Portal de Periódicos da CAPES

Evidence-Based Television

2008; Wolters Kluwer; Volume: 30; Issue: 18 Linguagem: Inglês

10.1097/01.cot.0000340712.02987.0d

1548-4688

Andrew Holtz,

Health Policy Implementation Science

Figure: ANDREW HOLTZ, MPH, is a former CNN Medical Correspondent and the author of “The Medical Science of House, M.D.” Send questions to him about how the media treat medical topics or suggestions for future columns to [email protected]Beginning with my first column, I've contended that health care professionals benefit from understanding more about the whats, whys, and hows of media portrayals of medicine and health. Even when the stories are fiction, the effects on people, both patients and policymakers, are real. Now I can point to fresh data. In May, more than 17 million Americans were part of a national health education experiment. The participants were exposed to…okay, enough of the research jargon…viewers plunked themselves down in front of their TV sets to get their regular Thursday night fix of Grey's Anatomy. What these viewers didn't know was that nestled among the personal revelations, emotional confrontations, and comic interludes of the hit show was a notable, yet little known, health fact: With treatment, pregnant women with HIV have a better than 98% chance of delivering an uninfected child. In a minor storyline that made three brief appearances in the episode, the character of Dr. Izzie Stevens (played by Katherine Heigl) counseled a couple that was pregnant unexpectedly. They had not planned on having children because the wife was infected with HIV. A national telephone survey by the Kaiser Family Foundation just before the episode aired found that barely one out of seven regular Grey's Anatomy viewers knew how well treatment could shield a fetus from infection with HIV. The same question was then asked just after the show aired. “We found an absolutely huge impact in terms of people's awareness of the facts that were presented in the episode,” said Vicky Rideout, Kaiser Family Foundation VP and Director of the Program for the Study of Media and Health. Increase in Understanding of More than Four Times from Before the Show The number of viewers who knew the facts had more than quadrupled, to almost two out of three. That result means that after one hour of prime time TV, some 8 million Americans had gained a whole new understanding of HIV and childbearing. Six weeks later another survey revealed that while recall faded a bit, almost half the respondents said that women with HIV had a better than 90% chance of delivering an uninfected child. That's triple the baseline survey result. “And that was just phenomenal to us, because this is an entertainment show. People are not tuning in to it in order to get information on a health issue. They are not thinking of it as being educational or news or informational,” Ms. Rideout noted. The crew at Grey's Anatomy knows the show is hugely popular, yet the health education impact of their drama impressed them. “It's really staggering that our fans pay such close attention to our show,” said Elizabeth Klaviter, the show's Director of Medical Research. “And I was proud that we had taken the time and the effort.” This experiment builds on data collected when the Kaiser Family Foundation worked with ER when that show was at the top of the ratings heap. In 1997 a TV patient was told about emergency contraception and in 2000 a character was told that HPV is linked to cervical cancer. In both experiments, national awareness of the medical facts rose and then subsided somewhat. Last spring, Vicky Rideout presented some of that data during a plenary panel session I organized at the Association of Health Care Journalists conference (OT 10/25/2007). Ms. Klaviter was also on the panel. Afterwards, the two began to talk. And talk led to this experiment on storytelling with a health message—and a message for health care providers. “I think the message is, for people in the health community, that they need to be paying attention, so they know what people are saying and learning and hearing about health,” Ms. Rideout said. Of course, while this sort of experiment is rare, health stories abound on prime time TV, but even I didn't realize just how ubiquitous they are. At the news conference in Washington, DC, where the Kaiser Family Foundation staff released the results of the Grey's Anatomy experiment, they and the Hollywood, Health & Society program at the University of Southern California also announced the findings of the most comprehensive content analysis of health messages on primetime TV. Combing through every episode of the top 10 primetime shows for three spring seasons in a row—947 episodes in all—the researchers documented that six out of 10 programs had at least one health-related storyline. That includes not just doctor shows, but all top comedies and dramas. When you couple the pervasiveness of health storylines on primetime shows with the experimental evidence of their educational effect, the awesome potential for patient education is clear. But hold your horses before you ring up your favorite show's executive producer to pitch your pet health fact: Elizabeth Klaviter says that while Grey's Anatomy writers and researchers call on the Hollywood, Health & Society staff almost daily for help finding experts and facts to flesh out their plots, they never get a hard sell about bending the storyline to serve a health agenda. The relationship works because the health education experts understand and meet the needs of the TV writers. Didn't Dictate And so it was with the HIV transmission episode. Rather than try to dictate story content, Ms. Rideout brought experts on HIV and a woman who had a child despite her HIV infection to meet with Grey's Anatomy writer Stacy McKee and other staff members. They offered their personal stories, but didn't try to control the creative process. And the final script shows the arrangement worked, Ms. Rideout said. “It wasn't anything like the ones we'd originally laid out. The quality was better and it was just great.” While health experts often bemoan oversimplification in popular media, writers of both fiction and news have to decide what facts must fall away in order to avoid sinking a story. “Yes, and that's the joy of dramatic writing, but it's also the frustration. Scenes are usually about one thing, so you are very limited in what you can achieve when your characters are not academics, when they aren't teachers,” Ms. Klaviter said. Statistics are usually thought of as dry, not dramatic. But when expressed in terms of a couple's initial fears and ultimate hopes, when infused with the image of a healthy newborn, a gray statistic takes on the colors of life. Prime Time Survey The Hollywood, Health & Society program at the University of Southern California is designed to provide television writers with accurate health and medical information and connect them with credible experts. Program funding originally came from the Centers for Disease Control and Prevention and other public agencies. The funders wanted to see evidence of effectiveness, so beginning in 2003, USC graduate students began systematically logging the health content of the top shows on prime time TV. A content analysis that looked at every episode of the 10 most highly rated prime time TV shows from the spring seasons of 2004, 2005, and 2006 found health everywhere. Overall, six out of 10 shows had at least one health storyline. And the prevalence rose from half in 2004 to two thirds in 2006. “I was a little surprised by how much health information there actually is on prime time and that the bulk of it is actually pretty educational and fairly accurate,” said lead author Sheila T. Murphy, PhD, of the USC Annenberg School for Communication. Emphasis on Peculiar Conditions But while the findings belie the common presumption that TV medicine is mostly exaggerated and wrong, Dr. Murphy did see what she calls the House effect: a heavy emphasis on peculiar conditions. “One out of every four health storylines ends up being something kind of rare or unusual or obscure that probably isn't going to be relevant. So while viewers may be presented with medical information that is by-and-large accurate, how useful is it to know, as House fans learned in one episode, that at least one case has been documented of sexually transmitted African Sleeping Sickness? Most TV viewers can rattle off the titles of hit medical shows, including House, Grey's Anatomy, ER, or even Scrubs. But much of the health content on TV is contained in crime dramas, or even comedies. For example, the report refers to an episode of The Simpsons that noted that thyroid problems are treatable. The episode also ventured into health policy: When Homer's boss cut prescription drug coverage, the “Doh!”-man made a run to Canada to save money. The show had it all: medical facts, policy debates—and laughs. The analysis of nearly a thousand TV shows concluded that health care gets mostly positive reviews on popular TV. The episode of The Simpsons was one of relatively few that confronted problems in the health care system. “It may be painting a little bit too rosy a picture of medical care, because it rarely shows any kind of a barrier. Only 10% of the storylines show there being any problem getting admitted to a hospital or even having a long wait or worrying about insurance coverage; that tends to be very rarely shown,” Dr. Murphy said. And the survey suggests that health care providers may be feeling their own version of the “CSI Effect.” Even as whiz-bang TV show forensics raises the expectations of jurors hearing real-world cases, TV portrayals of super-docs and no-holds-barred testing and treatment may encourage some patients to demand more aggressive interventions and unrealistically expect positive outcomes. In addition to analyzing the shows with the highest overall ratings, the researchers also looked at the top shows among African Americans and Hispanic audiences. The views are different. For example, African Americans tend to watch more comedies, which means they see fewer health storylines, while also being exposed to less of the violence in crime dramas. Vicky Rideout at the Kaiser Family Foundation says this survey complements the experiment they did with Grey's Anatomy: “The study that we did with Hollywood, Health and Society is the first time there have been basic overall data about how frequently health messages occur in prime time TV. It's an important marker to put out there,” she said. But when I asked Dr. Murphy about when to expect future reports on more recent seasons, I was startled to learn that the research project has been cut back, due to objections from some legislators who think the program is frivolous (OT 2/25/08). “We only do a very, very scaled down version that is focusing specifically on medical shows, which have the most health content, but as you can see there is a lot of health content in the other shows, too,” she said. “So we can't compare over time because of the budget cuts, which is sad, very sad, because we got it up and running, got it going well. But we need to pay coders; it's not for free.”