Risks get little air time on medical reality TV

With the success of "Survivor" and "American Idol," reality TV was bound to spread its contagious appeal to medicine. And has it ever.

Doctors and patients star in real-life dramas such as "Dr. 90210," "Untold Stories of the ER" and "The Biggest Loser," shows that have the airwaves buzzing with battles of the bulge, nips and tucks, and shunning of junk food -- all in the name of good health, and good ratings.

Intrigued by the pairing of reality TV and health, the Kaiser Family Foundation last month assembled TV and health care types to explore this small-screen marriage. A discussion paper for the foundation examined 10 health-based reality shows and their role in providing useful health information and shaping attitudes.

The main findings: Beauty and sex appeal are key themes; physicians are depicted as courageous and intelligent heroes; and procedures and treatments always seem to work with few or no complications.

"They can downplay risks, and they can set unrealistic [expectations]," said Victoria Rideout, vice president and director of the foundation's program for the study of entertainment media and health. "This is part of the mind-set of patients who are coming to see [physicians]. It behooves doctors to pay attention to what popular culture is saying and portraying about health issues."

Medical organizations are watching the trend, too.

The AMA's House of Delegates has discussed doctors' roles in reality TV and last year updated its policy on filming patients in health care settings. The policy says doctors should convey a treatment's risks and benefits to patients and "refuse to participate in programs that foster misperceptions or are otherwise misleading."

Because early programs dealt with plastic surgery, physicians in that specialty were among the first to give their opinions about health reality TV. After much thought, the American Society of Plastic Surgeons a few years ago decided to work with "Extreme Makeover," an ABC show about patients undergoing plastic surgery. But the society's interest soon fizzled when it said the program gave an incomplete picture of what patients went through, said society president Roxanne Guy, MD, of Melbourne, Fla.

In 2003, leaders of the American Academy of Cosmetic Surgery said the now-canceled "Extreme Makeover" could give patients the wrong impression about the risks and recovery of surgeries.

Cosmetic surgery programs "don't show you all the steps. They don't show you the people who are unhappy. They don't show you the complications," said academy president Jim Gilmore, MD, of Dallas. "[Patients are] getting a broken-up picture of reality."

Keeping it real

Beverly Hills, Calif., plastic surgeon Brent Moelleken, MD, said patients and physicians need to realize that reality TV gives a slice of life, not the entire story. He has appeared on "Extreme Makeover" and Discovery Health's "Plastic Surgery: Before and After." His patients had positive changes and viewers got an idea of the seriousness of surgery and potential complications, said Dr. Moelleken, clinical assistant professor of surgery at UCLA Medical Center.

Jon Perlman, MD, a plastic surgeon who also has appeared on "Extreme Makeover," said it's not easy taking several weeks of procedures and trimming them into a one-hour episode.

"They made a strong effort to make a representation of the patient's experience," said Dr. Perlman, clinical assistant professor of plastic surgery at UCLA Medical Center. "Most of my peers have felt it was an honorable presentation of our specialty."

Physician organizations should get more involved to ensure that viewers get accurate health information, experts said. And physicians who want to step in front of the camera should weigh the quality of the program and its public perception because the impression viewers get may last long after the series fades to black.

"The shows that you associate yourself with will forever taint your reputation or enhance it," Dr. Moelleken said.

The Kaiser paper found that much of the health information on reality programs is useful. NBC's "The Biggest Loser," for example, shows the role of diet and exercise in weight loss. More information appears on specialty cable shows such as The Learning Channel's "Honey We're Killing the Kids," in which a nutrition expert gets families to adopt healthy eating habits.

"We need to have more positive messages to educate people. We just have to make it entertaining or they won't watch," said Lisa Hark, PhD, who hosted the first season of "Honey We're Killing the Kids" and is director of the nutrition education and prevention program at the University of Pennsylvania School of Medicine.

Fred A. Williams Jr., MD, whose practice at Endocrine & Diabetes Associates in Louisville, Ky., deals with weight-loss management, said "The Biggest Loser" draws attention to society's obesity problem, and the show has encouraged some of his patients to get fit. But, he said, it is not a complete depiction of the weight-loss process.

"If they were to portray a show on weight loss without glitzing it up, nobody would watch it. They might get a little depressed by it," Dr. Williams said.

And while a cold may be more common to viewers, surgery and the sensational anomaly are more likely to be seen on TV.

"The conditions dealt with on these shows are not conditions that are relevant to most people's daily health," said Peter Christenson, PhD, who co-authored the discussion paper and is a professor of communication at Lewis and Clark College in Portland, Ore. "It's about the 275-pound tumor or plastic surgery on every defect you have."

That's entertainment.