February 15, 2006

House: finally worth blogging about!

Despite one of the worst traffic snarls of my life (Thanks Clippers), I managed to get home in time for House last night.

Which was a good thing.  With the Stacy plot out of the way, I guess the writers thought it was time to bring the H-man back in full force.  A great ep, especially the subplot with the sleazy researcher.

It's widely known in the medical research community that doctors and scientists who want to take shortcuts or outstep the FDA take their work overseas.  Usually, that means India because the medico-legal system hasn't caught up with technology.  India is unique in that it is a chaotic third world country, but it is also home to a wide array of state-of-the-art medical technology.  Doctors like Weber and sleazy pharmaceutical companies can test their drugs on people you've never heard of who would otherwise suffer in silence without having to go through the normal procedures, including long periods of expensive animal testing (which usually is done to verify that 1) the drug isn't lethal at normal dosage, and 2) it actually has some worthwhile effect)

Furthermore, India (and other small countries) is home to a number of questionable medical science journals.  Like most other professions that utilize the written word to communicate, biomedical science has a number of trade publications, commonly called medical journals, in which doctors and researchers publish their findings.  These journals, however, are not equal.  The top journals are the New England Journal of Medicine, Journal of the American Medical Association, and for more preclinical work, the journals Science and Nature.  There are also many specialty journals such as the Archives of General Psychiatry, or Alcoholism in Clinical and Experimental Research.  Both types of journals, general and specific, have their strata.    At the top are journals that most researchers strive to get published in.  At the bottom are journals that will take ANYTHING, as long as you pay for the pages you submit and it looks vaguely scientific.  Sometimes good researchers who feel they are on to something important will use these journals to get their ideas published ahead of someone else, but most commonly these crappy journals are used to publish work that no one else will touch, because after all, the university administration  only looks at the number of paper you put out, not the quality of your publications, although that is slowly changing.

When House accuses Weber of publishing in the New Dehli Journal of Medicine, what he's really saying is that Weber's work isn't strong enough to be published in the US and that the drug isn't good enough to be FDA approved.  And he proves it, if only to himself....  though that was a pretty damn bad migrane, I must say.

Best line of the night: "House, you can't keep doing this.  Get a hobby.  Get a Hooker."--Wilson.

Anyone else notice the confirmation of House's address at the end of the show?  He indeed lives at 221 B Baker St.

Posted by caltechgirl at February 15, 2006 11:03 AM | TrackBack

so, were they right on the brain stuff?

Just curious, because one of my favorite hobbies on the legal shows is to find spots where they're wrong on the law or make some lame strategic move in court...

Posted by: KG at February 15, 2006 01:35 PM

Interesting! Thanks for that.

Posted by: chanhay at February 15, 2006 08:30 PM

221 B Baker st, eh?

Well, Holmes was based on a doctor Arthur Doyle knew, so it all fits together.

Wilson is Watson, and Weber is Moriarty... where do our other irregulars fit?

Posted by: Bill at February 15, 2006 09:00 PM

That's very interesting. Thanks for the run-down.

Although if Weber's drug company wanted to get the drug FDA approved (and they must, that's where the real money is and a drug like this has the potential for some really big bucks) wouldn't they also want it tested in clinical trials in the US or another major country? I could see doing initial trials and publications in India but they would have to know that it needed to be legit before they can make money from it. I thought the bit where a single e-mail from one doctor shutting down a whole line of research rather unbelievable too.

Some universities do look at which journals the articles are published in before assigning merit pay, not just how many publications there are. Mine does anyway.

Just as a footnote, in Canada you know have to register a drug trial when you start it if you want to publish the results later. That's to prevent a company doing 10 studies, 9 of which are negative and one shows an effect and only publishing the one that shows it works.

Posted by: Ariadne at February 15, 2006 09:04 PM

Yes, they would still have to go through the FDA, but as the one Glaxo commercial points out, one in a million compounds turns out to be a testable drug. So where can they test the other 999,999? India and other countries similarly situated.

This is also a way to get around the study registration. Studies done outside the country don't always require registration, and the company can tweak the demographics of the study group until they know EXACTLY what will give them the results they are looking for in a registered study.

The single email might have been the straw that broke the camel's back, or House might have presented them with the info from the New Dehli study. The FDA moves slow, but they are pretty good at protecting patients from harmful drugs, hence all the meta-analysis that most IRBs require from clinical studies.

If this was a US study, run through a University hospital, say, then a single email directed at the right person (IRB chair, for example) could halt the study.

BTW, the IRB is the Institutional Review Board, the committee charged by the institution with overseeing the ethical implications of every human research study, including HIIPA concerns, harmfulness of the protocol, inclusion of diverse subjects, etc. The IRB chair usually has broad powers to stop a study in progress or demand justification for questionable practices.

Posted by: caltechgirl at February 16, 2006 11:15 AM

Oh, and Bill, While Wilson is definitely Watson, Vogler was Moriarty. Weber is just a silly villain....

Cuddy is Inspector Lestrade.

Stacy is Irene Adler (see A Scandal in Bohemia)

The residents (Foreman, Chase, Cameron) are the Baker St. Irregulars...

and he needs a Mrs. Hudson to clean up after him. Cameron, maybe?

Posted by: caltechgirl at February 16, 2006 11:20 AM