What's Up, Doc?

...You could see the change coming in the 1960s transformation of "medical insurance" to "health insurance...

...It may not have been what we really were, but it told us what people wanted us to be—what we could have been and might still be...

...It achieved the status of art form in the eighteenth century, when Voltaire acidly wrote: "Doctors are men who prescribe medicine of which they know little to cure diseases of which they know less in human beings of which they know nothing...

...Kildare replaced by institutional names...

...Early films also showed the dynamic tension between the need to help individual patients and the need to do research to find the cures that could help thousands...

...No Way Out (1950), with Sidney Poitier and Richard Wid-mark, remains one of those most powerful exposes of racism in film...

...Let me tell you something: I am God...

...Despite an activist Federal Trade Commission's success in the 1970s in gaining purview over medicine, doctoring is not a trade...

...Still, doctors' images in movies may have begun to recover: The 1997 As Good As It Gets, whose stars won best actor and best actress Oscars, is highly critical of managed care and insurance companies, but presents—in the professional, gray-haired doctor who treats the asthmatic child—as positive an image of doctoring as any in the Golden Age...

...This era of good feeling is captured in the doctors shown in Norman Rockwell's Saturday Evening Post covers, the Metropolitan Life Insurance Company's pamphlets on "Health Heroes," and a series of prints entitled "Great Moments in Medicine" commissioned in the 1950s by Parke-Davis Pharmaceuticals for display in doctors' offices...

...Hersholt played the doctor who delivered the Dionne quintuplets in The Country Doctor (1936...

...Fewer families had children with birth defects or the residua of polio...

...The birth of the "talkies" coincided with this era of good feeling...

...When the rights to Max Brand's series of stories about Kildare reverted to MGM, Ayres assumed the role and Lionel Barrymore created the character of Dr...

...doctors were portrayed more typically as greedy, arrogant, and villainous—not just as individuals but even in their professional lives...

...It's from those early films that you have pictures in your mind of the old head mirrors, interns reciting the Hippocratic oath, and doctors lighting up a cigarette whenever there's a break in the action...

...Not surprisingly, despite the presence of an occasional villainous doctor in films such as 1942's Kings Row, the image that predominated in the American psyche was that of the earnest Doctor Kildare...

...Hench's discovery of ACTH in 1948 and the development of steroid drugs helped patients with asthma and allergic conditions and especially those with Addison's disease, a deficiency of the adrenal glands that affected John F Kennedy...

...Anesthesia and antisepsis made once-fatal surgeries, like appendectomies and Caesarean sections, routine...

...Starring Joel McCrea and Barbara Stanwyck, this film in the gangster/doctor genre showed ordinary people feeling sorry for doctors who spent years of arduous training working for very low wages...

...The increasing use of these technologies to prolong the life of the terminally ill created the kind of backlash that Sidney Lumet illustrated in his angry 1997 film Critical Care, where unscrupulous doctors keep insured terminally ill patients alive on numerous life supports to run up exorbitant bills...

...Gillespie, the crusty curmudgeon with a heart of gold...

...This tendency was in large part due to a remarkable string of scientific breakthroughs...

...At mid-century, few counties had hospitals, and movies like Meet Dr...

...The grittier films of the 1950s and early 1960s—The Young Doctors (1961) is a typical example—were more ambivalent, though still largely complimentary...

...But much of the criticism fell silent during a period that the historian John Burnham has called the "Golden Age of Medicine," when doctors attained an "admiration for their work that was unprecedented in any age...

...As esteem for doctors diminished, their names began to disappear: Dr...

...This rather subtle shift in terminology signaled the existence of an open-ended right to health care and the idea that health itself could be insured...

...BY PETER E. DANS Myth is central to human existence: History may tell us what we have been, but myths tell us what we could have been and might still be—^as well as what others want us to be...

...In ancient times, doctors were considered to be practitioners of a noble profession and a calling—which is exactly what the Hollywood myth of the Doctor during the Golden Age called upon us doctors to be...

...As acute life-threatening diseases declined, they were replaced by chronic diseases less amenable to miracle drugs...

...Most people familiar with the Kil-dare films remember Lew Ayres in the role...

...Not As A Stranger (1955) touched on quotas for admission of applicants to medical school at a time when Jews, blacks, women, and Catholics were systematically discriminated against...

...Doctors were fortunate to have Jean Hersholt as their other predominant movie image, a man whose personal life was so exemplary that his name graces the Motion Picture Academy's humanitarian award given annually on Oscar night...

...Other movie doctors who leave active practice for research are played by Errol Flynn in The Green Light (1937) and George Brent in Dark Victory (1939...

...Public opinion polls from the 1930s through the 1950s consistently ranked physicians among the most highly admired individuals, comparable to or better than Supreme Court justices...

...And among the most commonly mytholo-gized characters have been doctors— whom Hollywood has sometimes loved and sometimes hated...

...Of course, criticism of doctors is as old as history...

...It set impossible expectations among patients and often led to burnout and disillusionment for the doctors who tried to live up to them...

...The elaborate criteria for "brain death" contrast sharply with the old movie doctor's use of a mirror held up to the person's mouth to see if it became fogged, or the simple checking of pulse and respiration (as Lew Ayres does in the 1938 Young Dr...

...In the days before television, these films also introduced medical advances to the public: In 1940's Dr...

...Enactment of the Hill-Burton Act in 1946, however, subsidized a hospital building boom that radically changed the look and content of American medical care...

...The cutting of payments for physicians to spend time with people in their offices, the over-reliance on technology, and the de-emphasis of medical education and research are also visible...

...Where doctors remain the principals, they are more likely to be arrogant egomaniacs, as in Malice (1993) in which the surgeon played by Alec Baldwin says, "You ask if I have a God complex...

...Spectacular health care advances did continue, particularly in the treatment of once-fatal leukemias and lym-phomas...

...From the 1930s through the 1960s, doctors were almost invariably portrayed as good guys both literally and figuratively...

...however, the first in the series was Paramount's delightfully titled Internes Can't Take Money (1937...

...During the past three decades, as institutions and those who wielded authority came to be perceived more harshly, Peter E. Dans is associate professor of medicine and health policy and management at the Johns Hopkins Medical Institutions...

...The effects were forecast in the prescient and still powerful 1971 film, The Hospital, in which one can see the shortage of skilled nurses and the revolving-door hospital admissions (which one commentator called "strangers caring for strangers") where patients must be processed quickly to satisfy insurance payers...

...The durability of the cliches in early Hollywood films—such as the doctor shouting, "Boil the water," when a woman is about to have a baby—is astonishing...

...Elsewhere, Northern Exposure, ER, and Chicago Hope, where the doctors are ensemble players and romances among the staff seem more important than what's going on in the lives of the patients they serve...

...But the alternative may be worse...

...Fortunately for doctors, the pendulum may be swinging back...

...This was a reaction to the influx of the large sums that transformed medical care from a cottage industry to one in which serious money could be made...

...Health status improved greatly, not just for the affluent, but with the advent of Medicaid and Medicare, for the poor and elderly as well...

...One result was that medical care, after decades of steeply rising costs, is now in the midst of turbulent market-driven cost-cutting under the reigning philosophy of "managed care...

...Kildare's and Christian's names were in the titles of their films, and they were easily transposed to the new medium of television where they were joined by such sympathetic figures as Marcus Welby and Ben Casey...

...The accumulated social concerns about the new technology are reflected in such films as Coma (1978) and Extreme Measures (1996), in which doctors and scientists exploit the unwary for scientific fame or profit...

...The author Oliver Wendell Holmes Sr., a physician at Harvard Medical School, wrote that after excluding wine, opium, and a few other drugs derived from nature, "if the whole materia medica were sunk to the bottom of the sea, it would be all the better for mankind and all the worse for the fishes...

...Later, he was the kindly Doctor Christian, who worked tirelessly for his patients and often received only bartered tomatoes in return...

...Despite the fact that Arrowsmith is a monomaniac who is not considerate to his wife and hardly a paragon, the film was said to have inspired many to choose medicine as a profession...

...Over the last hundred years, the most influential mythmakers have been moviemakers, reinforcing old stereotypes and creating new ones...

...Salk's and Sabin's vaccines liberated parents from fear of polio...

...The introduction of transplantation also made it necessary to define when someone was officially dead in order to harvest viable organs...

...In Arrowsmith (1931), a doctor played by Ronald Colman forsakes his practice in a small South Dakota town to join a research clinic patterned on the Rockefeller Institute...

...Ehrlich's discovery of Salvarsan for syphilis in 1908 was followed by the introduction of sulfa drugs in the 1930s, penicillin in the 1940s, and other antibiotics in the 1950s, which enabled the conquest of the pneumonia, meningitis, strep throat, and ear infections that had claimed the lives of many children or had left them ravaged by rheumatic fever, mastoiditis, or permanent retardation...

...Lost Boundaries (1949), with Mel Ferrer, dealt with discrimination in obtaining residency positions and the phenomenon of "passing for white...

...Critics haven't been lacking within the profession...

...Kildare...

...But most of the new developments after 1960 were what Lewis Thomas called "halfway technologies": cardiopulmonary resuscitation, artificial respiration, kidney dialysis, and long-term intravenous feeding, that saved lives but did not cure the underlying condition...

...House calls, which constituted 40 percent of all patient/physician encounters in 1930 fell to 10 percent in 1950 and to 0.6 percent in 1980...

...People Will Talk (1951) dealt with the attempt to disbar a doctor who practiced holistic medicine...

...During the fourteen films that followed, the exploits of a wonderful ensemble cast served as the visual equivalent of a radio soap opera...

...The ability to transfuse blood, plasma, and blood components saved many who would have died of hemorrhage or blood disorders and enabled the development of coronary-bypass surgery...

...Christian (1939) showed doctors fighting the establishment to get them built...

...The noted physician-writer Lewis Thomas captured the frustration of caring doctors during the 1920s in his reminiscences about accompanying his father on house calls: "What troubled him most all through his professional life was that there were so many people needing help, and so little that he could do for any of them...

...This essay is adapted from his new book Doctors in the Movies: Boil the Water and Just Say Aah (Medi-Ed Press...

...Nor is it, as it is sometimes alleged to be, a utility or a commodity...

...Of course, Hollywood's doctor myth back in the Golden Age was not an unmixed blessing...

...One researcher estimated that physicians appeared in half the eight hundred films made in 1949 and 1950 and that in only twenty-five was a doctor allowed to be a bad character...

...The nineteenth century caricaturists Rowlandson and Cruikshank portrayed physicians as pompous, greedy quacks who hid their ignorance under a veneer of Latin phrases...

...It's from those films that you know all the types: the Kindly Impoverished Country Doctor (who is always pitted against the Specialist with his newfangled technology), the Rich and Mighty Surgeon (who must be taught a lesson in caring for the poor and needy), the Driven Scientist (who is searching for the "Great Cure"), and the Disillusioned Dropout (who is drawn back to the practice of medicine by a woman's illness...

...No longer could the profession's ethos be set by a Hippocrates, a Sir William Osler, or the distinguished institutions that dominated it until the 1950s...

...By contrast, hospitals, which had been avoided as pesthouses for the sick poor, became increasingly important...

...Nonetheless, I find a part of me longing for the old-fashioned, more uplifting portrayals of doctors...

...Otherwise healthy women who suffered from anemia could be helped by iron and vitamin B12...

...The production of antitoxins, antisera, and vaccines (a consuming passion for dedicated researchers in 1930s movies) led to control of such major killers as diphtheria, rabies, and tetanus...

...The films from the later 1960s and on to the 1990s were made during medicine's fall from grace, which was due in large part to its successes...

...Banting and Best's discovery of insulin in 1921 saved many diabetic patients...

...The bond between patients and their physicians weakened as doctors no longer made house calls or saw patients in their home offices...

...It will probably take another decade before the smoke clears and the "health care system" is re-humanized...

...Of all the lay indictments of the profession, George Bernard Shaw's play The Doctor's Dilemma, written in 1906, remains the severest, accusing doctors of profiting from the misfortunes of others...

...It was necessary for him to be available, and to make all those calls at their homes, but I was not to have the idea that he could do anything much to change the course of their illnesses...

...On television, we saw M*A*S*H, St...

...Kildare's Crisis, for example, Kildare and Gillespie demonstrate the use of the fluoroscope...