Getting Into the Act
Tuesday, January 9, 2007
When Hollywood scriptwriters want to know when it's safest for a pregnant breast cancer patient to get chemotherapy or how to prevent cancer in intersex people, they know whom to call. Cue Michael Miller at Bethesda's National Cancer Institute (NCI).
Miller, a former TV game show producer, says he is responsible for helping writers "find the resources that will result in not only a dramatically interesting story line but also one that serves the science and informs the public in an intelligent manner." Miller's not alone.
In some of the biggest, most buttoned-down corners of the federal health-care bureaucracy, medical experts regularly field calls from L.A. hipsters crafting story lines for "Law & Order," "Grey's Anatomy," "ER," "House," "Numb3rs" and other TV dramas. The resources devoted to the effort vary, but offices taking the calls include the Agency for Healthcare Research and Quality (AHRQ) and the Health Resources and Services Administration (HRSA), both in Rockville, and the Centers for Disease Control and Prevention (CDC) in Atlanta.
It's a symbiotic relationship. The scriptwriters get the expertise they need to make their dramas plausible -- or almost so. "We make sure the science is right," says AHRQ director Carolyn Clancy, who consults with TV writers on patient safety and other issues. Jean Passanante, head writer for "As the World Turns," finds the access to such experts invaluable: "It's hard to imagine doing any health-related story line without them."
In return, federal medical experts and health-policy wonks hope to inject public health messages into some of Hollywood's hottest shows. Take these themes of episodes of "Law & Order: SVU (Special Victim Unit)": Violence can spread like an infectious disease. Don't let your kids test pesticides, no matter what assurances or perks pesticide-makers give you. Beware teen alcohol abuse and "pharm parties" involving prescription drug abuse.
"The bottom line is, we are trying to change people's behaviors," says Vicki Beck, who runs the "Hollywood, Health & Society" project at the University of Southern California.
Indications are that the collaboration is working and that TV -- beset though it may be by online competition -- is still a powerful shaper of health habits.
For example, viewers of Telemundo's "Amarte Asi" were more likely to exercise, eat more healthfully or take other action to prevent disease after the telenovela included diabetes in a 2005 story line, according to preliminary research by Leslie Rodriquez, a University of Georgia doctoral candidate in public health.
In separate studies, accepted for publication in the Journal of Health Communication, USC researchers Thomas Valente and Sheila Murphy found that viewers of "ER" were more likely to eat better, walk more, seek out a health provider or talk to someone after seeing 2004 episodes on teen obesity and heart disease. And when the daytime drama "The Bold and the Beautiful" ran two episodes of "Tony's HIV" in 2001 and listed the CDC's toll-free phone number, the agency saw its largest spike in calls for HIV-AIDS information. In all three of these cases, federal agencies offered input on the scripts.
According to a CDC analysis of a 2000 survey of the country's 102 million regular prime-time viewers and 38 million daytime-drama viewers, more than half reported having learned about health or medical issues from TV shows. More than a third reported taking action afterward, including getting mammograms, using condoms, visiting the doctor and getting tested for sexually transmitted diseases.
But public service has its limits in Hollywood. In the eternal clash between plot and science, plot is more often the winner.
In the second season of Fox's "24," the show's main character, Jack Bauer, seemingly dies while being tortured but is later revived by a shot of epinephrine. (Don't count on it.) A few years back, Clancy's agency got a call from writers of the now-defunct "Sunset Beach" who wanted to have a character put in a call for help -- from a pay phone in the wilderness -- after suffering a traumatic brain injury during a mountain climb.
"We have zero control of what ends up on the screen," Beck says. "We do what we can, and we recognize we're dealing with a highly creative medium. We try to provide accurate information and hope it gets in. There is a lot of interest on the part of writers and producers to get things right, but they want the drama, too."
Health experts took the first steps toward the federal initiative now linking Hollywood and top health agencies in 1994, when the CDC sought the help of the entertainment industry in boosting HIV-AIDS awareness.
By the time "ER" hit the airwaves later the same year, Neal Baer, a pediatrician who worked as the executive producer of the series, was calling CDC experts for help on story lines touching on hepatitis C, toxic spills and other public health issues. In 2001 the agency sought proposals to develop a more formalized cooperative arrangement. USC's Norman Lear Center got the grant. From the USC campus in Los Angeles, Beck and her small staff now facilitate meetings and calls between TV writers and federal health experts.
The initiative operates on a $530,000 annual budget, funded largely by CDC, AHRQ, HRSA and NCI. That's a decent bargain, says Miller, considering that one 30-second commercial on "Grey's Anatomy" in the fall of 2005 cost $352,000.
An NCI analysis found that prime-time and daytime dramas with cancer content reached an estimated 150 million viewers between September 2005 and August 2006. Buying the 101 minutes in which cancer topics were featured would have cost about $33 million, Miller said.
Beck gives generally high marks to her program's value: "The fact that we have three dramatic medical shows on network TV gives everybody an opportunity to learn about health," she said. " 'ER' is very conscientious. I think 'Grey's Anatomy' tries hard to get it right. And I think 'House' wants to be accurate," Beck said.
Beck cited one instance in which she said consultation on a script had a powerful impact:
"ER" co-executive producer Joe Sachs, an emergency medicine physician, picked up on a theme highlighted in a consultation he had with Harold Freeman, senior adviser to the director of the NCI. Freeman talked about a myth in African American communities about cancer. In April 2005, an "ER" episode focused on a middle-aged black woman seeking care for a fracture. The character, who had had a lump in her breast for several years, found her cancer had metastasized to the bone. She refused treatment, believing that if you cut into cancer, it would spread. Besides addressing this myth, the script also called for the woman to connect with a "patient navigator," a cancer survivor who helped her sort through the medical system and illness.
"That's a dramatic scene," Sachs said.
Two months later, President Bush signed the Patient Navigator Outreach and Chronic Disease Prevention Act, which helped expand the patient navigator concept that Freeman originated in 1990.
Getting It Right
Just how much medical accuracy you find in your favorite TV drama may depend on who you are. Sheila Murphy, a USC entertainment education researcher, runs a TV-monitoring project that assesses the accuracy of health information on top TV shows. She says that about 60 percent of the time, the top shows watched by whites and blacks over the past two seasons have portrayed health information accurately. But the measure drops to just 37 percent for the top shows that Hispanics watch.
Even when shows do get medical content right, producers' priorities may not match those of health experts.
In the past two prime-time TV seasons, heart disease and cancer -- two of the leading killers of Americans -- were highlighted only 8 percent of the time, according to Murphy's assessment of 900 shows. Health themes involving homicide and rare diseases were more common.
"We're definitely in the drama business, in the storytelling business," said Elizabeth Klaviter, director of medical research for "Grey's Anatomy." Because writers have only 42 minutes and 30 seconds to tell a story in a one-hour time slot, she says, patient procedures go more quickly, medications work faster, recovery is swifter. On a show such as "House," it's always the same team of doctors that seems to diagnose extremely rare cases, and they have all the latest lifesaving technology at their fingertips.
Occasionally, literary license bumps up against public health fears. So some squawked at a "Boston Legal" episode this season in which a character (played by Michael J. Fox) who goes to Brazil for a lung transplant is butchered so his organs can be sold on the black market in the United States and Canada.
"That's a problem," said Bryan Stewart, spokesman for Los Angeles-based OneLegacy, the largest nonprofit federally designated organ procurement organization.
Stewart and others maintain that such story lines distort facts, hurt donor efforts and upset donor and recipient families. So when a writer of the CBS show "Numb3rs" called and said he was doing a show on black-market organ transplants in Los Angeles, Beck said, "that raised a red flag for us. . . . The transplantation and donor process is not well understood."
Still, the crime show pursued the line. "It took a little while to establish trust," said J. David Harden, the show's executive story editor. The writer asked questions about the process, the system and medical facts, and spoke at length with James Burdick, director of HRSA's division of transplantation, and others. In the end, the "harvest" episode highlighted the difficulty of finding organs for transplantation and won a "Sentinel for Health" award from the USC project. "They did an excellent job," Beck said. ·
Christopher J. Gearon last wrote for the Health section about online tools designed to give consumers medical price and quality information.Comments: firstname.lastname@example.org.