Pubdate: Tue, 26 Jun 2001 Source: New York Times (NY) Copyright: 2001 The New York Times Company Contact: http://www.nytimes.com/ Details: http://www.mapinc.org/media/298 Section: Health Author: Sheryl Gay Stolberg C.D.C. Injects TV Dramas With Health Messages WASHINGTON, June 25 -- On the eve of Valentine's Day 1999, the characters on "Beverly Hills 90210" were in their usual tizzy. Donna discovered pictures of Noah and Gina kissing. Dylan, having sworn off heroin, cavorted with Gina. After Steve bragged about his flawless tan, his girlfriend noticed a strange mole on the back of his neck. Fearing skin cancer, he took a megaphone to the beach to shout out the benefits of sunscreen. Viewers did not know it, but the sunscreen reference fit neatly into a public education campaign being run by the federal Centers for Disease Control and Prevention. Agency officials pitched the skin cancer story to the staff of "Beverly Hills 90210" as part of a quiet effort to persuade Hollywood writers and producers to embed what the C.D.C. calls "positive health messages" into television shows. "We thought `90210' was a great opportunity to not only reach young adults, but also the teens who idolize those young adults," explained Dr. Cynthia Jorgensen, who runs cancer education campaigns for the disease control centers. When the episode was broadcast, she said, "We were thrilled." Call it the public health version of product placement. The makers of soft drinks and automobiles learned long ago that in an era when viewers are bombarded with commercial messages, simple advertising is not enough; sales climb when a product is seen in the hands of a star. Now federal health officials, citing studies showing that a substantial portion of the public gets its health news from TV dramas, are following suit. Whether it is hepatitis C or childhood immunizations or antibiotic resistance, television is grappling with some of America's most pressing public health matters, courtesy of the C.D.C.'s three-year-old entertainment education program. In addition to providing "tips for scripts," in the C.D.C.'s lexicon, on topics that include things like chlamydia and secondhand smoke, the agency is offering its experts as unpaid short-term technical advisers to help television writers get accurate information. Last week, Dr. Jeffrey P. Koplan, director of the disease control centers, visited the Warner Brothers studios to kick around health topics with the writers and producers of "E.R." and "The West Wing." The C.D.C. is not the first government agency to try to influence the entertainment media. Under a much-criticized arrangement, abandoned after it was disclosed last year, television networks received financial breaks from the government in exchange for including anti-drug messages in scripts. By contrast, officials at the disease control agency say, there is no quid pro quo in this program. Officials do not see scripts in advance, and the networks get nothing in return. Still, the effort makes some people uneasy, if only because the government's hand is unseen. "There is this element of deception and subterfuge, and that's where I think people get a little ambivalent about it," said Dr. Deborah Glik, who directs a health and media research center at U.C.L.A. "We try to promote media literacy, which is knowing where messages come from." But Dr. Koplan says his agency deserves equal time. "If they show Tom Cruise in a movie chain-smoking, is that because Philip Morris paid for it?" Dr. Koplan asked. "What we are trying to do is have the people putting on these shows consider what they are conveying." Studies show that television can have a strong impact on health. A 1999 survey conducted by the marketing firm Porter Novelli and analyzed by the C.D.C. found that 48 percent of the people who watched soap operas at least twice a week learned something about diseases and how to prevent them. The Kaiser Family Foundation, meanwhile, recently published a study of regular "E.R." viewers; it found that one-third got information from the show that helped them make choices about their family's health care. And while screenwriters typically bristle at anything that smacks of government meddling, they are always in search of good ideas. So they have been surprisingly receptive to this effort. "As long as everybody is upfront about their agenda, it's fine," said Laurie McCarthy, executive producer of "Felicity." Ms. McCarthy wrote the "Beverly Hills 90210" episode that included the sunscreen reference, and she has also worked with the agency on a story about rape. "The truth is, it was a good story for this character," she said of the skin cancer scare. "And if there is a way, without being preachy, to get a message out to the public, hooray! Why not do it?" Using television to transmit what academics call pro-social messages is not new. In the 1970's, after introducing America to the bigoted Archie Bunker, the producer Norman Lear used the situation comedy "Maude" to confront the abortion issue. When the Fonz, played by Henry Winkler, took out a library card on "Happy Days," children across America began borrowing books. In the late 1980's, Dr. Jay Winsten, a public health professor at Harvard, pressed television executives to help curb drunken driving by slipping messages about designated drivers into their shows. Today, said Dr. Martin Kaplan, associate dean of the Annenberg School for Communication at the University of Southern California, lobbyists for causes like environmentalism and gun control "spend time going from show to show saying, `I've got some fabulous material you might like to use.' " The notion that television could be used to change health behavior originated overseas, according to Dr. Phyllis Tilson Piotrow, an expert in population science at Johns Hopkins who helps create health-related soap operas and music videos for developing countries. "Many health ministries, with a bit of prodding from people like us," she said, "have come to recognize that if you want to get health messages to people on anything from immunization to tuberculosis, clean water, washing hands, you need to go via the mass media." The United States, of course, does not run entertainment media, so the international model does not translate easily here. But in the early 1990's, in response to the AIDS epidemic, officials at the C.D.C. wondered if they should try entertainment education. In 1994, they convened a panel of ethicists and social scientists to explore the idea. "There was overwhelming support," said Dr. Charles T. Salmon, a professor of public relations at Michigan State who was chairman of the panel. In the face of the AIDS crisis, he said, the ethicists thought that the agency had "a virtual obligation" to act. But they said the agency should confined itself to "a relatively passive role." In 1998, Vicki Beck, a C.D.C. health communications specialist who knew Hollywood because of a previous job in public relations for U.C.L.A., began developing a broader entertainment education program. She enlisted the help of Dr. Neal Baer, a pediatrician and former producer of "E.R." He urged her to develop "story bites" for producers and writers; those tip sheets are now available on CD-ROM and at the agency's Web site. "This whole thing about how we are only here to entertain, that drives me nuts," Dr. Baer said. "We know that people see things on TV that are related to health, and they are going to be affected by it. And that means you must be accurate." Under Ms. Beck's direction, the health agency last year established an award for soap operas that offer accurate depictions of health issues. The prize went to "One Life to Live" for a story about breast cancer. Ms. Beck is soliciting nominations for this year. But her primary objective is what she calls a "strategic effort" to coordinate television stories with the C.D.C.'s public information campaigns. When the agency wanted to teach Americans about hepatitis C, Ms. Beck met with writers for three shows, including "E.R.," and all three ran story lines about that disease. So by the time the campaign began, many Americans were already familiar with the disease. Yet tapping into the creative sensibilities of Hollywood writers, who value entertainment above education, is easier said than done, according to Ms. Beck and the writers themselves. Dr. Joe Sachs, an emergency room physician who writes for "E.R.," said he had spent years toying with a story idea on the overuse of antibiotics, one of the top items on the C.D.C.'s public health agenda. The idea languished until earlier this year, when Dr. Mark Greene, one of the main characters on the show, had brain surgery. He returned to work a changed man, brutally honest. He strode into the hospital waiting room and boldly informed patients not to expect antibiotics for the flu. Half of them got up and left. "We always start with the dramatic needs of the character," Dr. Sachs said. "If you were to take a television program and all it did was to dramatize public health issues, it would feel like a documentary. The challenge is to sneak it in." - --- MAP posted-by: Larry Stevens