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."