Artistic license allows you to fudge the facts for the sake of your art. A medical license allows you to practice medicine. What happens when they meet?
You get movies in which medicine plays a starring role or serves as a plot device, sometimes with great accuracy, other times with only accidental resemblance to what really goes on in the hospital.
Medicine is understandably an intriguing subject for filmmakers.
A good medical mystery can rival any criminal whodunit for excitement and surprise twists. A terminal illness is the ultimate tragedy; a cure is among the most uplifting of happy endings.
The Academy Awards over the years have rewarded medical themes: Movies such as "Rain Man" (autism) and "One Flew Over the Cuckoo's Nest" (inside a mental hospital) have won best picture Oscars.
Daniel Day-Lewis won in 1989 for playing a cerebral palsy victim in "My Left Foot"; and Marlee Matlin won in 1986 for her portrayal of a deaf woman in "Children of a Lesser God."
Several recent movies similarly have ventured into the medical world, and so, on the day of the real Academy Awards, we decided to issue our own Oscars to those brave enough to take on this precise and necessarily fastidious field.
We asked real doctors to give us scalpels up or scalpels down on how Hollywood has portrayed their particular specialties. The envelopes, please:
* Most overdue portrayal of a disease: "Philadelphia"
More than a dozen years into the Age of AIDS, "Philadelphia" is the first mainstream Hollywood movie to focus on the disease. And that alone is enough to win it plaudits from those who have dealt with its ravages.
"I thought overall it was a very moving film that will open a lot of people's eyes," says Dr. Joel Gallant, director of the HIV clinic at Johns Hopkins Hospital. "It puts a human face on AIDS."
If pressed, he will quibble with some of the medical details, such as how the film handles the tell-tale Kaposi's sarcoma lesions, a skin cancer common to people with AIDS. Early in the film, Mr. Hanks' character develops lesions on his face -- which he claims alerts his law partners to his disease and leads to his firing -- but then, apparently through chemotherapy, "they miraculously disappear," Dr. Gallant says. "They might improve, but they would not disappear."
Later, an ashen Mr. Hanks is on the witness stand testifying against his former partners. They allege his facial lesions were barely visible; thus they had no idea that he was suffering from AIDS when they fired him. His lawyer requests that he show lesions elsewhere on his body that resemble those previously on his face, and, weakened by the disease, Mr. Hanks slowly, painfully pulls aside his tie, unbuttons his shirt and reveals a chest riddled with lesions, raised and brown, as horrifying as a swarm of leeches.
"That was very realistic," Dr. Gallant says, "but they wouldn't have disappeared from his face at the same time."
Also, the movie is a bit unclear on what actually causes Mr. Hanks' death, Dr. Gallant says. It's probably enough for a mass audience to attribute the death to general "AIDS," which is a bit inaccurate because AIDS is a syndrome, rather than an actual cause of death. Dr. Gallant says what appears to cause the death in the movie is the cytomegalovirus, or CMV, which, among other things, causes vision problems such as those Mr. Hanks' character suffers toward the end of the film. CMV, he says, would also explain why he is hooked up to an intravenous line at home, a prop that plays into a particularly affecting scene in which Mr. Hanks speaks along with a Maria Callas recording of an aria.
* Most imaginative use of transplant surgery: "Blink"
Madeleine Stowe is a musician who has been blind since childhood, when her abusive mother smashed her into a mirror. She regains sight through successful cornea transplant operations, but with a complication: She "sees" things but doesn't organize them into coherent images until later.
This makes her a less-than-perfect witness when a neighbor is murdered by a serial killer whom she "sees" in the hallway.
"There would be some blurring of the images for a while," says Dr. Terrence O'Brien, a Johns Hopkins ophthalmologist who performs corneal transplants. "But there's no delay in the brain processing the image. The optical properties of the eye are very straightforward. A cornea transplant would have nothing to do with images which are processed at the level of the brain."
"You do not get delayed images," agrees Dr. Ronald Smith, president of the American Academy of Ophthalmology. "A cornea is simply a window -- it doesn't capture images and store them."
Dr. Smith, a professor at the University of Southern California medical school, doesn't come down too hard on the movie, though. "They do a good job of the technical part of cornea surgery," he says, referring to the scenes in the movie in which Ms. Stowe's character has transplants first in one eye and then the second one. "It is the most successful transplant surgery in the country. About 50,000 are done in a year, and up to 90 percent of the time, they're successful. So 'Blink' was helpful in bringing the idea of cornea transplantation to the public."* Most idealized view of mental illness: "Mr. Jones"
He jumps from his seat and starts conducting a symphony orchestra. He dances on the street in sheer joy of the moment. He is Richard Gere, who makes manic-depression kind of cute.
It's Hollywood treating mental illness "in its typical, clumsy, oafish Hollywood way," says Dr. Stuart Fischoff, a Los Angeles-based psychologist and sometime scriptwriter.
Dr. Fischoff, who studies how the media portrays mental illness, says Hollywood has a history of either demonizing or glamorizing those who suffer from serious ailments such as schizophrenia and depression. "Mr. Jones" is an example of the latter, following in the wake of last year's "Benny and Joon," which similarly portrays those with mental illness as somehow having a greater insight into the world than the rest of us, he says.
"It's what R. D. Laing said," says Dr. Fischoff, referring to the British psychiatrist who in the 1960s promoted the concept that madness perhaps was not a breakdown but a breakthrough and a liberation. "He thought mental illness was a portal to a higher understanding."
Dr. Fischoff has another problem with "Mr. Jones": Mr. Gere's character and his therapist engage in an affair. Besides being a grievous ethical lapse, the affair "indicates therapists have no sex life beyond their clients," Dr. Fischoff says, noting the numerous recent cases that have brought patient-doctor affairs to the attention of the general public.
And the treatment of this affair reveals a double standard in Hollywood: "If the therapist is female and the patient is male, it's less horrific than if a male doctor seduces a female patient," he says. "A woman is seen as doing it for more noble reasons than a man."
Of course, he adds, Richard Gere has had it both ways: In 1992's "Final Analysis," he plays a psychiatrist who falls in love with his patient's sister.
* Best use of a pharmaceutical as a plot device: "Malice"
This thriller, starring Nicole Kidman and Alec Baldwin, revolves around a medical malpractice case: Ms. Kidman plays a woman who develops ovarian cysts that need to be surgically removed. The surgery goes wrong, she is left infertile and sues for malpractice and -- well, without giving away the truly surprising ending -- wins the case.
No, there's a scam going on here, involving a couple of the characters. It turns out that Ms. Kidman's character was taking a larger-than-recommended dose of a fertility drug, Pergonal, and that's what causes the cysts to form.
And . . . well, we don't want to reveal too much in case you want to rent the video.
"It's definitely a great plot twist," says Dr. Alan DeCherney, chairman of obstetrics and gynecology at Tufts Medical School in Boston and an admitted movie buff. "Pergonal makes you form eggs. If you give too large of a dose, it overstimulates the ovaries to make too many eggs.
"An egg is surrounded by a cyst, and you usually make just one egg a month and the cyst ruptures as part of the monthly process," he says. "But if you make too many eggs, the cysts don't rupture."
Doctors treating infertile women give Pergonal in doses small enough to prevent this. "You manage the dose and go for only two or three eggs," he says.
"You hate to see any product used in a negative way, but it's clear in the movie that she abused the drug," says Gina Cella, spokeswoman for the Massachusetts-based Serono Laboratories, which markets Pergonal. She added that the company was unaware its drug figured into the movie. "I had no idea when I went to it that Pergonal was going to turn up. I just went for entertainment. I dropped my popcorn."
Meaning, don't try this at home!