This Doctor Is In
'House' Calls To TV Viewers, And the Quirky Minds Behind It
By Ceci Connolly Washington Post Staff Writer Sunday, April 17, 2005; Page N01
LOS ANGELESÂDespite reading Scientific American as a kid, David Shore never really knew much about medicine. So when the honchos at Fox put out word they were looking for a fresh medical drama, Shore wrote what he knows: cops and crooks. "I figured, what if instead of looking for bad guys, we're looking for germs," says Shore. "The germs are the suspects."
After years writing legal dramas such as "Family Law," "Law & Order" and "NYPD Blue," Shore, 45, substituted a cranky medical sleuth for his standard crusty police detective and started pumping his physician friends for ideas. "I'd go to a party and ask, 'Tell me about the weirdest case you ever had,' " recalls Shore. And he started scouring medical journals, looking for the rare diseases, missed diagnoses and just plain icky cases that had real doctors scratching their heads.
The result was "House," arguably the finest in a trio of new medical shows aimed at bringing the familiar genre into the 21st century. Named for the lead character, Dr. Gregory House, the show is an addictive blend of psychedelic special effects, Sherlock Holmes-style mysteries and -- in an unusual move for a prime-time series -- an ill-tempered physician. From "Marcus Welby" up through "ER," blood and guts -- or at least a hefty dose of human suffering -- have made for good television ratings. But screeching ambulance sirens and frantic interns yelling "Stat!" now seem awfully '90s.
This season, "Medical Investigation" on NBC went the deadly-disease route on Friday nights, with plenty of "CSI"-like graphics. "Grey's Anatomy" on ABC is more soap opera than medicine, and the ideal dessert after "Desperate Housewives."
But "House" is something else entirely. Not quite somber, not quite fluffy, it appeals to our inner Columbo. "Patients only come to House with things other doctors can't solve," says Shore.
Every Tuesday night the clock ticks down as the team at the fictitious Princeton-Plainsboro Teaching Hospital races to figure out just what the devil is about to kill this week's patient. Why, we wonder from the comfort of our living rooms, haven't they done a full body scan? Have they checked for vasculitis, cellulitis, encephalitis and transverse myelitis? Come on! There's only 11 minutes left in the show.
Played by a Brit, Hugh Laurie, House pops pain pills, watches his favorite soap opera on the job, shuns the traditional white coat and avoids patients because they'll only lie and mess up the diagnosis. This is not the physician you want at a loved one's deathbed. And yet we are drawn to him in the way we could not resist Archie Bunker or Andy Sipowicz all those years they behaved like Class-A jerks.
These days, Shore presides over a stable of young writers, and Laurie is yukking it up with Jay Leno. "House," which airs Tuesday nights at 9 on the Fox network -- is drawing an average of 12 million viewers, in part because it follows "American Idol" -- and has been renewed for a second season.
But before there was a show at all, it was just Shore and his neighbor Harley Liker, brainstorming over family barbecues. "It was pure nepotism," Liker jokes, describing the friendship the two struck up while their children attended Valley Beth Shalom nursery school.
An internist who once conducted research at the National Institutes of Health, Liker embodies the Hollywood cliche of Physician to the Stars. His official bio gives as much weight to a mention in Town & Country magazine as to any academic writings. In addition to his high-end private practice, Liker is medical director for the trendy pomegranate juice company POM Wonderful. And although he wouldn't dream of naming names, Liker readily offers that he has treated more than a few Academy Award winners.
In pressed slacks and tie, Liker looks out of place on a recent visit to the Fox lot in Century City. All around him are scruffy creative types in hiking boots, sweat shirts and jeans. Not a medical journal is in sight, not even in the office of David Foster, the physician-writer on the team. Although he has advised a handful of other medical programs, Foster gave up his own practice to work full-time on "House."
From the start, Shore knew the traits he'd give his central character: House had to be a superb diagnostician; he'd be unsentimental and smug, someone who doesn't talk about his past and shows little interest in other members of the human race. "I write what I like, and I find likable characters boring," Shore says.
Part of the inspiration for the show came from Shore's guilt over pestering his doctors with trivial problems, such as the hip pain that had disappeared by the time he arrived for an appointment. "I'm saying to the guy, 'It used to hurt here,' " Shore laughs. "They shouldn't be so nice to me. I've got to be wasting their time."
Liker's job was to give House the right credentials and keep the science relatively accurate. To make Shore's fictional doctor both brainy and exotic, Liker proposed board certification in three specialties -- internal medicine, nephrology and infectious disease, because in the post- 9/11 era bugs are "kind of a sexy thing."
House gets the lines we all wish we could deliver, resulting in a cascade of medical -- not to mention etiquette -- breaches. What other physician could get away with giving a pill container of breath mints to a hypochondriac patient or prescribing cigarettes for the Santa Claus with irritable bowel syndrome? House routinely calls patients morons and liars and does not argue when one of his students speculates she got hired for her good looks and another thinks it was because his wealthy daddy made a call. He even flirts with a nun.
Some real-world docs grouse that "House" is giving healers a bad name.
Philip Brachman, who ran the epidemiology program office at the Centers for Disease Control and Prevention and investigated the first anthrax epidemic in the United States, in the 1950s, is disturbed by the portrayal. "It plays down the seriousness of what physicians do," he says after watching the show and reading several scripts. "I don't think this is typical."
Even more unusual -- some would say unbelievable -- are the cases House and his team of doctors-in-training tackle each week. Brachman says the episode in which a woman develops a tapeworm in her brain from eating ham was just one of the wacky cases he had trouble swallowing.
And then there was Sister Augustine, the demure nun who developed a near-fatal reaction from an copper IUD accidentally left inside her for 30 years. Turns out that before she took her vows, she had lived on the streets, got into drugs and attempted to self-abort a pregnancy.
As head of the allergy division at George Washington Hospital and former president of the Medical Society of D.C., Daniel Ein is pretty familiar with allergic reactions. In all his years practicing, he's never seen or heard of that one. "From a medical point of view, it's terribly farfetched," Ein says. But that's the whole point.
"Making a fetish of realism is a mistake," says Laurie.
One week it's African sleeping sickness, the next it's pesticide poisoning from unwashed jeans. Bats infect a homeless woman with rabies and termites cause a teenager to develop acute naphthalene toxicity. (Although most episodes end with a miraculous eleventh-hour save, Liker "insisted" the rabies victim die for the sake of accuracy.) The real fun comes as House eventually deciphers the medical clues, Ã* la Dr. Joseph Bell, the man who was the inspiration for Sherlock Holmes.
"If there's certainty in the diagnosis and certainty about how to treat, then where's the drama?" says Liker. His job is often to find the "decoys" or false diagnoses that send the "House" cast down the wrong medical path.
What looks to be anthrax turns out to be leprosy. What started out as a case of amyotrophic lateral sclerosis, or Lou Gehrig's disease, is a birth defect of the circulatory system called arteriovenous malformation.
When the doctors discover three infants with high fevers and low blood pressure, it looks like a bacterial infection. But the treatment causes fatal kidney failure in one baby and the autopsy reveals a virus. The remaining babies test positive for three different viruses, and they don't have enough blood for the doctors to keep testing. House rolls the dice with an experimental drug and -- presto! -- the mystery is solved. Roll credits.
"It turns out we get it wrong three times and right on the fourth. It has something to do with commercial breaks," says Laurie, candid about the constraints of a 43-minute weekly format.
The son of a British physician, Laurie brings to the program an appreciation for the world of medicine, quirky patients and all. As a teen, he answered his father's phone and often found himself uh-huhing through the caller's litany of aches and pains. Laurie says he considered studying medicine. "I was too lazy so I ended up faking it," he says. "It is a matter of some discomfort that I make so much more money imitating what my father did in real life."
"House" manages to make medical investigating funny. Take the story of Willie. He's looking to score some Viagra because "the little man doesn't have the same bounce in his step."
House offers him insulin for the diabetes Willie didn't mention to the admitting nurse.
Huh? How'd he know that?
First there were the hairless hands, a sign of nerve damage, House says. Second, tight shoes, which often mean a loss of sensation in the feet.
"And then there's your pants," House says.
"My pants tell you I have diabetes?" poor Willie asks.
"No, they tell me you're an idiot," House replies. "Powdered sugar on the right pant-leg."
Hey, this is television, not your family doctor.
(Staff writer John Maynard contributed to this report.)