A Physician Brings Accuracy to "E.R."

Show: FRESH AIR
Date: APRIL 30, 1997
Time: 10:00
Tran: 043001NP.217
Type: PACKAGE
Head: Tobacco Industry Under Fire
Sect: News; Domestic
Time: 12:06

MARTY MOSS-COANE, HOST: This is FRESH AIR. I'm Marty Moss-Coane in for Terry Gross.

It's been a rough couple of weeks for tobacco companies. Several more states attorneys general have filed suit against the industry, hoping to recoup the cost of paying for smoking-related illnesses, making the total number of states 24.

Individual cases against specific tobacco companies are making their way through various court systems around the country.

And last Friday, a federal judge in North Carolina ruled that the federal government, meaning the Food and Drug Administration, has the authority to regulate cigarettes and smokeless tobacco. This is a huge defeat for tobacco companies, who have lobbied long and hard to keep the FDA's hands off tobacco, fearing the agency would take measures to regulate the amount of nicotine in cigarettes.

The judge also ruled that the FDA has no authority to restrict tobacco advertising and promotions, which was a blow to anti-smoking forces.

We invited Philip Hilts to join us today to put this news in context. He writes about health and science for the New York Times and is the author of the book "Smokescreen: The Truth Behind the Tobacco Industry Cover-up," which was published last year.

He says what's truly significant about this recent ruling is that for the first time, a court has labeled nicotine a drug.

PHILIP HILTS, HEALTH AND SCIENCE POLICY CORRESPONDENT, THE NEW YORK TIMES, AND AUTHOR, "SMOKESCREEN: THE TRUTH BEHIND THE TOBACCO INDUSTRY COVER-UP": The law says that the agency in the government that is supposed to be watching drugs -- who sells them, how they're sold, what's a drug, what's not a drug -- is the Food and Drug Administration. And because of some peculiarities in history, tobacco had been left out of that. And so for years, people have been trying to put it back in, and say this is, after all, a drug. Let's go ahead and have FDA regulate it.

But then David Kessler at the head of the FDA in 1994 said, we're going to investigate this, and we are going to put together enough information to convince everybody that nicotine is a drug. This is what the companies intend. They intend to use it as a drug. And he did that.

And so he then declared, OK, nicotine is a drug, FDA will regulate it from now on, despite the history. And then the companies came in and said, no, wait a minute, we're going to court. We're going to block that. And what we have now is the result of that fight.

And the court -- and this is a court in Greensboro, North Carolina, tobacco country, a judge who understands the companies because he's worked with them, he represented tobacco farmers himself, so this is their best venue, and this judge quite clearly said the FDA is right, nicotine is a drug, cigarettes are a drug delivery device, and it should be regulated.

MOSS-COANE: Now, the other half of the judge's decision said that the FDA could not restrict tobacco advertising or the promotion of tobacco products. On what legal grounds did he make this argument?

HILTS: Yeah, it was kind of a narrow ground. What he said was, if anybody's going to be regulating the advertising of a product, it's gotta be the FTC, which is the agency normally that does that sort of thing. And in the law, the FDA -- it says the FDA can regulate sale, manufacture -- but it doesn't say advertising.

Normally with drugs, you don't regulate the advertising in the way that you'd regulate, say, the Marlboro Man, because drugs normally aren't handled that way.

So, what he said was the FDA law doesn't say you should handle advertising. The FTC law says you should. So he said if you're going to do it, let the FTC do it. Do not let the FDA do it.

But he also made a point, he said, I'm not going to rule on the general issue of whether advertising constitutes free speech and that kind of thing, not the constitutional issue. He stayed away from that. Just on the narrow legal grounds, he said FDA is the wrong agency to be doing it.

MOSS-COANE: So Joe Camel will be around for a while.

HILTS: Yes, at least until the companies decide not to use him.

MOSS-COANE: Are you surprised at all about this judge -- from North Carolina, the country's number one tobacco state -- that this judge issued this particular ruling? Back in the '70s, he did represent tobacco companies as a private attorney. Many people are fairly surprised by his strong ruling. Are you?

HILTS: I was surprised. I thought it would go the other way. I thought he would find some grounds to protect the companies. If there's anybody who could see this from the company's point of view, it would have been him.

But I read his ruling, and what you can see as he goes through it, what he's thinking is the law on this is actually pretty clear. The law says if an agency's job is to regulate something like drugs, and they do a reasonable interpretation of what the law says, then they should go ahead.

And the only body that can stop them is Congress. Congress can change their marching orders, but once Congress has given the marching order, says FDA, you regulate drugs, they're doing it in a reasonable way. They ought to go ahead.

And so he said you can't deny it. It's a reasonable thing for the FDA to be doing.

MOSS-COANE: How do the courts define a drug? And of course, this has been one of the issues which has made for such a contentious issue.

HILTS: Yeah. The main thing is, it says -- the law says -- anything that affects the structure or function of the body and that the seller of it intends for it to do that.

So in this case, you have the tobacco coming into the lungs and it's affecting the lungs, of course. The tobacco itself is tearing up the lungs.

But mainly what we're talking about is the nicotine, which goes directly into the blood stream, up to the brain, across to receptors all over the brain, and creates this buzz, this simultaneous calm and alertness, which smokers enjoy. That's the effect of a drug.

And then the question is intent: do the companies, and have the companies, marketed this product with the intention of getting the nicotine from their plant into the lungs of the smokers?

And the FDA investigation which took a couple of years found all the internal evidence which suggests that the companies knew perfectly well what they were doing. They regulated the amount of nicotine in there. They didn't go too high or too low. They made sure plenty was being delivered, and so on.

So that the answer was yes, the companies intended to get nicotine to their smokers. And that's all you have to have. It is a drug and it was intended.

MOSS-COANE: When you look at this particular ruling and the fact that states attorneys general have sued tobacco companies to recover some of the costs of smoking -- of smokers within their own states, is the tide beginning to turn against the tobacco industry?

HILTS: I think so. I think what has happened here -- this is all of one piece. You had a time in 1952 and '53 when tobacco was king. Half the population was smoking. It was in the movies. And there was a crisis when the scientific data came in that showed this is causing a huge epidemic of disease. Cigarettes specifically are causing this epidemic of lung cancer and heart disease. But the companies fought that, and struggled to a stand-still. So for the last 40 years, not much has happened.

But then beginning in 1994, we had a sudden break-out. Whistle-blowers coming out. Huge amounts of documents. The FDA declaring that it was going to investigate and try to regulate the nicotine as a drug. And so the thing broke. And at that point, all this information feeds into the normal processes of American society.

You're talking about courts, the Justice Department, Congress, debates everywhere, newspapers. And as it works it way through the system from 1994 'til now, you can see the companies losing one after another. There was a loss in court in Florida. The 24 attorneys general now have gone into court against them. One item after another, they've gradually -- this information is working its way through the system.

MOSS-COANE: In March, the Liggett Company, maker of Chesterfield, made a startling admission: "We at Liggett know and acknowledge that cigarette smoking causes health problems, including lung cancer, heart, and vascular disease, and emphysema."

What does this statement represent -- coming from a small tobacco company, but coming from a tobacco company?

HILTS: It represents the great desire of the executives of the companies and the scientists at the companies to get out from under the burden that they've been carrying for 40 years.

They're as aware -- much more aware, in fact -- of all the details of what cigarettes do than the rest of us. They really know it, but they've been blocked because of a strategy they picked a while back -- legally blocked from being out front about it.

And for the last 40 years, that hasn't mattered too much because what's happened is that profits have kept up year after year, and the number of smokers has been still relatively high. But now they're facing a real problem. They really may be attacked not only in this country, but their worldwide sales would be threatened if they started losing suits one after another, and if the Justice Department indicts them, and if, and if, and if.

So they need to get out from under this denial phase and get into a point where they can negotiate directly with members of Congress, with lawyers, with the public at large. They must make a deal with the public at large about how we're going to handle cigarettes in society.

And the first thing they have to do is come clean. And so that's what's happened with Liggett and now it's beginning to happen with the other companies.

MOSS-COANE: The Liggett settlement included using 25 percent of pre-tax income over the next 25 years to pay for public service announcements. And I assume warnings, even more warnings about cigarette smoking. Is there more that they agreed to? And did they agree to use the word "addictive"?

HILTS: Yes, they agreed to a lot more. Probably the most important thing they agreed to was to turn over all their files, with all these papers which shows what they've known over the years -- that they knew it was addictive, that they knew it was harmful, that they were -- and this was a really incredible admission -- that they did directly target children and intended to, as young as 12, 13, 14 years old.

These kind of admissions they made, and they said they will turn over their papers and they will testify. All their executives will go into court and testify against the other companies.

So that's really significant turnaround. Of course, it doesn't cost them much financially to do this, but it's a big thing for the plaintiffs to have these people in court fighting against the other tobacco executives.

I think that's probably the single greatest reason why the executives from RJR and Phillip Morris are now themselves negotiating because it's going to be hard for them to go into court and argue against Liggett.

MOSS-COANE: Well, with all these negotiations going on, and with more and more documents coming to light, do the tobacco companies as -- and I guess I'm thinking of the big ones -- do they still maintain that there's no particular health risk associated with smoking? Do they still hold to that?

HILTS: Well, this is kind of a funny question.

In court, when you asked them, and there were depositions a few days ago, in Florida, the head of RJR, Schindler (ph), was asked these questions, and he said, as they have said all along, no, I don't believe it's harmful, no, I don't believe it's addictive. This is what he's saying in court under oath.

On the other hand, privately and at the table of these negotiations, they really have a very different feel about what they say. They say, well, yeah, you know, there is a problem. We know. We're going to admit that, and so on. But they can't do it legally in a formal setting.

So because the negotiations are going on, you have this kind of -- two things going at the same time. Eventually, it will be resolved -- presumably when negotiations are over they will be able to finally admit it -- but legally if they admit it, it gets them in trouble.

MOSS-COANE: How -- I'm wondering, though, because these are people who are testifying under oath, how they even say that, and whether they come down to saying things like, well, there's no actual proof -- or there -- I assume that there ...

HILTS: That's what they say.

MOSS-COANE: I assume there are studies. I mean, you can find a study to prove just about anything or not prove just about anything. How do they position that in court?

HILTS: They, themselves, have a lot of documents showing what cigarettes do, and they acknowledge that their own scientists have demonstrated that cigarettes cause various kinds of illness and so on. But they don't want to say "proof." They say, we don't actually have the final proof. They say, well, it's a risk factor.

And I think you have to ask a psychological question here, because they can't legally admit it. Their lawyers tell them, don't admit it. Don't say directly it causes it, 'cause that will get us in trouble.

But, so what you have is the heads of the companies saying what they believe they have to say in court, while privately they probably have a different opinion.

In fact, I don't know about Schindler, but I have talked to some other tobacco company executives privately who are quite straight about this. They say, absolutely, of course it causes these problems, of course it causes disease. But they can't do it publicly.

So it's a difficult psychological bind for them, in a sense. They'd like to be able to admit it, but it could hurt their industry if they do, at least now. Maybe two weeks from now when the negotiations are over, they will be able to.

MOSS-COANE: What about the question about -- and again, I guess, looking at proof and what tobacco industry folks are willing to say in court and what they're willing to say when they're negotiating with attorneys general or perhaps members of Congress -- are they willing to make the link between smoking and addiction?

HILTS: Yes. Liggett has done that already, and the companies at the table have said, or suggested, that they will do that also. That they are willing to admit that it is addictive. That they have targeted children. And that it does cause cancer, heart disease, emphysema and so on.

That will be one of the results, probably, of the negotiation if it's successful. And they have offered to do that, assuming they can have what they need. And from their point of view, of course, that is they need to keep their business alive. They need to have some kind of immunity from the number of suits out there and so on.

MOSS-COANE: Philip Hilts is our guest on FRESH AIR today. He's a writer for the New York Times, covers health and science. Last year, came out with a book called "Smokescreen: The Truth Behind the Tobacco Industry Cover-up." And we're talking about the various lawsuits that are making their ways through the court system dealing with tobacco companies.

We'll be back after a short break. This is FRESH AIR.

BREAK

MOSS-COANE: Our guest is New York Times writer Philip Hilts, and we're talking about smoking and the tobacco industry.

You know, when you think about the anti-smoking education campaign in the last couple of decades in this country -- several surgeon generals, including C. Everett Koop (ph) coming out very strongly against tobacco -- and then you look at the numbers of teenagers, the increasing numbers of teenagers that are smoking, is there a danger of making smoking so forbidden that teenagers will do it because it's their way of rebelling in those adolescent years, that way of sort of defining themselves against the culture?

HILTS: Yes, I think that's what's happened so far, and the ads, the PSAs, the education campaign so far hasn't dented that. The fact is that the teenage smoking is going back up.

MOSS-COANE: Yeah.

HILTS: That's a good indication that the one image, that is the image of being tough and independent and smoking helps give you an identity, is succeeding. And the other image of death and destruction that will come to you later on is not succeeding.

The only way to deal with that is -- if you have any faith in advertisers, you can assume that there are ways to get to the psychology of teenage smokers, but they haven't been tried yet. And in fact the people who know this best and have outlined this are the tobacco companies themselves in confidential documents. They talk about what would have an effect on teenagers. But they've never been used by the other side.

MOSS-COANE: Well, what do they say? What do they -- please.

HILTS: What they say is, for example, at the bottom of the desire to smoke is insecurity. The teenagers who start smoking are less secure than the average teenager, and they're more worried about themselves, and they need this badge more than anyone. And what the teenagers fear is that people will see them as more insecure and more needy and more of a problem personality.

So what the companies have done is they've hidden that by saying, if you smoke, it's going to give you a boost. You're going to look more manly or more macho or more free or whatever.

What the companies fear is that the other side will see this and go after the insecurity and say, one teenager to another, you realize when you pick that up everybody knows you're more insecure, that you're really, psychologically, you have more problems than the rest of us, that you're, in fact, weaker-willed than the rest of us.

If you went with that line, you'd have a much bigger effect. Of course, it's not easy to do. You'd have to have professional advertising people doing it. You'd have to package it the right way and have enough dollars to get it across, so that it's a competing message.

But that's the one thing that has not been tried, and the thing that the companies, in their documents, say they fear.

MOSS-COANE: We've been talking about some of the legal rulings and tobacco in the last month or so. But I wonder whether there is now pressure on politicians to do something more in Congress.

And I know from the last election, I think there was some $6.8 million in soft money that went to the '96 election, and this is from the Center for Responsive Politics. About 85 percent of that went to the Republican Party for their party organizations and the get out the vote and all the things that soft money can do.

But I wonder, as pressure is exerted more from the public and more information comes out about what tobacco companies know about tobacco products, whether that's really going to change what happens in Congress?

HILTS: Yes, the landscape is completely different than it was. Over the last 40 years, what you had is the tobacco lobbies had high presence in Congress. They were there with the money when the people needed it. And then, when the votes came, the votes were always private. They were always small. They were never noticed. The issue was never out there in a big way.

So it was quite easy for the people to -- the people in Congress, the senators and representatives -- to go along with tobacco, take the money, because it was never a big deal in the district. It meant nothing.

Now, the situation is just turned around. The issue is big, and getting bigger. It is going to be a big, bitter fight when it gets to Congress. And the Representatives are no longer going to be able to do anything quietly. If they take the money, they're going to be marked for it, and then they're going to have to argue for it.

So, it's a very different situation, and you can see the politicians -- one by one -- turning around on it. And a number of them recently have said, OK, no more tobacco money for me.

These are the more liberal ones. There's still a large number of congressmen taking a large amount of money, but the situation is quite different now.

And it will end up in Congress. There's almost no way around that. After these negotiations, if there is some kind of settlement worked out, it doesn't automatically happen. You have to take it to some body to ratify, some way society itself is putting the stamp on the deal.

MOSS-COANE: And what goes back to Congress is what? What's under the jurisdiction of the FDA and the FTC and other government organizations?

HILTS: Various things. The single most important item would be, can we prevent citizens of the United States from suing the companies? You have to pass a law that says, you may not sue the companies. And whether that's constitutional or unconstitutional, Congress has to pass a law saying that.

And that's what the companies want. They want immunity from prosecution, immunity from suits, immunity from suits of the states, immunity from the Justice Department itself. And Congress is the only one that can do that.

MOSS-COANE: Well, Philip Hilts, thank you very much for joining us today on FRESH AIR.

HILTS: Thank you.

MOSS-COANE: Philip Hilts writes about health and science for the New York Times and is the author of "Smokescreen: The Truth Behind the Tobacco Industry Cover-up."

I'm Marty Moss-Coane and this is FRESH AIR.

Dateline: Marty Moss-Coane, Philadelphia
Guest: Philip Hilts
High: Journalist Philip Hilts, long-time correspondent on health and science policy for The New York Times, discusses recent developments in the tobacco industry: the federal court ruling allowing the FDA to label tobacco a drug and the historic admission by the Liggett Company that cigarettes are a health hazard and addictive. Hilts broke the now-famous story of the Brown and Williamson tobacco industry papers and is the author of "Smoke Screen: The Truth Behind the Tobacco Industry Cover-Up.
Spec: Cigarettes; Tobacco Industry; Lawsuits; Courts; Litigation; Regulation.
Copy: Content and programming copyright 1997 Cable News Network, Inc. ALL RIGHTS RESERVED. Prepared by Federal Document Clearing House, Inc. No license is granted to the user of this material other than for research. User may not reproduce or redistribute the material except for user's personal or internal use and, in such case, only one copy may be printed, nor shall user use any material for commercial purposes or in any fashion that may infringe upon Cable News Network, Inc.'s copyright or other proprietary rights or interests in the material; provided, however, that members of the news media may redistribute limited portions (less than 250 words) of this material without a specific license from CNN so long as they provide conspicuous attribution to CNN as the originator and copyright holder of such material. This is not a legal transcript for purposes of litigation.
End-Story: Tobacco Industry Under Fire

Show: FRESH AIR
Date: APRIL 30, 1997
Time: 12:00
Tran: 043002NP.217
Type: FEATURE
Head: Dr. "ER"
Sect: Entertainment; Domestic
Time: 12:30

MARTY MOSS-COANE, HOST: This is FRESH AIR. I'm Marty Moss-Coane.

Joe Sachs wears two hats. On the weekends, he's an attending physician at the emergency room at Northridge Hospital Medical Center in Los Angeles. On weekdays, he's poring over scripts for the TV series "ER," making sure that all the instruments and procedures and language and sounds are true to life, and would take place in a real ER.

Even though Joe Sachs got his job as medical-technical adviser for ER through a chance meeting, he studied both medicine and film making in college, thinking he would do training films for medical staff. In his spare time, he's a flight physician for Air Rescue International.

Before we talk with Joe Sachs about bringing reality to a fictional series, let's listen to a scene from last week's show -- a seriously ill child has been brought into the emergency room by his mother.

(BEGIN AUDIO CLIP OF "ER")

JULIANA MARGULIES, ACTRESS, "CAROL HATHAWAY": I've got a sick kid here.

GEORGE CLOONEY, ACTOR, "DR. DOUG ROSS": Yeah.

ACTRESS, "MOTHER": He was asleep in his crib. I couldn't wake him up.

DR. ROSS: How long was he down?

MOTHER: Ten minutes.

NURSE HATHAWAY: (unintelligible) IV, (unintelligible) down the tube.

DR. ROSS: All right.

MOTHER: (Unintelligible) plastic in his heart. They put a Blaylock (ph) something last month. He was doing fine.

NURSE HATHAWAY: What's you name, ma'am?

MOTHER: Andrea Thompson.

DR. ROSS: One, two three.

NURSE HATHAWAY: I'm Carol Hathaway. This is Dr. Ross.

DR. ROSS: Give me an arm bore (ph) and a 22-gauge angiocath (ph). I'll insert an IV.

MOTHER: His surgeon's name was Dr. Lewis. His cardiologist is Ferris. And his pediatrician is Vargas.

DR. ROSS: Hook up a 12 lead and get an echo.

MOTHER: He's on (unintelligible), lasix, and potassium.

DR. ROSS: Chuney, would you escort Mrs. Thompson out of here please.

ACTRESS, "CHUNEY MARQUEZ": Come on, sweetheart.

MOTHER: No, please, I want to stay. Carol?

NURSE HATHAWAY: All right, but you stay back there. We need to work.

DR. ROSS: I need (unintelligible) 100 of saline.

MOTHER: Did he (unintelligible)?

DR. ROSS: He may have.

MOTHER: What's that for?

DR. ROSS: I don't have time to explain everything to you right now.

She shouldn't be in here.

NURSE HATHAWAY: It's her child.

DR. ROSS: Chuney, get this up to lab.

(END AUDIO CLIP)

MOSS-COANE: I asked Joe Sachs how he choreographs a scene.

JOE SACHS, EMERGENCY ROOM PHYSICIAN AND CONSULTANT TO TELEVISION SHOW "ER": The first thing that has to happen, of course, is that we have to get all the supplies that we're going to need, so the prop department may get a list of 200 props that we have to obtain. Some we may have, some we may have to special order or get from manufacturers.

The next thing that I need to do is meet with the director, and just to go over the medical correctness of the scene, where the principal characters need to be standing to doing certain procedures. And once the director and I are on the same page, I then have to fill in all of the detail and all of the activity that goes on in the room.

And that takes about one hour for every 40 seconds that you see on the air, the amount of pre-production work to choreograph the movement.

In each of the two rooms, there are eight people, approximately, working on the patient. There's all of our regulars, and then there are background artists, some of whom are real nurses who lend additional medical realism to the scene.

So, I'm choreographing all the movement, all the passing of instruments. So anytime you're seeing Dr. Ross examining the kid, in front of his face, they're throwing up and setting IVs, and behind him somebody's running with an X-ray cassette to put under the child to take an X-ray, so all of that activity, all that crazy chaos that you see in our trauma and critical care scenes, is choreographed to the very exact move. And everything is cued to the dialogue.

Once I've choreographed what each person is doing in the room, it kind of looks like a conductor's score. And then each person gets an individual miniaturized script with all of their technical notes on the scene. So, Dr. Ross knows when he says this line, he gets the scalpel from Hathaway. And when he says this line, the chest tube is passed from Marquez and he puts it in.

And this really helps the actors, 'cause they're not really doctors. So they know exactly what they're doing every moment, every beat of the scene.

MOSS-COANE: Well, I'm curious how much of a medical education you've given the actors and how much you demonstrate the correct way of passing a scalpel from one person to the other? Or the correct way of leaning over a baby's body, if you're doing some critical form of surgery?

SACHS: It has to be done really, really fast, because we do a lot of work. Our scripts are 80 pages long, which is about twice as long as your average one-hour television script, because our pace is so fast. We have so much work to do in a day, that I can't waste a lot of time rehearsing and instructing people.

So everybody gets about two minutes with me before we get to the scene, and then we rehearse the scene maybe two or three times before we start shooting. So everybody has to learn very quickly.

And often the featured aspects of the procedure don't involve the actual surgery and incisions on the body. The producers and the network, obviously, doesn't want to see that. We don't show a lot of blood and guts.

But what we work on is the correctness of how people are handed and are handling surgical instruments. And, for instance, a scalpel may be passed through the frame. They'll use it. And when it comes back up to be passed back, it may be bloody. And that gives the impression that a procedure is done, where you're not going to actually see the skin splitting open on a patient.

MOSS-COANE: What about being able to pronounce medical terms, not just correctly, but meaningfully?

SACHS: I have to correct and very often, a day or two before we get to a scene, I'll know what are the tough words that someone's going to say, and I'll just kind of go over them so they don't learn them incorrectly.

We had a guest star on an upcoming show who has about a 60-second monologue of the most complex, complicated medical terms that he has to rattle off. And for him, I made a tape, I made an audio tape, and he studied that for two or three days, and he came in and just nailed it.

MOSS-COANE: Well, since we're on the radio and I have a, you know, a partial feeling for sound, how much are just the sounds of an ER or even maybe the sounds of a physician putting their hands inside someone's chest cavity, how important is that, do you think, in creating an atmosphere of the ER?

SACHS: Right. Very important. And after a show is edited, I'm very intimately involved in the sound mix for the medical sound effects, and the additional background dialogue. The show is filmed with no sound except for the voices of the people who are talking. And when you look at a rough cut of ER, it feels very empty, because all you hear is the dialogue.

And then we have a fabulous post-production department who goes to work at creating a 48-track sound mix that includes all of the background activity of visitors talking, people talking, nurses talking, all the beeps and the boops of the medical equipment, all of the special sound effects, distant ambulances wailing, intercoms. And it just really brings it to life. So sound's a very important part of the show.

MOSS-COANE: Are there certain sounds you've had to make that are really the sounds of an ER or perhaps the sounds of a particular kind of surgery that maybe you don't -- can't find on a CD collection?

SACHS: Oh, yeah. We go to the real hospital and record the real, the real machines and the real, the real monitors. Most of the sound effects that you hear are the real, actual medical noises that you would hear in a hospital, just as all of the medical props that you see are the real pieces of medical equipment that are really used in a hospital.

I sometimes jokingly say that we're better stocked than many community hospitals are. And it's somewhat true. We could do major procedures and resuscitations right there on the sound stage at Warner Brothers.

MOSS-COANE: What have you found is the hardest procedure to try to recreate on ER? I mean, in certain ways, you want to make it as real as possible, but you do have to think about the camera.

SACHS: Well, we tend not to feature the real gore and guts of the procedures that are being done on the patient's body. The frame of the camera stays a little bit above it, so we don't have to detail all of that work. So it's a very easy question to answer, as to what the hardest procedure to do on camera is, and that's putting on surgical gloves.

MOSS-COANE: Really? Now why is that?

SACHS: Yeah. There's nothing harder than that, 'cause that's something that there is no, there is no cheating. There is no hiding. You know, when you take your scalpel or you take your forceps and you dive down below frame, it doesn't matter what you're doing. You know, you could be, you could be fingerpainting down there, and no one would know the difference.

But when you have a nurse holding out gloves and you've got to pop your hand right into it and come up and look like you've done it a million times in your life, and inevitably when we're doing a scene where someone has to glove up, they'll put their hand down and they'll come up with the thumb in the index finger and the pinkie in the middle one, and then there'll be two little bunny rabbit ears sticking up that don't have any fingers in them at all. And we have to cut the camera.

MOSS-COANE: Then back to the practice session ...

SACHS: So putting on -- yes -- putting on gloves is a really difficult skill and few people understand that.

MOSS-COANE: Well, what are the medical staff doing below the frame. And it's true, in ER most of what is going on is implied, and you don't see, you know, serious surgery right in the camera. But right below the camera, of course, their hands are out of the camera's eye. Are they doing anything? Are they just...

SACHS: Oh, sure. They're doing -- they're -- I teach them the proper moves that they would be doing because we see their forearm and we see their upper arm, and it has to look like they're sewing or pushing or sliding a tube in. So the upper body moves are all correct. The detail of exactly what they're doing with their fingers and at the end of the surgical instruments is not seen.

MOSS-COANE: Joe Sachs is an emergency room physician and medical-technical adviser for the TV series ER. We'll talk more after a short break. This is FRESH AIR.

BREAK

MOSS-COANE: Joe Sachs is a medical-technical adviser to the TV program ER. He's also an emergency room physician.

Let me ask you about your own decision to be an emergency room physician. What was it that made you want to specialize in that?

SACHS: Well, I love it.

MOSS-COANE: It's that simple.

SACHS: I love working in emergency departments. Yeah, it's -- there's a couple of reasons why. I think if you ask anyone, you know, if you asked the first violinist in the New York Philharmonic, why do you play the violin, you know, why are you doing that, there's a love for what you do. And I really love working in an emergency department.

There's two aspects of it. One is the cognitive or intellectual aspect. People come in off the street with a problem, and you really have to use all of your problem-solving skills to come up with a diagnosis. And I enjoy that part of it, to be on the front line.

The other part of it is the interpersonal part of the fact that strangers are coming in and you have to walk into a room and develop an instant rapport with them, put them at ease. They're nervous. They have a perceived emergency. They're afraid. The family's there. They're concerned.

And there's really -- there's really a very magical moment where you can go into the room, kind of break through all that, relax people, put them at ease, make them laugh. And that, for me, is very rewarding. So there's the two aspects of that that I, that I really enjoy.

And then the third aspect is that emergency medicine, unlike some of the other specialties, gives you a lot of flexibility in terms of pursuing other interests. You work shifts in the emergency department, so your schedule is known in advance. You don't have to have a beeper. You're not called back to the hospital. You're not on call. So, many emergency physicians have and pursue other interests.

And for me, had I not been in the specialty of emergency medicine, I wouldn't be able to devote as much time as I can to the show and still keep my hand in clinical medicine.

MOSS-COANE: When you're working in the real ER, the real emergency room, do you sometimes say to yourself, oh, OK, I've got to remember this, and perhaps incorporate it on the show "ER."

SACHS: Absolutely. In fact, most of our stories come from real emergency department experiences with real patients. We change them and we modify them to protect the innocent, and no one's story is ever told verbatim. But certainly, interesting situations, conflicts, dilemmas, hilarious moments, I do make notes of, and sometimes they'll end up in a distorted form on the show.

But I think it's just like any writer, you have life experiences and when something happens to you...

MOSS-COANE: You're gonna use 'em.

SACHS: ... you decide to use it.

MOSS-COANE: Last year, you wrote one of the shows, "A Shift in the Night," and this was about an all-nighter that Dr. Green pulled in the emergency room. Was that based on a night of yours?

SACHS: It was an amalgam of several nights. There are some nights where you are inundated and overwhelmed by patients and by the health care system and no matter what you do trying to take a step forward, you get pushed back several steps. And it's really frustrating.

You try and you try to do the right thing, and perhaps somebody's managed care organization or HMO doesn't want the patient admitted to the hospital, so you have to kind of do battle with that.

You want to admit patients to the hospital, but there are no beds. You want to take care of people, but you're just overwhelmed, and you're feeling bad 'cause people are waiting a long time and they're getting angry.

And sometimes you just wish you could wave a magic wand and take care of everyone without all the red tape of the system.

And that's kind of what the episode was about. And it was the basis of -- it was based on two things. One of which was the day of the big earthquake in southern California. The Northridge earthquake had its epicenter at the hospital where I work.

MOSS-COANE: Wow.

SACHS: So instead of seeing 100 or 150 patients a day, we saw 500 patients that day. The electricity was out. The backup power was on. And we saw 500 patients with more efficiency and with shorter waiting times than we normally do because there were no charts, there was no registration, we were set up outside to do virtually all wound care, including suturing in the parking lot. And to get inside, you needed to be really sick or need an X-ray.

So I kind of had an epiphany when I was working there on the day of the earthquake and putting a cast on somebody's leg, and I looked at their little slip at what time they had signed in outside in the parking lot. And in less than an hour, they had been seen, been examined, had their X-ray taken, been casted, and had their prescription for pain medicine, which is pretty much unheard of on a normal day. You can often wait an hour just to make your chart and have your personal data entered into the computer.

So this episode was about cutting through all the red tape, and Dr. Green did a heroic thing, which is when the emergency department was gridlocked, when nothing was going right, he went out to the waiting room with a few doctors and a few nurses, and just saw and took care of as many people as he could right out there in the waiting room.

MOSS-COANE: How'd you get this job?

SACHS: It was pure chance. It was pure chance.

I actually came on the show halfway through the first season, and my entree to the show was a phone call to the hospital where I work that came well before the show was on the air.

One of the writer-producers, his name is Paul Manning (ph), was doing his research, just talking to real emergency physicians, well before the show was on the air, and he happened to call the hospital where I work, and the person he talked to put him in touch with me. So we got to talking, and I told him a little bit about my background.

At that time, Dr. Lance Gentile (ph), who's still on the writing staff, was with the show and was trying to cover the set at the same time that he was attending writing meetings, and that proved to be impossible.

So my initial role and responsibility was that actors and writers would come to the real ER and kind of hang out with me just to get a feel for how things work and the vibe and the lingo and the interactions that go on.

And then halfway through the first season, Lance was just overwhelmed between writing and trying to cover the set, and it became clear that they needed someone like me on the set all the time.

MOSS-COANE: Have you ever appeared in one of the scenes, in the background?

SACHS: Yeah, I actually had a speaking part.

MOSS-COANE: Did you really? What was that part?

SACHS: I've been on the air about three times. There was a show called "Motherhood" in the first season that was written by Lydia Woodward (ph), one of our executive producers, and directed by Quentin Tarantino (ph). And in that episode, there was a patient who had a cardiac and respiratory arrest while eating at an all-you-can-eat buffet, and I was the paramedic who brought him in. So I came running down the hall, giving the bullet, as we say, explaining exactly what was wrong with him until we transferred him on the bed in the trauma room.

And this particular patient had aspirated or inhaled his partial denture plate, and Dr. Lewis had to go fishing for that and pull out a partial plate of dentures from his windpipe.

MOSS-COANE: Is that a thrill for you? To play somebody (unintelligible)?

SACHS: It was all right. There was a tremendous amount of ribbing from the actors and the crew, because normally I'm in a position where I'm always going in and correcting them and giving them advice. And I'm sure there are times when they resent that. So, on the first take, when I perhaps didn't do my delivery as quickly or as sparkling as the director wanted it, Eric Lasalle (ph) was all over me, giving me a hard time, trying to, trying to get me to screw up.

But we did two takes of the scene coming down the hall. They printed the second one, and that was it. So I was proud of my performance.

MOSS-COANE: Well, you have a show coming up in May, one that you wrote, called "Make A Wish." Is there anything you can tell us about it?

SACHS: Well, I wrote the story and Lydia Woodward wrote the teleplay, and it is the second-to-last show of the year. And for those of you who are following the show and watch the show, they know that Peter Benton's girlfriend Carla is pregnant, and this is the show where the baby's born. So a great deal of the show focuses on that.

MOSS-COANE: Well, Joe Sachs, thank you very much for joining us today on FRESH AIR.

SACHS: Thank you for having me.

MOSS-COANE: Joe Sachs is an emergency room physician, and a medical-technical adviser for the TV series ER.

THEME MUSIC FROM "ER"

Dateline: Marty Moss-Coane, Philadelphia
Guest:
High: Host Marty Moss-Coane talks with Dr. Joe Sachs, medical consultant to the hit television series "ER." He discusses how he works with the show and his work in the real ER.
Spec: Emergency Rooms; Hospitals; Television; "ER"; Health and Medicine
Copy: Content and programming copyright (c) 1997 National Public Radio, Inc. All rights reserved. Transcribed by Federal Document Clearing House, Inc. under license from National Public Radio, Inc. Formatting copyright (c) 1997 Federal Document Clearing House, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to National Public Radio, Inc. This transcript may not be reproduced in whole or in part without prior written permission. For further information please contact NPR's Business Affairs at (202) 414-2954
End-Story: Dr. "ER"
Show: FRESH AIR
Date: APRIL 30, 1997
Time: 12:00
Tran: 043003NP.217
Type: FEATURE
Head: "Ellen"
Sect: Entertainment; Domestic
Time: 12:50

MARTY MOSS-COANE, HOST: Tonight on "Ellen," after months of teasing and talking and promoting and waiting, the character played by Ellen DeGeneres comes out as a Lesbian -- something the actress herself has already done this month in Time magazine and in a TV interview with Diane Sawyer.

TV critic David Bianculli has seen the one-hour episode and was pleasantly surprised.

DAVID BIANCULLI, TV CRITIC, NEW YORK DAILY NEWS: There's been so much hype about Ellen coming to terms with her sexual orientation -- Ellen the actress, as well as Ellen the sitcom character -- it's hard to imagine this week's show living up to it. But it does.

It's even savvy enough to start out by making fun of the whole thing -- including the long delay between the original announcement and this one-hour special -- in the scene where Ellen is getting dressed in the next room while her friends wait impatiently.

(BEGIN AUDIO CLIP OF "ELLEN")

FIRST ACTRESS: Ellen, you're gonna be late for your dinner date with your old college friend Richard.

FIRST ACTOR: I can't believe it.

SECOND ACTRESS: What, that Ellen has a date?

FIRST ACTOR: No, that she went to college.

LAUGHTER

It's like she's been in there forever.

SECOND ACTRESS: Ellen, are you coming out or not?

LAUGHTER

SECOND ACTOR: Yeah, Ellen, quit jerking us around and come out already?

ELLEN DEGEGERES, ACTRESS, "ELLEN": What is the big deal? I've got a whole hour?

LAUGHTER

(END AUDIO CLIP)

BIANCULLI: The plot of this expanded episode is pretty straightforward. Instead of getting involved with her old friend Richard, Ellen is attracted to his friend Susan, who happens to be gay. Susan, played by guest star Laura Dern, thinks Ellen is gay, too.

Ellen denied it, but then thinks about it, dreams about it, and even talks to her therapist about it.

The therapist is played by Oprah Winfrey, and the mixture of honesty and humor in their exchanges is one reason this episode works so well.

All Ellen wants, she tells her therapist, is a normal life, someone to love, and someone who loves her.

(BEGIN AUDIO CLIP OF "ELLEN")

ELLEN: I just want to be happy.

OPRAH WINFREY, "THERAPIST": And you think you can't have these things with a woman?

ELLEN: Well, society has a pretty big problem with it, you know? I mean there are a lot of people out there who think people like me are sick. Oh, God why did I ever rent "Personal Best?"

LAUGHTER

THERAPIST: I can't blame this on the media, Ellen.

LAUGHTER

It isn't going to be easy. No one has it easy.

ELLEN: You don't understand. Do you think I want to be discriminated against? Do you think that I want people calling me names to my face?

THERAPIST: Hmm. To have people commit hate crimes against you just because you're not like them?

ELLEN: Thank you.

LAUGHTER

THERAPIST: To have to use separate bathrooms and separate water fountains and sit in the back of the bus?

ELLEN: Oh, man. We have to use separate water fountains?

LAUGHTER

(END AUDIO CLIP)

BIANCULLI: There's a dream sequence in this episode that makes room for everyone from Billy Bob Thornton to Demi Moore, and from Gina Gershon to K.D. Lang. It's a riot.

And so is the entire hour, which manages to make its point without being exploitive or overt. Ellen plants only one romantic kiss in the entire episode, and it's during a fantasy sequence with a guy.

The only problem with the show is that the studio audience, like everyone else in America, knows what to expect. Imagine how much more effective this Ellen episode could have been if ABC had just sprung it on viewers. But for the network, telling people in advance was the price to pay for a shot at drawing a much larger audience.

Will Ellen get a lot of viewers this week? Sure. But what matters is what happens in the weeks after that -- and that's true for the show's content as well.

Yes, Ellen is the first name-in-the-title sitcom character to come out as gay -- unless you count "Love, Sidney," the early '80s Tony Randall sitcom based on his "Sidney Shore" (ph) telemovie. The disclaimer there, though, is that Sidney was identified as gay in the movie, but never was in the series. So in that sense, "Ellen" the sitcom really is making history.

What will matter more in the long run, though, is not how it makes history, but how it makes comedy. And since this week's show is the funniest episode of Ellen I've ever seen -- and I've been watching since it premiered three years ago, under the title "These Friends of Mine" -- it's definitely starting off in the right direction.

MOSS-COANE: David Bianculli is TV critic for the New York Daily News.

For Terry Gross, I'm Marty Moss-Coane.

Dateline: Marty Moss-Coane, Philadelphia
Guest:
High: David Bianculli, TV critic for the New York Daily News, previews the "Ellen" episode that's been talked about for months: the one in which she comes out as a lesbian.
Spec: Homosexuality; Television; "Ellen"; Ellen DeGeneres; Culture
Copy: Content and programming copyright (c) 1997 National Public Radio, Inc. All rights reserved. Transcribed by Federal Document Clearing House, Inc. under license from National Public Radio, Inc. Formatting copyright (c) 1997 Federal Document Clearing House, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to National Public Radio, Inc. This transcript may not be reproduced in whole or in part without prior written permission. For further information please contact NPR's Business Affairs at (202) 414-2954
End-Story: "Ellen"
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.