New Kind of Film Noir: Health Care

A half-hour into “Money-Driven Medicine,” a new documentary that skewers the U.S. health care system for its insensitivity toward patients and excessive spending, a father talks about the doctors who treated his toddler for leukemia.

As melancholy music plays in the background and photographs of his bald daughter flash across the screen, the father says that two years of chemotherapy failed to stop his daughter’s cancer. But when he balked at recommendations for additional painful treatment, they threatened to sue him.

The emotionally charged vignette is typical of a handful of provocative health care-focused documentaries circulating amid the increasingly contentious debate in Washington over how to fix the health care system. While lawmakers are targeting rising costs and growing numbers of uninsured as the major problems, the film makers offer a darker, more conspiratorial view: Powerful vested interests lusting for profits are responsible for the country’s medical malaise.

One film, “Food, Inc.,” targets the food industry for the nation’s explosion of obesity. Another, “Under Our Skin,” details an alleged conspiracy by insurers and physicians to downplay the severity of Lyme disease. A third, “Unnatural Causes,” pinpoints poverty in a class-stratified society as root cause of illness.

Each film has a strong point of view and makes only limited efforts to present opposing viewpoints. None has created the buzz of Michael Moore’s 2007 “Sicko,” which assailed the insurance industry and was championed by advocates for government-run health care. Still, some of the filmmakers hope to capitalize on, and perhaps influence, the political debate raging on Capitol Hill and around the country.

As a critique of the current fee-for-service payment system, the issues raised in “Money-Driven Medicine” have gotten some political traction, partly because Obama’s budget director, Peter Orszag, has talked up research from the Dartmouth Institute for Health Policy and Clinical Practice that shows wide variation in how doctors practice medicine. In some parts of the country, physicians perform far more procedures and run up much bigger tabs without improving patients’ health. 

“It’s better than a power-point presentation,” says Maggie Mahar, who wrote the book “Money-Driven Medicine” that the film is based on. “It really could be useful as propaganda and I really hope people use it as that.”

That kind of talk frustrates the targets of some of the films, who say the movies make misleading, and at times, dangerous assertions. Richard Lobb, a spokesman for the National Chicken Council, an industry group, said in an interview that Food, Inc., “is a documentary about the American food system the way ‘Raiders of the Lost Ark’ was a documentary about archaeology.”

Food, Inc. is a cinematic version of the agribusiness critique proffered by Eric Schlosser (“Fast Food Nation”) and Michael Pollan (“The Omnivore’s Dilemma”). Made by Robert Kenner and Schlosser, it portrays a network of corporations that, with the complicity of the federal government’s chief regulators, has foisted cheaply produced but unhealthy, corn-based food on the nation, causing diabetes, obesity and bacterial outbreaks such as e. coli. The movie champions local, organic farming, nutritional labels on restaurant menus and stricter regulation of genetic engineering, industrial animal factories and healthier eating.

Food manufacturers have set up their own Web site to dispute the film, which they say unfairly smears the country’s food production industry’s success in providing cheap and safe meals for millions of people. “To suggest that everyone eat local, unless you live in the Central Valley of California, doesn’t leave you with a lot of options,” says Lobb.

Dr. John Halperin, a professor of neurology at Mount Sinai School of Medicine in New York, lamented that the vantage of “Under Our Skin” has gained some credence with Connecticut lawmakers. In June, Gov. Jodi Rell signed legislation protecting doctors from being disciplined for treating Lyme as a long-term disease-incidents of which are detailed in the movie, which argues that Lyme disease has been undertreated as a short-term illness rather than a long-term, persistent infection, requiring extended doses of antibiotics.

“Because of the perspective pushed by this film, you have legislatures like Connecticut’s saying it’s legitimate to treat these patients with months and months of medication,” Halperin says.

A spokesman for the Infectious Disease Society of America, an association of doctors, scientists and health care experts that is criticized in the film, says long-term antibiotics is “a treatment protocol that is dangerous to the patient and is not supported by medical evidence.”

The filmmaker, Andy Abrahams Wilson, says his movie highlights a broader problem in the health care system, in which the rules for treatment of diseases are set by people who have financial stakes in the issue.

“My hope is people don’t just think of this as an isolated situation in terms of Lyme disease: it implicates our health care system in general,” he says.

There’s nothing wrong with the strong arguments in all of the films, says Robert Thompson, a Syracuse University professor of popular culture. He believes that the films’ biases are “a good and healthy thing,” and adds, “We use our greatest dramatic story telling devices for big explosive action adventures, and all of us, at some point, probably wistfully dream of a utopian culture where we would use film and television to talk about important things.”

Some of the documentaries have appeared at film festivals, on television, and in limited releases in theaters around the country. Others have been distributed as teachers’ materials, shown at universities and screened at small gatherings of activists and discussion groups and on the Internet.

As part of their promotional campaigns, the filmmakers have incorporated explicit calls to action. For instance, the makers of “Food, Inc.” have put forth an agenda, “Hungry for Change,” that calls for stronger laws to protect farm workers and discourages people from eating meat or dining out.

Executive Producer Larry Adelman says the purpose of “Unnatural Causes,” is “to organize folks to get them eager to mobilize for change.” The multi-part documentary, originally broadcast on PBS, focuses on the social causes of sickness, including the stress from poverty, environmental pollutants seeping through impoverished neighborhoods and regimented low-level jobs. It also examines the racial aspects of health, including the greater prevalence of diabetes among Latinos and the fact that African-Americans are more likely to get sick or die than whites from the same economic class. Adelman says that more than 400 groups-including major unions, church groups and local public health agencies-have screened the movie since then, and PBS is re-broadcasting it this fall.

As the health care debate intensifies in Congress, films directly commissioned by groups involved in the fight may end up overwhelming independently made features. Already, activists with opposing views have produced films. Conservatives for Patients’ Rights, a group founded by former hospital executive Rick Scott, an opponent of Democratic health care proposals, bought TV time in May to air its documentary, “End of Patient’s Rights – The Human Consequences of Government-Run Health Care.”  The film features residents of Canada and Britain decrying their experiences with state-provided health care. Liberal activists demanded, without success, that the film be pulled off the air.

Even before the 2008 election, Health Care for American Now, a liberal group that favors health care changes along the lines recommended by President Barack Obama, commissioned its own documentary. “Diagnosis: Now” is filled with anecdotes of insurance companies refusing to authorize tests and treatments and is by Robert Greenwald, who has created documentaries critical of Fox News, Wal-Mart Stores Inc. and the Bush administration.

 


Maggie Mahar responds to KHN:
While I appreciate mention of “Money-Driven Medicine,” I would like to clarify two points. First, we did not conceive of the film as “propaganda.” In my conversation with your reporter I noted that conservatives like Rick Scott have been spreading misinformation about health care reform, and I hoped that “Money-Driven-Medicine” could counter that “propaganda” by setting the record straight.

The next paragraph begins: “That kind of talk frustrates the targets of some of the films, who say the movies make misleading, and at times, dangerous assertions.” As I explained to your reporter, no one has suggested that “Money-Driven Medicine” makes misleading statements. (comment received 7/2/09 at 2:12 p.m.)