Health Check: A different kind of screen scare

WHEN MICHAEL Hutchence, the INXS rock star, hanged himself in Australia he triggered a series of actual and attempted suicides by fans, as well as one attempt by his partner, Paula Yates. The copycat suicide is now a well-recognised phenomenon: to link one's death with that of a real or fictional character increases its emotional power.

Last week, doctors reported a doubling of paracetamol overdoses, and an increase of almost a fifth in all self-poisonings, following an episode of the BBC series Casualty in which an RAF pilot facing personal and domestic difficulties was shown collapsing after swallowing 50 paracetamol tablets two days previously. The main problem with a paracetamol overdose, the most commonly used drug for self- poisoning, is that although it kills slowly, the damage done to the liver is irreversible. Without prompt treatment with an antidote, a liver transplant may be the only hope. The effect of the Casualty episode was intriguing.

Professor Keith Hawton of Oxford University, writing in the British Medical Journal, effectively blamed the programme makers for the rash of poisonings. "It is questionable whether methods of self-harm should be portrayed," he wrote.

In a separate survey of the effect of the episode, Dr Susan O'Connor and colleagues of the United Bristol Healthcare Trust found the episode led to increased understanding of the risks of a paracetamol overdose. Their conclusion was that TV soaps were powerful vehicles for conveying medical messages.

What these surveys neatly demonstrate is the variety of messages viewers and readers can take from the same information. As Professor Christopher Bulstrode, one of the researchers, observed: "For ordinary people the message was, `Jeepers, paracetamol is dangerous in large doses and you must get pumped out quick.' But for another group it said, `Let's take it.'"

This problem is not confined to TV soaps. Government announcements are similarly prone to misinterpretation as the contraceptive pill scare of 1996, told elsewhere on this page, illustrates. The former chief medical officer, Sir Kenneth Calman, felt it important that women were alerted to the small increased risk associated with third generation pills but the manner in which the announcement was made triggered a flight from contraception and a surge in abortions.

Early advertising in the drugs and Aids campaign in the 1980s showed a wasted figure slumped against a wall in a dimly lit warehouse. Instead of conveying the dangers of injecting, the ads became a fashion statement marking the birth of heroin chic. The ads were withdrawn.

Professor Hawton says writers and producers of TV soaps must take the potential impact of their product seriously. But as John Collee, the doctor, novelist and scriptwriter writes elsewhere in the BMJ, they do. In most cases, producers go to enormous lengths to ensure programmes are accurate and, as Dr Collee points out, formal guidelines would amount to a kind of medical censorship. If we ban suicide, would we also ban fast driving, violence, unsafe sex and smoking on TV?

The difficulty is that different people will draw different conclusions from the same events. But that is something we have to live with.