Drug Policy

Treatment House

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It looks like the running plot on House about the brilliant but cranky diagnostician's Vicodin habit is heading exactly where I feared: toward the realization that Gregory House (Hugh Laurie) pops all those pills not to relieve the chronic pain in his leg but because he's an addict. At first the story seemed to illustrate the injustices of the war on drugs, with a cop (David Morse) barging in to override the medical judgment of the doctors who had prescribed painkillers for House, freeze their bank accounts, disrupt their practices, and threaten them with jail. But in the latest episode House's colleagues cut off his supply of Vicodin, sending him into withdrawal and prompting desperate "drug-seeking behavior" that includes pretending to have a facial fracture and stealing a dead cancer patient's OxyContin. After he pops a few OxyContin, House is repeatedly asked whether he's "high"; then he finishes off the whole bottle in short order (a puzzling escalation for someone who was taking a weaker narcotic in smaller doses), washes it down with whiskey, and ends up lying on the floor of his apartment in a stupor. The episode closes with him trying to accept a plea deal involving drug treatment that the cop presented, in so many words, as a choice between House's principles and his career. The cop says the deal is no longer on the table. Scenes from episodes to be aired when the series resumes in January show House apologizing to the cop and announcing that he is checking himself into rehab.

I suppose there might still be a surprise that redeems what is shaping up to be (in a departure from what is usually a quirky and highly entertaining show) a morality play only slightly more sophisticated than an anti-drug after-school special. But it's hard to see how such a twist can be pulled off at this point. The last thing we need is yet another story about a proud professional forced to admit his drug problem only after he hits rock bottom. It would have been much more interesting (as well as useful to the cause of drug policy reform) to portray a doctor who takes Vicodin to control the pain in his leg but is mistaken for an addict by a heedless, ignorant, overzealous cop. All the ingredients were there: House, who walks with a limp, really does suffer from severe postsurgical leg pain. The one time he was able to function without painkillers (and without his cane) was after a radical neurological procedure that temporarily eliminated his pain. Most important, there has never been any indication that the Vicodin impaired his ability to do his job; to the contrary, his one misdiagnosis occurred when he was prevented from getting his usual dose. He plausibly attributed the mistake to distraction caused by untreated pain, while his colleagues saw it as confirmation that he was an addict in withdrawal. The show seems to be taking their side, reinforcing the ideas that 1) pain patients commonly become addicted to their medication and 2) even people with medical histories that support their complaints of chronic pain may be faking or exaggerating their symptoms so they can get high. These ideas are two of the reasons it is so difficult for people suffering from chronic pain to get adequate treatment in this country.

Ideally, it wouldn't matter whether House is a pain patient, an "addict," or some combination of the two. Morally, the relevant point is that he functions better when he's taking Vicodin than he does when he's not. His actual job performance, which (as other characters repeatedly emphasize) involves saving the lives of patients who otherwise might never have been correctly diagnosed, ought to be the relevant legal and professional criterion as well. But that is not the way the current system works, so the decision about how to label House and his Vicodin consumption has serious implications for him and his patients. It can ruin his career and send him to jail. Since that would end the show, it's not going to happen. The only plausible alternative is for House to admit he has "a drug problem," go into "rehab," and emerge a changed man. Or he could pretend to do all of that while privately continuing to reject the "addict" label, which would be in character for him as well as subversive, making a politically incorrect point about the forced re-education system that we call drug treatment. But then he would still face the challenge of getting the pain medication he needs, a problem faced by millions of Americans whose predicament is only reinforced by trite stories about addicts posing as pain patients.

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  1. Jacob, nice piece.

    I’ve Tivo’d the last two episodes so behind the curve a bit and must say I am disappointed to read this.

    The overzealous (SOB) cop that screws over anyone vaguely associated with House in an attempt to get even with our drug addled Dr House was/is a nice touch even though the writers cast House as deserving the cop’s wrath. The cop’s vendetta is a study in police power gone wrong in modern America. I hope they don’t turn it into a but it was for House’ own good, ends justify the means morality play. I can see that coming too.

  2. Awesome anaylsis….it really is a shame too, because the show has been so great as showing House as an anti-hero who rejects convention and is always validated for it.

  3. Jacob, thanks for giving House, M.D. some attention and respect. I also really enjoy the show and was hoping for a storyline more aligned with the real issues, especially as you have pointed out. The most recent episode is disappointing, but maybe the scriptwriters will pull something unexpected.

  4. Jacob, you’re seriously disappointed and surprised that Hollywood has pandered to the prevailing attitudes Americans have toward “pain management”? Didn’t some famous wit state that you could take all the integrity in Hollywood, fit it into a thimble, and still have room for your thumb?

    (He may have said “sincerity” but I couldn’t resist)

  5. No one in this society is willing to accept the lesser of two evils. We are supposed to be able to conquer everything and live a great life through healthy living. If you have chronic pain, getting through the day without pain and maybe suffering some long term side effects like hearing loss or learning to live with unbearable pain every day, I am taking the former. But our society can’t accept that. If it allows you to enjoy your life and be a productive member of society rather than an invalid, who cares if you are an addict?

  6. Great article! I stupidly taped over the episode, so I appreciate the recap. Who knows when it will be rerun, or whether I’ll remember to tape it. [No DVR in the kevrob household, as yet.]

    I disagree about the dramatic possibilities of a defrocked Greg, however. House, Mob Doctor would make a great series, even if it had to move to HBO.

    Kevin

  7. Maybe I am skewed too much toward the “doctors are just as dumb as the rest of us” position, but it seems to me that House & Co are largely engaged in blindly flailing around: trial-and-error experimentation involving the “What if we pump him full of this…” school of diagnosis.

    ———–

    Having said that, (and that I would like to see the cop character fall down an elevator shaft, incurring severe, permanently debilitating, excruciatingly painful injuries, et c, et c) I cannot help but wonder if a representative from the Ministry of Morals had a little sit-down with the producers of this show.

    ps- any drug which can turn Bertie Wooster into Gregory House SHOULD be banned.

  8. I didn’t start watching the show until the second season, and it quickly became one of my favorites. However, I had hoped that this story arc would be done with by the end of November sweeps, but instead it is dragging on in depressing, awful fashion.

    I hate to say it, but has House jumped the shark?

  9. Nice write-up Jacob.

    Love the show too, but to expect that a major TV network is going to take a couragous stand on anything, let alone drug use, is a fool’s errand.

  10. On more than one occation House has made the distinction that he is addicted to drugs, but does not have a drug problem. The fact that in this past episode he cuts himself to distract to the pain (and in the past has done other forms of self-mutilation when both on and off his meds) while at the same time detoxing highlights the fact that he has both a pain problem and is addicted.
    Later in the episode Wilson points out that removing House from the world due to his drug problems would be a negative, not a positive.

  11. My favorite episode of House is the one where a guy comes in with a malady and House’s initial diagnosis is incorrect and even makes the condition worse. Then he comes up with another theory, which is also incorrect, but while running the tests for the second theory, they stumble upon the real cause.

    That one was almost as good as the Gilligan’s Island where they almost got off the island.

  12. Wow, a discussion of my favorite show on my favorite website…

    I, too, felt a bit worried after this last episode, for the same reasons as Mr. Sullum. However, I think there’s still a (slim) chance they could pull it out without compromising. His speech to the dwarf mother seemed to subtly paint his character as one whose stance required a strength of character not usually associated with a flaw. So, it seemed just as likely that they could go more with the good-guy-finally-beaten-down angle, though that might be too much for primetime TV.

  13. Yes, the show is formulaic, but so is Dinosaur Comics. It’s character driven, not plot driven.

  14. Actually having some experience with prescription drug using physicians, I can say anecdotally that addicted physicians are not exactly a rarity. Nor is it uncommon to find addicted patients who may have at one time used their drug of choice to remedy a medical condition. Perhaps it would have been more dramatic to make House completely functional, if self medicating, and get harassed by the Man. But the story as described isn’t completely out of left field as far as real life possibilities.

    Having only seen the show once, my observation is that I’d like to see House get sued into oblivion, basically for being an asshole, as he was in the episode. Simply to illustrate the tendency for completely competent asshole doctors to get sued, while less competent, but nicer, docs gain the admiration of their patients.

  15. Rush Limbaugh said that House is just faking his pain.

  16. It’s character driven, not plot driven.

    Jonathan, you got that right. Without the snappy dialogue and character interaction that show would suck.

  17. Actually having some experience with prescription drug using physicians, I can say anecdotally that addicted physicians are not exactly a rarity.

    Famously, Dr. William Stuart Halsted, one of the founders of Johns Hopkins hospital was addicted to cocaine and then morphine throughout his career. He was known to be one of the most brilliant surgeons of his time.

    Jacob, maybe you should submit a spec script?

  18. House’s addiction to Vicodin isn’t at issue. The show established that back in the first half of Season 1, when he went off them for an episode and immediately started getting withdrawal symptoms. House acknowledged the addiction, in public, at the end of that episode, but maintained that the Vicodin didn’t impair his performance. The events of the third season support that so far – he was able to quit the medication (apparently cold-turkey) when his pain was gone, but went into a spiral when he was cut off from Vicodin after the pain returned. As far as I can tell with an amateur psychoanalysis of the character, the addiction that’s causing his “junkie” behavior is House’s “addiction” to not feeling the chronic pain in his leg (which leads to his kneejerk rejection of lower-impact treatments).

    I think what the show is getting at is the intense irony of laws that allow a person to be prescribed chemically addicting medication for a chronic condition, and then be prosecuted for becoming chemically addicted to it – especially when, since the condition is chronic, he’d be taking the pills, possibly for the rest of his life, whether or not he’s addicted.

  19. Of course, one thing to note is that he was addicted BEFORE his leg thing.

  20. Didn’t MadTV use this exact same plot for their parody of the show?

  21. I saw the episode as well and it does not look like this is going to end in a libertarian victory.

    Of course once he gives into the reeducation process and triumphs over his evils just let him try to get his federal DEA license, on any hospital medical staff or managed care plan.

    He would have better job prospects busing tables in the hospital cafeteria.

  22. I share Jacob’s concerns about the plot line, but I love the characterization of the cop; he is one evil bastard. I don’t think they’ll change that.

  23. A couple thoughts –

    First, if you think about it, imagine how funny a couple eps with Greg House loose in a touchy-feely rehab clinic would be.
    Secondly, when this arc started I felt – and still feel now – that before House actually gets into rehab, the cop will find himself befallen with some weird malady and House gives him a choice – drop the charges or I let you die.
    I do agree tho with the thought that a rehabbed House simply wouldn’t be the same character any more – just another lovable old curmudgeon.

  24. If anything, that’ll probably be how this ends – Tritter’s methods come back to bite him and House ends up going free on a lack of usable evidence/testimony.

    Not the most realistic plot for a drug trial, but they’re running out of ways to end the plotline while keeping the main character out of jail.

  25. The show is unwatchable and the writers are hacks: who’s surprised that they approach drug use in the same way as the Facts of Life (see recently linked bong clip).

  26. Respectfully, Jacob gets this completely wrong:

    1) If House needs his medicine for pain and is either (a) not an addict or (b) a person whose addiction causes them no harm, then the logical policy response is to just tell police to back off doctors prescribing for pain and their patients who aren’t being harmed. That’s tinkering at the margins of the current system.

    2) If House’s addiction is causing him harm, then the choice is much starker: the policy choice is either (a) to do something like what the cop is doing or (b) to let House alone even if he is harming himself. That dilemma puts the whole system in question.

  27. Ivan,

    So what shows do you like? (It’s only fair to let us know your tastes so we can trash them too.)

  28. I was left a bit confused by this plot line too. Remember, it all started when he pissed off the cop. The cop pulled him over and accused him of behaving like an addict (taking a pill in front of a patient) and then performed what I believe was an illegal search (grabbing his coat pocket with no reasonable suspicion or threat of danger to feel for pills).

    It’s like the second-string writers took over and didn’t know where they were supposed to take the plot so they defaulted to “drugs are bad and even doctors can’t handle them.”

  29. Years ago I found this online about a “clinic” in Atlanta that specializes in brainwashing doctors, lawyers, and other licenced professionals (under threat of their licences of course). It’s not pretty. http://www.peele.net/debate/talbott.html

  30. “that before House actually gets into rehab, the cop will find himself befallen with some weird malady and House gives him a choice – drop the charges or I let you die.”

    I’d pay to see that.

  31. I was talking to my dentist about this show, which I love, and he complained that it was way too unrealistic. Somehow, I think an hour watching a patient on hold with the insurance company just wouldn’t be as interesting. That’s just me.

    Ivan, lemme guess, it’s not as good as Boston Legal? Beat it.

  32. Since the beginning of the 2nd season, we’ve known that House is addicted. He has detoxed twice, and after both detoxes he is shown feeling relief the second he takes a pill, without there being time for the medicine to get into his system, showing that it’s a mental problem as well as a physical one.

    I think the storyline is trying to show the cop version of House. The cop is right, House is addicted, and he’s going to ruin everyone’s life to prove that he’s right. Just like House is right about a diagnosis and he will ruin everyone’s life to prove it.

  33. I only have one question.

    How do I program my DVR to skip anything not relevant to that night’s plot?

    I really don’t give a rat’s ass about House’s love live or legal troubles. What this show does well, and differently, is the medical mystery, and the politically incorrect interaction between House and his patients.

    I loved the “let’s go for a spin” line. 🙂

  34. I didn’t see the traffic stop. On what planet does a detective make a traffic stop?

  35. I agree that the direction House is taking is disheartening. I’m wondering where this cop came from, however. It is typical of the show to reveal secret agendas and this cop must have one. He just showed up one day to pick a fight? There has to be more. PLEASE, let there be more.

  36. bluecat and bubba:

    you missed the episodes with the backstory. the cop showed up to the clinic with a sore on his penis. House came in and was snotty when the cop complained about having to wait 2 hours to be seen. House told him he was dehydrated (from popping lots of nicotine gum to get over his own (the cop’s) cigarette addiction) and suggested “foreplay or using a lubricant instead of just shoving it in”. the cop insisted House take a swab sample, House replied there’s no need and started to leave, when the cop kicked the cane out from under him, saying “act like an ass, you’ll be treated like an ass”. House took a swab sample, then asked Detective Tritter to drop trou for a rectal thermometer, since the gum chewing would interfere with an oral temperature reading. He left the room, saying he’d be right back to take the temperature reading, but went home instead, leaving the cop standing around with a thermometer in his rear. House later refused to apologize, and Tritter decided to get back at him.

  37. Here’s a recap of the 1st David Morse (Tritter) appearance.

    Kevin

  38. I don’t watch that show, but I’m glad to see *Reason* people acknowledging that, indeed, the media does have an influence over peoples’ attitudes and behavior. See, it’s possible to be against government censorship while *still* acknowledging that some forms of expression can be harmful and should prompt lawful, peaceful protest from those who don’t like the message conveyed.

    I could say, “it’s only a TV show,” but my sarcasm circuits are out for repair.

  39. He’s named and modeled after Sherlock Holmes, so what’d you expect?

  40. I’ve probably seen too many episodes of The Wire because my first thought after Wilson revealed his deal with Tritter was that House could make the case go away if he just killed Wilson before he could testify about the prescriptions. Didn’t Cameron kill a patient? I’ll bet she could seduce and then poison Wilson if she wanted to…

  41. Scenes from next month’s episode show House in court. I think House fights the charges and wins, but also quits the drugs. Cops look bad, addiction looks bad, and the show keeps its sponsors. I’m tired of the pill theme anyway.

  42. I’ve probably seen too many episodes of The Wire because my first thought after Wilson revealed his deal with Tritter was that House could make the case go away if he just killed Wilson before he could testify about the prescriptions. Didn’t Cameron kill a patient? I’ll bet she could seduce and then poison Wilson if she wanted to…

    That wouldn’t work, he’s not sick enough for Cameron to want to seduce him.

  43. I guess I don’t have to watch the show now that House is just an ordinary guy. Heck, I know ordinary people in my ordinary life. Good analysis, Jacob. I was angry at the same predictable plot “twist”.

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