PAGE 52 / JANUARY 25, 2007 SCRIPTDOCTOR: MEDICINE IN THE MEDIA Fact-checking Fiction By Andrew Holtz, MPH tice medicine. But then he became a Andrew Holtz, MPH, is a former CNN Medical Correspondent full-time writer on the staff of House. young doctor and an older and the author of “The Medical Science of House, M.D.” This He also sits in on the filming of many of man step through the buzzing column examines mass media programs, particularly the medical scenes, but it is a nurse activity of a hospital emer- entertainment TV, for insight into popular perceptions, so that who has the lead role in monitoring A gency department. The older rather than merely wincing at distortions or accuracy on the House set. man sits on the edge of an empty bed oversimplifications in the portrayals of medicine on these “She is the one who is there for all and the doctor pulls up a chair. The shows, health care professionals can learn something from the medical scenes. She makes sure doctor quizzes his patient, trying to media professionals about the way that medical and health they are holding the scalpel correctly, figure out why he had a bad reaction topics are presented. or a patient is draped correctly, or peo- to his medication. It turns out the man Send questions to him about how the media treat ple are wearing gowns when they had switched drugs on his own, using medical topics or suggestions for future columns about a should be wearing gowns, or that when some leftover pills from a friend. they are in x-ray that they are wearing particular show or topic to discuss to [email protected] Taken aback, the doctor asks the man protective lead aprons, that type of why he would risk his health by taking thing,” Dr. Foster said. someone else’s medicine. It’s ironic that a nurse is the prima- “I’ve got no insurance. You know This isn’t an ER; it’s the set of ER, see that the right equipment is used at ry on-set medical adviser for House. The how much these drugs cost?” the elder statesman of primetime med- the right time in the right way. Having show has been criticized by nurses for Then they get up and do it again. ical dramas. Each movement, each an on-set medical adviser is one of the often portraying them as little more And again. word of the “doctor” and his “patient” ways medical shows work to assure than housekeepers and rarely showing are scripted by writers, and then played accuracy. nurses providing direct medical care. out in from of the cameras and crew At ER, MDs have always been in In each scene, it is not only the squeezed between the ER beds and the mix. One of the first writers was actions and words of the actors that Having an on-set medical nurses station. But just behind the cam- Neal Baer, MD, who eventually rose to must be checked for medical accuracy; adviser is one of the era, alongside the director, there’s a become an executive producer of the bedside monitors, screens, x-rays, and chair for someone who wouldn’t be on show. Dr. Baer introduced other physi- other images added to the visual flavor ways medical shows work the sets of most other TV shows. cians to Hollywood, including his med- of a show can also introduce errors. The occupant of that chair is an ical school friend David Foster, MD. If the actors are talking about a sus- to assure accuracy. MD. He is listening to the pronuncia- Dr. Foster worked with ER and picious mass on a lobe of a patient’s tion of medical jargon and watching to other shows, while continuing to prac- lung, then the image they are huddled “I would argue that we need to ized: “For now, in fit patients, most of NSCLC exercise some degree of caution. There us would recommend cisplatinum- continued from page 51 are several inconvenient truths regard- based doublets. Despite a median age The next Intergroup trial ing CALGB 9633. The three-year dis- of 59 to 62 in trials, older patients often in early-stage NSCLC who constituted a very small minority ease-free survival still favors adjuvant benefit. Preoperative adjuvant chemo- of enrollees, the data are far shakier, Dr. treatment, as does three-year overall therapy is still being investigated,” he (ECOG 1505 study) will Langer said. survival. There is a nine percent abso- said. “As of 2006, we have observed a lute difference in recurrence and death The next Intergroup trial (the take bevacizumab, which clear-cut benefit for adjuvant cisplatin- rates. Median follow-up is still under Eastern Cooperative Oncology Group has shown a benefit in based therapy, particularly in Stage II five years, and I would argue, too, that 1505 study) in early-stage NSCLC will and Stage III NSCLC. In one primary this is probably the second premature take bevacizumab, which has shown a advanced disease, and trial—CALGB 9633—devoted to Stage reporting of this trial. While 150 deaths benefit in advanced disease, and look at IB NSCLC and in subset analyses of were needed for analysis, only 131 that in combination with chemotherapy look at that in combination other, larger trials that included Stage deaths have occurred.” versus chemotherapy alone, he said. with chemotherapy versus IB as well as earlier stages, the evidence Carboplatin-based therapies do for benefit in Stage IB NSCLC is not offer advantages, though, he said: “The ‘Premature to Criticize Trials chemotherapy alone. compelling. This general reservation is best results obtained in Stage IB have of Carboplatin amplified by the LACE meta-analysis. been attained with carboplatin-paclitax- “Under these circumstances, it may el, not cisplatin. The subset analysis in Asked for his opinion, A. Philippe “The results are underpowered because be necessary to repeat controlled, ran- four-cm tumors still demonstrates a Chahinian, MD, Professor of Medical there were only 170 patients per arm, domized trials in Stage IB NSCLC com- survival benefit. This has not been test- Oncology at Mount Sinai School of which is well below expected because paring standard chemotherapy to ed in Stage IIB-III in the adjuvant set- Medicine in New York City, said, “I early results were positive. observation. Finally, advanced age is ting, so the absence of data does not agree that carboplatin in not dead. It is “The differences in disease-free not an impediment to standard adju- prove absence of benefit. And finally, a premature to criticize trials of carbo- survival were very large. The three- vant therapy in fit individuals.” substantial percentage of adjuvant platin. year survival is still significant. More patients are poor candidates for cis- “If you look at Stage IIIB or IV dis- importantly, for the largest tumors, Some Dismiss Role of platin-based therapy because of age ease, carboplatin does as well as cis- there was a significant favor in overall Adjuvant Carboplatin and various comorbidities.” platin, or the difference is extremely survival in the paclitaxel group.” Clinically, statistically significant small. Based on results in advanced CALGB is still a positive trial, he “A lot of my colleagues have taken overall survival benefits have been stages of disease, carboplatin is not said, and deserves to be confirmed with great delight in looking at these data observed with platinum doublets in inferior to cisplatin.” an appropriately powered trial with and dismissing the role of carboplatin Stage II-IIIA disease overall in three to The CALGB trial is important larger numbers of patients and com- in the adjuvant setting,” Dr. Langer four cycles, he said, noting that Stage IB because it was specifically designed for pared with cisplatin and vinorelbine in O said. treatment still needs to be individual- Stage IB disease, Dr. Chahinian said. an adjuvant setting. T PAGE 53 / JANUARY 25, 2007 around better have a shadow in that Zwerling’s professional experiences “Hollywood, Health & Society” both patients receive kidneys. The writ- area, or viewer complaints are sure to and reading, including 20 or so medical (HH&S) Program at the Norman Lear ers wanted to explore a conflict be- follow. These medical images usually journals each month, but also stories Center at the USC Annenberg School tween two physician characters on the come from real patients, with any iden- gleaned from focus groups and panels for Communication in Los Angeles. show about some of the ethical chal- tifying information stripped off or of physicians and patients, and material The program was created by the lenges that might arise with such organ altered. culled from newspapers, magazines, Centers for Disease Control and Pre- donation match-making. “There are a number of places that and elsewhere by a full-time researcher. vention and is now also funded by the “To really get all the lowdown on provide de-identified x-rays and other National Cancer Institute and other fed- paired organ exchange programs, images,” Dr. Foster says. “For the gen- Hollywood, Health & Society eral health agencies. HH&S put [Dr. Zwerling] in touch with eral things, say you need a chest x-ray, Program at USC ER called on HH&S after reading Dr. Jim Burdick, who is the head of the there a number of prop houses in Los about paired kidney exchange pro- Johns Hopkins paired exchange pro- Angeles that have that sort of thing; a When writers at ER and other medical grams, for example. In these programs, gram,” Dr. Sachs says. normal head CT scan or something like shows need a specific medical question a patient who has a willing donor who Over the past year, HH&S has that.