In an extraordinary example of life imitating art, a 55-year-old German man was successfully cured of cobalt intoxication when a doctor recalled a similar case he had seen on the popular medical TV show, House.
When the patient was first admitted to a clinic in Marburg, Germany, in 2012 with severe heart failure, medical examinations ruled out the most likely cause, coronary artery disease. The man returned several times over the course of the year, presenting a range of symptoms including fever, enlarged lymph nodes, increasing deafness and loss of sight — yet doctors were still unable to solve the mystery.
Image: Professor Jürgen Schäfer (Credit: FürSie)
That is until Dr. Dr. Jürgen Schäfer, director of the Marburg University Clinic Center for Undiagnosed Diseases, recalled an episode of House (Season 7, Episode 11). In this episode, there was a fictional patient who presented similar symptoms and was eventually diagnosed with cobalt intoxication caused by a metal hip replacement. This inspired Dr. Schäfer to examine the patient’s clinical history in more detail.
Image: Metal ball with hole from hip replacement, showing severe metal loss (Credit: The Lancet)
Sure enough, Dr. Schäfer discovered that 2 years earlier the patient had undergone an operation to replace a broken ceramic hip prosthesis. But the new hip was made from different material, containing the causative element — cobalt-chrome metal. Tests confirmed dangerously high levels of cobalt in the patient’s blood, and German doctors subsequently replaced the metal hip with another ceramic one, leading to the patient’s recovery.
A case of beer and hips: Cobalt intoxication has been a well known cause of heart failure for over 50 years. In one of the first published studies on the subject, doctors were investigating why there was a high mortality rate for a group of middle aged men from Quebec City. As it turns out, the men all drank beer from the same brewery which used cobalt to stabilize the beer’s foam. After the study came out, the addition of cobalt in beer was suspended throughout the world.
Image: Metal hip replacement causing cobalt intoxication (Credit: NMA News Direct)
Recently, newly invented metal hip replacements have come under growing scrutiny for causing cobalt poisoning. As the hip wears out over time due to the grinding of its components, nanoparticles of the metal can be released into the bloodstream causing system toxicity. In the conclusion of his study published in the Lancet, Dr. Schäfer notes that “cobalt intoxication is [becoming] an increasingly recognised and life-threatening problem.”
Image: Failure rates of hip replacements. From L to R: (a) metal on plastic, (b) ceramic on ceramic, (c) metal on metal (Credit: NMA News Direct)
TV saves lives? Given Dr. Schäfer's success, will we start seeing baffled doctors around the world regularly reaching for the House box set instead of the New England Journal of Medicine? The seems unlikely, even though Dr. Schäfer himself uses cases from the TV show as a teaching tool for his rare diseases class. Scott Morrison, a physician in O’Fallon, Ill. who has reviewed every single episode of House for medical accuracy, states that the average rating for an episode is a “C”. While the show used a team of technical directors to help come up with story ideas and check for realism, former employees happily claim that the writers would only take on “maybe half of [their] advice on a good day.”
And that’s perfectly understandable. House was compelling because it was a modern day interpretation of Sherlock Holmes, replete with mystery, drama, and intrigue. Like the fictional representation of any occupation, real life just isn’t quite like that. To create gripping storylines, House inhabited a modified universe that was based on real medical science but where “probabilities and time were severely stretched [though] not broken.”
What then, can we learn from House? In both Dr. Schäfer’s real life scenario and the equivalent fictional episode of House (which incidentally, rated an above average B+ for accuracy), the key to solving the case was not more diagnostic tests, but a better examination of the patient’s medical history. The show’s medical advisers say that House demonstrates that ordering one test after another (a current trend in medicine) does not alone make a great doctor. Making a diagnosis is a collaborative process requiring a strong relationship of participation and trust between patient and doctor.