Based on a 'True' Story? How Medical Dramas Mislead You

Grey's Anatomy is an awful program. Overly dramatic, scientifically inaccurate, and saturated with political messaging, the show is more propaganda than quality television. I can't stand it. Naturally, my wife watches it religiously.

The joys of marriage aside, I caught a snippet of a 2020 episode titled “A Hard Pill to Swallow” the other night. The episode originally aired two years ago, on the tail end of the EVALI panic, initially (and wrongly) blamed on nicotine vaping products. [1] Following the CDC and a wide swath of media reports at the time, Grey's Anatomy told a scaremongering story about the dangers of vaping. According to one summary of the episode:

Meredith and Cormac [two of the show's lead characters] team up to help a 17-year-old swimmer who starts spewing up blood. Eventually, they figure out Kai has been vaping — his lungs look like a 60-year-old smoker’s — and Grey’s proceeds to give us a heavy-handed Special Episode about why vaping is evil … It just felt very PSA-directly-to-camera.

There's something especially obnoxious about an industry as debauched as Hollywood lecturing anybody about healthy living. What makes the moral preening even worse is that the producers of Grey's Anatomy badly misrepresented the science to their audience of nearly four million viewers.

This points to a much broader issue with television shows in this genre: Hollywood's portrayal of modern medicine has misinformed the public about important health issues and undermined trust in physicians—all for the sake of entertainment.

Anti-vaping fairy tales

The assertion that a vaping teenager's lungs could even remotely resemble those of a 60-year-old smoker is preposterous. A high school student hasn't been exposed to anywhere near as many carcinogens as a lifelong smoker. The Grey's Anatomy writers should have Googled “risk assessment” before penning this episode. Such a homework assignment may have led them to an important concept widely employed by public health agencies: Risk = Hazard (times) Exposure.

Studies investigating the potential harms of vaping have nicely illustrated why this idea is so important. Since aerosols emitted by e-cigarettes contain far fewer harmful chemicals than tobacco smoke, vaping can't possibly pose the same level of risk as smoking. Additionally, vaping seems to mitigate some of the damage caused by tobacco use. There is evidence, for example, that vaping “may reverse some of the harm resulting from tobacco smoking in COPD patients,” according to one 2018 study.

This isn't academic nitpicking on my part; misleading the public about vaping has deadly consequences. A 2021 study published in BMJ Open found that smokers were less likely to switch to e-cigarettes after viewing tweets suggesting that vaping and smoking are equally harmful. “These findings suggest that misinformation about e-cigarette harms may influence some adult smokers’ decisions to consider using e-cigarettes,” the authors concluded.

TV patients more likely to die

Medical dramas haven't just misled the public about the benefits of vaping. At least three studies published over roughly the last decade have found that these shows tend to exaggerate the likelihood that a patient will die. According to a 2014 analysis:

Several empirical studies have examined the depiction of patient survival and outcomes of care in medical dramas. A study of three popular medical shows—ER, Chicago Hope and Grey’s Anatomy—showed mortality rates of fictional patients in television hospitals to be nine times higher than that of patients in real-world hospitals [emphasis mine].

Fans who watch many hours of these shows are more inclined to believe that real patients can do little to prevent serious illness and effective treatments are “bound to fail,” the authors added. Since 60 percent of Americans live with at least one preventable, treatable chronic disease, this is the worst possible message TV could send.

Heavy viewers of medical dramas in this study were also more likely to misunderstand which diseases pose the greatest threats to their health. Although cardiovascular disease and cancer cause the majority of deaths in the US, these programs tend to focus on “atypical” conditions—like a tree growing inside a patient's lung. The authors warned that this under-representation could “lead to the erosion of public support to address issues relating to cancer and cardiovascular disease.”

It gets worse, though. After reviewing the existing literature, the researchers surveyed a nationally representative sample of 11,555 adults ages 18 and older. Respondents who spent more time watching medical dramas were more likely to endorse the following statements:

• “It seems like almost everything causes cancer.”

• “There are so many recommendations about preventing cancer, it’s hard to know which ones to follow.”

Like the results of earlier research, these examples are concerning because they may distort how people think about their well-being and the health care they receive. “For example,” the authors noted, “confusion and fatalistic views resulting from cumulative viewing of medical dramas may prevent individuals from seeking health professionals when their health is at risk.”

TV doctors: unethical jerks

Multiple studies have also shown that television profoundly influences how we think about physicians. “Heavy viewers of medical dramas compared to light viewers perceived doctors to be more unethical, tense, and inconsiderate,” the authors of a 2003 paper reported. This may be expected in situations where people have limited access to health care. But according to one 1995 study, even adults who regularly see a doctor tend to believe television depictions over their own experience with a health care provider. The researchers concluded:

Compared with physician perceptions of the profession, television portrays physicians, and the public perceives them, as more powerful, as imbued with greater income, status, and strength. In addition … television depicts physicians, and the public perceives them, as lower in character, meaning less moral, right, unselfish, good, and honest.

What to do?

In an ideal world, Hollywood would clean up its act and stop lying to people for the sake of ratings. But we don't live in that universe. Perhaps the second-best solution is to consume medical dramas as we do any other indulgence—in moderation. The occasional cocktail or dessert won't wreck your health, and a little bit of drama-laden television won't blind you to the realities of modern health care.

Nevertheless, it's worth remembering that we're good at recalling information but not the source it came from. That means we're liable to confuse facts with expertly delivered dialogue from a fictional story. So, cultivate a little skepticism. Don't believe what actors say until you verify that it's true. Guard your mind against bad ideas; no one else will do it for you.

[1] Lung injury in these cases was caused by illegal devices used to vape THC oil. See Dr. Bloom's excellent story Can Chemistry Explain 'Vaping Lung'?