...First Do No Harm
Encyclopedia
...First Do No Harm is a 1997 television film, directed by Jim Abrahams
, about a boy whose severe epilepsy
, unresponsive to medications
with terrible side effects, is controlled by the ketogenic diet
. Aspects of the story mirror Abrahams' own experience with his son Charlie.
) is the mother of three children and the wife of Dave (Fred Ward
), a truck driver. The family are presented as happy, normal and comfortable financially: they have just bought a horse and are planning a holiday to Hawaii. Then the youngest son, Robbie (Seth Adkins
), has a sudden unexplained fall at school. A short while later, he has another unprovoked fall while playing with his brother, and is seen having a convulsive seizure. Robbie is taken to the hospital where a number of procedures are performed: a CT scan
, a lumbar puncture
, an electroencephalogram (EEG) and blood tests. No cause is found but the two falls are regarded as epileptic seizures
and the child diagnosed with epilepsy
.
Robbie is started on phenobarbital
, an old anticonvulsant
drug with well known side effects including cognitive impairment and behavior problems. The latter cause the child to run berserk through the house, leading to injury. Lori urgently phones the physician to request a change of medication. It is changed to phenytoin
(Dilantin) but the dose of phenobarbital must be tapered slowly, causing frustration. Later, the drug carbamazepine
(Tegretol) is added.
Meanwhile, the Reimullers discover that their health insurance
is invalid and their treatment is transferred from private to county hospital. In an attempt to pay the medical bills, Dave takes on more dangerous truck loads and works long hours. Family tensions reach a head when the children realize the holiday is not going to happen and a foreclosure
notice is posted on the house.
Robbie's epilepsy gets worse and he develops a serious rash known as Stevens–Johnson syndrome as a side effect of the medication. He is admitted to hospital where his padded cot is designed to prevent him escaping. The parents fear he may become a "vegetable" and are losing hope. At one point, Robbie goes into status epilepticus
(a continuous convulsive seizure that must be stopped as a medical emergency). Increasing doses of diazepam
(Valium) are given intravenously
to no effect. Eventually, paraldehyde
is given rectally
. This drug is described has having possibly fatal side effects and is seen dramatically melting a plastic cup (a glass syringe is required).
The neurologist in charge of Robbie's care, Dr. Melanie Abbasac (Allison Janney
), has poor bedside manner and paints a bleak picture. Abbasac wants the Reimullers to consider surgery and start the necessary investigative procedures to see if this is an option. These involve removing the top of the skull and inserting electrodes on the surface of the brain to achieve a more accurate location of any seizure focus than normal scalp EEG electrodes. The Reimullers see surgery as a dangerous last resort and want to know if anything else can be done.
Lori begins to research epilepsy at the library. After many hours, she comes across the ketogenic diet
in a well-regarded textbook on epilepsy. However, their doctor dismisses the diet as having only anecdotal evidence
of its effectiveness. After initially refusing to consider the diet, she appears to relent but sets impossible hurdles in the way: the Reimullers must find a way to transport their son to Johns Hopkins Hospital
in Baltimore, Maryland with continual medical support—something they cannot afford.
That evening, Lori attempts to abduct her son from the hospital and, despite the risk, fly with him to an appointment she has made with Dr Freeman at Johns Hopkins. However, she is stopped by hospital security at the exit to the hospital. A sympathetic nurse warns Lori that she could lose custody of her son if a court decides she is putting her son's health at risk.
Dave makes contact with an old family friend who once practiced as a physician and is still licensed. This doctor and the sympathetic nurse agree to accompany Lori and Robbie on the trip to Baltimore. During the flight, Robbie has a prolonged convulsive seizure, which causes some concern to the pilot and crew.
When they arrive at Johns Hopkins, it becomes apparent that Lori has deceived her friends as her appointment (for the previous week) was not rescheduled and there are no places on the ketogenic diet program. After much pleading, Dr Freeman agrees to take Robbie on as an outpatient. Lori and Robbie stay at a convent in Baltimore.
The diet is briefly explained by Millicent Kelly (played by herself) a dietitian
who has helped run the ketogenic diet program since the 1940s. Robbie's seizures begin to improve during the initial fast
that is used to kick-start the diet. Despite the very high-fat nature of the diet, Robbie accepts the food and rapidly improves. His seizures are eliminated and his mental faculties are restored. The film ends with Robbie riding the family horse at a parade through town. Closing credits claim Robbie continued the diet for a couple of years and has remained seizure- and drug-free ever since.
, was inspired to make the film as a result of his own experiences with his son Charlie. Charlie developed a very serious seizure condition that proved intractable despite several medications and surgery. His cognitive decline was described by Abrahams as "a fate worse than death". He came across the diet in a book on childhood epilepsy by Dr John Freeman, director of the Pediatric Epilepsy Center at Johns Hopkins Hospital. Charlie was started on the diet and rapidly became seizure free. In addition, medications were tapered and his mental development restored. Abrahams was outraged that nobody had informed him of the diet. He created the Charlie Foundation to promote the diet and funded research studies to demonstrate its effectiveness.
Although the film plot has parallels with the Abrahams' story, the character of Robbie is a composite one and the family circumstances are fictional. Several minor characters in the film are played by people who have been on the ketogenic diet and had their epilepsy "cured" as a result. The dietitian Millicent Kelly plays herself. Charlie Abrahams appears as a young boy playing with Robbie in the hospital, whose mother quickly removes him when she discovers Robbie has epilepsy—as though it were an infectious disease.
Commenting on the film, Dr John Freeman said "The movie was based on a true story and we see this story often, but not everyone is cured by the diet and not everyone goes home to ride in a parade." He later noted that the film had "fueled a grass-roots effort for more research on the diet."
The ketogenic diet
was developed by Russel Wilder at the Mayo Clinic
in 1921. The diet aims to reproduce some of the metabolic changes seen during fasting
, which had been shown to be effective in treating epilepsy but obviously not sustainable. Although initially popular in all age groups, the diet was largely replaced by effective anticonvulsant
medications beginning with phenytoin
in 1938. It remained a treatment of last resort in children with intractable seizures. Since the film was produced, the diet has seen a dramatic revival with numerous published research studies and it is now in use at 75 epilepsy centers in 45 countries.
The film was first aired on CityTV and ABC for public viewing on 16 February 1997. It is available on DVD from retailers and directly from the Charlie Foundation. Meryl Streep
's performance was nominated for an Emmy, a Golden Globe and in the Satellite Awards
in the category Best Actress in a TV Film. Writer Ann Beckett was nominated for the Humanitas Prize
(90 minute category). Seth Adkins
won a Young Artist Award
for his performance as Robbie.
Jim Abrahams
Jim Abrahams is an American movie director and writer.Abrahams was born in Shorewood, Wisconsin, to a Jewish family, and attended Shorewood High School...
, about a boy whose severe epilepsy
Epilepsy
Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases...
, unresponsive to medications
Anticonvulsant
The anticonvulsants are a diverse group of pharmaceuticals used in the treatment of epileptic seizures. Anticonvulsants are also increasingly being used in the treatment of bipolar disorder, since many seem to act as mood stabilizers, and in the treatment of neuropathic pain. The goal of an...
with terrible side effects, is controlled by the ketogenic diet
Ketogenic diet
The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control epilepsy in children. The diet mimics aspects of starvation by forcing the body to burn fats rather than carbohydrates...
. Aspects of the story mirror Abrahams' own experience with his son Charlie.
Plot
The film tells a story in the life of a Midwestern family, the Reimullers. Lori (played by Meryl StreepMeryl Streep
Mary Louise "Meryl" Streep is an American actress who has worked in theatre, television and film.Streep made her professional stage debut in 1971's The Playboy of Seville, before her screen debut in the television movie The Deadliest Season in 1977. In that same year, she made her film debut with...
) is the mother of three children and the wife of Dave (Fred Ward
Fred Ward
Freddie Joe "Fred" Ward is an American actor. He began his career in 1979 alongside Clint Eastwood in Escape from Alcatraz. He is best known for his starring roles in the motion pictures Remo Williams, Tremors, Henry & June, Short Cuts, The Right Stuff and Exit Speed...
), a truck driver. The family are presented as happy, normal and comfortable financially: they have just bought a horse and are planning a holiday to Hawaii. Then the youngest son, Robbie (Seth Adkins
Seth Adkins
Seth Elijah Adkins is an American actor. He made his debut in the mid-1990s as achild artiste in the TV shows Small Talk and Sabrina, the Teenage Witch in 1996 and the films ...First Do No Harm and Titanic in 1997. He later made a successful transition to an adult performer...
), has a sudden unexplained fall at school. A short while later, he has another unprovoked fall while playing with his brother, and is seen having a convulsive seizure. Robbie is taken to the hospital where a number of procedures are performed: a CT scan
Computed tomography
X-ray computed tomography or Computer tomography , is a medical imaging method employing tomography created by computer processing...
, a lumbar puncture
Lumbar puncture
A lumbar puncture is a diagnostic and at times therapeutic procedure that is performed in order to collect a sample of cerebrospinal fluid for biochemical, microbiological, and cytological analysis, or very rarely as a treatment to relieve increased intracranial pressure.-Indications:The...
, an electroencephalogram (EEG) and blood tests. No cause is found but the two falls are regarded as epileptic seizures
Seizure
An epileptic seizure, occasionally referred to as a fit, is defined as a transient symptom of "abnormal excessive or synchronous neuronal activity in the brain". The outward effect can be as dramatic as a wild thrashing movement or as mild as a brief loss of awareness...
and the child diagnosed with epilepsy
Epilepsy
Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases...
.
Robbie is started on phenobarbital
Phenobarbital
Phenobarbital or phenobarbitone is a barbiturate, first marketed as Luminal by Friedr. Bayer et comp. It is the most widely used anticonvulsant worldwide, and the oldest still commonly used. It also has sedative and hypnotic properties but, as with other barbiturates, has been superseded by the...
, an old anticonvulsant
Anticonvulsant
The anticonvulsants are a diverse group of pharmaceuticals used in the treatment of epileptic seizures. Anticonvulsants are also increasingly being used in the treatment of bipolar disorder, since many seem to act as mood stabilizers, and in the treatment of neuropathic pain. The goal of an...
drug with well known side effects including cognitive impairment and behavior problems. The latter cause the child to run berserk through the house, leading to injury. Lori urgently phones the physician to request a change of medication. It is changed to phenytoin
Phenytoin
Phenytoin sodium is a commonly used antiepileptic. Phenytoin acts to suppress the abnormal brain activity seen in seizure by reducing electrical conductance among brain cells by stabilizing the inactive state of voltage-gated sodium channels...
(Dilantin) but the dose of phenobarbital must be tapered slowly, causing frustration. Later, the drug carbamazepine
Carbamazepine
Carbamazepine is an anticonvulsant and mood-stabilizing drug used primarily in the treatment of epilepsy and bipolar disorder, as well as trigeminal neuralgia...
(Tegretol) is added.
Meanwhile, the Reimullers discover that their health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
is invalid and their treatment is transferred from private to county hospital. In an attempt to pay the medical bills, Dave takes on more dangerous truck loads and works long hours. Family tensions reach a head when the children realize the holiday is not going to happen and a foreclosure
Foreclosure
Foreclosure is the legal process by which a mortgage lender , or other lien holder, obtains a termination of a mortgage borrower 's equitable right of redemption, either by court order or by operation of law...
notice is posted on the house.
Robbie's epilepsy gets worse and he develops a serious rash known as Stevens–Johnson syndrome as a side effect of the medication. He is admitted to hospital where his padded cot is designed to prevent him escaping. The parents fear he may become a "vegetable" and are losing hope. At one point, Robbie goes into status epilepticus
Status epilepticus
Status epilepticus is a life-threatening condition in which the brain is in a state of persistent seizure. Definitions vary, but traditionally it is defined as one continuous unremitting seizure lasting longer than 5 minutes, or recurrent seizures without regaining consciousness between seizures...
(a continuous convulsive seizure that must be stopped as a medical emergency). Increasing doses of diazepam
Diazepam
Diazepam , first marketed as Valium by Hoffmann-La Roche is a benzodiazepine drug. Diazepam is also marketed in Australia as Antenex. It is commonly used for treating anxiety, insomnia, seizures including status epilepticus, muscle spasms , restless legs syndrome, alcohol withdrawal,...
(Valium) are given intravenously
Intravenous therapy
Intravenous therapy or IV therapy is the infusion of liquid substances directly into a vein. The word intravenous simply means "within a vein". Therapies administered intravenously are often called specialty pharmaceuticals...
to no effect. Eventually, paraldehyde
Paraldehyde
Paraldehyde is the cyclic trimer of acetaldehyde molecules. Formally, it is a derivative of 1,3,5-trioxane. The corresponding tetramer is metaldehyde. A colourless liquid, it is sparingly soluble in water and highly soluble in alcohol. Paraldehyde slowly oxidizes in air, turning brown and producing...
is given rectally
Rectum
The rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...
. This drug is described has having possibly fatal side effects and is seen dramatically melting a plastic cup (a glass syringe is required).
The neurologist in charge of Robbie's care, Dr. Melanie Abbasac (Allison Janney
Allison Janney
Allison Brooks Janney is an American actress, best known for her role as C.J. Cregg on the television series The West Wing.- Personal life :...
), has poor bedside manner and paints a bleak picture. Abbasac wants the Reimullers to consider surgery and start the necessary investigative procedures to see if this is an option. These involve removing the top of the skull and inserting electrodes on the surface of the brain to achieve a more accurate location of any seizure focus than normal scalp EEG electrodes. The Reimullers see surgery as a dangerous last resort and want to know if anything else can be done.
Lori begins to research epilepsy at the library. After many hours, she comes across the ketogenic diet
Ketogenic diet
The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control epilepsy in children. The diet mimics aspects of starvation by forcing the body to burn fats rather than carbohydrates...
in a well-regarded textbook on epilepsy. However, their doctor dismisses the diet as having only anecdotal evidence
Anecdotal evidence
The expression anecdotal evidence refers to evidence from anecdotes. Because of the small sample, there is a larger chance that it may be true but unreliable due to cherry-picked or otherwise unrepresentative of typical cases....
of its effectiveness. After initially refusing to consider the diet, she appears to relent but sets impossible hurdles in the way: the Reimullers must find a way to transport their son to Johns Hopkins Hospital
Johns Hopkins Hospital
The Johns Hopkins Hospital is the teaching hospital and biomedical research facility of Johns Hopkins University School of Medicine, located in Baltimore, Maryland . It was founded using money from a bequest by philanthropist Johns Hopkins...
in Baltimore, Maryland with continual medical support—something they cannot afford.
That evening, Lori attempts to abduct her son from the hospital and, despite the risk, fly with him to an appointment she has made with Dr Freeman at Johns Hopkins. However, she is stopped by hospital security at the exit to the hospital. A sympathetic nurse warns Lori that she could lose custody of her son if a court decides she is putting her son's health at risk.
Dave makes contact with an old family friend who once practiced as a physician and is still licensed. This doctor and the sympathetic nurse agree to accompany Lori and Robbie on the trip to Baltimore. During the flight, Robbie has a prolonged convulsive seizure, which causes some concern to the pilot and crew.
When they arrive at Johns Hopkins, it becomes apparent that Lori has deceived her friends as her appointment (for the previous week) was not rescheduled and there are no places on the ketogenic diet program. After much pleading, Dr Freeman agrees to take Robbie on as an outpatient. Lori and Robbie stay at a convent in Baltimore.
The diet is briefly explained by Millicent Kelly (played by herself) a dietitian
Dietitian
Dietitians supervise the preparation and service of food, develop modified diets, participate in research, and educate individuals and groups on good nutritional habits. The goals of dietitians are to provide medical nutritional intervention, and to obtain, safely prepare, serve and advise on...
who has helped run the ketogenic diet program since the 1940s. Robbie's seizures begin to improve during the initial fast
Fasting
Fasting is primarily the act of willingly abstaining from some or all food, drink, or both, for a period of time. An absolute fast is normally defined as abstinence from all food and liquid for a defined period, usually a single day , or several days. Other fasts may be only partially restrictive,...
that is used to kick-start the diet. Despite the very high-fat nature of the diet, Robbie accepts the food and rapidly improves. His seizures are eliminated and his mental faculties are restored. The film ends with Robbie riding the family horse at a parade through town. Closing credits claim Robbie continued the diet for a couple of years and has remained seizure- and drug-free ever since.
Background
The director and producer, Jim AbrahamsJim Abrahams
Jim Abrahams is an American movie director and writer.Abrahams was born in Shorewood, Wisconsin, to a Jewish family, and attended Shorewood High School...
, was inspired to make the film as a result of his own experiences with his son Charlie. Charlie developed a very serious seizure condition that proved intractable despite several medications and surgery. His cognitive decline was described by Abrahams as "a fate worse than death". He came across the diet in a book on childhood epilepsy by Dr John Freeman, director of the Pediatric Epilepsy Center at Johns Hopkins Hospital. Charlie was started on the diet and rapidly became seizure free. In addition, medications were tapered and his mental development restored. Abrahams was outraged that nobody had informed him of the diet. He created the Charlie Foundation to promote the diet and funded research studies to demonstrate its effectiveness.
Although the film plot has parallels with the Abrahams' story, the character of Robbie is a composite one and the family circumstances are fictional. Several minor characters in the film are played by people who have been on the ketogenic diet and had their epilepsy "cured" as a result. The dietitian Millicent Kelly plays herself. Charlie Abrahams appears as a young boy playing with Robbie in the hospital, whose mother quickly removes him when she discovers Robbie has epilepsy—as though it were an infectious disease.
Commenting on the film, Dr John Freeman said "The movie was based on a true story and we see this story often, but not everyone is cured by the diet and not everyone goes home to ride in a parade." He later noted that the film had "fueled a grass-roots effort for more research on the diet."
The ketogenic diet
Ketogenic diet
The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control epilepsy in children. The diet mimics aspects of starvation by forcing the body to burn fats rather than carbohydrates...
was developed by Russel Wilder at the Mayo Clinic
Mayo Clinic
Mayo Clinic is a not-for-profit medical practice and medical research group specializing in treating difficult patients . Patients are referred to Mayo Clinic from across the U.S. and the world, and it is known for innovative and effective treatments. Mayo Clinic is known for being at the top of...
in 1921. The diet aims to reproduce some of the metabolic changes seen during fasting
Fasting
Fasting is primarily the act of willingly abstaining from some or all food, drink, or both, for a period of time. An absolute fast is normally defined as abstinence from all food and liquid for a defined period, usually a single day , or several days. Other fasts may be only partially restrictive,...
, which had been shown to be effective in treating epilepsy but obviously not sustainable. Although initially popular in all age groups, the diet was largely replaced by effective anticonvulsant
Anticonvulsant
The anticonvulsants are a diverse group of pharmaceuticals used in the treatment of epileptic seizures. Anticonvulsants are also increasingly being used in the treatment of bipolar disorder, since many seem to act as mood stabilizers, and in the treatment of neuropathic pain. The goal of an...
medications beginning with phenytoin
Phenytoin
Phenytoin sodium is a commonly used antiepileptic. Phenytoin acts to suppress the abnormal brain activity seen in seizure by reducing electrical conductance among brain cells by stabilizing the inactive state of voltage-gated sodium channels...
in 1938. It remained a treatment of last resort in children with intractable seizures. Since the film was produced, the diet has seen a dramatic revival with numerous published research studies and it is now in use at 75 epilepsy centers in 45 countries.
The film was first aired on CityTV and ABC for public viewing on 16 February 1997. It is available on DVD from retailers and directly from the Charlie Foundation. Meryl Streep
Meryl Streep
Mary Louise "Meryl" Streep is an American actress who has worked in theatre, television and film.Streep made her professional stage debut in 1971's The Playboy of Seville, before her screen debut in the television movie The Deadliest Season in 1977. In that same year, she made her film debut with...
's performance was nominated for an Emmy, a Golden Globe and in the Satellite Awards
Satellite Awards
The Satellite Awards are an annual award given by the International Press Academy. The awards were originally known as the Golden Satellite Awards.- Film :*Best Actor – Drama*Best Actor – Musical or Comedy*Best Actress – Drama...
in the category Best Actress in a TV Film. Writer Ann Beckett was nominated for the Humanitas Prize
Humanitas Prize
The Humanitas Prize is an award for film and television writing intended to promote human dignity, meaning, and freedom. It began in 1974 with Father Ellwood "Bud" Kieser — also the founder of Paulist Productions — but is generally not seen as specifically directed toward religious...
(90 minute category). Seth Adkins
Seth Adkins
Seth Elijah Adkins is an American actor. He made his debut in the mid-1990s as achild artiste in the TV shows Small Talk and Sabrina, the Teenage Witch in 1996 and the films ...First Do No Harm and Titanic in 1997. He later made a successful transition to an adult performer...
won a Young Artist Award
Young Artist Award
The Young Artist Award is an accolade bestowed by the Young Artist Foundation, a non-profit organization founded in 1978 to recognize and award excellence of youth performers, and to provide scholarships for young artists who may be physically and/or financially challenged.The Young Artist...
for his performance as Robbie.
External links
- The Charlie Foundation A US charity and information resource, set up by Jim AbrahamsJim AbrahamsJim Abrahams is an American movie director and writer.Abrahams was born in Shorewood, Wisconsin, to a Jewish family, and attended Shorewood High School...
.