TV: Miracle Workers
Authors: Janice Hopkins Tanne
Journal: BMJ (2006)

Each episode of this reality television show, which began last week, tells the story of two people whose serious medical problems have not so far been helped by the high tech US medical system. Guided by two attractive doctors and two extremely attractive nurses, and sponsored by a chain of drug stores, the “contestants” are given “cutting edge” care—cutting edge as in surgery, the programme often reminds viewers. In each episode we follow the patients from the initial consultation with the medical team that will treat them to the treatment itself—“state-of-the-art special effects will take viewers inside the patients' bodies”—and the results.

One of the two patients in the first episode is Todd Heritage, a 34 year old hospital assistant who has been blind for the past 22 years because of a Stevens-Johnson reaction to penicillin. Three times he has major surgery to repair his scarred corneas, apparently involving several corneal transplants, but in each case the transplant has become scarred. “It's like trying to see through a potato chip [crisp],” his surgeon says later, as he holds up the opaque yellowish cornea he has just removed.

The programme often reminds us that Todd has never seen his wife or his children and that his sister is risking her eyesight to help him. And reminds us again.

The surgeon, Edward Holland of the Cincinnati Eye Institute, plans to restore Todd's sight by using stem cell implants taken from the edge of his sister's cornea and from a cadaver donor, as well as a cornea from a cadaver.

The second patient is Vanessa Slaughter, a 47 year old woman who cannot get out of her wheelchair because degenerative disease of her spine has compressed vertebrae so that they pinch nerves and cause extreme pain. She has had several operations, without success. Her sister says it's like seeing her die emotionally.

Her surgeon, Stanley Gertzbein of Christus St Joseph Hospital in Houston, Texas, plans to implant titanium disks filled with bone chips from her hips between her damaged vertebrae. She'll be a bit more stiff, he says, but she should have no pain.

There's an edge of the seat moment when Todd opens his eyes after receiving his sister's corneal stem cells and a corneal transplant. Alas, he can't see. But Dr Holland assures him that the new corneal stem cells may grow into his cornea and provide support for another corneal transplant.

A potentially similar tense moment for Vanessa is that she could bleed to death if her surgeon injures a major blood vessel in his approach through her abdomen to her spine. But Vanessa's treatment goes well from the start, although it is clearly major surgery. Later we see her with her supportive sister. Vanessa is walking, bending, and what she hoped to do: working in her own flower store.

And, yes, Todd's second procedure works. The “miracle worker” removes the “potato chip” cornea and implants a clear one. Todd sees! Sees his wife and children, hugs them, and goes to look at the ocean that he's always wanted to see.

How did these people get these treatments, and who is paying for them?

The programme never explains why Todd and Vanessa weren't able to get these treatments as part of their regular medical care. Have their insurance companies given up on them? Has their insurance run out? Are these treatments not covered?

Although both the surgeons in this episode say that their methods are approved and offer cure rates of around 90%, sometimes US health insurance companies don't cover treatments they consider experimental.

On the other hand, maybe health insurers are right to consider these treatments as too experimental to pay for and as not having a high enough success rate. In which case Todd and Vanessa are lucky to be the ones whose treatment worked. As a professional sceptic I wonder whether the programme tells only the success stories. (My calls to the programme makers weren't returned.)

The New York Times, reviewing the programme (6 Mar: sect E, p 10), managed to extract some information that most documentaries would include:

Who's paying for all this, and how much is it costing? If you guessed ABC for the first (except for those families that have insurance), you'd be right, but no one in need of these operations probably could stand to hear the answer to the second. The closest we get to a hard number is a shameful plug at the program's end in which the CVS pharmacy [the sponsoring company] gives Mr Heritage a $25 000 [£14 440; €20 930] gift card for his medications.

Apparently it's not easy to get on this programme and have your medical care paid for. Miracle Workers is a soap opera that exploits vulnerable people. The blessing is that it may help those who pass the auditions. Like various medical dramas, it plays to the public's interest in high tech medicine—“cutting edge,” as the announcer says.

I hope the series will make some viewers ask important questions. Why are other people who need this care not getting it? Do these treatments really help most of the people who receive them? And why don't Americans have a healthcare system that works?