Doc Hollywood

Gasping for breath, an elderly man lies in a hospital emergency room in a recent episode of the hit TV show “ER.”

“I think we need to accept that the time has come to let nature take its course,” a somber Dr. Carter advises the man’s wife.

The white-haired woman wrings her hands. “I don’t know what to do,” she says. “Barry always made all the important decisions.”

“Do you know what a ‘Do-not-resuscitate’ order is?” Dr. Carter asks.

“Yes.”

“I think you need to sign one for your husband. Would you do that?”

“Yes,” the woman says, as she cries and kisses her husband goodbye. It makes for good drama.

It also makes for good education, says Last Acts, a coalition of health-oriented groups that aims to inform the public about end-of-life issues, including pain management, hospice care and legal documents.

While health organizations have traditionally relied on brochures, public service announcements and advertising campaigns to get their message across, they now say that TV shows may be the most effective and dramatic medium of all.

After being tipped off by producers about the upcoming “ER” episode, for instance, Last Acts quickly placed an ad in TV Guide to refer readers to its hotline number.

“On this week’s episode of ‘ER,’ someone may die,” the ad read. “Unfortunately in real life, there’s no script to help you make the difficult decisions that come with dying.” Within five days, Last Acts logged more than 4,000 calls. For foundations and nonprofit groups concerned with health education, the ability to reach millions of TV viewers with their messages is highly desirable.

“It was a great opportunity for us to spotlight our issues, because it was incorporated right into the story line,” says Vicki Weisfeld, a spokeswoman for the Robert Wood Johnson Foundation in Princeton, N.J.

The days when health foundations simply published educational brochures and did little more are over, says Vicky Rideout, director of the entertainment media and public health program at the Kaiser Family Foundation, a nonprofit health care philanthropy and policy research organization in Menlo Park.

Working on Different Fronts

Rideout’s program has worked with such TV shows as “Felicity,” “Dawson’s Creek,” “Moesha” and “General Hospital.” Some of these shows target teens and young adults, two groups that experts say are heavy TV watchers. But even among the general public, “we realize that, like it or not, a lot of people get their health information from TV,” says Rideout.

Exactly how many may come as a shock. Dr. Deborah Glik, director of UCLA’s recently established Health and Media Research Center, says one U.S. study found that about 70% of people relied on TV for health information. Her own study of 400 “ER” viewers found that 57% of them got their health information from TV. That information comes not only from news programs, but also from talk shows, daytime soap operas, sitcoms and prime-time dramas.

“It reflects a shift away from people getting their health information mainly from their family doctors,” Glik says. “There’s been a trend for the mass media to be a surrogate professional, not just in health, but also in child rearing and careers. The media is an important informant in our culture.”

Health organizations are keenly aware of the huge audiences that TV offers for their messages about safe sex, breast cancer prevention, smoking, HIV testing and other issues. And these groups see TV as a way to reach viewers with timely and accurate information.

“There’s considerable lack of control over the ultimate product, but you have to work on many different fronts,” explains Weisfeld of Robert Wood Johnson. For many health groups, this now includes sending information to producers and writers highlighting their fields of expertise and research capabilities. Some create Web sites that provide writers with story ideas, links to other health sites and lists of experts. Others hire consultants to reach the Hollywood community.

Smaller groups are getting into the act too. The Alzheimer’s Assn. of Southern California, for instance, was a consultant for a recent episode of “ER” in which a doctor played by Alan Alda exhibits symptoms of early Alzheimer’s. The association also reviewed the script for an episode of “7th Heaven” that airs tonight for technical and medical accuracy, said spokeswoman Gloria Lopez.

Some organizations are welcomed onto TV filming lots each season to brief writers on new advances and trends in medical care and public health. Others use guerrilla tactics, relying on informal contacts and networking.

UCLA’s Glik recalls a project she led to persuade Hollywood to write in scenes promoting the importance of inoculations and vaccines. After a blizzard of cold calls, mailings and working personal contacts, Glik got the message across on a variety of shows, including segments about whooping cough and hepatitis B on “ER,” measles vaccinations on “Sabrina, the Teenage Witch,” and flu shots on “Frasier.”

TV isn’t the only medium targeted by nonprofit groups and charitable foundations trying to get health messages across to the general public. These organizations also aggressively pursue radio, magazines and newspapers, providing editors and reporters with research and contacts that they hope will evolve into stories.

Equipped With Drama and Urgency

To be sure, giant health charities such as Robert Wood Johnson Foundation and the Kaiser Family Foundation, which have significant financial resources at their disposal, pursue specific agendas that have been set by their boards--be it anti-smoking or safe-sex campaigns.

There are many equally worthy causes that can’t compete on this media playing field because the groups lack money to fund similar campaigns. Others, such as some conservative religious lobbying groups, might object to some of the aims of the Media Project, which focuses on responsible depictions of teen sexuality. But they have their own media programs in place to promote alternatives such as abstinence.

Health care professionals who work with the entertainment industry insist that their messages don’t need to be preachy, drawn-out or boring. “It’s very possible to accurately portray these issues and still maintain the compelling drama,” says Weisfeld of Robert Wood Johnson, which runs several media projects and also funds Last Acts. “End-of-life situations are not boring; they have all the drama and urgency of good TV.”

Kate Langrall Folb is director of the Media Project, a partnership between the Kaiser Family Foundation and the group Advocates for Youth that focuses on the TV depiction of adolescent reproductive health. She says Hollywood producers and writers sometimes laud her intentions but maintain that their shows, especially comedies, don’t need to send such serious messages.

“I understand that not every show can be dealing with that,” Folb concedes. “But we want people to know that we are here and they can give us a call. Besides, health messages can be humorous. Condoms are very funny. It’s easy to use them as a comedic device.”

She recalls a writer for the TV show “Two Guys and a Girl,” who, after talking to her, wrote a scene in which a character holds up a long accordion strip of condoms that unfolds, tumbling down to the floor.

“Even that helps the attitude out there,” Folb explains. “You don’t even need dialogue, just a scene of a condom going into someone’s pocket or someone brushing their teeth and taking their birth control pill as they are getting ready for work in the morning.”

She likens such images to how the seat-belt campaign of the 1970s was incorporated into the public consciousness via TV. “Anyone who got into a car, you’d see them put their seat belt on, and next thing you know, we’re all wearing our seat belts,” she says. “TV wasn’t the sole cause of that, but it helped reinforce the attitude that this is the responsible thing to do.”

Glik estimates there are 70 organized groups lobbying producers and writers of TV shows on everything from health issues to the inclusion of more Christian programming to diversity.

‘Font of Information’

Health organizations must also walk a fine line between suggesting ideas and pressuring producers, which can easily backfire. According to an “ER” executive, the Kaiser Family Foundation is one organization that hits the right note.

“They don’t ever push,” says Neal Baer, co-executive producer and writer for “ER.” “They may suggest things I’m not interested in, but that’s fine. There are no veiled threats, no ulterior motives. They’re just a real font of information.”

Even with four doctors on the writing staff and a full-time researcher, Baer says he sometimes calls the Media Project for information. For one script, he wanted to know exactly how the sexually transmitted disease chlamydia can make a woman more susceptible to HIV infection. Another time, the Media Project provided research on teen access to abortion in the U.S. and the legality of transporting a minor across state lines for an abortion. For yet another occasion, Baer needed information about emergency contraceptives.

“People watch the show as a drama, but they also take away many of the medical facts we toss around on the show,” says Baer, who also works as a resident at Childrens Hospital in Los Angeles. “It really brings home to us the importance of being as accurate as we can.”

With the plethora of shows about teens and 20-somethings on the air, there are many opportunities to hammer home a safe-sex message. “Felicity,” in particular, has dealt with many aspects of sexuality, including date rape.

As producers prepared a two-part series on date rape last year, they called Folb at the Media Project for an overview of the medical and legal ramifications of a college date rape. The story line involved the character Julie.

Additionally, Folb provided information on emergency contraception, or the “day-after pill,” and the writers included a scene in which Julie takes such contraception.

“That was a great opportunity to educate them and show how it’s used,” Folb explains. “They put a rape crisis hotline number at the end of the show and it received about 1,000 calls. That’s concrete evidence that kids are watching, and given some opportunity to act, they will.”