Friday, June 02, 2006

Globalization, "House" and "CSI"

Back in March this year I watched my first episode of "House". And I became enraptured. The diagnostic process, interpreting signs, symbols and symptoms is endlessly fascinating. It is research, of course. Apart from House's (Hugh Laurie) execrable American accent, it is augmented by his wonderful personality--acerbic, occasionally profane, a maverick to delight the senses. House comprises that necessary combination of rigorous science and intuition that enables breakthroughs to appear suddenly.

"CSI" shares some of the same features. The dogged determination to ferret out the truth and wayward characters who are prepared to shun normalcy and officialdom and not be deterred from their paths. Grissom is completely dedicated to his vocation that one could never imagine him doing anything else. Conversely, Horatio Caine in "CSI: Miami", isn't portrayed the same way. Rather, he comes across as a policeman following clues.

There are two aspects to these TV shows I want to emphasize. First, they are very locally based. You would never suspect that there is a world outside their little domains, with the possible exception of Latin America, which seems to be populated with drug smugglers spending their crime proceeds in the fleshpots of Miami. Boston, Las Vegas, and Miami seem to be hermetically sealed environments. There's no intellectual or other engagement with the wider world. Globalization has not percolated through to here yet. And I'm deliberately avoiding taking the ironic view that says the shows themselves have become globalized artefacts: my approach is emic not etic.

Second, the organizations to which the characters belong are remarkably well-endowed and never seem to want for resources. The part of the CSI: Miami office where Horatio meets the victims' families would make an ideal loft space any day. The light, the clean lines--it's a modernist's dream. Nothing like the broken down, ramshackle police stations we see in the UK. They always have the latest equipment that can decode crackly videotapes and run a DNA test in a trice.

House, too, seems to have limitless resources to pursue complex illnesses. It seems like he has the entire Harvard Medical School behind him. In a recent episode he shot a corpse with hollow-point bullets to see if they would react with an MRI scanner. They did and put it out of action for two weeks. Given that the going rate for a scan in this country is £750 and up, that's a lot of moolah foregone. He has a team of experts who are at his continual beck and call. If you are going to fall ill, do it in Boston. (Or, I would also recommend Reykjavik, Iceland, where I came down with appendicitis/peritonitis and had the best treatment.)

Of course, "real life" isn't made up of endless searches for the holy grail with no thought for cost. Once we begin to take a global view of these things, we see a different world. This was manifested in an article in the Financial Times where the American Society of Clinical Oncologists has decided to debate for the first time the costs and benefits of cancer treatments. Cancer therapies have been traditionally sheltered from cost analyses, but treatment is rising in expense and insurers and others want value for money. The chair of the debate, Neal Meresol, said, "Certainly other countries do this routinely." In the UK we have NICE which decides on the expected efficacy and costs of treatments. This is, of course, miles away from the maverick House approach; it is more the dull, routine of evidence-based science that determines how we should spend our tax pounds. Occasionally, the process gets hijacked as it did with the breast cancer treatment, Herceptin, when politics overcomes science. Usually, it is difficult to explain to a sufferer that the treatment can't be prescribed because it's too expensive.

Sometimes, TV life hijacks real life. It seems juries were beginning to refuse to convict in criminal cases unless there was ample DNA evidence, thus usurping normal evidence in favour of "hyper-evidence": the CSI effect. Forensic evidence requests have shot up as a result. However, the more normal approach appears to treat forensic and specialist evidence in a more cavalier way as Professor Sir Roy Meadow, the expert's expert, did in the cot death cases, eg, the Sally Clark case.

The contrasts between TV life and real life can be hard to absorb. If it works in one setting, why can't it work in others? As anodyne and escapist as these TV shows are, they have a potential to raise people's awareness. We don't always have to accept standards that don't accord with our desires.

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