Pediatric Annals

EDITORIAL 

A Pediatrician's View: Is the Media Friend or Foe to Our Children?

William A Altemeier, III, MD

Abstract

Managed care is an experiment. The United States is the only country using managed care to control medical costs, and although we've had managed care for more than four decades, it has been limited to a handful of companies serving healthy populations in geographical pockets until the last few years. Managed care is growing like wildfire and will become the dominant system in medicine very soon. Will this experiment work? Only time will tell. We know managed care changes things, and we can make some guesses about good and bad impacts. One of the positive effects of managed care is that it promotes prevention. Fee for services rewards physicians for being very busy seeing patients. Managed care rewards physicians for keeping patients from getting seriously ill. Pediatricians have always been at the forefront in prevention, and we will not change as much as other specialties, but the importance of prevention will rise in all of medicine under managed care.

So what does this have to do with this month's issue on Children, Adolescents, and the Media? First, let's step back to look at the big picture and see where the priorities are for prevention. The latest Morbidity and Mortality Weekly Report (MMWR) summarized in Pediatrics provides some insight into what problems need to be reduced.1 The fourth most common cause of death for all ages in the United States is still automotive and other accidents, the fifth is infections with acquired immunodeficiency syndrome (AIDS) becoming predominant, the seventh is suicide, and the ninth is homicide. These last two accounted for 2.5% of all deaths in the provisional 1993 data.

How do accidents, AIDS, suicide, and homicide relate to the media, music, and video games presented in this issue? There are two ways. First, the way sex and violence permeate these entertainments and the information we have about how this correlates with attitudes on violence and sex are reviewed in this issue. Thus, entertainment may change the acceptance of, or worse, increase violent tendencies and high-risk sexual behaviors that promote AIDS, suicide, and homicide. Second, the media may serve as a tool to prevent high-risk behaviors that lead to accidents, sexually transmitted diseases, and homicide or suicide.

What can the pediatrician do to offset adverse effects of entertainment on our children? This issue makes the convincing point that we should start by educating ourselves through watching and participating in the most popular entertainments experienced by our children and patients. We also can encourage parents to do the same and while doing so, add their own contrasting viewpoints. Can you keep television out of the home? You can for a while but the best way to make a chocolate addict is to forbid chocolate, and our children must learn to live in the culture in which they will spend the rest of their lives. However, moderating and exerting some control on our children's entertainment seems wise. Another thing parents should do, with our guidance and encouragement, is to become advocates for media reform. Every parent should know where to write when they find something in the media that they feel threatens their child's development. The addresses of broadcast networks found in Table 1 of "Addressing Television Sexuality With Adolescents" should be available in every pediatric office. The media will listen because this hits them in the pocketbook: advertisers are not interested in supporting shows the public find unpalatable.

Can the media be a positive force for prevention? "Television Advertising for Health" and the review of educational computer programs in "Video Game Controversies" suggests that it can, and managed care probably will attempt…

Managed care is an experiment. The United States is the only country using managed care to control medical costs, and although we've had managed care for more than four decades, it has been limited to a handful of companies serving healthy populations in geographical pockets until the last few years. Managed care is growing like wildfire and will become the dominant system in medicine very soon. Will this experiment work? Only time will tell. We know managed care changes things, and we can make some guesses about good and bad impacts. One of the positive effects of managed care is that it promotes prevention. Fee for services rewards physicians for being very busy seeing patients. Managed care rewards physicians for keeping patients from getting seriously ill. Pediatricians have always been at the forefront in prevention, and we will not change as much as other specialties, but the importance of prevention will rise in all of medicine under managed care.

So what does this have to do with this month's issue on Children, Adolescents, and the Media? First, let's step back to look at the big picture and see where the priorities are for prevention. The latest Morbidity and Mortality Weekly Report (MMWR) summarized in Pediatrics provides some insight into what problems need to be reduced.1 The fourth most common cause of death for all ages in the United States is still automotive and other accidents, the fifth is infections with acquired immunodeficiency syndrome (AIDS) becoming predominant, the seventh is suicide, and the ninth is homicide. These last two accounted for 2.5% of all deaths in the provisional 1993 data.

How do accidents, AIDS, suicide, and homicide relate to the media, music, and video games presented in this issue? There are two ways. First, the way sex and violence permeate these entertainments and the information we have about how this correlates with attitudes on violence and sex are reviewed in this issue. Thus, entertainment may change the acceptance of, or worse, increase violent tendencies and high-risk sexual behaviors that promote AIDS, suicide, and homicide. Second, the media may serve as a tool to prevent high-risk behaviors that lead to accidents, sexually transmitted diseases, and homicide or suicide.

What can the pediatrician do to offset adverse effects of entertainment on our children? This issue makes the convincing point that we should start by educating ourselves through watching and participating in the most popular entertainments experienced by our children and patients. We also can encourage parents to do the same and while doing so, add their own contrasting viewpoints. Can you keep television out of the home? You can for a while but the best way to make a chocolate addict is to forbid chocolate, and our children must learn to live in the culture in which they will spend the rest of their lives. However, moderating and exerting some control on our children's entertainment seems wise. Another thing parents should do, with our guidance and encouragement, is to become advocates for media reform. Every parent should know where to write when they find something in the media that they feel threatens their child's development. The addresses of broadcast networks found in Table 1 of "Addressing Television Sexuality With Adolescents" should be available in every pediatric office. The media will listen because this hits them in the pocketbook: advertisers are not interested in supporting shows the public find unpalatable.

Can the media be a positive force for prevention? "Television Advertising for Health" and the review of educational computer programs in "Video Game Controversies" suggests that it can, and managed care probably will attempt to promote health by means of the media. Marketing that it isn't "cool" to die from accidents, AIDS, suicide, and homicide makes sense and is already done to some degree. Is the media powerful enough to change behavior? It is: the Table summarizes data from a MMWR that studied brands of cigarettes used by consumer groups.2 You can probably guess outcomes. These large differences between adolescents (12 to 18 years) and adults, and between black and white adolescents suggest that advertising can be a powerful influence on teen behavior. One striking observation made by the MMWR was that Camels increased from 9.2 to 144 percent of the white adolescent market share between 1989 and 1993. This 56% increase coincided with a change in Camel advertising from $27 million to $43 million. How many of you also had my experience from the TV antismoking campaign directed at young children in the 1970s? The destruction of my cigars at the hands of my children (with the support of my wife) helped me stop smoking.

You probably want to talk about the disadvantages or adverse effects of managed care. The most worrisome question is where will this "experiment" take us and how will it end? The way I see it, medicine has been a protected industry for most of the past 25 years. Third-party payers, including Medicaid and Medicare, have more or less reimbursed our charges. Physicians (primary care less so than subspecialists) and hospitals flourished and expanded until their proportion of the gross national product exceeded what employers, the government, and the public were willing to pay. Managed care in effect takes us out of this protected environment and thrusts medicine into market forces whereby price is determined by supply and demand (remember your college courses in economics?). The price in managed care is defined as the HMO bid per employee per month.

Table

TABLEPercentage of Cigarette Brands Usually Purchased by Current Smokers

TABLE

Percentage of Cigarette Brands Usually Purchased by Current Smokers

So here we are with a presumed surplus of subspecialist physicians and hospital beds (the Supply) compared to what is needed in HMOs (the Demand). The question is, how far and how fast will HMO bids fall? In areas furthest along in managed care like California, bids are starting to plummet. When will it stop? When supply equilibrates with demand (a frightening thought) or when bids drop to the point wherby the public steps in and pulls health back from market forces because health is too important. Future issues will include more about how we got to this state and what options we have. Your counter-views are welcome!

REFERENCES

1. Wegman ME. Annual Summary of Vital Statistics. Pediatrics. 1993;94:792-803.

2. Centers for Disease Control and Prevention. Changes in the cigarette hrand preferences of adolescent smokers- United States. 1989-1993. MMVITR. 1994:43:577581.

TABLE

Percentage of Cigarette Brands Usually Purchased by Current Smokers

10.3928/0090-4481-19950201-04

Sign up to receive

Journal E-contents