Tuesday, December 23, 2008

House MD: Merry Little Christmas Error

I was doing what every med student does in place of studying, learning from House, when I noticed an error in the medicine on the show. I'm fairly certain the writers get their medical advice from real doctors, so this is actually quite surprising. However, there is also a good chance the writers get their information from wikipedia, so maybe the American healthcare system has nothing to worry about (on the flip side, that means us medical students DO have something to worry about because wikipedia is THE source for PBL info...haha, just kidding of course...).

In the episode, "Merry Little Christmas", the patient, Abigail, has both liver problems and lung problems. House advises Foreman to get ahead of the disease and look at the pancreas. I have no idea whether this is good advice or not...I'm a first year student, I can barely spell pancreas! However, Foreman follows this advice by testing for alpha-1 antitrypsin deficiency. When Cuddy and Wilson question him about the test, they ask why he suspects a problem with the pancreas.

The problem with this sequence of events is that the pancreas is not related to alpha-1 antitrypsin deficiency. Alpha-1 antitrypsin is a protein that is created by the liver and its function is to protect the lungs. Genetic mutations that lead to alpha-1 antitrypsin deficiency result in defective alpha-1 antitrypsin being created in the liver. The liver is unable to secrete this protein into the blood stream and it ends up accumulating in the liver cells and damages them. The absence of alpha-1 antitrypsin also results in lung damage because the protein is not present to protect the lungs. Thus, alpha-1 antitrypsin deficiency is a good diagnosis for the liver and lung damage...but has absolutely nothing to do with the pancreas.

Seriously...if House can't get this right, where am I supposed to learn about medicine?

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