Andrew Holtz, the author of The Medical Science of House M.D.
answers questions about the book especially for the House M.D. Guide site.
- Why write a book about the medicine on House? After all, it's fiction, not a documentary.
- There are at least three answers to that question.
The first is that there are a lot of people watching House each week, and during each show almost every viewer wonders at some point, "Could that really happen?" The book digs into some of the more bizarre cases of the series, and I was somewhat surprised by what I found.
The second reason is that popular TV shows with medical themes actually influence people's beliefs about health and medicine. Sure, viewers understand that the show is fiction and that things are exaggerated or altered to suit the story, but many surveys have documented that after watching a drama about a medical topic, TV viewers accept certain events as being realistic. For example, after ER and Grey's Anatomy aired shows involved breast cancer genetics, more viewers knew surgery, done before there are any signs of cancer, can reduce the risk of breast cancer among certain women with a very high-risk genetic mutation.
The third reason connects to the first one. I've been covering health and medicine for many years for CNN and other news outlets, but a lot of people don't watch the news. Since so many people are watching House, it's a marvelous opportunity to reach a wide audience. House gets people's attention, but I hope readers will learn not only interesting facts about the show, but useful and important things about health and health care in the real world.
- Well, then, could the bizarre cases on "House" really happen?
- First, let me say that something weird must be going on in the Princeton-Plainsboro area. I'd be wary of living in a community where so many really awful things suddenly strike people in the prime of their lives.
The short answer is that while the cases are highly improbable (and that's putting it mildly), they are not completely impossible. Of course, often what appears as one case is really a combination of strange features from several real cases. And some of the reports in medical journals that describe similar cases are autopsy reports; that is, the strange disease happened, but in the real world, doctors didn't figure it out in time, or even if they did, there was nothing they could do to save the patient.
In the book, I go into a number of the cases in some detail. But I also explored the general ways that the show either matches or diverges from the real world of medicine and health care.
- Two of the three reasons you mentioned for writing the book have more to do with health care than "House" itself, so is the book about House or is it about medicine?
- Both, really. It's not an episode guide with blow-by-blow descriptions of each case; there's no need to duplicate what's already available on the Internet. The book, like the show, starts with how patients come to the attention of doctors, the "case presentation" that is shown before the show's title sequence, and then it flows through the diagnostic process and describes how real-world doctors make decisions about which tests and treatments to use.
I dug deeper into selected cases, such as the teenager with a mutant measles virus attacking his brain, or the pregnant woman with lung cancer facing a decision about treatment that might harm her fetus. Sometimes I found case reports in the literature that I believe may be the same ones the writers used to create their stories. For instance, in "Fidelity" House refers to an article on sexual transmission of African Sleeping Sickness that he says he read in a Portuguese medical journal. I don't read Portuguese, but I did find a letter in The Lancet (http://www.thelancet.com/) from a doctor in Lisbon, Portugal that told of a similar case.
- How many episodes do you cover in the book?
- I had to finish the book early in the year, so I was able to research the entire first season and most of the second season. Looking at the case studies in the book will help "House" fans understand how the writers use real medicine to develop dramatic stories. And since the book focuses on the general themes of the show and its style of medicine, readers can apply the lessons to decipher new episodes as they air. After reading "The Medical Science of House, M.D." viewers will have a better sense of where the show is realistic and where the writers use dramatic license in order to keep things exciting.
- In this third season, the show is confronting Greg House's Vicodin use and some of his other problems relating to co-workers and patients. Is any of that in the book?
- Even though I hadn't seen these new episodes when I was writing the book, I did spend a lot of time looking at House's Vicodin use, his beside manner (such as it is), and his relationship with his colleagues and administrators. These issues are incredibly serious. I wrote about how doctors with similar issues are dealt with in the real world. So it is fascinating to now see the show, and Greg House, face the problems head-on.
- What qualifies you to write about "House," are you a doctor?
- No, I'm not an MD; but I've reported on health and medicine for CNN and other news outlets for many years. I was a CNN Medical Correspondent and co-host of CNN's weekly health show. I covered some cases that would be worthy of "House," including transplants of baboon hearts into people, and mysterious infections that eventually led to the identifications of HIV and Hantavirus.
Before getting onto the health news beat full-time I covered other big stories for CNN, including the early eruptions of the Mt. St. Helens volcano, several Space Shuttle landings, and the discovery of the Ozone Hole.
After 17 years reporting for CNN, I returned to my hometown, Portland, Oregon, where I've been working independently. My stories have been on PBS and local public TV and radio. I hosted a health series that aired on Fuji TV in Japan. I've also written for health and medical web sites, including www.thescientiest.com. I'm the past President and a board member of the Association of Health Care Journalists, www.healthjournalism.org
Currently, I'm writing a column for a bi-monthly publication for cancer doctors and nurses, Oncology Times. The column was inspired by "The Medical Science of House, M.D.," but instead of talking about medicine for fans of a TV show, the column tries to explain television to health care professionals. I write about why television shows portray medical issues the way they do. I've interviewed writers at "House," including Lawrence Kaplow and David Foster, M.D. for some of the columns. At some point soon, revised editions of these columns may appear in other publications aimed at a general audience.
Although I don't have an M.D. degree, I do have an M.P.H. It doesn't mean I'm speedy; it stands for Master of Public Health. My studies focused on how information in news, entertainment and advertising affect what people know about health and then how they act on those beliefs. So a book about how health and medicine are portrayed on a hit TV show like "House" is right up my alley.
- And finally, would you want Greg House to be your doctor?
- While we all would want a brilliant doctor caring for us if we faced a mysterious, life-threatening ailment, all the high-tech devices and aggressive treatments showcased on House, M.D. are essentially irrelevant to protecting our health. Staying healthy in the first place depends mostly on where and how we live, factors that Dr. House would be powerless to change.
But if I did get sick with something really unusual, yes, I would want a doctor who could think of all the possible "zebras" that might be lurking in my body. But I would also want a physician who really cared about me as a person and always remembered that the patient is more important than his or her desire to solve a mysterious disease.
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