How Netflix's 'Diagnosis' Upends 'House': Dr. Lisa Sanders Looks to the Wisdom of Crowds to Solve Medical Mysteries
Willie Reyes was losing his memory and neurologists couldn't explain why. After Reyes, 46, suffering a seizure, doctors had found lesions on his brain, which caused mood swings, memory loss and hearing problems. Doctors dismissed Alzheimer's, cancer and the rare inflammatory disease CLIPPERS as causes. Eventually Reyes lost his job as a prison guard and accrued $10,000 in medical debt after being denied early retirement and disability retirement. In part that was because there was no name to put his illness.
Reyes and his family found themselves in a zone of uncertainty, with medical tests repeatedly confirming his symptoms but failing to provide a diagnosis.
In the new Netflix series Diagnosis, Dr. Lisa Sanders, author of the New York Time Magazine column of the same title, explores cases where a course of treatment may not be immediately obvious, because a clear cause has not yet been identified.
"Before I went to medical school, I had no idea there was this much uncertainty in medicine," Sanders, an internist on the faculty of the Yale School of Medicine, told Newsweek. "I don't think people recognize that. That's been my interest from the beginning."
Her focus on diagnosis-as-mystery, which acknowledges the many possible uncertainties a doctor can encounter even before treatment can be contemplated, inspired screenwriter and television producer Paul Attanasio to create the hit medical drama House, for which Sanders served as technical advisor.
"Sometimes, figuring out which disease you have is easy—I'm more interested in when it's hard," Sanders said.
In House, diagnostic enigmas were solved by cheeky genius Dr. Gregory House (Hugh Laurie), who often rescued patients in the nick of time with a magic-bullet treatment. On Netflix, Diagnosis takes an almost opposite approach, centering patients and engaging the wisdom of experts and laypeople around the world. In each episode, Sanders uses her column to share a diagnostic mystery with her readers, soliciting video responses from doctors, medical students and amateur medical investigators.
"Because the amount we know is so much greater now than it has ever been in the past, and growing exponentially every day, there's not a single brain that can hold all this. When people talk about AI in medicine, what they're really asking for is a brain we can all access," Sanders said, referencing the diagnostic tool Isabel. "The crowd really functions as that artificial intelligence. Just like AI, not all possibilities are reasonable in each case. Instead, they give us a broad palette to expand our thinking."
On House, a last-minute diagnosis is the pathway to an episodic-television resolution. But for the people profiled on Diagnosis, learning the name of their disease can sometimes be the end in itself: For Reyes, whose case is documented in the third episode, video respondents from around the world proposed something his doctors hadn't previously considered: Gulf War syndrome.
"I had read all of his records and had some thoughts about it. I wasn't sure what it was, but what the crowd came up with, that it was a service-related illness, never crossed my mind. Half the people who wrote in suggested that!" Sanders said. "Just goes to show how blind doctors can be. I read all of his records; none of his doctors referenced that. I mean, it just never came up."
More than a third of the 697,000 veterans of the first Gulf War continue to suffer a range of chronic symptoms, with many exhibiting conditions similar to Reyes. Rather than a single illness with a clear cause and treatment, Gulf War syndrome is believed to have a complex of causes, from low-dose exposure to sarin (from detonated Iraqi munitions) to the depleted uranium rounds used by U.S. tanks.
Treatments for the illness are still being researched, including at the Department of Veteran Affairs' War Related Illness and Injury Study Center, where Reyes applies for support at the end of the episode.
Reyes isn't the only Diagnosis subject who finds an answer that offers no cure—or even a clear pathway to managing symptoms. In another episode, "Looking for a Village," the mother of Kamiyah, a 6-year-old with a rare fainting disease, finally learns about the genetic mutation causing her daughter's symptoms.
Research into the condition is ongoing in mice, but the prospect of a treatment for humans is likely years away.
But one of the most remarkable aspects of Diagnosis is how much relief an answer can bring, even if a prognosis remains out of sight. For Reyes, a diagnosis offered new avenues of support, from both VA medical centers and the veteran's community itself. At the end of the fourth episode, Kamiyah and her mother visit a family in Denmark whose son is living with the same condition.
"I think there is a lot of hope now," Kamiyah's mother, Breteni, says in the episode. "The collaboration of all the people who have come forward, and the fact that we're not all alone in this anymore, it adds a little bit more color where there was once a whole lot of gray."
"'A diagnosis is just a word, why are you so obsessed with this word?' But a diagnosis is more than a word," Sanders said. "'If it's not linked to a treatment, what do you care what it's called?' It turns out people do care: understanding at least what it might be and what the future holds."
All of seven episodes of Diagnosis are now streaming on Netflix. A collection of Sanders' "Diagnosis" columns, Diagnosis: Solving the Most Baffling Medical Mysteries, is also available now from Broadway Books.
