Patrick Clinton

as Geoffrey House, a brilliant, arrogant, impossibly rude diagnostician. He mocks his patients, taunts the doctors who work for him, and does end runs around hospital policies, while making brilliant diagnoses of ludicrously rare diseases. (If there's a real-life physician in House's home state of New Jersey who in a single month has diagnosed rabies, leprosy, sexually transmitted African sleeping sickness, and acute naphthalene toxicity caused by breathing fumes from termites, I'd love to hear from him or her.)

House's nemesis is Vogler, the wealthy owner of a pharma company, who contributes $100 million to the hospital and demands the job of chairman. He wants to turn the hospital into a clinical trial mill, even if it lowers standards of care. He bullies the doctors and blackmails House into giving a speech for his company's overpriced new ACE inhibitor. He denies a dying woman his company's experimental drug because she might screw up his data. In short, he's a swine. (Chi McBride, the actor who plays Vogler, said in a recent interview that even in Canada—where presumably the cost of his fictional ACE inhibitor would be far more reasonable—people approach him on the street to say, "I hate you.")

When you get right down to it, risk in its various forms is House's main subject. The doctors are never quite sure what disease they're dealing with. (Could it be a heart infection? No, but how about a sinus infection overlaid on hypothyroidism? An error at the pharmacy that gave the patient gout medicine instead of cough medicine? No, it's just tainted Ecstasy.) The point is to watch House being brilliant, but the message is that disease can be bewildering. Good message.

Medications on the show are incredibly powerful for good and ill. The right drug brings patients back from the brink in seconds. The wrong one triggers computer-animated respiratory shut-downs and EKG flatlines. If the public in general believes that drugs are safer than they really are, they'll get a counter-education (only moderately exaggerated) here.

The best, to me, is the way the show's writers have made risk/benefit part of the drama. A husband has to weigh the dangers of a drug that kills one time in six against the chance that his wife (now comatose) was lying when she denied having the affair that would have infected her. A mother-to-be with fast-moving cancer has to balance the danger to herself of delaying for a C-section and the danger to her unborn child of having one right away. This is the kind of material that patients often have a hard time understanding. Here, in the setting of a TV melodrama, it's emotionally compelling and remarkably easy to comprehend.

That's important. The current furor over pharmaceutical marketing will eventually pass. The need to make patients understand risk will always be with us. When an entertainment company makes millions of people eagerly tune in each week for a reasonably accurate lesson, they're doing a public service. Evil exec character notwithstanding, we owe them thanks.

Patrick Clinton is Pharmaceutical Executive's editor-in-chief and can be reached at pclinton@advanstar.com
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