Film | Nature

October 5, 2005

Quit Blaming Hollywood

A new study uses shoddy stats to hold the movie industry responsible for society's poor health choices.

David Goldenberg

A new study in the October issue of the Journal of the Royal Society of Medicine reviews the top-grossing movies worldwide and concludes: "The most popular movies of the last two decades often show normative depictions of negative health behaviours. The motion picture industry should be encouraged to depict safer sex practices and to depict the real consequences of unprotected sex and illicit drug use."

Pretty Woman
The only hooker movie recommended by the Royal Society of Medicine.
Yes, a respected medical journal published a paper that involves doctors and research assistants taking detailed notes on lots of movies in an effort to determine whether Jason Biggs et al wore condoms. And, yes, the study does try to blame Hollywood for normalizing "negative health behaviours." But even if we disregard the fact that people don't necessarily take their public-health cues from films like Scary Movie and Rambo: First Blood Part II, the study has serious flaws that undermine even its tenuous claim on our attention.

Though the title of the paper is "Sex and drugs in popular movies: an analysis of the top 200 films," the paper only deals with 87 films—those that were produced and set in the last 20 years and have a rating above PG. While the reviewers explain why they did this—they discarded animated movies, films that took place in the pre-HIV era, and those that were unlikely to depict sexual acts—they often fail to explain how this artificially increases their numbers. (The 39 movies excluded because they were filmed or set before the HIV era may well have depicted sex and drug use, but the 74 G- and PG-rated flicks and animated films probably didn't. Shouldn't Hollywood get credit for those?)

For example, a BBC article about the study notes: "Movies with cannabis (8%) and other non-injected illicit drugs (7%) were less common than those with alcohol intoxication (32%) and tobacco use (68%), but tended to portray their use positively and without negative consequences, the researchers said." Those percentages are of the movies that the researchers preselected as movies that would be likely to have these events in them, so the stats are virtually meaningless. If the excluded 113 movies didn't show marijuana usage, then only seven of the top 200, or 3.5%, show any form of toking. (The public-health concerns raised by marijuana usage are scant, at best, but that's a topic for another day.)

The quote from the BBC article comes directly from the press release issued by the Journal of the Royal Society of Medicine (see a reproduced version here), as does most of the rest of the article. Certainly, press-release plagiarism is more the BBC's fault than the journal's, but the fact that the journal so willfully distorts data is cause for concern.


Moreover, researchers chose these films from the top 200 grossing films of all time, according to the All-Time Worldwide Box Office list at As Dr. Hasantha Gunasekera, the University of Sydney clinical research fellow who is first author on the paper, notes (in both the press release and the BBC article), these movies are important because they "have grossed in excess of $70 billion US dollars [£39 billion] in box office takings." But it's not up to Hollywood to decide who goes to see what films. Gelf is not sure how different the list would be if, say, the researchers instead focused on the films that had cost the most to make, but the point is that the researchers looked at outcome, not intent, and then blamed the movie makers. Maybe people would simply rather see escapist movies that didn't stop to explain that a pus-filled infection could result from careless sex. There are plenty of serious movies with major actors who suffer consequences as a result of unprotected sex, and it's not Hollywood's fault that more people want to see There's Something About Mary than Philadelphia.

And the researchers certainly biased their results by using the director's cuts and extended versions of the movies they were studying, which they stated "were viewed in preference to standard releases." Anyone who's bought one of those DVDs recently knows that they are generally unrated boobfests, and can be very different from what was shown in theaters.

Quotes from the Study

One of the hilarious side effects of writing about pop culture in stodgy journals is that examples must be couched in serious language. Here are a few of our favorite quotes from the paper. See if you can figure out which movies they're referring to:

•In one episode a car accident resulted from oral sex while driving.

•There were also some references to the spread of STDs ("disease-spreading whore" and "I get checked every month").

•Promiscuous behaviour was glorified ("I got laid 23 times this year", "He's called rabbit 'cos he likes to fuck a lot") and celibacy was ridiculed ("If he decides to take the lock off his cock").

•There were scant references to birth control (robot prostitute: "You're not going to get us pregnant").

Gunasekera et al were also looking only at international box-office receipts; it's not exactly Hollywood's fault that international distributors tend to pick up the crappiest flicks for worldwide distribution. If they had focused on IMDB's All-Time USA boxoffice list, for example, they would have found a few movies with more drug and sex-related consequences (like Traffic) to go along with the requisite Adam Sandler movies. (Surprisingly, the study's authors decided not to adjust for inflation, either, when selecting their box-office hits; instead they just used IMDB's list. By not adjusting for inflation, researchers might miss movies seen by more people back when movie tickets were cheaper. Gelf isn't sure how the adjustment would have changed the results, but it does indicate a bit of laziness.)

Throughout the study, the researchers consistently manipulated their data in ways that would make movies appear to be sinister agents of poor public health. Here's how they coded sexual acts:

Defining an act of sexual intercourse presented coding challenges as these movies were designed for mass release to worldwide audiences and rarely depicted explicit scenes. Reviewers were instructed to code any episode in which an overtly sexual physical encounter either took place or was implied which could potentially result in an unwanted pregnancy or the transmission of an STD.

They included any implied scene of sex, yet they also demanded that birth control use be explicit, not just implied. In other words, even if a couple is humping offscreen, the researchers counted it as "no condom" unless the condom was onscreen. They were very serious about this; Gelf finds it hilarious to picture these researchers intently focusing on the screen and on the sex acts. "Two reviewers watched each film to minimize omissions due to concentration lapses," according to the paper.

They claim that of the 53 sex scenes—implied or otherwise—in the movies they watched, there was only a single coupling in which condoms were assumed to have been used. They also claim, "This single episode was also the only time any form of birth control was used in the 45 episodes of sex which could have resulted in pregnancy." They later add, "None of the movies portrayed HIV transmission, other STDs or unwanted pregnancies."

Forrest Gump
"What, Jenny? Do you have a cough due to cold?"
The condom "episode" occurs in Pretty Woman, when Julia Roberts offers Richard Gere his choice of condom colors. I guess the zoom-in on the condom wrapper during the coitus interruptus scene at the start of American Pie 2 didn't make into their charts. Nor did Jenny's death from AIDS in Forrest Gump.

In order to make sure their data was accurate and to test interobserver reliability, the authors had both research teams code a group of the 10 movies. They found several conflicting results, including 15 instances where one team had coded a sex act as involving "no condom" and the other team had coded "don't know." That didn't seem to tone down their conclusions: "Importantly," they wrote, "there were no disagreements between the teams as to whether condoms were used... "

Even more confusing? In the conclusions, they wrote, "Deciding whether a scene depicts a sexual encounter and whether safe sex practices were adopted will always be subjective. Different audiences can sometimes interpret the same scenes differently and discerning this was beyond the scope of our study." Gelf thought this was exactly the scope of their study. There are certainly important things to say about how popular culture and public health intertwine. But feeding us biased studies about the supposed evils of silly movies is unhelpful at best, and at worst diverts energy and support away from legitimate public-health concerns.

—Carl Bialik contributed to this article.

Journal of the Royal Society of Medicine press release

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Top movies condone unsafe sex and drug misuse

Depictions of sex and drug use in popular movies have lacked public health messages, reveals a new study in the October issue of the Journal of the Royal Society of Medicine.

The study, which looked at movies over the last 20 years, urges the motion picture industry to depict safer sex practices and show the harmful consequences of illicit drug use.

"The movie industry influences the perception of billons of people around the world," said Dr Gunasekera (1).

"The top 200 movies in cinematic history have grossed in excess of $70 billion US dollars [£39 billion] in box office takings.

"With globalisation and the growth of home-based media technologies, movies are more accessible to a wider audience and there is convincing evidence that the entertainment media influences behaviour," he said.

Dr Gunasekera analysed the portrayal of sex and drug use in the top 200 movies of all time (2).

Films released or set prior to the HIV era [pre 1983], animated features, those not about humans and G or PG rated (3), were excluded. Of the 87 movies reviewed, there were 53 episodes of sex, where the researchers found:
• Only one suggestion of condom use, which was the only reference to any form of birth control;
• In 98% of sexual episodes, which could have resulted in pregnancy, no form of birth control was used or suggested;
• No depictions of important consequences of unprotected sex such as unwanted pregnancies, HIV or other STDs.

Movies with cannabis (8%) and other non-injected illicit drugs (7%) were less common than those with alcohol intoxication (32%) and tobacco use (68%) but tended to portray their use positively and without negative consequences.

Fifty-two (52) percent of cannabis usage was shown in a positive light and 48% in neutral light with no negative consequences.

The study revealed that only one in four movies was free from negative health behaviours such as unprotected sex between new partners, cannabis use, non-injected drug use, smoking and alcohol intoxication.

"The study showed there were no references to important consequences of unsafe sex such as HIV transmission, spread of STD's or unwanted pregnancy," Dr Gunasekera.

"The social norm being presented in movies is concerning given the HIV and illicit drug pandemics in developing and industrialised countries.

"The motion picture industry should be encouraged to depict safer sex practices and the real consequences of unprotected sex and illicit drug use."

1. School of Public Health, University of Sydney, NSW, Australia
2. Using the Internet Movie Database, accessed on 3 March 2004.
3. Australian Office of Film and Literature Classification. Had the British Board of Film Classification ratings being used, it would have only made a 3% difference to the excluded movie list.

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Article by David Goldenberg

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