they have seizures (which happens a lot in House). Doctors also run all the various tests, putting radiographers, microbiologists and biochemists out of a job. I tried not to burst out laughing as I saw one of them hoik a gel out of a tank and inspect it before gravely announcing, "It’s not Epstein Barr Virus". Reader, I failed. By the way, it’s a lovely lab, apparently for the sole use of House and his team. New equipment and nice glass walls. In fact, pretty much every interior wall in this hospital is made of glass. I am still waiting for a crash team in a rush to run full tilt into one of these. Still, being able to see across several rooms at a glance must be useful for spotting the patients having one of their many seizures.

On top of this, Team House are regularly dispatched on field trips to the patient’s home, place of work, commonly used restrooms etc. to check what they have been eating, or for toxins or infectious substances. Usually, this means they have to break in somewhere, presumably because this is much more exciting than, say, taking a thorough history. In fact, it is pretty obvious why House’s boss is so concerned. House treats fewer patients than anyone else, and encourages staff to break the law. His cure ratio is high, it’s true, but were he to treat more patients maybe it would start to dip.

What House is really good at is curing people who will otherwise die. This is, in fact, a pretty nonsensical statement. All any physician can do is delay death, for as long as possible. But for some reason House only has to treat people who will die soon. Or at least he blithely asserts the certainty of this even while having no idea what is wrong with them.

This leads not just to bad science or medicine, but to dreadful drama. I am pretty sure you could splice two or three of the episodes together, switching them during the ad breaks, and no-one would be the wiser. House plots work according to a formula: a seemingly healthy person suddenly collapses (note not an old person because presumably they have less life to save). House reluctantly takes the case. He brings his three gofers into his (glass walled) office, riffs off some diagnoses, picks one and sends one of said gofers to start treating the patient, who has a seizure (House never gets his diagnosis right first time, you’d think someone as clever as he is supposed to be would have noticed this and done some statistics showing he should pursue the third thing he thinks of). The team then throw every test they can think of at the unfortunate person in their care, while House works his way through the A-Z of family medicines before hitting on a cure, all the while talking about the near and certain death of the patient. Family members get angry and are then grateful, and Robert Sean Leonard (remember him?) blows through a couple of scenes. What is he doing there? Who knows. He certainly seems to have no idea.

Now, maybe I am way too serious, but I find this pretty offensive. In reality, there are patients with chronic diseases. They seem not to matter in House-land. And how about the real physicians who have to make treatment decisions in the middle of a busy ward round? House is such a misrepresentation of medicine that the good bits about science can’t rescue it. Hugh Laurie is as entertaining and funny as British audiences know he can be, but in the end, he’s the main reason to watch it.

This is casting in which everyone wins. The programme makers get a Brit whose American accent is at best occasionally convincing and, having no image and reputation in the US, is happy to spout some of the most politically incorrect lines on mainstream US, or come to that UK television (to a subordinate accusing him of dishing out an inappropriately hard time: "Hmm, can’t be the race thing. You’re just as black as you were last week."). Hugh Laurie gets to play both the villain and the hero at the same time, and presumably on a better salary than he would get on Holby City.

So I can’t bring myself to cast the show into the outer darkness. Irritating though it may be, any show which includes one half of A Bit of Fry and Laurie, a fragment of Dead Poets’ Society, diagnostic procedures, sarcasm and infectious disease has to have something going for it.

So B-. But only because of Hugh.

House, MD is aired in Britain on Channel 5, Thursdays at 10 PM.