Debunking the Science of House, M.D.

House, M.D. is a Fox television show whose titular character, Dr. Gregory House, played by Hugh Laurie, is a brilliant but misanthrop­ic diagnostician who works at the fictional Princeton-Plainsboro Teaching Hospital. As a medical show, its scientific explanations are supposedly grounded in fact. However, to what extent is this the case?

The second episode of season five (aired Sept. 23, 2008), titled “Not Cancer,” opens with the sudden deaths of four individuals: a tennis player dies of heart failure during a game; a construction worker dies of liver failure at the seat of a crane; a martial arts fighter dies of neurological problems during a match; and a tuba player dies of lung fail­ure during a rehearsal. All four are revealed to have been the recipients of donor organs from a single donor five years earlier.

Interestingly, the organs they received were not the organs whose failures caused the deaths.

A math teacher named Apple, who re­ceived a cornea transplant from the same donor, is taken to Princeton-Plainsboro Teaching Hospital to be diagnosed and treated before the same happens to her. At the hospital, Apple begins to hallucinate and develops a rapid heart rate and difficulty breathing.

After a series of proposed diagnoses that are disproven, House determines that the or­gan donor had cancer stem cells that were introduced into the bodies of the organ re­cipients, where they were spread throughout the body through the bloodstream and dif­ferentiated into abnormal cells in various organs. Apple, House discovers, has these abnormal cells in her brain. She undergoes surgery to have them removed and makes a full recovery.

Cancer stem cells are cancer cells that, like normal stem cells, have the ability to renew themselves through mitotic cell division and differentiate into different types of cells. Al­though there is still much to be learned about cancer stem cells, they are often thought to result from mutations in normal stem cells. This episode of House features cancer stem cells as its key medical concept, but the por­trayal has some inaccuracies and inconsisten­cies.

For example, the cancer stem cells are de­scribed as hematogenously spread (distrib­uted by way of the bloodstream), but Apple received a corneal transplant from the organ donor, and corneal tissue is one of the few tissues in the body with no blood vessels.

The cornea gets oxygen directly from the atmosphere rather than through a blood sup­ply. Because the cornea is bloodless, hema­togenous spread of cancer stem cells from a cornea transplant would be impossible; the cancer stem cells should never have gone to the cornea in the donor or from the cornea to the brain in the recipient. Furthermore, cancer stem cells are known to be tumori­genic (tumor-forming). They self-renew and differentiate to build up a tumor comprised mostly of differentiated cells, while some cancer stem cells remain undifferentiated in the tumor and continue the process.

However, on the show, cancer stem cells are described as differentiating in order to incorporate themselves into organs, form­ing tissues that looked normal but could not function properly. During the episode, autopsies that were performed on the four organ recipients who died did not uncover any tumors, and no tumors showed up on the imaging that was done on Apple’s brain.

In reality, cancer stem cells would have caused tumorigenesis, not the organ weaken­ing in the way that the show describes.