HEALTH CARE/Joan Retsinas

Health, Illness Beyond TV

We adore television. TV Guide has the highest circulation of any periodical, followed by People, full of gossip on television stars. Television's version of Health and Illness, though, is a fantasy.

On sitcoms, people are bitchy, litigious, libidinous and demonic, but rarely ill. No Parkinson's to ruin the camaraderie of Friends. Chlamydia doesn't stop Sex and the City's crew. On soap operas, illness is a device to write an actor out of the script. Reality shows highlight the Darwinian victory of the fit over the less fit. The median age on prime-time is below 40.

Sick people star in commercials, but their illnesses are not life-threatening. The illnesses aren't even debilitating. Anxiety, incontinence, impotence, allergies, depression, asthma, arthritis &endash;- we see lots of sufferers. Yet they look great. They are trim, well-coiffed, well-dressed, happy. They don't seem any the worse for their condition. The woman with arthritis is dancing a tango; the child with allergies is playing in the grass; the man with erectile dysfunction is grinning. They have asked their doctors about pharmaceuticals. And those potions have erased all symptoms.

Senior citizens dominate the pharmaceutical commercials. This group of golden-agers also looks astoundingly fit: They dance, garden, chase grandchildren &endash; thanks again to a litany of pharmaceutical miracles. Even the people who are losing their minds have arrested that decline, thanks to a once-a-day regimen.

Television's take on disability is just as sanguine. The chief forensics detective of CSI-Las Vegas was losing his hearing, but surgery fixed it. In Wal-Mart ads the few employees (and customers) in wheelchairs are energetic enough to work and/or shop.

In short, Health and Illness, on television, shows Americans as basically healthy, with minimal pain, anguish and disability. If they are ill, they can reach for a remedy.

Health and Illness, playing outside the tube, is not so pleasant.

Outside the tube, 43 million Americans cannot just "call their doctor." They have no health insurance, which makes that call a costly one. In the real world of twenty-somethings, health insurance is a topic: 40% of recent college graduates will lack insurance during that first year post-school.

Many real-world illnesses, moreover, have no quick fix. Multiple sclerosis, traumatic brain injury, Parkinson's, chronic obstructive pulmonary disease, cancer. Even for conditions with remedies, those wonders do not necessarily restore people to the well-being promised in commercials. Drugs can have side effects. Their effects can wane over time. Sometimes they work well for some people, not for others. Walk down a nursing home corridor: You'll meet a person who has arthritis who can no longer dance, a person with Alzheimer's who can no longer speak.

These drugs tax a middle-income budget. Whenever I see, on a commercial, a white-haired couple amorously dancing, thanks to drug x, I wonder: Who paid for those pills? Did they have a supplemental Medi-gap policy?

And the real-world take on disability is not sanguine. Millions of Americans struggle with basic tasks: bathing, dressing, navigating and eating. Yet the money for home care is scarce. Our leaders are trying to shrink, not grow, both the Medicare and Medicaid budgets. While the Americans for Disabilities Act nudged all kinds of institutions, public and private, to incorporate more people with disabilities into the mainstream, that effort costs money &endash;- more money than either government or the private sector wants to spend. Even as injured soldiers return home, Congress is not pouring millions into rehabilitation.

It is time for another reality show, featuring some real-time anguish. How about The Chemotherapy Rush, as uninsured people, newly diagnosed with cancer, scramble for treatment? Or The Parent Trap, as uninsured parents pay hospital bills for sick children? Or Medicare Roulette, as frail seniors seek care for demented spouses? Too many Americans can star in one of those versions of Heath and Illness. 

Joan Retsinas is a sociologist who writes about health care in Providence, R.I.

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