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The Unreal World: 'Body of Proof's' suicide … or murder

Parsing familial Mediterranean fever, beta thalassemia and Munchausen syndrome by proxy.

May 30, 2011|Marc Siegel | The Unreal World
  • Dr. Megan Hunt (Dana Delany) examines the body of a young woman who appeared to have several diseases.
Dr. Megan Hunt (Dana Delany) examines the body of a young woman who appeared… (Claire Folger, ABC )

The premise

When teenage socialite Nikki Parkson (Mary Fegreus) dies of an apparent suicide, medical examiner Dr. Megan Hunt (Dana Delany) investigates the death. It turns out Nikki had some serious health issues. Her doctor had been treating her for familial paroxysmal polyserositis, an inherited auto-inflammatory disease also known as familial Mediterranean fever or FMF. As if that weren't enough, Nikki had another genetic disease, beta thalassemia, that kept her from making enough hemoglobin for her red blood cells. Nikki's doctor felt this condition also led to attacks of gout, adding even more misery to her life.

Nikki's doctor had prescribed the drug colchicine to treat her gout as well as her FMF. But the treatment hadn't been working especially well, and after her death, Dr. Hunt discovered why: Nikki's mother (Jill Eikenberry) had been replacing her colchicine with sugar pills. This provoked more attacks, giving the mother sympathetic attention among her circle of friends, which she craved. The actual cause of death turned out to be something even more sinister — not a suicide but a murder.

Medical questions

Are Nikki's illnesses realistic? What are the usual symptoms of FMF? Is colchicine really an effective treatment? Is it common for attention-seeking parents to withhold treatments from their sick children? Could a doctor determine this before a patient was placed in jeopardy?

The reality

The show's portrayal of familial Mediterranean fever is limited, says Dr. Wayne Grody, professor of medical genetics and molecular pathology at UCLA and a world expert in FMF. The classic presentation involves periodic attacks of abdominal pain, fever and sometimes inflammation of the lining of the heart and lungs, arthritis or rash. Colchicine, an anti-inflammatory medication, is the main treatment, Grody says, and "is effective in preventing the attacks in almost all patients." If not treated, abnormal amyloid protein can build up in various organs and the condition can be fatal, he adds.

However, not all of Nikki's medical problems really make sense, Grody says. Most glaringly, gout is not a typical complication of thalassemia. Like FMF, gout responds to colchicine, which leaves Grody wondering why the writers of the show felt they needed to invoke two genetic diseases instead of one, since FMF was sufficient for the plot.

Withholding treatment from a sick child is an unconscionable act, but it really does happen, says Dr. Carole Jenny, director of the child protection program at Hasbro Children's Hospital and a professor of pediatrics at Brown University's Alpert Medical School in Providence, R.I. No matter what the parent's motivation — whether it's religious zeal or a quest for attention — letting a sick child suffer amounts to abuse, she says.

According to Jenny, it is often hard for a physician to realize that a parent may be lying about a child's symptoms or treatment. But a physician should always be aware that parents may be seeking attention by either fabricating an illness or actively making a child sick. Doctors sometimes call this kind of behavior Munchausen syndrome by proxy (MSBP), and in fact Dr. Hunt considers this as she analyzes Nikki's case. Such deception should be considered when treatments are not working as expected, Jenny says.

Withholding medical treatment as depicted in the show is clearly neglect and may be an example of MSBP, says Dr. Randell Alexander, chief of the division of child protection and forensic pediatrics at the University of Florida College of Medicine in Jacksonville. Alexander says that, tragically, this abuse often only comes to light "once the child is seriously ill or dead."

Siegel is an associate professor of medicine at New York University Langone Medical Center. His new book is "The Inner Pulse: Unlocking the Secret Code of Sickness and Health."

marc@doctorsiegel.com

"Body of Proof"

10 p.m. May 17, ABC

Episode: "Broken Home"

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