Portal de Periódicos da CAPES

No Poster Children Here

2008; Wolters Kluwer; Volume: 30; Issue: 4 Linguagem: Inglês

10.1097/01.cot.0000313057.01959.e5

1548-4688

Andrew Holtz,

Media Studies and Communication

They aren't the stereotypical courageous patients so often trotted out in media portrayals of people facing cancer treatment. A nonsmoker dealing with adenocarcinoma and a new mother who delayed examination of a breast lump are two portraits of cancer patients that won kudos this year from a group that advises television scriptwriters on health and medical issues. Award for General Hospital The character of Alexis Davis, on ABC's General Hospital daytime drama, is in remission following treatment for Stage II adenocarcinoma. She's a nonsmoker in her mid-40s. The judges of the Sentinel for Health Award noted that the storyline, which has been going on for more than a year, “addresses a common myth about lung cancer—that only smokers get it—and accurately depicts the struggles during treatment from surgery and chemotherapy.” In one scene, Alexis (played by Nancy Lee Grahn) is alone in a room, looking in a mirror at what's left of her hair, thinned by treatment. She reaches into a box, takes out a wig, and tries it on. The reflected image makes her laugh. She pulls off the wig. Then her laughter crumbles into tears and she screams, “Oh, god, this sucks! This sucks! It just sucks! God!” Sobbing, she pushes the mirror down. General Hospital head writer Robert Guza says the wig scene turned out extremely well, capturing the range of emotions that whipsaw people who have cancer, and avoiding a sugar-coated portrayal of battling disease. “We really made a commitment to do it honestly. We've all had various experiences with cancer; and it's not like these people are striding forward to thwart the disease. It's scary. It's terrifying. It's humiliating. Some of it is funny,” he said. Award for Grey's Anatomy There was also not a whit of heroic idealism in the portrayal of a young mother with breast cancer on Grey's Anatomy, also on ABC. Guilt was the theme of the episode that won the award for best Primetime Minor Storyline. “There's the guilt of just putting everything into yourself and having to really be selfish for that moment; taking care of yourself and maybe putting off part of the family,” says writer Zoanne Clack, MD. The character feels guilty also for, at least in part, blaming her baby for causing a delay in diagnosis; the changes in her breast were assumed to just be part of her pregnancy. Something similar happened to a friend of Dr. Clack's: what turned out to be a tumor was first thought to be just the development of a milk duct. She says she hopes the episode alerts women that breast tumors do sometimes appear during pregnancy, when the many changes in a woman's body may mask an abnormal growth. ‘What Public Health Messages?’ While telling stories that capture viewers is the first priority of all TV writers, Dr. Clack says that when interviewing medical experts as part of their story research, she and her colleagues always keep in mind the reach of their dramas. “We'll always say, before the end of the call, ‘What public health messages would you like 25 million people to hear?’” A Sentinel for Health Award is affirmation that they've used their broadcast pulpit well. “To be recognized for that and to be able to know that our stories have gotten those messages across is incredibly important to me and to the rest of the staff,” she said. The Awards are given out each fall to television dramas and comedies that address health topics by the Hollywood, Health & Society program at the USC Annenberg School's Norman Lear Center in Los Angeles. The program, with support from the Centers for Disease Control and Prevention and the National Cancer Institute, advises television writers on health and medical topics. (See box on the Congressional debate over CDC funding.) Robert Guza says he also prizes the Sentinel for Health award recognition as an endorsement of their efforts to be accurate in how they depict important health and medical subjects. “The accuracy is very important to us,” he said. “Now, I'll do other stories that aren't medically related and I'll make the whole thing up and I don't care particularly. If I can compel and interest you, that's fine. But in these particular instances, these specific [health and medical] stories, it was real important that we got it accurate….As much as we try to entertain around here, it's nice to send some messages out there, if you can.” Emotional Roller Coaster Illustrating the emotional roller coaster of cancer diagnosis and treatment is not only more accurate than sanitized tales of valiant struggles by “courageous” patients; it also makes for richer stories. On General Hospital, Alexis is in remission, but the writers haven't declared her cured. There hasn't been a victory celebration. The ultimate outcome remains in doubt. So the writers get to take the character through a series of emotional phases: relief as treatment pushed back the cancer, questions about whether it would return, hope it might not, nagging concerns that it will. Guza says they haven't decided just how the whole story will play out, but he knows something about the real life odds facing people who've been through lung cancer treatment. “I would say the chances are very good that she will recur in the future,” he predicts. A recurrence would present new opportunities for emotionally gripping storytelling—and it would match the frequent reality. “This is the kind of thing that is ongoing in many cases. I think we'd like to honor that.” Fade to Black? Some members of Congress want to yell “Cut!” on the set of the Hollywood, Health & Society program. Wisconsin Congressman Paul Ryan (R) called the outreach to TV writers a “boondoggle” and “frivolous” as he introduced an amendment to legislation funding the Labor, Health and Human Services, and Education departments that would have forbidden the CDC from spending money on its Entertainment Education Program. A spokeswoman said that Rep. Ryan thinks TV shows should pay for their own story research. The Ryan amendment was included in the bill passed in the House. Over on the Senate side, Oklahoma's Tom Coburn, MD (R) issued a report titled “CDC Off Center,” that attacked the Hollywood liaison program and some other CDC projects. “A question taxpayers might consider appropriate: Should the CDC spend $1.9 million to help Hollywood develop its plotlines?” Sen. Coburn's report asks. The $1.9 million figure includes all the CDC money spent on the Hollywood, Health & Society program over an eight-year period. The program also receives support from NCI and other agencies. Sen. Coburn also thinks TV shows should do their own homework. “With the multi-billion dollar television industry, million-dollar-per-episode salaries for TV actors, and millions of dollars of revenue from daytime and prime-time dramas, should it be a priority for taxpayers to have CDC-funded Hollywood liaisons to help producers get the health storylines correct?” his report asks. As the Senate bill headed toward a vote, supporters of the Hollywood, Health & Society (HH&S) program rallied. The Executive Director of the American Public Health Association, Georges C. Benjamin, MD, sent a letter that called the Ryan amendment “ill-conceived.” “The truth is that these restrictions would interrupt effective and evidence-based public health programs,” he wrote. A blogger who does entertainment education work, but is not connected with the HH&S program, sent out an alert to readers: “Entertainment education is so much more cost-effective than producing and buying media time for 30-second commercials. Because nowadays, what people are paying attention to in the media is the entertainment content. They are not looking at the advertisement anymore. They are zooming past them with their TiVos and their DVRs [digital video recorders]. So when we can get health promotion information into the actual content of what people are watching, that is so much more effective,” Nedra Kline Weinreich said in an interview. While the Ryan amendment was added to the House bill without opposition, things were different in the Senate. No Senator spoke in favor of the amendment, and Sen. Coburn withdrew the section forbidding CDC spending on the HH&S program. The House-Senate conference committee then dropped Rep. Ryan's spending ban. President Bush vetoed the first version of the bill. But the final spending package that passed just as Congress adjourned for the year left the entertainment education funding intact. Grey's Anatomy writer Zoanne Clack, MD, welcomed the news that she would continue to be able to call on the HH&S staff. “They get these fantastic experts, which I'm sure we wouldn't be able to find,” she said. “It removes many, many steps to get to the right information, to get to the most accurate information, and to the people who are the most involved and the most connected to it. They are actually doing the research. They are invested in it and invested in what kind of information is getting out there.”