Portal de Periódicos da CAPES

Get Real

2007; Wolters Kluwer; Volume: 29; Issue: 21 Linguagem: Inglês

10.1097/01.cot.0000300446.83837.62

1548-4688

Andrew Holtz,

There is fact. There is fiction. And then there is Reality TV. Not entirely made up, but also not beholden to news department standards, reality shows deserve special consideration as a medium for communicating health and medical information. The genre got some of that attention from a report and expert panel session commissioned last fall by the Kaiser Family Foundation (The “Reality” of Health: Reality Television and the Public Health; available online atwww.kff.org/entmedia/entmedia101806pkg.cfm) There have been numerous studies of the effects of health content in dramas and on the news, and even experiments using pre- and post-surveys of viewers of primetime TV dramas that contained specific health messages. But even as the number of hours of reality programs begins to exceed that of scripted shows in primetime, there is little hard evidence about the impact of health and medical storylines in reality shows. The Kaiser Family Foundation report was an effort to get the discussion going, asking what's distinct about reality shows, and what the characteristics of this genre mean for health experts and institutions interested in communicating through popular television shows. ‘Incredibly Relatable’ At first glance, it appears that reality TV may well be more persuasive than either dramas or conventional news. A producer of a reality TV show used the term “incredibly relatable” to describe the characters they display. That's a sharp contrast to the impossibly beautiful and talented characters populating most TV dramas and comedies. Meanwhile, while the news is real (well, as real as TV gets) and the story subjects are real people, there is little character development, so the stories can't carry as much dramatic punch as longer-format programs. The combination of verisimilitude and well-developed, everyman characters is both the greatest strength and potentially the most worrisome feature of reality TV, notes report coauthor Peter Christenson, PhD, Professor of Communication at Lewis & Clark College in Portland, Oregon. “If the information is good, then that kind of personal identification with ‘people like me’ is clearly, I think, for most viewers more powerful than some statistics, let's say, on how to lose weight.” Or how to avoid becoming infected with HIV. Last year, the Kaiser Family Foundation introduced producers and writers at America's Next Top Model to Marvelyn Brown, a young woman with HIV. But rather than that meeting just providing inspiration for the writers, as would usually happen with a scripted drama or sitcom, Marvelyn Brown was incorporated into the show itself as a part of one the “rewards” that contestants vie for during competitions in each episode. “The two winners were told that they and their castmates would be meeting with somebody who was a spokesperson and that they would learn about being a spokesperson and have an opportunity to do some on-camera work that would be aired by the CW,” said Tina Hoff, Kaiser Family Foundation Director of Entertainment Media Partnerships. The contestants weren't told that Ms. Brown was infected with HIV. “And this is all captured on film,” Ms. Hoff said. “She was saying basically, ‘You guys are becoming celebrities by virtue of being on this show and you have a lot of power to speak out. I speak out about an issue that I really care about. That issue is HIV, and I do it because I'm living with HIV.’ So they captured these girls connecting with her and then realizing she was HIV-positive. They were struck by the fact that this was somebody they could be.” In interview clips aired during the show, some of the contestants spoke about how they had never known anyone with HIV and that only when they met Marvelyn Brown did it really sink in that something like this could happen to them. Ms. Hoff says that the segments raised, and then corrected, misconceptions, such as fears that people could become infected with HIV by sharing earrings.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]The Kaiser Family Foundation wanted to work with America's Next Top Model because it is popular with African-American young women and girls, who are at elevated risk of HIV infection. Vicky Rideout, the foundation's Director of the Program for the Study of Entertainment Media and Health, adds that their report on Reality TV was a natural response to the phenomenal growth of this genre. “What I'm most interested in is the shows that are explicitly about health,” she said. “I think it's just a really interesting phenomenon, and one for the health community to try to wrap their head around, think about, and figure out how to engage with them. I think there is a lot of opportunity there.” Professor Christenson and his coauthor, Maria Ivancin, MBA, Assistant Professor of Communications at American University, reviewed 10 reality series (see box). He says the specific facts seemed to be generally accurate, and may be even more useful than quick hits on the news. “All you get on the news are these little one-minute pieces, about the latest ‘breakthroughs’ or the latest medical procedure. It's very brief. So I would say that the shows that I watched, minute-per-minute, probably provide more useful information than either drama or news. “If you happen to be a person who has a given condition, however bizarre, then I think probably you are getting information that is at least as good as what you get on the Internet, but most people who watch don't have those problems. They are watching for entertainment, but they are nonetheless learning things.” And that's where Professor Christenson gets concerned, he says, because of the way these shows frame “reality.” “My problem is not so much with the accuracy of the information,” he said, “but the setting of the agenda: You would think from watching this stuff that the biggest medical problem that Americans have is that their noses are too big. There's no attention to cancer or heart disease. Those things are not as dramatic, I suppose, as a 250-pound tumor.” Actually, it was a 175-pound tumor that was the star of a show on the Discovery Health network in the fall of 2004. The company paid for a Romanian woman's surgery in return for the rights to her story. Her case was depicted as a great success: she got treatment with no big medical bills. That's the usual outcome on reality shows. Unlike real life, nothing ever seems to go wrong and cost is never a concern. Physicians, nurses, personal trainers, and other experts seem to grow on trees, ready with open schedules to individually guide show participants. Back to the Future While reality shows are a new trend in TV, the general assumptions and themes of many of the medically oriented series hearken back to an earlier era. While primetime dramas no longer put physicians on a pedestal, increasingly portraying them as mortals with flaws and foibles—major flaws in the case of House, for example—reality TV shows are generally deferential to health and medical experts. It's like jumping back to the days of Marcus Welby. Yet some real-world experts have had a tough time dealing with reality show producers. The Kaiser Family Foundation report highlights the experience of James Wells, MD, former President of the American Society of Plastic Surgeons. He told the authors that his society tried to consult with the Extreme Makeover series. Society leaders wanted to present both the risks and benefits of procedures, and they wanted to see the series focus on reconstructive procedures. But Dr. Wells said eventually the society “lost control of the message.” He added, “The public is just interested in the cosmetic side of things.” Of course, there is wide variation among reality TV shows, just as some dramas and news programs are better or worse than others. Whether good or bad, there will certainly be more reality TV shows in the future, if only because they typically cost less than half as much as scripted shows. And so reality TV is likely to become an ever-greater source of health and medical information (or misinformation) for millions of viewers. In my next column, we'll hear from a veteran producer of documentaries and reality-based TV shows about how the business has changed—for the worse to her eyes. And then, we'll look at an example of one recent series that bucks the trend and grapples with serious health policy issues, while still entertaining viewers, with the help of a big, really big, host.