House Wannabe and the Case of the Real McCoy
Foreman: "Looks like they got the pheo out successfully. So. what now?"If you think back to Season 2, Episode 1, you might remember the story of Clarence, played by LL Cool J. Clarence was an inmate who had been put in jail on the charges of multiple counts of murder. Just prior to being brought into the Princeton-Plainsboro hospital, he was experiencing an episode of uncontrolled rage and hallucinations. During the course of the show, House discovered that Clarence suffered from a pheochromocytoma, a tumor of the adrenal gland that oversecretes adrenaline. Too much adrenaline in the body typically causes episodes of headaches, high blood pressure, sweating, and heart palpitations. House figured that in Clarence's case, the extra adrenaline was making him have episodes of rage. Foreman took this argument even further and claimed that perhaps Clarence should be acquitted for his murders because they may have been conducted during one of his raging episodes. The episode ends with Foreman saying that he planned to testify in Clarence's trial.
House: "Clarence goes back to death row."
Foreman: "Just like that?"
House: "He's cured."
Foreman: "That tumor caused random shots of adrenaline, which obviously led to the rage attacks that made him become a murderer in the first place."
House: "By God, you're right! Let's call the surgeons. We gotta save that tumor; put it on the witness stand."
Foreman: "We could testify at Clarence's appeal."
House: "You smell that? I think that is the stink of hypocrisy. You wouldn't even consider the notion that Clarence's social upbringing was responsible for what he became, but now you're sprinting to the witness stand to blame everything on a little tumor."
Foreman: "A person's upbringing and their biology are completely different."
House: "Yeah. Because you only overcame one of them."
This argument at best spurious. I agree that it makes sense on a certain primitive level that excess adrenaline should cause a person to be violent. But that's it. There is no data anywhere that suggests that a pheochromocytoma can actually cause a person to be violent. In fact, even in forensic medicine journals, pheochromocytomas are acknowledged primarily for their ability to cause sudden death and panic attacks. As people who've suffered from panic attacks can tell you, the last thing a person who is having a panic attack is interested in is killing someone else.
So consider my surprise when I saw in the Washington Post today that "the real McCoys," renouned for their violent feuds with the Hatfields, have a hereditary disease that results in pheochromocytomas. Von Hippel-Lindau disease is apparently the cause of the violent history shared by members of the McCoy and Hatfield families, according to Dr. Revi Mathew at Vanderbilt University. Dr. Mathew says: "This condition can certainly make anybody short-tempered, and if they are prone because of their personality, it can add fuel to the fire."An interesting statement, even if it is at least somewhat incorrect. Maybe he saw it on House?
posted by k-deep at 9:49 PM
4 Comments:
As a person with VHL (vonHippel-Lindau Disease) and recurring pheo's I can tell you that when a pheochromocytoma is active it can cause you to lose your temper faster at times. The story about the disease causing some of the issues with the Hatfields and the McCoys, is hard for me to believe. The House episode where it caused someone to commit murder and have halucinations is absolutely rediculous.
This disease is very rare and serious. For more information visit www.vhl.org
It's interesting to see a disease such as pheo depicted on television because it's so rare and many of us students (including me) have never worked with a patient who has it. Your personal experience with the symptoms is much appreciated, and I think that while House overdramatizes some of the aspects of the disease (murder, hallucinations), it also draws attention to a disease that doesn't otherwise have much public awareness.
I agree completely that everyone is responsible for his or her actions, no matter how lousy they feel.
The press focused on "VHL" as the cause of the adrenal surges. That is not correct. The adrenal surges are caused by pheochromocytoma, which is one of six kinds of tumors that may occur in VHL. Not all VHL families are even at risk for pheos -- it depends where the flaw occurs in the gene.
The real crux of the problem is the difficulty of diagnosis and localization of pheochromocytoma. Six different genetic alterations can result in a pheo. VHL is one of them, but only one. And they also occur in the general population, much more often that they run in families. To focus only on the McCoys, or only on VHL, is not to appreciate the real problem of pheos.
Still today, in 2007, fully half of pheos are diagnosed on autopsy. See http://vhl.org/newsletter/vhl2005/05dapheo.htm
For doctors, I would highlight in the original McCoy article from Vanderbilt that Winnter, the young girl, was misdiagnosed with Attention deficit disorder and hyperactivity. Pregnant women with pheos are usually misdiagnosed with pre-eclampsia. Many people are told they have anxiety disorders and are given psychotropic drugs, which only make the problem worse.
Pheos occur in the general population, and in people with any of six tiny genetic flaws.
If anyone feels they are having uncontrolled high blood pressure, palpitations, unexplained bursts of panic or rage, and/or excessive sweating, they should ask their doctor to do a test called "plasma free metanephrines". This is the most accurate test for a pheo.
Wishing you all the best,
Joyce Graff, Executive Director
Cancer Research Fund / VHL Family Alliance
http://www.vhl.org 800-767-4845
I too suffered from a Pheo and I appreciated this episode. TV dramatizes everything, but I have talked to several people in pheo support groups and i have found a few [men mostly] that suffered from extreme bouts of rage and violent night terrors. I have also spoke to many that have cited unnatural strength...and the feeling you could lift a car over your head. These things treat people differently...house just picked the most "exciting" of symptoms to display prominently
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