Maggie: You don't even know what I have.

House: What you have is one last Christmas with your daughter. One last chance to give her a present. The truth. It's inexpensive. Highly valued. You never have to stand in line to return it the day after Christmas.

Maggie: What are you talking about?

— It's a Wonderful Lie

It's a Wonderful Lie is a 4th season episode of House that first aired on January 29, 2008. It is a Christmas episode. House has seemingly met his match when he treats a woman and her young daughter and they insist on being honest with each other. However, when the mother's case appears hopeless, House pulls off a Christmas miracle. When Kutner suggests a Secret Santa, House decides to both test the cohesion of his team and get a bonus for himself.

Once again, the series turns back to its main theme. Similarly as in Paternity, we have an adopted child whose adopted parent refuses to tell them the truth. Unlike Paternity however, the child hasn't figured out the truth yet.

When we compare this episode to the following season's key episode, Birthmarks, this theme - the main theme behind the credo Everybody lies, comes into sharp focus. In Paternity, the 17-year-old Dan has figured out, without his parent's help, that he's adopted. In Birthmarks, we learn that 12-year-old Gregory House has also figured out that his "father" isn't his biological father. Here, 11-year-old Jane is still oblivious to the fact despite the clue that gives it away to House, who figures out the relationship in all three cases and faces denial and evasion all three times.

In retrospect, House is desperately trying to convince Maggie to avoid the fate he suffered, finding out the one "big lie". He manages this when he seems to find a mother-daughter pair that seems to defy his credo, and when he sees the direct effect of what brutal honesty brings to a relationship. In Daddy's Boy, he makes the same observation of his putative father - a person with an insane moral compass that won't let them lie about anything; a fine quality in a police witness, but a lousy one in a dad. When House does find out about the big lie, it drives a permanent wedge between the two men as House realizes his father isn't nearly as honest as he seemed to be.

Even the clinic patient gets in on the act, telling House that she hasn't revealed to her own mother that she works as a prostitute. She realizes that although the truth would make her "righteous" (a wonderful religious allusion) that it would also deeply hurt her mother and that the grace of God isn't worth the cost. Even more ironically, she appears at the end of the episode as the Virgin Mary, turning the tables on House by misleading him as to her own sexual limits, only to let him off the hook.

In the subplot, House becomes upset that the creativity of his new team has been stifled by their new found job security and works to manipulate them into distrust. However, he finds his new team up to the challenge and although the manipulation works, the team unites instead showing them to be very much House's equals in this regard.

A young girl is climbing a rock wall while her mother Maggie belays her. The girl slips, but her mother has a hold of the rope. However, all of a sudden, the mother can't hold onto the rope anymore and the daughter drops to the floor. They realize the daughter has a broken arm, but the mother is no longer able to move her hands.

Taub is explaining to the rest of the team that the patient has been to several doctors who haven't been able to figure out what is wrong with her hands. House comes in and tears down the Christmas decorations. Kutner denies it was him who put up the decorations, but House figures out it was him by process of elimination. Kutner then asks to hold a Secret Santa. Thirteen tells House that it's unlikely the patient is lying as her own mother died of breast cancer without telling her about her illness and she was determined not to do that to her own daughter. House tells them to MRI the patient's chest to look for breast cancer despite the patient's preventative double mastectomy and then goes to speak to the daughter about her mother's drug use. The daughter denies the mother uses anything stronger than marijuana. House cross-examines the daughter about lying when the daughter denies ever doing it. House is surprised by the daughter's candor, however, when she is able to tell him that her mother has sex on her stomach to stop her various lovers from staring at the scars from her mastectomy.

House discusses the necessity of lying with Wilson. Wilson looks at the patient's scans and dismisses the possibility the cancer has recurred. However, the patient has had multiple sexual partners. The team has ruled out an STD, but House thinks it's related. Taub and Foreman go to speak to her sexual contact, who denies doing anything wrong. However, the contact appears to be always thirsty and they diagnose him with the same thing the patient has. He admits to giving the patient ecstasy and the doctors admit they lied about the diagnosis.

Taub comes back to report about the ecstasy. House is not impressed that Taub is so straightforward and fearless around him.

They start treatment for ecstasy overdose. All of a sudden, the patient starts complaining that the lights have gone off. They realize she has gone blind.

The ecstasy turns out to be pure - no other toxins. Ecstasy wouldn't explain the onset of blindness days after she took it. Kutner is surprised that House has agreed to a Secret Santa. They choose names and start discussing the case. House orders an environmental scan, including the computer. Foreman thinks it is Kearns-Sayre syndrome, but House dismisses it because of the lack of family history. He allows Taub to test for MS and check for bleeding in her eyes.

They start testing the patient's eyes and discussing why House thought the patient was lying. The patient's eyes look fine, so they aren't the problem.

House tells Wilson the Secret Santa is designed to drive everyone apart. He thinks that buying the wrong gift proves how little they know about one another.

Kutner and Thirteen come back with the patient's computer. Foreman thinks the paralysis and blindness might be a conversion disorder - something psychological. House decides they have to trick her mind. Thirteen opposes it, but they try to convince the patient's daughter to lie to her mother even though the daughter believes her mother won't lie to her. However, the daughter won't agree because she won't believe her mother is depressed.

Taub gives the patient a placebo and starts talking about the daughter with the patient while the rest of the team keeps the daughter distracted and talk about the Secret Santa. The daughter mentions that her mother buys the best presents for the teachers with whom she gets along least.

House tells Wilson that his name was the only one in the Secret Santa draw. However, the team has also figured this out, and they get Kutner to agree not to buy House anything.

The patient starts getting worse as her lymph nodes swell so much they cut off her airway.

House figures the swollen lymph nodes rule out a conversion disorder. House goes through the patient's e-mail until Thirteen stops him. However, House has realized she might have sarcoidosis - she's been cutting back on physical activity. House gets his first present - an iPhone.

The team starts testing the patient, and try to figure out who bought House the iPhone. However, House just stole it from Wilson. Thirteen tells the team to stop speculating who bought it - it was obviously House. However, they realized the patient is now bleeding out of her eyes. They have ruled out sarcoidosis but now fear she will bleed to death. House orders a bone marrow aspiration to determine why she isn't producing platelets. Kutner asks why House got a present when he's his Secret Santa. He then gives House a present anyway.

Chase starts the aspiration by drilling into the patient's bone, but Foreman notes that it's smoking, meaning the bones are harder than the steel drill bit.

They can't find any hot spots in the bone scan that would indicate higher bone density, but Foreman doesn't think Kutner screwed up the test - he believes her entire skeleton has the same high density. Kutner comes up with a diagnosis for this symptom that House rejects until Kutner reminds House that any other cause of the bone hardening would be fatal.

House tells Wilson his gambit worked, the team attacked Kutner thinking he screwed up the test.

Taub tells the patient if they are right she will need a bone marrow transplant from her daughter. However, the patient objects to the daughter donating or even being tested despite the low risk to the daughter.

Taub finds a 5/6 bone marrow donor, but House wonders why the patient doesn't want the daughter tested - she's likely to be a perfect match. Taub gives House a present too. However, Thirteen comes in to say the transplant won't help - the blood test for what they hoped she had was negative. Her condition has to be terminal. Thirteen gives House a present too. House agrees to tell the patient she's terminal, but tells his team they can't go home until they have a diagnosis. However, while they search Kutner points out there are dozens of terminal diseases that could account for the symptoms. Kutner apologizes for breaking down and buying a present, but the rest of the team quickly forgives him - it will make House crazy. The daughter comes in to ask for a marrow test.

The patient rejects the prognosis, but House tells her she knows that her daughter's marrow test will show they aren't related. The mother admits she didn't want to have her own kids because they would have the same genetic problems she had. The daughter's biological mother was a drug addict, and the patient promised not to tell. The daughter comes in to confront her mother about the prognosis and the mother says the doctors may be wrong. The daughter coldly tells her she's dying and it's not going to be okay. As Thirteen and House walk away, Thirteen comments about the callousness of the daughter's directness.

House is leaving for the night, walking as quickly as he can through the hospital Christmas party. Wilson begins walking with him and asks about the gifts he got. House describes all the expensive gifts he got from his team (a watch from Kutner, a vintage LP from Thirteen and a second edition Arthur Conan Doyle from Taub). However, he comments that if that isn't bad enough, his patient is also dying. He tells Wilson about seeing the daughter be honest - the pure truth of telling her mother she's going to die. He realizes the daughter did it because she cared about her mother. When they discuss the fact that things don't care about what happens to them, House gets an idea.

House starts singing "God Rest Ye Merry Gentlemen" to his team. He orders risperidone, an antipsychotic, and promises a Christmas miracle.

House tells the patient that breast tissue sometimes gets mixed up in the developing fetus and winds up in the wrong part of the body. They rejected breast cancer as a possible cause of bone hardening because they couldn't find it in her chest. House injects her with the risperidone and a bulbous growth shows up behind her knee. House sticks a needle into it tells the daughter to open her mouth. He tells her not to worry as she's had it before and squirts the liquid into her open mouth. She makes a face as House explains that risperidone stimulates breast milk production. The bulbous growth behind her knee is actually breast tissue full of milk. House orders surgery to remove the excess breast tissue and chemotherapy.

House's new team meets with Chase and Cameron for a party while House heads out alone.

A woman comes in complaining of a sore throat and stomach pain. House diagnoses her with strep throat. She worries about it being contagious, and House figures she's a prostitute worrying about passing it off to clients because she's wearing a St. Nicholas medal and, among other things, Nicholas was the patron saint of prostitutes.

However, the patient comes back. She has a rash on her neck. House thinks it is gonorrhea, but she says there is no rash on her labia. Her lips also look like she has lipstick although she's not wearing any. The only disease that would cause it would be from an equine animal, like a donkey. House quizzes her about it, suggesting she contracted it from participating in a donkey show, and she admits to having recent contact with either a donkey or mule. House diagnoses her with contagious ecthyma, a form of streptococcus. House prescribes an antibiotic cream, and the patient invites him to her show.

Later, House goes to see the patient's show - she's playing the Virgin Mary in a nativity play and appears to be sitting on a real mule.

Breast cancer is the leading cause of death from disease in women the patient's age, although the presentation was a strange one.

• This episode is the first one to have Kal Penn, Peter Jacobson, and Olivia Wilde credited under "Also Starring" for the first time.
• Fox originally planned to show this episode earlier, in time for Christmas, instead of in January. It was delayed because of the 2007-2008 Writers Guild of America strike, which forced Fox to spread out the episodes that had been written before the strike started.
• The rock climbing scenes were shot at Boulderdash Indoor Rock Climbing in Thousand Oaks, California. The wall shown is "The Prow" - 45 feet high that leans back slightly against the vertical.
• St. Nicholas was a 4th century bishop who, among other things, served as the inspiration for Sinterklaas (a gift-bringer in the Netherlands, Belgium and parts of Germany), one of the origins of Santa Claus. He is the patron saint of children, coopers (barrel makers), sailors, fishermen, merchants, broadcasters, the falsely accused, repentant thieves, brewers, pharmacists, archers, pawnbrokers, Aberdeen (Scotland), Galway (Ireland), Russia, Greece, Hellenic (Greek) Navy, Liverpool (England), Bari (Italy), Siggiewi (Malta), Moscow (Russia), Amsterdam (the Netherlands), Lorraine and the Duchy of Lorraine (France) and, yes, prostitutes. His patronage over prostitution was from an act of generosity that saved three sisters from prostitution when he provided all of them with money for a dowry.
• The Trojan Horse was ostensibly a large sculpted horse that the Greeks offered to the Trojans as a gift during the siege of Troy, ostensibly to promote peace between the two sides. However, it was actually a subterfuge - Greek soldiers were hidden inside the horse and once the Trojans brought it inside the city's walls, the soldiers got out and opened the main gate for the invading Greek forces.
• Although it may sound sexy, an "Alpine Butterfly" is a type of knot used in climbing. It can be made from the middle of a rope without access to the ends, but remains secure if stress is put on the loop or on either end of the rope. Climbers can use it as a foothold or handhold.
• Garfield is a comic strip about a large tabby cat by Jim Davis that has been syndicated since 1978.
• Red Ryder BB Gun is a reference to the 1983 film A Christmas Story.
• More about Satanism and Druids. Wilson's wish of "Happy Solstice" to House plays to House pretending to be a Druid as the solstices were important dates in pre-Roman Britain.
• Kwanzaa is a celebration of West African culture held in the United States for one week starting the day after Christmas.
• The second edition Conan Doyle House receives is another reference to Sherlock Holmes.
• A Dreidel is a toy top associated with Hanukkah.
• "A love glove for Francis" refers to Francis the Talking Mule, a character featured in several Universal-International film comedies during the 1950s.
• Cleveland is the second largest city in Ohio. It is also mentioned in Post Mortem.
• Ebenezer Scrooge is the protagonist of the Charles Dickens short story A Christmas Carol.
• The sound clip that starts when Thirteen asks "who's going to tell the patient she's dying" is a combination of the song "Sun King" and "The Little Drummer Boy"
• Upon receiving the final diagnosis Maggie says to her daughter, "I love you." Jane responds, "I know." This may be a reference to the famous exchange between Han Solo and Princess Leia in Star Wars Episode 5 the Empire Strikes back.
• This is one of several episodes where the opening scene suggest the wrong character will be the featured patient.
• Cameron appears in the episode, but has no dialogue.
• The e-mail seen on Maggie's computer while House searches for clues says "Sorry to hear you won't be coming along on the Halloween Day Climb. You're going to miss Matt's famous Ghou () Dance. Not to mention the wine and smores. Pam." Pam is most likely episode writer Pamela Davis and Matt probably refers to episode director Matt Shakman.
• Hugh Laurie and Stephen Fry parodied the original "It's a Wonderful Life" on their show A Bit of Fry & Laurie. which aired in the UK from January 13, 1989 to April 2, 1995. The "Soarway Life Sketch" sees Laurie playing Fox Network head Rupert Murdoch in the sketch while Fry portrays his guardian angel with the sketch ending with Fry's character pushing Laurie's character off a bridge into the river below and calling him a twat after realizing the man is a lost cause who will never change his ways.

Fry & Laurie It's a Soaraway Life Segment

• During the episode, House also mentions the word, "lesbionic" which was heard during the Fry and Laurie sketch, "Judge Not".

One of the most contentious issues in treatment is whether or not it's ethical to treat a patient with a placebo - essentially misleading them into believing they are being treated when, in fact, they are not.

In the immediate case of Maggie in this episode, it is clear in modern medical practice that giving the patient a placebo is totally inappropriate in cases of conversion disorder. The patient should be assessed and treated by a psychiatrist and the attending should let the patient know the possible diagnosis and provide reassurance. In most cases, a definitive diagnosis of conversion disorder requires ongoing treatment until the condition can be resolved.

In addition, it's not clear how the term "placebo" should be defined. Should it include every treatment that has no defined therapeutic effect but may still be helpful (like bedrest and even psychotherapy) or only those treatments that are designed to have no effect at all?

It should be noted that in clinical trials, the control group will be given something that looks like a treatment, but isn't (usually saline). However, clinicians have noted that this gives rise to the "reverse-placebo" effect - patients often realize that they are on the trial drug because of side effects, while those not on the drug soon realize that what they are being given is not therapeutic. This expectation can affect how the patient perceives the drug is working, and they tend to over report improvement when there are side effects. Later in the series, when Foreman is in charge of a clinical trial, he even accidentally learns that the therapy and the placebo have different smells, and from that learns that Thirteen is on the placebo.

The question is incredibly complex and there are many cases where issuing a placebo is the entirely correct procedure, such as a patient demanding antibiotics for the flu. In that case, it is clear that the placebo will have the exact same therapeutic effect on the disease as the "real drug" - none at all.

The series first toys with this issue in the Pilot where House prescribes mints to a patient suffering from a vague set of symptoms. Unfortunately, in some cases (including the one in that episode) the "treatment" works. There's no question that patients "improve" on placebos, but as the late British-Canadian oncologist Rob Buckman pointed out when questioning alternative medicine, there are only three outcomes when a treatment is tried - improvement, deterioration, or nothing at all. Since many diseases either resolve without treatment (e.g. the common cold) or stay the same no matter what treatment is given, a placebo may seem to have therapeutic effect and this basic fallacy can even fool doctors.

In fact, although the "placebo effect" seemed to be well documented, a clinical trial actually showed that patients given nothing at all had the same rate of improvement as those "given" a placebo. In other words, "no treatment' was just as good as a "placebo" and the placebo effect could, in the end, be a placebo effect - we think it's going to be there, so we see it when there's evidence that seems to confirm our hypothesis.

• The rope sliding through the belay device as shown at the start of the episode is actually impossible. The daughter Jane was climbing top rope style. Which means the rope comes from the climber, goes up to some anchor above the climbing route and then goes back down to the person performing the belay (the mother Maggie). When the climber starts their ascent, the rope will be at its maximum extension, which is at least twice the length of the climbing route. If the rope was too short, then it would have been obvious from the start.
• The powerless left hand that Maggie looks at in shock is not the hand used to stop the rope. You would stop the rope below the belay device, not above. So the right hand in the background was actually the important one.
• In case of a fall, the belay device will create most of the friction required to bring the climber to a very quick halt. Little to no grip strength is required, at least with the belaying device that they used. If the mother had just lowered her right hand, then the belay device would have blocked automatically.
• In some shots, there is a rope on the ground beside Maggie, but in others it is no longer there.
• Hardening of the bones should most properly be described as osteosclerosis. Osteopetrosis is one disease which presents with osteosclerosis.
• The doctors confuse osteopetrosis, a genetic disease which does cause greatly increased bone density, with diffuse bone metastasis, which also causes increased bone density. In a female patient presenting with increased bone density, breast cancer should be part of any competent differential diagnosis, particularly when the patient has no family history of osteopetrosis but does have a family history of breast cancer.
• In addition, there is a second cause of osteosclerosis that, although not curable, is also not dangerous - benign osteopetrosis.
• If you try to drill into a bone affected with osteosclerosis, it will shatter, not be resistant to the drill. Although the bones become harder, they also become more brittle. In any case, it is doubtful that any organic structure, no matter how hard, could resist a stainless steel drill. Additionally Chase incorrectly holds the drill with both hands around the trigger handle, best practice when holding any power tool is with one hand on the trigger and one hand around the barrel or top of the drill for stability, safety, and guidance.
• Bone marrow aspirations aren't performed with surgical drills, but with specially constructed needles.
• Although metastasis of breast cancer can cause osteosclerosis, it will be specific to sites where the cancer has migrated to. It won't affect the whole skeleton. In addition, if the cancer were that widespread, the prognosis would be very poor.
• Although risperidone can cause breast tissue enlargement and milk production, it rarely does. If it does, it happens after several doses and after a long period of time.
• When they think Maggie has a conversion disorder, they try to treat her with a placebo. However, that never works. Conversion disorder requires ongoing psychiatric treatment.
• Dialysis is not used to treat an ecstasy overdose, although it is used to treat an overdose of an unknown drug or toxin. It could be they believed it was something mixed with the ecstasy was causing the symptoms.
• Contagious ecthyma is self-resolving. Melanie didn't need antibiotics and House should know better than to give them to her. It also doesn't affect donkeys, only sheep and goats.
• During the scene where House and Thirteen have an argument as they walk down the hall, the position of her necklace watch changes.
• When House and Wilson are outside talking just before House's eureka moment, there is snow on the top of the street lamp. Street lamps use incandescent bulbs and if it had been dark for any period of time, any snow on the lamp would have melted.
• During the lollipop eating session with House, the position of Jane's braid changes.