Thursday, January 31, 2013

"Do No Harm" Does Harm

Tonight on NBC there is the series premiere of a new show called “Do No Harm.” I’ve known this show was coming for quite some time. In fact, I knew about it when they were filming the pilot, mostly due to the fact that one of my favorite Broadway actors is in the show. Turns out SEVERAL Broadway actors I like are in the show, and it was directed by a Broadway director that I also like.

Because of that, I had been waiting on this show to air. Waiting for news about it. Getting little snippets of what was going on. A week or so ago, NBC made the premiere episode available online. I watched it last week. Of course, I watched it on the chance to see some actors I know from the stage, like Lin Manuel Miranda, Michael Esper, and the star of the show Steven Pasquale.

I won’t spoil the whole show for you. I won’t give away all the details, but the basic premise of the show is that Dr. Jason Cole is a brilliant neurosurgeon with a problem. He has Dissociative Identity Disorder… also known as a split personality. His alter ego, Ian Price, is not a nice person. He’s aggressive, a playboy, and an all-around NOT good guy. Ian shows up at 8:25 every night and goes away at 8:25 every morning. So basically, for 12 hours a day, Dr. Jason Cole can’t be around anyone he knows or cares about, as Ian will hurt them.

There is an outstanding cast of actors in the show. It has an interesting plot line. It COULD be the kind of show I would like to watch. BUT (there’s always a but) there was some terribly incorrect information regarding diabetes throughout the entire show. And the saddest part of the entire thing is that some of the information regarding diabetes will probably continue to be a part of the show for as long as it lasts.

“Why?” you ask? Most medical shows will touch on diabetes for an episode or two here and there, but it never lingers very long. In “Do No Harm” Dr. Cole says he has diabetes. As he is a brilliant neurosurgeon, he has to test his blood sugar levels before he performs surgery. The machine they use is interesting. It’s not an actually BLOOD sugar machine. It’s some sort of device that he places his finger in and it uses infrared light to test his glucose levels.

Honestly, it looked like a pretty awesome machine, except that it was HUGE (think a rolling blood pressure machine from a hospital). And I’m pretty sure it doesn’t exist. I did some research on the internet after I saw this. From everything I can find, this technology doesn’t exist yet. There areseveral companies working on the technology that would allow us to check ourglucose levels with infrared technology, but so far nothing has been approved, and from what I can find, it doesn’t even really exist more than what scientists seem to be TRYING to develop. Basically, nothing headed our way anytime soon.

So, what I wanna know is how to get one… cause if it’s on TV, it must exist, right? You see where I’m going with this? Um, I don’t want people telling me I don’t have to poke my fingers all the time cause I can get this cool machine that tests my glucose with infrared technology. I don’t want to have to take the time to explain that it’s Hollywood making something else up.

That was alarm bell number one in my head. But, you know, it’s not THAT big of a deal….but then Dr. Jason Cole has a conversation with the director of his hospital, Dr. Vanessa Young (a lovely and talented Phylicia Rashad).  

Dr. Young offers Dr. Cole tickets to a Phillies game because it’s his birthday. He tries to turn them down and she says “Just because your diabetes keeps you from working at night doesn’t mean it keeps you from going to a game.” And there’s alarm bell number two in my head. What do you MEAN that diabetes keeps you from working at night?!? I know several people who live with diabetes (T1 & T2) who work the night shift. And why wouldn’t a DOCTOR (and probably a pretty extensively trained doctor, if she’s running a major hospital like in the show) call bullsh** on that? A doctor that knows anything would know that isn’t true.

And that led into alarm bell number three….how does someone who is unable to work for at least 12 hours a day able to make it through medical school? I know people who have gone through med school. There are many, many long shifts. Many times they end up sleeping at the hospital and definitely working night shifts during their residency and/or fellowship. So how did Dr. Cole make it through medical school to become this stellar neurosurgeon??  

Obviously, he is using diabetes as a reason to be able to be home and away from everyone when his alter ego takes over, but what diabetes? It’s kind of a flimsy excuse, especially if you are in the medical profession. And this makes it obvious that the character doesn’t actually HAVE diabetes.

The show continues on and there is an incident in which Dr. Cole can’t remove himself far enough away from people to keep his alter ego from taking over. Dr. Cole reschedules a brain surgery for nighttime. At first I couldn’t figure out WHY. Alter ego Ian Price has no medical training. And Ian pretends to be Dr. Cole… so this untrained person is going to operate on a human? Turns out there is a reason that Dr. Cole did this. And this is where alarm bells four, five, six, etcetera went off in my head.

Ian Price, pretending to be Dr. Jason Cole, enters the surgery room and they demand that he checks his glucose levels (on that awesome, non-existent machine) before he operates on the patient. When the results come they are 315. Here is the basic of what happens in the operating room at that point:

Ian Price asks what’s going on. A nurse says, “You’re hypoglycemic (the closed captioning read “hyperglycemic”, but if you listen to it several times like I did, it SAYS hypoglycemic). You’re going into diabetic shock!” Another nurse/doctor says “Give him 20 units of regular insulin.”

I’m going to stop right there and point out the things wrong with JUST that part. First off, a blood sugar level of 315 isn’t going to send someone into diabetic shock. Possible ketones maybe. Thirst, headache, at worst, blurry vision. But I’ve never known anyone to enter into diabetic shock (I’m assuming they mean full diabetic ketoacidosis with unconsciousness) from a 315.

Secondly, 20 units of regular insulin for almost anyone with diabetes could be lethal. It’s way, way, way too much insulin for a 315. I assume there are cases of super insulin resistance that would call from something like that, but in general, 20 units of regular insulin is crazy. Also, regular insulin is kind of outdated. I know some people who use it still, but in general, it is so slow working that insulin like Levimir, Humalog, and Novolog are used. They work faster.  

Onto the rest of the scene (which was only about 30 seconds to a minute long). The doctors and nurses in the operating room restrain Mr. Ian Price (who fights them the whole time) and the jab him with some epi pen looking thing while he thrashes around. He immediately goes into convulsions. A nurse says, “He’s tachycardiac-Adverse reaction from the insulin.” Some else yells “Call anesthesia stat! And get me a stretcher.” Mr. Ian Price passes out.

Okay, all the things wrong with that part…. Oh my. Well, first off, the epi-pen looking thing. I suppose it might have been an insulin pen of some sort. Perhaps. But really it just look like they jabbed him with this thing in the arm. Insulin doesn’t need to be administered like that at all. And a true diabetic would have administered the insulin themselves.

Then there is the immediate onset of convulsions. Insulin does NOT work that quickly. There is NO insulin out there that works that quickly. It doesn’t exist. In fact, when you look at active insulin times, the quickest I could find was Aphidra, which according to WebMD has an active insulin time of 1 ½ to 2 hours. This means that while it might start working right away, there’s nothing that would drop the blood glucose levels so quickly as to put someone into immediate convulsions, even if their blood sugar was completely normal and they were given 20 units of insulin. Also a note: Regular insulin has an active insulin time of 5 to 8 hours.

Then there is the next part. About the tachycardia. I actually did not know what that word meant. I had to look it up. The American Heart Association says that tachycardia is a heart rate of more than 100 beats per minute in an adult. I didn’t know that insulin (or a low blood sugar) could cause a rapid heart rate. But apparently it can. I googled that one too, just to be sure. Again, I just can’t imagine blood sugar dropping so rapidly that it would cause immediate convulsions and rapid heart rates. I suppose that this could be considered an “adverse reaction to the insulin” but I just call it a low blood sugar.

And what was that about calling anesthesia?  Why? Were they going to knock out the man already passed out on the floor? I mean really? What was the point of that? Why did no one suggest glucagon (or the more medically potent D50, also known as dextrose). This would have brought around a person having a low in just a few minutes.

At this point, I’m laughing hysterically at the computer screen as I watch the show. I wanted to tell them how crazy they were being. But it just got worse and worse.

Dr. Jason Cole wakes up the next day in a hospital room and Dr. Marcado, a friend who is helping him try to keep Ian from coming out every night, is in the room with him asking him what went happened. Dr. Cole states that he moved up the surgery on purpose because he knew that Ian would fail the glucose test.

When Dr. Marcado asks how he knew he’d fail he says “Come on, Ruben, personality affects body chemistry. Aggression triggers adrenaline” and Dr. Marcado follows up with “Which looks like high blood sugar.” Dr. Cole finishes up with “He’d be given insulin, which he didn’t need.” And Dr. Marcado chimes in, “It would knock him out.”

Okay, I’m not a medical professional. I could be wrong. But again, I googled it. Everything I found in regards to adrenaline and high blood glucose levels was directly related to people who already have diabetes. I KNOW adrenaline causes my liver to kick out sugars, raising my blood sugar levels. But someone without diabetes (which we know Dr. Jason Cole to be) should be covered by their own, working pancreas, right?

And what was that about personality affecting body chemistry? Huh? How would it affect his body chemistry? It’s just so completely out there that I was appalled. By the end of the show I was laughing, but I was also saddened.

taken from the Do No Harm facebook page
What happens when a show is SO full of misleading information about diabetes? Especially when it’s a medical drama? I mean, people listen to the stuff on these shows. They believe the stuff on these shows. And I get to spend all of my free time and energy trying to correct what Hollywood destroyed.

I’ve been told that any medical show is supposed to have a medical technical advisor. I googled. I checked IMDB. I googled again. I couldn’t find anywhere that there was a medical technical advisor listed. It confused me. Maybe because it was a pilot episode they didn’t have one? I wanted to know who told them this information was correct.

The only thing I could find was the name of the writer of the episode and the producers of the show. It was written by David Schulner, directed by Michael Mayer (a Broadway person that I LOVE), and produced by Rachel Kaplan, Michael Mayer, David Schulner, and Peter Traugott.

I really do want to like this show, but they can’t ditch the diabetes storyline at this point. It’s too engrained in who Dr. Jason Cole/Ian Price is as a character. But it’s also a lousy cover for his Dissasociative Identity Disorder and perpetuates the myths about diabetes.

You can find “Do No Harm” on facebook, twitter, and about a million other social networking sites. Do something. Watch the first episode. Then SAY something. Blog about it. Post on facebook about it. Tweet them about it.  I tried to find twitter accounts on the producers and writer but was unable to.

Personally, I just hope this blog post gets out there. Because “Do No Harm” could actually cause a lot of harm by misleading and perpetuating untruths about diabetes. I plan on asking them on twitter & facebook who their medical advisor was. I hope I get an answer. If they don't have one, they should hire me. At least for the diabetes related stuff. I'd tell them to scrap the entire storyline involving diabetes. But then they'd probably try to write about a medical cure.


Scott E said...

In the context of a comedy or satire (like Conan O'Brien) I can understand it. But this is just inexcusable...

Unknown said...

This comment is going to be long, this post apparently struck a chord with me:

I do agree with you that most of this sounds over-the-top insane, and I was hoping somewhere in the show it would be made obvious that Dr. Cole is lying about having diabetes, and that imaginary blood glucose testing machine is also even more imaginary, perhaps measuring his level of sanity. Maybe he has a third identity that he is able to cover up! Soap opera-ish shows usually have something crazy going on in them.

For the record, as someone with tachycardia, yes, my heart beats faster than a normal person’s. Nobody’s been able to explain its cause to me yet, but I’ve been assured that (for me, anyway) it’s not related to my diabetes. Is it related to how much insulin I’m taking? I don’t really know. That’s not exactly a cause any medical professional has ever suggested to me. It takes my heart getting up over 100 BPM for me to start feeling really uncomfortable, and even then I don’t go thrashing about as though I’m seizing.

Honestly, I think I want to watch this show as an MST3k-style riff fest, or maybe treat it as a drinking game. I think they used to have more realistic storylines on ‘One Life to Live', and you know how often people on soap operas get amnesia or have multiple personalities. :P

Now—the insulin thing. “Secondly, 20 units of regular insulin for almost anyone with diabetes could be lethal. It’s way, way, way too much insulin for a 315. I assume there are cases of super insulin resistance that would call from something like that, but in general, 20 units of regular insulin is crazy.” Making a sweeping generalization like this is practically spreading just as much misinformation as this wacky television show. I just dialed up 315 mg/dl on my pump to see what it suggested as a correction for me, and the response I received was 19.5 units.

I guess I have “super insulin resistance”—seriously, as someone who needs to take more insulin than the average type 1, as someone who has sought out the reason for this for YEARS because I feel like I’m broken when other people tell me I take “a lot” of insulin, the only reason I have come up with for taking so much insulin is that it’s just what my body needs. Times like these we need to heed the motto of YDMV.

Of course, since I am not a medical professional either, I don’t know if 20 units of regular versus 20 units of Novolog or Apidra would be more or less dangerous. Maybe if someone reading this *is* a medical professional, they can explain this better.

I assume the show called the insulin regular because one of the writers discovered that there are regular and long-acting insulins, and “regular” insulins work right away. Now, if you have diabetes, you know the implications of that, but if you don’t, then you probably assume it all hits your bloodstream at once.

They wouldn’t use Apidra, Humalog, Lantus or any other brand because they are just that—brands. If you hear specific brands mentioned on a TV show, most of the time it’s because the company owning that brand has paid for it to be mentioned, and I don’t think that you can legally do that with brand-name medications. Somebody who knows FDA marketing guidelines could probably explain this. They can’t say, “Give him 20 units of Humalog!” and then show him going into shock or whatever because (a) it makes Humalog look dangerous and (b) Lilly would have paid a TON of money to get their brand integrated as product placement in a show. And like I said, I don’t think pharmaceutical companies are allowed to advertise like that at all.

Cara said...

Hannah, you're totally right about the insulin amount thing! I apologize. I do know that there are people out there like you who have to take more insulin for whatever reason. And healthy is better, no matter HOW much insulin you take.
As for the heart thing, I did read that a low blood sugar can cause an increased heart rate, but I think it is more related to the body trying to compensate for the low than the insulin itself.

Unknown said...

Thanks, Ms. Cara. :)

One more thing I just thought of...they at least could have called it 'rapid-acting insulin' if they were going to be more specific. But I doubt that'll happen with that show.

Wendy said...

Hannah already hit on what I was going to speak to. It's nothing for me to take 24 units or more for a meal because of insulin resistance and the way my body metabolizes the insulin. If I pinged a 315, I would be taking 20 units immediately and more a half hour to hour later.

I wasn't planning to watch the show at first. The description you gave of a neurosurgeon with DID sounded intriging--until the details started piling up. Dr. Jekyl & Mr. Hyde stories have been around for years--we don't need someone fingering diabetes as an excuse for acting out.

Alecia said...

This level of irresponsibility sickens me. If watching this show makes me anywhere near as angry as I am this second, I may explode. Thanks for spreading the word about this Cara! xo

k2 said...

I'd really love for Hollywood to get diabetes right! Thanks so much for writing this post and letting us know about the show!

SIDEBAR: I want that infra red blood sugar machine/InfraRed Glucose Monitoring Device - Once it gets past the FDA approval process and they shrink it down about 125%!

Hannah makes a good point about insulin resistance and she's right, YDMV - We all need to be reminded of that - myself included.

But your description about the other diabetes muck-ups, about why the Dr. needs the 20 units (it ain't diabetic shock, that's for sure!) and what happens after he takes the 20 units doesn't (at least in my humble opinion) paint an accurate picture of living with diabetes.

And if diabetes is going to be a continuing story line on this show, the writers should get diabetes right, because, quite frankly it's incredibly dangerous and irresponsible if they don't.
If people see something on television, they take it as fact. And God forbid someone out in TV land follows the shows lead when it comes to diabetes.

What if if a potential employer interviews a person with diabetes for a night job/shift and or job that requires additional work at night, and that person thinks (thanks to what he or she saw on the show,) that people with diabetes can't work work at night.

And if this character didn't have diabetes and was given insulin, and that much - Again if he doesn't have diabetes, he most likely does not have that degree of insulin resistance - it most likely would be deadly, or coma inducing.

And how does someone make it through medical school and become a Brain Surgeon if they are a completely different person (who I assume doesn't want to study medicine) from 8:25 pm until 8:25 am? Dude better not be doing my brain surgery!

Cara, thanks for putting this out there and creating this discussion!
Kelly K

Stephanie said...

I watched this show last night and was SO MAD! I thank you for this blog post. I immediately commented on their FB page last night and I have been sharing your blog everywhere I can. We fight enough misinformation and stereotypes. This needs to stop.

Val said...

I agree with your post - haven't seen the show, but at this point I doubt I would want to... yet I find myself completely distracted by Hannah's suggestion of an MST3K style review - we ought to build little robots out of meters and tubing and have them sitting in the front row calling out all the bad information... bet that could get more hits on you tube than the show!

adaynasmile said...

Thank you for sharing this. I won't waste my time watching it and getting mad. It breaks my heart since my 2.5 year old is diabetic and will have to fight these stereotypes and misinformation for many years to come. And I am already tired (after a year plus) of explaining to people and educating. Wish there wasn't such a huge battle due to media. Thanks for the blog post.

Abby said...

Let alone the fact that DID is argued by many physicians as not real, and it is not a specific time when the person "changes", its under extreme stress that they can't cope with. DID is a coping mechanism (or most would say).

This is bologna. Let's call it science fiction?

sarah jane said...

Yeah 20 units is about what it would take me to get down from a 315... But I digress. I always assumed my insulin resistance is from being overweight. I could be wrong but seemed logical. Dr what's his butt is hardly overweight.

Last time I was in the ER, I was not dka but over 500 and I was given regular insulin. They said it was the only kind they use in the hospital because it is the cheapest. The nurse even told me she had never been educated on other fast actings or how they work. *shrug*

I honestly don't think this show will gain much ground or go on much longer. I kind of think the concept is redic and unrelateable.

Unknown said...

I'm debating whether to watch the show or not. I had never even heard of it! I doubt I will be viewing Hansel and Gretel, either!!!! "The sugar sickness," indeed!

Jeremy said...

I haven't seen the show, but your disappointment and anger sound completely justified.

Just in reading your discription, I noticed another (non-diabetes related) mistake. But first let me make a quick excuse for one of your points. When he was having convulsions, perhaps they wanted the anesthesiologist to intubate him, rather than put him to sleep (OK, it's weak, but my point relies on it). So "calling" anesthesia makes more sense, except... Wasn't he just about to scrub in to surgery? So shouldn't there have been an anesthesiologist waiting patiently behind the next door (or maybe even in the same room) to put someone to sleep?

Anonymous said...

I didn't and won't watch this show because I don't bother to own a tv. For good reason. I found the link to this page through a Type 1 diabetes page.
Dissociative Identity Disorder is NOT known as "split-personality disorder" or multiple personality disorder or any other magical Jekyll & Hyde mental illness. Don't give out mental health information unless... hmmm... you want to like a stupid tv show. I'm sure you won't publish my comment because that would involve admitting that you were wrong about something and god know, nobody does that. So maybe you can just go back and correct your page by saying something like, "the show claims he has Dissociative Identity Disorder that they portray as if it were a split-personality, which is, in fact, untrue (Google it)." Then you could be doing the same kind of favor you want done for diabetics, done for people who experience mental illness. Just a thought.

Unknown said...

I was part of testing for an infrared glucose meter, over 20 years ago. It was proven accurate, but at the time they couldn't make it small enough for home use AND with no strips to absorb the cost of research & development, the machines themselves were said to be unable to be purchased by any but the BIG hospitals. It just wasn't a money maker. The tech has changed, but the economics have not. We get meters for free, because it's the strips we're locked into.
As for the rest of it... Hollywood is STUPID and so is anyone who thinks to get their medical info from it. Unfortunately, that's our society.

Mike Hoskins said...

Is there something in the air? Or the universal water supply or something??? I mean, seriously... what's with all the crappy diabetes mistakes and misinformation circulating right now in media, movies, and on TV!?! This is so frustrating and tiring. It's like a zombie plague spreading, infecting more and more... :( Well, obviously, I echo the complaints and concerns everyone else has. It's so time we do more about this, better leveraging the D-Advocates media awareness initiative. We need to do something.

Anonymous said...

I saw this show, too, and found the 305 reaction completely baffling. However, if they wanted to lower his blood glucose quickly, the fastest method is probably regular insulin injected into a vein. For an intravenous injection, it can take effect within minutes, and reach its peak in about 10. There's no real advantage to using Humalog or other faster acting insulins in this type of injection. It's not something to do lightly, and they'd probably carefully monitor his glucose to make sure they didn't kill. It would, however, still take more time than the few seconds it seemed to on the show.

Anonymous said...

I think the dangerous part is a nurse saying, "you're going into diabetic shock" (which usually means *low* blood sugar, and he wasn't low, he was high), and another nurse saying, "give insulin." No no no, if someone is in diabetic shock for real (with low blood sugar) then they need food, not insulin. arrgh. really unbelievable. A BG of 315 is nothing to worry about in the short term.

Cristina said...

Whoa, what a horrible show. For real, they should get their facts straight.

But just a little FYI, adrenaline CAN increase blood sugar in a person without Diabetes. You see, adrenaline activates Glycogenolisis, which is the process of breaking down glycogen to get glucose. And it also activates cortisol, which is another hormone in charge or getting glucose levels up in the blood. These mechanisms are activated with adrenaline so that in a moment of danger, the human body has extra energy to manage outrageous tasks, like lifting a car or running super fast (it's called Fight or Flight Syndrome). So that part is actually true. About the personality affecting the body chemistry, it is kinda true also. Whether you're happy or sad, the hormones in your blood stream may vary.

I am not making this up, neither I looked it up on google, I'm a Med Student (with T1D) and I know this for a fact and from my medical books. We actually learn this in class during the first years, because it's something supper basic. You can look it up in the McConnell book of The Human Body, Form and Function: Bases of Anatomy and Physiology.

Hope this helps :)

Anonymous said...

There seems to be a lot wrong with all the medical info on the show. Dissociative Personality Disorder used to be called Multiple Personality Disorder. However, it doesn't actually result in full fledged personalities. It makes for an interesting premise for a television show, but not realistic. As for the diabetic info...yeesh. There are insulins that work within about 10 to 15 minutes and there are a good number of diabetics who take very large (20+ unit) doses. Some even take multiple insulin types. I haven't seen the show, but I'm going to guess the device with the red light is something called a pulse oximeter. We use them on just about everyone and as you might imagine they read blood oxygen levels :-D Popular media does the public a huge disservice when it comes to a lot of medical conditions. I think the three biggest would be diabetes, epilepsy, and mental illness in general. Thanks for letting me know they are still dumbing down the public!