5 Questions: Neal Baer on the healing power of TV

Neal Baer

Neal Baer, MD, has an unusual way of practicing medicine: He tells stories. Baer is executive producer of the NBC television series "Law & Order: Special Victims Unit," and prior to that worked for seven seasons on another of the network's programs, "ER," first as one of its original writers, then producer and ultimately executive producer.

At 5 p.m. on Oct. 26 in Fairchild Auditorium, Baer, a graduate of Harvard Medical School and a pediatrician, will deliver the annual Jonathan J. King Lecture; his talk is titled, "Doctors as storytellers" and will address the role of the doctor who can educate the public about health issues through television. Medical Center Report managing editor Jonathan Rabinovitz spoke with Baer about walking the tightrope between entertainment and education.

1. As a genre, "ER" and other television shows about medicine are almost as old as the medium itself. Why do they lend themselves so well to story telling?

BAER: Life and death. There's nothing that's more dramatic.

But "ER" was a breakthrough. You never knew what was coming in. It was like, "Wow, another gurney through the doors." It could be something terrible. It could be something funny. It could be something poignant. It could be something horrifying. And it just so grabbed you.

More important, the show was told from the doctors' and medical students' point of view—not the patient's. In all the previous shows, from "Dr. Kildare" and "Marcus Welby" to "St. Elsewhere," the storyline almost always was woven around a special guest star patient. But "ER" focused on the doctors, who were much more human with their foibles than on previous shows. By contrast, Marcus Welby was a god.

This opened the door for a more anthropological approach to television. We brought this cultural texture and attention to minutiae to the show. Take, for example, when Noah Wyle's character is taught how to do a lumbar puncture, or a spinal tap. In hospitals, the morés are that if you do it correctly with no red blood cells, it's called a champagne tap. That's not because it looks like champagne (though it is clear), but because your resident has to give you a bottle of champagne when it's your first time.

So Noah does it. He's nervous. He gets the champagne tap. And he gets the bottle of champagne that he drinks on the roof with Sherry Stringfield. The audience loves, I believe, to find out all the little things they never experienced and don't know about. It's critical because that's what draws people in.

2. I recently watched an episode of "Law and Order: SVU" about the murder of a 15-year-old prep school student who had become involved in the porn industry and tested positive for HIV. Where did you get the idea?

BAER: That was inspired by a true story in the porn industry in Los Angeles, where one of the actors tested HIV positive. That was sort of the stepping off point. But I was also inspired by a piece that had run in the New York Times about a year before on the changing sexual morés of teenagers. I wanted to show the shifting attitude among adolescents about "friends with benefits" and using the Internet to "hook up," to have sex without any emotional ties whatsoever.

3. It was great television but is there any redeeming value?

BAER: In that one episode alone, even though some viewers might think it was tawdry and sensational, you could see how the detective worried about his own teen-aged daughter being at risk for HIV after he learned that a boy she had dated had been exposed to the virus. And then the medical examiner on the show remarks that one of every three teens who is sexually active will contract a sexually transmitted infection. It gives the audience a sense that all you need is one kid infected for things to get really bad.

4. But do viewers actually get these messages?

BAER: It's pretty shocking what people learn from an episode of "ER." I published a piece about this with the Kaiser Family Foundation in Health Affairs a few years ago. Among the questions, we asked people what they knew about HPV—human papillomavirus—and its association with cervical cancer before and after an episode about the subject.

Before the show aired, 24 percent of viewers had heard of HPV. After the show aired, 48 percent had heard of the virus. Before the show aired, 9 percent could give a correct description of HPV; after the show aired, 28 percent could.

It was the first time anyone had done this sort of survey, and we were pretty amazed and alarmed. I mean, one out of seven viewers also said that they had called a doctor after they had seen something on "ER."

Like it or not, people do learn a lot from watching television. And because they do, I think we should be as accurate as possible. That's why I'm not a fan at all of "Gray's Anatomy." It's such a mish-mosh: they're surgeons and they do neurosurgery, gynecological surgery, general thoracic surgery, orthopedic surgery. Each of the characters is a full-service surgeon! If you want people to believe it is real—and you know that they are going to believe it is real—then you have that responsibility to be accurate.

5. There's lately been a public backlash against science. Does this issue come up in the stories you want to tell?

BAER: That's my next show. I'm doing a pilot about science for NBC. There's a huge and growing gap between those who know science, understand it and practice it and those who consume the benefits of it or use it. It really frightens me that people have so little knowledge about science. I want to find a way that as a culture and a country we can debate and deal with a lot of these very, very tough issues that are coming up about stem cells, cloning, designer babies, climate change and all of those things. But I can't go into the details. You're just going to have to watch it next year.