City of Hope’s Vijay Trisal, M.D., has an unusual hobby, particularly for someone who does not own a television: He consults for medical TV shows like “Grey’s Anatomy” and, most recently, “The Big C.”
The quirky and controversial new Showtime “dramedy” stars Laura Linney as a teacher confronting a terminal stage IV melanoma diagnosis. It examines her evolving reactions as she re-embraces her life in the face of death.
|Vijay Trisal provides expertise that influences medicine’s portrayal on TV. (Photo ©Philip Channing)|
As with previous consultancies, Trisal became involved with “The Big C” through the University of Southern California’s (USC) Norman Lear Center, a clearinghouse connecting writers working on medical storylines with physicians who advise them in how to depict characters, plots and medical conditions authentically. The center is located at the USC Annenberg School of Communication & Journalism.
Trisal, a surgical oncologist who specializes in melanoma, began meeting with “The Big C” writers nearly a year ago. They wanted to know whether their medical scenarios made scientific and biological sense, and if their characters and plotlines seemed believable. They were particularly interested in exploring how the disease affects patients’ relationships.
Writers already determined that Linney’s character would have stage IV melanoma, but “they were still kind of finessing the storyline, and they only had a nebulous idea of what the characters would be,” Trisal recalled.
Trisal views collaborations between Hollywood and physicians as potential “teachable moments.”
He regards his consulting role as a duty that is also personally satisfying since he is helping to educate the public and guide them toward treatment.
Fictional shows may educate in ways public awareness campaigns cannot — and reach far greater audiences. “When you put a face on this metastatic disease, it conveys awareness,” said Trisal, Viewers may begin paying more attention to their own health, and the dangers of melanoma, too.
Trisal said the show’s writers listened to his suggestions, but sometimes took artistic license. For instance, Linney’s character flirts outrageously with her oncologist on the show. The oncologist character eventually deflects the romantic advances, but Trisal tried to dissuade writers from scenes he described as “over the top.”
Doctor-patient dalliances may make for intriguing storylines, but they are unethical, and could compromise care by affecting a physician’s judgment. “You’d be putting everything at risk,” he said.
Despite occasional fictional lapses, however, Trisal believes medical consultants improve the work of writers and actors, allowing them to offer viewers more honest insights into the drama of real-life medicine.
One of the aspects of medicine he has helped illuminate on television is how hard it can be to communicate with patients, particularly those who have little time left. “It’s difficult to maintain the right balance,” Trisal said. “If you get too involved you can’t function. If you’re not involved at all, you can’t do a good job.
“Physicians must not only understand the disease, but its potential for emotional collateral damage on patients,” Trisal said. “We need to compassionately interact with patients to help them find balance in living with the disease and getting the right treatment.
“There is a big disconnect between research being done on melanoma and the public’s understanding of it. Sometimes we live in a big citadel of research. We need to put science into more digestible moments for patients, and make them aware of treatments that might save their lives.”
TV program shines spotlight on melanoma
Melanoma is the fastest-growing cancer in the U.S., and scientists are unsure why. They do know one thing: It can be dangerous.
This disease of pigment-forming cells only makes up 5 percent of all skin cancers, but accounts for the most skin cancer deaths by far.
Of the 1 million new cases diagnosed each year, about 55,000 patients have the disease in its most advanced form: stage IV.
“These are responsible for 95 percent of all the problems that happen from skin cancers,” said surgical oncologist Vijay Trisal, M.D.
But melanoma can be caught early if people know the warning signs. These can include: a new spot on the skin or an existing spot that is changing in size, shape or color; a sore that doesn’t heal; itchiness, tenderness and pain; a change in the surface of a mole (such as scaliness, oozing or bleeding) or a new nodule.
Melanoma has gained renewed attention among the public because of the television program “The Big C,” which revolves around a woman with stage IV disease. Trisal hopes the show will convince viewers to begin getting checkups from dermatologists, particularly to investigate suspicious lesions, as well as adopt healthier habits.
Melanoma is caused by a mysterious collaboration between genetics and the environment, he said. “We can’t control genes,” he said, “but one modifying factor we can control is our exposure to sunlight.”
Presuming “The Big C” survives ratings, the character may enjoy future seasons despite her prognosis.
“The drama of melanoma, even in stage IV patients, is that a small number of them — maybe one in 500 — can be cured by themselves, even without treatment,” apparently due to the body’s immune response, Trisal said.
“That’s why we’re going toward vaccines and immunotherapy in melanoma,” he said. “We’re going more toward molecular treatments rather than a shotgun approach.”