Neal Baer

Two teenage girls appear in the emergency room of a Chicago hospital, fearful that they may have contracted an STD. A dedicated nurse promises to respect their confidentiality and discovers that one girl indeed has been infected by the human papilloma virus (HPV), which causes cervical cancer. Equally of concern to the nurse were the circumstances in which the girl was infected-through so-called sex parties organized with her classmates. Should the nurse compromise the girl's confidentiality in order to warn about an STD possibly spreading through the student population at her school?

The episode-drawn from a real-life case in suburban Atlanta involving teens and syphilis-was written by physician and HMS alumnus Neal Baer, who spoke to an HSPH audience on September 26 in Kresge G-2 about health messages in prime-time TV.

"How many times during the day at rounds with colleagues, at consults, or in the studies you are doing in public health, do you tell someone's story-are you telling a story about how someone contracted a disease, what caused them to contract this disease, the setting in which the disease was contracted, or how it can be prevented?" Baer asked. "You're always fashioning it into a story."

A pediatrician who maintains a practice, Baer began writing episodes for ER in 1994 when he was a medical student. He left the show in 2000 to become an executive producer on Law & Order: SVU.

Baer's talk was the first in a new series of lectures on health messages and the media co-sponsored by the Center for Health Communication, Division of Public Health Practice, and Office of Communications at HSPH. He was introduced by Jay Winsten, director of the Center, which studies how mass media can change public health policies and people's behaviors. One of the best known of the Center's initiatives was the launch of the "Designated Driver" campaign in the U.S., during which Winsten worked directly with Hollywood producers, directors, and writers to incorporate the terrible impact of drunk driving into TV and movie scripts.

Said Winsten, "A lot of people think 'the media' equals 'news coverage,' but truth be told, in the same way that medicine is only one component of a comprehensive health strategy, news coverage is only one component of a comprehensive communications strategy that includes advertising, public relations strategies, and entertainment programming." He joined Baer after the talk for a working dinner at which they continued to discuss how the entertainment industry can convey public health messages.

For Baer, scriptwriting is not simply an exercise in the dramatic arts. He is careful that the medical information he interweaves into his scripts is factual.

"Watch this clip and count the number of medical facts," he encouraged audience members before showing a segment from a Law & Order: SVU episode about the illegal sale of human kidneys in the U.S. Within seven minutes, the characters had conveyed that 16 Americans die from kidney failure every day, that African Americans are at particular risk, that other countries allow the sale of kidneys, that receiving a kidney from a live donor is better than getting one from a cadaver, and that ethical concerns exist about who will benefit from the legalization of human organ sales.

Baer does not see his job as strictly entertainment or educational. But he does believe that factual information in otherwise fictional scripts is important because Americans receive health messages by watching TV. And that's not just his opinion. In an issue of the journal Health Affairs, Baer co-authored a paper on communicating health information through the entertainment media. The paper described a study funded by the Kaiser Family Foundation that tested what health information viewers learned and retained after watching episodes of ER. For the episode about HPV and the schoolgirl, the co-authors found:

Before Episode Aired
24% of study participants had heard of HPV
9% could give a correct description

One Week After Episode Aired
47% of study participants had heard of HPV
28% could give a correct description

Six Weeks After Episode Aired
38% of study participants had heard of HPV
16% could give a correct description

Similar results were shown for other episodes.

"I don't want to tell the audience how to think about a topic," said Baer. "I want to put it out there because I think there is a growing gap, particularly between what scientists do and what doctors do and what the public knows. Even though the public has access to the Internet and things like that, the gap is widening and, like it or not, they're getting their information from television and making decisions."