WASHINGTON – When the cop shop at TV's "Law & Order: SVU" uncovered a murder plot earlier this fall surrounding a man who killed homosexuals who spread HIV through a dance club, a health message was behind the script: Meth use among gay men is on the rise, and it can be deadly.
A quick scan of the airwaves for adult and children's programming can reveal any number of health-related messages tied to popular programming, and it's not by mistake. Government and private agencies are both seeking to insert health information into television entertainment, and they are managing to get their messages regularly placed into plot lines.
Those messages don't appear only in doctor dramas. Cookie Monster of "Sesame Street" fame now knows that cookies are "sometimes food" and shouldn't be eaten daily. President Jed Bartlet on "The West Wing" battles multiple sclerosis on screen. Teenager Lily Montgomery copes with autism on "All My Children."
Like Tuesday's rerun of the meth-HIV story, coming episodes of "Law & Order: SVU" are expected to tackle other health problems, including those raised by Hurricane Katrina. One story line that recently aired tackled the issue of the security of biochemicals that needed to be moved ahead of the storm. SVU Executive Producer Neal Baer said he thinks it won't be long before someone also writes story lines about bird flu.
Those central to placing messages in TV entertainment say that the growing public reliance on electronic communications has forced health experts to make sure accurate health information appears in the dramas and comedies that fill the airwaves. They say that while studying the effects is difficult, data so far show that educating through entertainment has impact far beyond viewers' sofas.
Vicki Beck heads a program at the University of Southern California that provides health experts to act as consultants to the entertainment industry. The program is funded primarily by the U.S. Centers for Disease Control and Prevention and the National Institutes of Health. She and others appeared at a conference on the matter last month in Washington, hosted by the nonprofit group Population Communications International, or PCI.
Beck said getting accurate health information on television is critical, and cost comparisons done by her office show it's far cheaper to slip messages into TV series than it is to buy advertising time.
"We basically are providing health information to writers when they need it so they will call us and ask us for help. ... Most writers don't have a health care background," Beck said.
Beck said her Hollywood, Health & Society program draws on national health experts in government and the private sector to consult on story lines, but doesn't hold editorial control over storytelling.
Rather, her program aims to make sure the health information in plots is correct. She said her group has been instrumental in getting plots into shows like "ER," "The Bold and the Beautiful" and Spanish-language tele-novellas. Her program also runs a health-in-entertainment awards program — The Sentinel Health Awards — as well as two annual conferences that bring writers and producers together with top health industry speakers and practicing physicians.
Beck said her staff analyzed the time spent on health messages her program helped place into television shows and figured the minute-by-minute cost would have been about $720 million in comparable prime-time advertising for public service announcements. The program's annual budget is less than one-tenth of that, at about $600,000 annually.
SVU's Baer said it's a matter of duty to get accurate information into entertainment shows, and an accurate show doesn’t have to be a boring show. Baer also produced "ER" until 2001 and is a practicing pediatrician.
"As writers for television, we draw on what's going on in the world, and if we're going to draw on what's going on in the world, for instance, HIV and AIDS, I think it's important for us to be accurate," Baer said. "We know that the health information we present on shows is accepted as the truth ... We need to be careful that we don't misinform the public."
Some studies show that health messages embedded in dramas have been effective.
One 2003 survey of 501 gay men showed that those who had seen an episode of "ER" about syphilis were more likely to get tested for the virus than those who had not seen the episode. In another study of a story line about human papilloma virus on "ER" from 2000, the number of people who said they'd heard of the disease had doubled in the time before the episode aired and two weeks afterward.
Beck said this is what makes her work worthwhile.
"You get people emotionally engaged, and once they're emotionally engaged about a story and character ... the education that results is really subliminal. They're really interested in what's happening," Beck said. "It registers."
Turning Viewership Into Awareness
Whether the messages have a larger effect on viewers is difficult to study, said Nielsen Media Research spokeswoman Anne Elliot. She said her firm can't determine if the messages spike the ratings or the ratings rise and fall as part of a cyclical pattern of entertainment.
For instance, "ER" traditionally has had good ratings, even with several cast changes, but "shows tend to peak and valley and it's hard to point a finger and say, 'this is why' people are watching," Elliot said.
Nielsen tracks how many people watch shows. The typical shows that might revolve around a social health theme — investigative and medical shows — are no doubt doing well.
In the last week in November, 10 out of the top 20 shows were either investigative or medical dramas, including three of the "CSI" incarnations, "Grey's Anatomy," "Law & Order: SVU" and "House."
So far this season, those shows are maintaining solid audiences, according to Nielsen data: "CSI" has an average weekly viewership of about 19.5 million; "Grey's Anatomy," 13.3 million; "ER," 10.6 million; "House," 9.7 million; and "Crossing Jordan," 8.9 million.
Harnessing the power of TV is the continuing focus for the entertainment education program at the CDC, said Varian Brandon, who coordinates the agency's efforts to get its talking points into broadcasts.
"That’s our job, is to get health information out there," Brandon said. "We have a heck of a lot of information, and a heck of a lot of experts who can tell great stories. ... Real life is just incredibly dramatic too."
Brandon said that a balance is reached between trying to get good information into shows and the believability of entertainment. She said she saw a TV pilot episode recently that had a CDC worker discussing a meteor impact with a NASA employee — that probably wouldn't happen in real life.
But putting the government experts in touch with Hollywood can only be beneficial, she said.
"The more our scientists understand kind of what [writers'] parameters are, then the more we can kind of suggest things they could possibly use," Brandon said. That can include something as complex as researching a disease that fits a plot problem or as simple as change of scenery: replacing a cookie jar on a table with a bowl of fruit, having people converse over a jog, or showing people putting seatbelts on as they get into a car.
Some shows these days are also linking their Web sites to government data, and providing information on diseases that they highlight, an area that Brandon said can be expanded.
The efforts aren't going without its critics, though. The "SVU" episode on methamphetamine use among homosexuals drew fire from groups representing the gay community for what they said put gays in a poor light. One group that offers TV critiques questions the efforts, favoring education that's not TV-based.
"Unfortunately, we all know it takes numbers and numbers of hits of any kind of even direct message to register with the public," said Robert Kesten, executive director of the Washington-based TV Turnoff Network. "Those messages, although well-intended, often do not reach the targeted audience."
He said that the problem is one of message dilution: While some shows might make the effort to put good information in their plot lines, others obviously stray from reality. "The public doesn't know any longer what's real or not real."
Additionally, certain messages, like ones about obesity — which is a message Brandon says is a priority — seem counterproductive, Kesten said. He cited Nielsen statistics that show average households now watch eight hours and 40 minutes of television each day.
"It would be nice if there was something that reminded people there is still an outdoors," Kesten said.
Kim Thompson, a Harvard professor who studies entertainment messages directed at children, said it's true that TV watching is itself almost epidemic, but people should accept that it is an educational tool. Once that is accepted, it's easier to help make improvements.
In addition to television, children are exposed to video games, movies and iPods; the number of media outlets keeps expanding beyond the control of parents, Thompson said. The remedy is to teach parents to be attuned to the messages coming through media, and weed out the good from the bad.
"If you are a parent, you have to really be active, and teach [kids] to be active consumers," Thompson said.
How the impact of health shows will take shape in the future is still being determined. Efforts right now are being made to help poorer nations get their own programs — in southeast Asia, the Caribbean and Africa, among other places. For instance, one South African version of "Sesame Street" now has a puppet character who is HIV positive.
As diseases and other health problems continue to evolve, TV viewers can be sure that their favorite shows will incorporate new circumstances into story lines. Beck said her group's spring symposium will focus on gaps between rich and poor in health care, including possible discussions on the increasing AIDS prevalence among African-American women, diabetes in black and Hispanic populations and health issues for illegal immigrants.